Abstract
Objective: We assessed the current status of patients with rheumatoid arthritis（RA）residing in aging and depopulated regions, then investigated optimal future models for delivery of regional RA care.
Methods: A questionnaire-based survey was administered to RA outpatients across six medical institutions in Shimane Prefecture, yielding responses from 1,282 participants.
Results: The mean respondent age was 66.9 years; 63.0% were aged ≥ 65 years. The prevalence of individuals living alone increased with age, particularly in the western region of Shimane Prefecture, a designated depopulated area. Among female patients aged ≥ 80 years in this region, 32.0% reported living alone. Overall medication adherence among elderly patients was high; fear of adverse effects was frequently cited as a barrier to adherence. Private vehicles were the predominant mode of transportation; significantly fewer women aged ≥ 65 years reported driving compared with men. Living alone and residing in the depopulated western region were associated with delays in seeking medical attention when feeling unwell, a trend especially pronounced among those aged ≥ 80 years in age-stratified analyses.
Conclusion: The severe shortage of specialists in rural areas has reduced specialized care access for patients with RA. This change contributes to delays in initial diagnosis and healthcare-seeking behavior during episodes of illness, hindering provision of appropriate care. To achieve optimal RA management in regional settings, collaboration must be enhanced between hospitals and clinics; access to specialists should be expanded through implementation of telemedicine.
