The impact of ageing and rurality on the use of medical services in Parkinson's disease: A data linkage study using the 45 and up study and medicare benefits schedule

Objectives: Parkinson's disease (PD) is a neurological disorder with increasing prevalence and use of medical services. Both ageing and geographic locality have been shown to be associated with the prevalence of PD. Therefore, the purpose of this research was to determine the influence of ageing and locality on medical service use in PD. 
Study design: A retrospective data linkage analysis. 
Methods: Data were acquired from the Sax Institute's 45 and Up Study baseline and linked with the Social, Economic and Environmental Factors (SEEF) and Medicare Benefits Schedule (MBS) databases. Statistical analyses were performed on participant age and locality and persons who self-reported with PD living in New South Wales, Australia. 
Results: A total of 1676 persons self-reported with PD from the 45 and Up Study baseline and were linked to the SEEF and MBS databases. Linear regression analysis showed increased likelihood for use of medical specialist services (46.9% for Neurology and 25.9% for Pathology) in major cities, however, there was a 44.9% increased use of General Practitioner (GP) services in rural, regional, remote (RRR) locality (p < 0.01). Moreover, a reduced Neurology and Pathology service use beyond the statistical age threshold was shown in PD (p < 0.05). 
Conclusions: Specialist medical and support services are influential in the early stages of diagnosis and in maintaining health-related quality of life in persons with PD. Disparities in the use of medical services were identified between geographic locality and ageing in persons with PD. The increased use of GP services may be associated with reduced accessibility to medical specialist services in RRR localities.