Visiting consultant clinics improve access to orthopaedic care in rural areas

Patients living in rural areas are more likely to be older, overweight and less physically active--all risk factors for orthopaedic conditions. And yet, with few orthopaedic surgeons practicing in rural areas, access to care is limited. A new study in the May 4 issue of the Journal of Bone and Joint Surgery assessed the impact of visiting consultant clinics (VCCs), staffed by orthopaedic surgeons, who routinely travel to meet with patients in rural areas.

While America's rural population is aging faster than its urban population, only 30 percent of rural hospitals have a full-time orthopaedic surgeon. As a result, patients often must travel long distances for orthopaedic care, and many patients delay treatment resulting in poorer outcomes and increased costs.

In this study, researchers specifically looked at VCCs in Iowa, an arrangement that involves regular visits by an orthopaedic surgeon to an outreach site, typically a rural hospital located in a community too small to support a full-time specialist. Patients meet with doctors in person, and receive diagnostic services and some outpatient procedures. More complex procedures are usually referred to larger hospitals with the appropriate resources to support major procedures.

Data from 2014 were used to estimate average trip length for participating orthopaedic surgeons and patients in all Iowa census tracts. Primary practice locations, visiting consultant clinic locations, and census tracts were classified according to 2010 Rural-Urban Commuting Areas (RUCA) classifications.

Among the results:

• In 2014, 4,596 VCC days were provided in 80 predominately rural sites throughout Iowa.
• Forty-five percent of all Iowa-based orthopaedic surgeons participated in a VCC, driving a total of 32,496 miles per month.
• The number of Iowa counties with an orthopaedic surgeon increased from 35 to 88, out of 99 counties.
• For rural patients, the average driving distance to the nearest orthopaedic surgeon was reduced more than 50 percent--from 19.2 miles to 8.4 miles--improving access to orthopaedic surgeons for between 450,000 and 670,000 Iowa residents.

"Orthopaedic surgeons in Iowa have been involved in rural outreach for more than 25 years," said lead study author Thomas S. Gruca, PhD, a professor in the Tippie College of Business, University of Iowa. "By traveling to 80 different sites every month, these physicians from Iowa and surrounding states reduced patient travel times and improved access to orthopaedic care."