Mapping rheumatic and musculoskeletal disease in Scotland and Wales

This project will investigate the prevalence and outcomes of rheumatic and musculoskeletal disease (RMD) in rural and urban areas.

Delays in diagnosis and treatment are associated with poorer outcomes for RMD. Up to a third of the UK population live in rural areas, but most specialist health services are in urban areas. Poor transport infrastructure makes healthcare difficult to access, particularly for those without cars, and rural communities face greater challenges in recruiting and retaining healthcare workers. Rural populations are older and the average age is increasing faster than in urban areas. Musculoskeletal diseases are the most common cause of disability in the elderly, and negative effects may be compounded for an older rural population by social isolation and lack of carers. However, the prevalence and outcomes of RMD in rural versus urban areas is largely unquantified.

Scotland and Wales, with large rural populations and unique healthcare linkage capabilities, provide ideal settings to examine geographical differences in RMD outcomes. Within the National Safe Haven network in Scotland and the Secure Anonymised Information Linkage (SAIL) databank in Wales, primary care datasets will be linked to national datasets collected at the community, GP, ambulatory and hospital level. Primary care data will include health conditions, prescriptions, appointments, referrals, and socioeconomic and lifestyle details relevant to the patient’s health. Secondary care datasets will provide information on hospital inpatient and outpatient records, A&E, mental health, cancer registry and mortality data. Complementary datasets including Census data, WEALTH (Welsh Employment and Linkage to Health) and Health Wise Wales will also enable the team to explore wider determinants of health.

The researchers will conduct a longitudinal analysis of healthcare journeys and outcomes across a wide range of RMD conditions to produce a geographical profile of prevalence and outcomes. Finally, to identify the key priorities in diagnosis, treatment and healthcare access for rural RMD patients, the researchers will undertake a priority-setting survey, informed by a series of focus groups with patients from across the UK.

Our patient and professional partners will continue to play an integral role at all stages of the study and engage in a number of different ways to ensure outputs and recommendations are relevant to key stakeholders. In conjunction with Rheumatosphere we will hold a series of stakeholder engagement events to present study fundings, gather feedback and disseminate key study recommendations.

The project will produce an interactive digital geographical map of RMD across Scotland and Wales, showing prevalence, health outcomes and patterns of healthcare use across a range of conditions. It will identify the priorities of patients with RMD conditions living in rural areas, as well as the priorities of healthcare professionals involved in their care. The findings will be used to develop recommendations to inform UK healthcare policy.