Patient and Surgeon Views on Maximum Acceptable Waiting Times for Joint Replacement

Abstract

Objective: To assess patient and surgeon views on maximum acceptable waiting times (MAWT) for hip and knee replacement, their determinants and their relationship to levels of urgency based on the Western Canada Waiting List Priority Criteria Score (PCS). Methods: At the decision date for surgery, orthopaedic surgeons assessed consecutive patients with the PCS and MAWT. Patients were surveyed 3-12 months post-surgery for MAWT and potential determinants. Results: The patient sample of 208 was 56% female, mean age 69 years (SD 11). Mean MAWT for patients was 18 weeks (SD 11) and for surgeons, 17 weeks (SD 11). Median MAWT for three levels of urgency (PCS) ranged from 13-17 weeks (patients) and 9-26 weeks (surgeons). Patient MAWT was unrelated to the surgeonrated measures: MAWT (r=.05) and the PCS (r=-.10). Multiple regression analysis showed that males, knee vs. hip replacement, a longer waiting time and a perception of fairness in regard to waiting time were significant predictors of longer patient MAWT. Knee replacement, a better ability to walk without significant pain and less potential for progression of the disease were significant predictors of longer surgeon MAWT. Conclusions: Patient and surgeon perspectives on MAWT are important to the development of waiting time benchmarks. Benchmarks based on levels of urgency ensure a more transparent and fair process for waiting time management. Knowledge of determinants of MAWT should inform better management of waiting time and access, by understanding the basis of patient and physician views on acceptable waiting times. Méthodes : À la date de la décision, les chirurgiens orthopédiques ont évalué des patients consécutifs au moyen de la CCP et du TAMA. On a interrogé les patients entre 3 et 12 mois après la chirurgie relativement au TAMA et à ses facteurs détermi-nants potentiels. Résultats : L' échantillon de 208 patients était composé à 56 % de femmes dont la moyenne d' âge était de 69 ans (écart-type de 11). Chez les patients, le temps médian du TAMA était de 18 semaines (écart-type de 11) et chez les chirurgiens, de 17 semaines (écart-type de 11). Le temps médian du TAMA pour trois degrés d'urgence (CCP) allait de 13 à 17 semaines (patients) et de 9 à 26 semaines (chirurgiens). Chez les patients, le TAMA n' était pas lié aux mesures évaluées par les chirurgiens : TAMA (r = 0,05) et le CCP (r = -0,10). De multiples analyses de régression ont révélé que chez les hommes, pour l' arthroplastie du genou par rapport à la hanche, un temps d' attente plus long et un sentiment d' équité relativement au temps d' attente étaient des indices importants d'un TAMA plus long chez les patients. L' arthroplastie du genou, une meilleure capacité de marcher sans douleur importante et une moins grande possibilité de progression de la maladie étaient des indices importants du TAMA plus long chez les chirurgiens. Conclusions : Les points de vue des patients et des chirurgiens sur le TAMA sont importants pour l' établissement de temps d' attente de référence. La référence fond...

‘There are too many of us to fix.’ Patients’ views of acceptable waiting times for hip and knee replacement

“…In the postsurgery group, the time interval between surgery and the survey had no significant effect on MAWT, consistent with previous testing. 14 In multiple regression analysis, adjusting for sex and actual WT, variables significantly associated with a longer MAWT were younger age, group (waiting), a longer self-reported WT, better EQ-5D index, an acceptable WT, a perceived fairness and a view that others worse off should have priority (Table 3).…”

“…The questionnaire was designed to assess patients' perspectives on waiting for surgery and had been previously tested in postsurgery patients. 14 For the current study, items were adapted for the waiting group questionnaire and both questionnaires were evaluated for interpretability and comprehensiveness by participants of four focus groups, randomly selected from the Registry.…”

“…To assess MAWT for levels of urgency, we categorized patients into three clinically distinct groups: PCS 0-30 (least urgent), PCS 31-74 and PCS 75-100 (most urgent). 14 We used content analysis to analyse open-ended questions on patients' reasons for MAWT and ideal WT. The primary researcher identified common themes and coded the data.…”

The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery

“…Questionnaire items were previously tested in a consecutive group of post-surgery patients [27]. For the current study, items were adapted for the waiting group questionnaire and both questionnaires were reviewed for clarity, interpretability, and comprehensiveness by participants of four focus groups, randomly selected from the Saskatchewan Surgical Registry.…”

Expectations Confounded: Patients Are Satisfied with THR and TKR Delivery in Australian Public Hospitals—A Multisite Case Study

“…There has been some investigation of patient perceptions of waiting time for THR and TKR 2 ISRN Public Health surgery in the Canadian health system-a system which, like Australia, is supported by a taxation-based funding structure. Individuals in these studies reported maximum acceptable waiting periods ranging from 12 (SD 8.35) to 18 (SD 11.0) weeks [15,16]. No similar information is available within the Australian population.…”