Reducing wait time from referral to first visit for community outpatient services may contribute to better health outcomes: a systematic review

Abstract

BackgroundMany people wait long periods for community outpatient services. However little is known about the impact of waiting from referral to first visit on patient outcomes. The aim of this systematic review is to investigate whether waiting for community outpatient services is associated with adverse effects on patient outcomes.MethodsMedline, Embase, Psych Info and CINAHL databases were searched, combining the key concepts of waiting for healthcare and patient outcomes. Studies were included if they reported data comparing health outcomes for patients with different waiting times for the same period. Three reviewers applied inclusion and exclusion criteria to identified studies and assessed quality using the McMaster Critical Review Forms. Levels of evidence were assessed using National Health and Medical Research Council guidelines. Included studies were analysed using a descriptive synthesis, and summarised according to levels of evidence and clinical significance for key outcomes.ResultsFourteen studies that included 69,606 adult patients were selected. Selected studies included patients referred for treatment for musculoskeletal disorders (n = 28,722) or to cardiac rehabilitation (n = 40,884). There was low-level evidence that reduced wait time is associated with moderate improvement in workplace participation for patients seeking care for musculoskeletal conditions; and moderate improvement in exercise tolerance for patients referred to cardiac rehabilitation. There was inconsistent evidence that improvements in quality of life, patient satisfaction and psychological symptoms may be associated with shorter wait times. Pain, function and physical activity outcomes were not associated with wait time.ConclusionsThis review found low-level evidence suggesting an association between early access to community outpatient services and improvement of some patient outcomes. Specifically, shorter wait times from referral to first visit for musculoskeletal pain services may improve patient work participation. Shorter wait times for cardiac rehabilitation may improve patient exercise capacity. The effects of a short wait time for other patient conditions and patient outcomes, including quality of life, psychological symptoms and patient experience, are inconclusive. The modest benefits in health outcomes observed in reducing wait time for community outpatient services suggest that other possible benefits such as increasing patient flow should be explored.Trial registrationPROSPERO registration no: CRD42016047003

Access to Norwegian healthcare system – challenges for sub-Saharan African immigrants

“…If countries with limited means can achieve the virtual absence of waiting lists, then what excuse can there be for countries such as Ireland, the UK, Sweden or Norway to keep having waiting list problems?. However, reducing patients wait time may contribute to better health outcome [69] and should be a priority for the Norwegian health care. Family and job responsibility were emphasized to influence immigrants access to healthcare particularly among married immigrants and those with children, who perceived conflict between their own care and to the care for their family and protecting their jobs.…”

Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: a qualitative study

“…Results from this study add further weight to this argument, as this perception also appears to have been a barrier to acceptance of the STAT model by some participants. However, a systematic review involving 14 studies found that delays in access to community outpatient services were associated with poorer health outcomes and workplace participation [28]. Excessive waiting times for chronic pain have also been found to be associated with adverse health effects during the waiting period [29].…”

Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review

“…Despite a reduction over time, SES had a statistically significant effect on waiting time in every year of analysis ( Table 2). 58 There are multiple review papers that describe the interaction between waiting time for allied health services and clinical outcomes; [74][75][76][77] however, there is little evidence available on whether these times are affected by SES. We identified 4 studies that describe waiting-time inequality in the allied health sector.…”

“…Among respondents who reported their clinic time during the 24-hour assessment period, a median (95% CI) of 86 [83][84][85][86][87][88] minutes was spent in-clinic. 63 Those in the lowest income quartile reported a mean [95% CI] clinic time of 91 [87][88][89][90][91][92][93][94][95] minutes compared with those in the highest income quartile, who reported a mean clinic time of 72 [65][66][67][68][69][70][71][72][73][74][75][76][77][78] minutes. 63 Disproportionate ill health in lower SES patients has consistently been rejected as an explanation for this gradient.…”