Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data

Abstract

Background:The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. Methods:We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks.Results: Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral.Interpretation: Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care. Abstract ResearchResearch CMAJ OPEN E206CMAJ OPEN 4(2)

Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study

“…This trend may be a reflection of rheumatologists declining these types of referrals in more recent years and instead seeing more patients with systemic inflammatory conditions, and/or fewer referrals to rheumatologists for these noninflammatory conditions. Indeed, in a study of 2430 patients referred to a rheumatologist in Ontario, 17% did not result in a rheumatology consultation 10 .…”

“…Currently, changes to rheumatology wait times over time are unknown; however, wait times exceed established benchmarks 10 . An alternative explanation to the reduction in new consultations is that some patients (such as those with regional MSK conditions) are being referred to other care providers.…”

“…In Canada, rheumatologists are currently among the most frequent nonsurgical specialty referrals 7 and they also have among the longest specialist wait times 8,9,10,11 . A better understanding of longitudinal trends in rates of rheumatology encounters with new and existing patients is needed to help identify why patients have such long waits for rheumatology care.…”

Rheumanomics: Addressing Scarcity and Need in Rheumatologic Care

“…While benchmarks for time to referral to rheumatologic consultation are unmet, the Widdifield, et al study suggests that this is not the most significant bottleneck from symptom onset to management 6 . The study further dissects the median 327 days from RA symptom onset to rheumatologist consultation, revealing that the majority of the time was spent preconsultation (median 173 days from symptom onset to primary care visit, and median 115 days from first mention at primary care to rheumatology referral).…”

“…A contemporary and enlightening study by Widdifield and colleagues found an equal proportion of referrals made for osteoarthritis (OA) and systemic inflammatory rheumatic diseases, with each accounting for about one-third of the consultations requested 6 . Herein lies an opportunity, as many rheumatologists believe OA care falls predominantly within the realm of primary care.…”