Orthopedic patients living in rural areas are more likely to be older, overweight, and less physically active, but their access to care often is limited because there aren’t enough local practitioners.
However, a new study from the University of Iowa finds that visiting consultant clinics (VCCs) staffed by visiting orthopedic surgeons can improve patient outcomes by increasing access to physicians.
Only 30 percent of rural hospitals are staffed with a full-time orthopedic surgeon, so patients often must travel long distances for care, prompting many to delay treatment, resulting in poorer outcomes and increased costs. The new study used a database of Iowa physicians maintained by the UI Carver College of Medicine to examine how VCCs are used in the state.
VCCs are outreach sites regularly visited by an orthopedic surgeon, 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 them.
The researchers used data from 2014 to estimate average trip length for participating orthopedic surgeons and patients in all of Iowa’s census tracts. The study found that 35 of Iowa’s 99 counties are home to a practicing orthopedist, but that number jumps to 88 when VCCs are accounted for.
For rural patients, the average driving distance to the nearest orthopedic surgeon was reduced by more than 50 percent—from 19.2 miles to 8.4 miles—improving access for 450,000 to 670,000 Iowans.
"Orthopedic surgeons in Iowa have been involved in rural outreach for more than 25 years," says lead study author Thomas Gruca, professor of marketing in the UI Tippie College of Business. "By traveling to 80 different sites every month, these physicians from Iowa and surrounding states reduced patient travel times and improved access to orthopedic care."
The survey also found that 45 percent of all Iowa-based orthopedic surgeons visited at least one predominately rural VCC site in 2014, driving a total of 32,496 miles per month and providing care on a total of 4,596 days.
Gruca’s paper, “Improving Rural Access to Orthopaedic Care Through Visiting Consultant Clinics,” was co-authored by Gregory Nelson, of the Office of Statewide Medical Programs in the UI Carver College of Medicine, and Tae-Hyung Pyo, assistant professor at the State University of New York at New Paltz. It was published in the Journal of Bone and Joint Surgery.