Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

RELATIONSHIP BETWEEN GEOGRAPHIC DISTANCE AND INDIVIDUAL AND AREAL SOCIODEMOGRAPHIC FACTORS WITH PREFERENCE FOR SITE OF CARE AMONG RHEUMATOID ARTHRITIS (RA) PATIENTS

Author

Arul Earnest

Institution

Duke-NUS Graduate Medical School

Abstract

Objectives: The determinants of preference for site of care among RA patients have not been adequately studied. Our aim was to identify the individual socio-demographic and geographic location factors associated with the preference of hospital care among RA patients in Singapore.

Methods: This was an observational study (conducted from November 2011 to January 2012) of all RA patients seen at the Singapore General Hospital (SGH). Preference for site of care as well as individual socio-demographic factors and travel patterns was measured through a patient survey. Measures of socio-economic advantage and disadvantage were derived from the Singapore population census 2010. Geographic Information System (GIS) software was also used to calculate shortest distance to hospital. Random effect regression models were used to study factors associated with preference of hospital care.

Results: There were 717 patients who were recruited into the study, with a mean age of 59 years and majority being female (85%). Multivariate analysis indicated that shorter self- reported travel time to hospital, higher educational level, greater satisfaction with current RA care and greater number of years diagnosed with RA were positively associated with preference for hospital care. For instance, those who took more than 1 hour to travel to SGH were 0.5 times (95% CI: 0.3- 0.8) less likely than those who took less than half an hour to prefer hospital care (p=0.007). Those with tertiary education were also 3 times (95% CI: 2-6) more likely than those with no formal education to choose hospital care (p=0.002).

Conclusion: Our study has identified socio- demographic and disease related factors which distinguish patients who prefer different sites of care. We have also found that shorter travel time is more important than distance to hospital, and this may prove useful for administrators when planning locations for community clinics.