UMass Chan Medical School Faculty Publications


Assessing the need for improved access to rheumatology care: a survey of Massachusetts community health center medical directors

UMMS Affiliation

Department of Medicine, Division of Hospital Medicine

Publication Date


Document Type



Antirheumatic Agents; Community Health Centers; Data Collection; Health Services Accessibility; Humans; Immunosuppressive Agents; Insurance, Health; Massachusetts; Medicare; Physician Executives; Questionnaires; Rheumatic Diseases; United States


Community Health and Preventive Medicine | Health Services Administration | Health Services Research | Musculoskeletal Diseases | Rheumatology


OBJECTIVE: Access to rheumatology care can expedite diagnosis and treatment of rheumatic diseases and reduce disparities. We surveyed community health center (CHC) medical directors to evaluate rheumatology care in underserved areas and potential strategies for improvement.

METHODS: We identified 77 Massachusetts CHCs that provide adult medical services and sent a 40-item survey to their physician medical directors. Survey questions assessed the centers' prevalence of rheumatic diseases, prescribing practices of immunosuppressive medications, and possible interventions to improve care. We compared CHC characteristics and rheumatology-specific items and then stratified our data by the response to whether improved access to rheumatology care was needed. Qualitative data were analyzed thematically.

RESULTS: Thirty-six CHC physician medical directors returned surveys (47% response rate). Fifty-five percent indicated a need for better access to rheumatology care. Eighty-six percent of CHC physicians would not start a patient with rheumatoid arthritis on a disease-modifying antirheumatic drug; 94% would not start a patient with systemic lupus erythematosus on an immunosuppressant. When we compared CHCs that reported needing better access to rheumatology care to those that did not, the former described a significantly greater percentage of patients with private insurance or Medicaid who required outside rheumatology referrals (P < 0.05). Language differences and insurance status were highlighted as barriers to obtaining rheumatology care. Sixteen directors (57%) ranked the patient navigator-a layperson to assist with care coordination-as their first-choice intervention.

CONCLUSIONS: Community health center medical directors expressed a need for better access to rheumatology services. A patient navigator for rheumatic diseases was proposed to help improve care and reduce health disparities.

DOI of Published Version



J Clin Rheumatol. 2013 Oct;19(7):361-6. doi: 10.1097/RHU.0b013e3182a6a490. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Journal of clinical rheumatology : practical reports on rheumatic and musculoskeletal diseases

PubMed ID