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Published in: BMC Primary Care 1/2014

Open Access 01-12-2014 | Research article

Waiting to see the specialist: patient and provider characteristics of wait times from primary to specialty care

Authors: Liisa Jaakkimainen, Richard Glazier, Jan Barnsley, Erin Salkeld, Hong Lu, Karen Tu

Published in: BMC Primary Care | Issue 1/2014

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Abstract

Background

Wait times are an important measure of access to various health care sectors and from a patient’s perspective include several stages in their care. While mechanisms to improve wait times from specialty care have been developed across Canada, little is known about wait times from primary to specialty care. Our objectives were to calculate the wait times from when a referral is made by a family physician (FP) to when a patient sees a specialist physician and examine patient and provider factors related to these wait times.

Methods

Our study used the Electronic Medical Record Administrative data Linked Database (EMRALD) which is a linkage of FP electronic medical record (EMR) data to the Ontario, Canada administrative data. The EMR referral date was linked to the administrative physician claims date to calculate the wait times. Patient age, sex, socioeconomic status, comorbidity and FP continuity of care and physician age, sex, practice location, practice size and participation in a primary care delivery model were examined with respect to wait times.

Results

The median waits from medical specialists ranged from 39 to 76 days and for surgical specialists from 33 days to 66 days. With a few exceptions, patient factors were not associated with wait times from primary care to specialty care. Similarly physician factors were not consistently associated with wait times, except for FP practice location and size.

Conclusions

Actual wait times for a referral from a FP to seeing a specialist physician are longer than those reported by physician surveys. Wait times from primary to specialty care need to be included in the calculation of surgical and diagnostic wait time benchmarks in Canada.
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Literature
3.
go back to reference Coyte PC, Wright JG, Hawker GA, Bombardier C, Dittus RS, Paul JE, Freund DA, Ho E: Waiting times for knee-replacement surgery in the United States and Ontario. NEJM. 1994, 331 (16): 1068-1071. 10.1056/NEJM199410203311607.CrossRefPubMed Coyte PC, Wright JG, Hawker GA, Bombardier C, Dittus RS, Paul JE, Freund DA, Ho E: Waiting times for knee-replacement surgery in the United States and Ontario. NEJM. 1994, 331 (16): 1068-1071. 10.1056/NEJM199410203311607.CrossRefPubMed
5.
go back to reference Knudtson ML, Beanlands R, Brophy JM, Higginson L, Munt B, Rottger J: Treating the right patient at the right time: access to specialist consultation and noninvasive testing. Can J Cardiol. 2006, 22 (10): 819-824. 10.1016/S0828-282X(06)70299-9.CrossRefPubMedPubMedCentral Knudtson ML, Beanlands R, Brophy JM, Higginson L, Munt B, Rottger J: Treating the right patient at the right time: access to specialist consultation and noninvasive testing. Can J Cardiol. 2006, 22 (10): 819-824. 10.1016/S0828-282X(06)70299-9.CrossRefPubMedPubMedCentral
8.
go back to reference Chan BT, Austin PC: Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach. Med Care. 2003, 41 (4): 500-511.PubMed Chan BT, Austin PC: Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach. Med Care. 2003, 41 (4): 500-511.PubMed
9.
go back to reference Haider A, Mamdani M, Shaw JC, Alter DA, Shear NH: Socioeconomic status influences care of patients with acne in Ontario, Canada. J Am Acad Dermatol. 2006, 54 (2): 331-335. 10.1016/j.jaad.2005.03.029.CrossRefPubMed Haider A, Mamdani M, Shaw JC, Alter DA, Shear NH: Socioeconomic status influences care of patients with acne in Ontario, Canada. J Am Acad Dermatol. 2006, 54 (2): 331-335. 10.1016/j.jaad.2005.03.029.CrossRefPubMed
10.
go back to reference Pell JP, Pell AC, Norrie J, Ford I, Cobbe SM: Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. BMJ. 2000, 320 (7226): 15-18. 10.1136/bmj.320.7226.15.CrossRefPubMedPubMedCentral Pell JP, Pell AC, Norrie J, Ford I, Cobbe SM: Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. BMJ. 2000, 320 (7226): 15-18. 10.1136/bmj.320.7226.15.CrossRefPubMedPubMedCentral
11.
12.
go back to reference Laudicella M, Siciliani L, Cookson R: Waiting times and socioeconomic status: evidence from England. Soc Sci Med. 2012, 74 (9): 1331-1341. 10.1016/j.socscimed.2011.12.049.CrossRefPubMed Laudicella M, Siciliani L, Cookson R: Waiting times and socioeconomic status: evidence from England. Soc Sci Med. 2012, 74 (9): 1331-1341. 10.1016/j.socscimed.2011.12.049.CrossRefPubMed
13.
go back to reference Sorensen TH, Olsen KR, Vedsted P: Association between general practice referral rates and patients’ socioeconomic status and access to specialized health care: a population-based nationwide study. Health Policy. 2009, 92 (2–3): 180-186.CrossRefPubMed Sorensen TH, Olsen KR, Vedsted P: Association between general practice referral rates and patients’ socioeconomic status and access to specialized health care: a population-based nationwide study. Health Policy. 2009, 92 (2–3): 180-186.CrossRefPubMed
14.
go back to reference Glazer RH, Agha MM, Moineddin R, Sibley LM: Universal health insurance and equity in primary care and specialist office visits: a population-based study. Ann Fam Med. 2009, 7 (5): 396-405. 10.1370/afm.994.CrossRef Glazer RH, Agha MM, Moineddin R, Sibley LM: Universal health insurance and equity in primary care and specialist office visits: a population-based study. Ann Fam Med. 2009, 7 (5): 396-405. 10.1370/afm.994.CrossRef
15.
go back to reference Siciliani L, Versulli R: Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE. Health Econ. 2009, 18 (11): 1295-1306. 10.1002/hec.1429.CrossRefPubMed Siciliani L, Versulli R: Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE. Health Econ. 2009, 18 (11): 1295-1306. 10.1002/hec.1429.CrossRefPubMed
16.
go back to reference Chaix B, Boelle PY, Guilbert P, Chauvin P: Area-level determinants of specialty care utilization in France: a multilevel analysis. Public Health. 2005, 119 (2): 97-104. 10.1016/j.puhe.2004.05.006.CrossRefPubMed Chaix B, Boelle PY, Guilbert P, Chauvin P: Area-level determinants of specialty care utilization in France: a multilevel analysis. Public Health. 2005, 119 (2): 97-104. 10.1016/j.puhe.2004.05.006.CrossRefPubMed
17.
go back to reference Cook NL, Ayanian JZ, Orav EJ, Hicks LS: Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care. Circulation. 2009, 119 (18): 2463-2470. 10.1161/CIRCULATIONAHA.108.825133.CrossRefPubMed Cook NL, Ayanian JZ, Orav EJ, Hicks LS: Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care. Circulation. 2009, 119 (18): 2463-2470. 10.1161/CIRCULATIONAHA.108.825133.CrossRefPubMed
18.
go back to reference Ehrmann-Feldman D, Xiao Y, Bernatsky S, Haggerty J, Leffondré K, Tousignant P, Roy Y, Abrahamowicz M: Consultation with cardiologists for persons with new-onset chronic heart failure: a population-based study. Can J Cardiol. 2009, 25 (12): 690-694. 10.1016/S0828-282X(09)70528-8.CrossRefPubMed Ehrmann-Feldman D, Xiao Y, Bernatsky S, Haggerty J, Leffondré K, Tousignant P, Roy Y, Abrahamowicz M: Consultation with cardiologists for persons with new-onset chronic heart failure: a population-based study. Can J Cardiol. 2009, 25 (12): 690-694. 10.1016/S0828-282X(09)70528-8.CrossRefPubMed
19.
go back to reference Zuvekas SH, Hill SC: Does capitation matter? Impacts on access, use, and quality. Inquiry. 2004, 41 (3): 316-335. 10.5034/inquiryjrnl_41.3.316.PubMed Zuvekas SH, Hill SC: Does capitation matter? Impacts on access, use, and quality. Inquiry. 2004, 41 (3): 316-335. 10.5034/inquiryjrnl_41.3.316.PubMed
20.
go back to reference Gosden T, Sibbald B, Williams J, Petchey R, Leese B: Paying doctors by salary: a controlled study of general practitioner behaviour in England. Health Policy. 2003, 64 (3): 415-423. 10.1016/S0168-8510(02)00204-X.CrossRefPubMed Gosden T, Sibbald B, Williams J, Petchey R, Leese B: Paying doctors by salary: a controlled study of general practitioner behaviour in England. Health Policy. 2003, 64 (3): 415-423. 10.1016/S0168-8510(02)00204-X.CrossRefPubMed
21.
go back to reference Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, Sergison M, Pedersen L: Capitation, salary, fee-for-service and mixed systems of payments: effects on the behavior of primary care physicians. Cochrane Database Syst Rev. 2000, 3: CD002215 Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, Sergison M, Pedersen L: Capitation, salary, fee-for-service and mixed systems of payments: effects on the behavior of primary care physicians. Cochrane Database Syst Rev. 2000, 3: CD002215
22.
go back to reference Gosden T, Pedersen L, Torgerson D: How should we pay doctors? A systematic review of salary payments and their effect on doctor behaviour. QJM. 1999, 92 (1): 47-55. 10.1093/qjmed/92.1.47.CrossRefPubMed Gosden T, Pedersen L, Torgerson D: How should we pay doctors? A systematic review of salary payments and their effect on doctor behaviour. QJM. 1999, 92 (1): 47-55. 10.1093/qjmed/92.1.47.CrossRefPubMed
23.
go back to reference Neuhausen K, Grumbach K, Bazemore A, Phillips RL: Integrating community health centers into organized delivery systems can improve access to subspeciality care. Health Aff (Millwood). 2012, 31 (8): 1708-1716. 10.1377/hlthaff.2011.1261.CrossRef Neuhausen K, Grumbach K, Bazemore A, Phillips RL: Integrating community health centers into organized delivery systems can improve access to subspeciality care. Health Aff (Millwood). 2012, 31 (8): 1708-1716. 10.1377/hlthaff.2011.1261.CrossRef
24.
go back to reference Kwon JS, Carey MS, Cook EF, Qiu F, Paszat LF: Addressing wait times for endometrial cancer surgery in Ontario. J Obstet Gynaecol Can. 2007, 29 (12): 982-987.CrossRefPubMed Kwon JS, Carey MS, Cook EF, Qiu F, Paszat LF: Addressing wait times for endometrial cancer surgery in Ontario. J Obstet Gynaecol Can. 2007, 29 (12): 982-987.CrossRefPubMed
25.
go back to reference Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S: A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Aff (Millwood). 2009, 28 (6): w1171-w1183. 10.1377/hlthaff.28.6.w1171.CrossRef Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S: A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Aff (Millwood). 2009, 28 (6): w1171-w1183. 10.1377/hlthaff.28.6.w1171.CrossRef
26.
go back to reference Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R, Applebaum S: A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Aff (Millwood). 2012, 31 (12): 2805-2816. 10.1377/hlthaff.2012.0884.CrossRef Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R, Applebaum S: A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Aff (Millwood). 2012, 31 (12): 2805-2816. 10.1377/hlthaff.2012.0884.CrossRef
28.
go back to reference Bichel A, Erfle E, Wiebe V, Axelrod D, Conly J: Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Q. 2009, 13: 61-68. 10.12927/hcq.2009.21100.CrossRefPubMed Bichel A, Erfle E, Wiebe V, Axelrod D, Conly J: Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Q. 2009, 13: 61-68. 10.12927/hcq.2009.21100.CrossRefPubMed
29.
go back to reference Grunfeld E, Watters JM, Urquhart R, O’Rourke K, Jaffey J, Maziak DE, Morash C, Patel D, Evans WK: A prospective study of peri-diagnostic and surgical wait times for patients with presumptive colorectal, lung, or prostate cancer. Br J Cancer. 2009, 100 (1): 56-62. 10.1038/sj.bjc.6604819.CrossRefPubMed Grunfeld E, Watters JM, Urquhart R, O’Rourke K, Jaffey J, Maziak DE, Morash C, Patel D, Evans WK: A prospective study of peri-diagnostic and surgical wait times for patients with presumptive colorectal, lung, or prostate cancer. Br J Cancer. 2009, 100 (1): 56-62. 10.1038/sj.bjc.6604819.CrossRefPubMed
30.
go back to reference Snider MG, MacDonald SJ, Pototschnik R: Waiting times and patient perspectives for total hip and knee arthroplasty in rural and urban Ontario. Can J Surg. 2005, 48 (5): 355-360.PubMedPubMedCentral Snider MG, MacDonald SJ, Pototschnik R: Waiting times and patient perspectives for total hip and knee arthroplasty in rural and urban Ontario. Can J Surg. 2005, 48 (5): 355-360.PubMedPubMedCentral
31.
go back to reference Armstrong D, Barkun A, Chen Y, Daniels S, Hollingworth R, Hunt RH, Leddin D: Access to specialist gastroenterology care in Canada: the Practice Audit in Gastroenterology (PAGE) Wait Times Program. Can J Gastroenterol. 2008, 22 (2): 155-160.CrossRefPubMedPubMedCentral Armstrong D, Barkun A, Chen Y, Daniels S, Hollingworth R, Hunt RH, Leddin D: Access to specialist gastroenterology care in Canada: the Practice Audit in Gastroenterology (PAGE) Wait Times Program. Can J Gastroenterol. 2008, 22 (2): 155-160.CrossRefPubMedPubMedCentral
34.
go back to reference Mitiku TF, Tu K: Using data from electronic medical records: theory versus practice. Healthc Q. 2008, 11 (4): 23-25. 10.12927/hcq.2008.20088.CrossRefPubMed Mitiku TF, Tu K: Using data from electronic medical records: theory versus practice. Healthc Q. 2008, 11 (4): 23-25. 10.12927/hcq.2008.20088.CrossRefPubMed
36.
go back to reference Birtwhistle R, Keshavjee K, Lambert-Lanning A, Godwin M, Greiver M, Manca D, Lagacé C: Building a pan-Canadian primary care sentinel surveillance network: initial development and moving forward. J Am Board Fam Med. 2009, 22 (4): 412-422. 10.3122/jabfm.2009.04.090081.CrossRefPubMed Birtwhistle R, Keshavjee K, Lambert-Lanning A, Godwin M, Greiver M, Manca D, Lagacé C: Building a pan-Canadian primary care sentinel surveillance network: initial development and moving forward. J Am Board Fam Med. 2009, 22 (4): 412-422. 10.3122/jabfm.2009.04.090081.CrossRefPubMed
37.
go back to reference Jaakkimainen L, Tu K, Barnsley J, Salkeld E, Lu H, Pylypenko B, Glazier R: Measuring wait times from family practice to specialty care in Ontario, Canada. Abstract from the 2011 NAPCRG Annual Meeting. Fam Med J. 2012, 44 (Suppl 1): Jaakkimainen L, Tu K, Barnsley J, Salkeld E, Lu H, Pylypenko B, Glazier R: Measuring wait times from family practice to specialty care in Ontario, Canada. Abstract from the 2011 NAPCRG Annual Meeting. Fam Med J. 2012, 44 (Suppl 1):
38.
go back to reference Tu K, Mitiku T, Ivers N, Guo H, Lu H, Jaakkimainen L, Lee D, Tu J: Validation of an Electronic Medical Record Administrative Data Linked Database (EMRALD). Abstract from the 2011 NAPCRG Annual Meeting. Fam Med J. 2012, 44 (Suppl 1): Tu K, Mitiku T, Ivers N, Guo H, Lu H, Jaakkimainen L, Lee D, Tu J: Validation of an Electronic Medical Record Administrative Data Linked Database (EMRALD). Abstract from the 2011 NAPCRG Annual Meeting. Fam Med J. 2012, 44 (Suppl 1):
39.
go back to reference Thiru K, Hassey A, Sullivan F: Systematic review of scope and quality of electronic patient record data in primary care. BMJ. 2003, 326 (7398): 635-641.CrossRef Thiru K, Hassey A, Sullivan F: Systematic review of scope and quality of electronic patient record data in primary care. BMJ. 2003, 326 (7398): 635-641.CrossRef
42.
go back to reference Watson D, Mooney D, McKendry R, Martin D, McLeod C, Regan S, Wong ST: On the road to renewal: mapping primary health care in British Columbia. September 2009, Vancouver (BC): Centre for Health Services and Policy Research Watson D, Mooney D, McKendry R, Martin D, McLeod C, Regan S, Wong ST: On the road to renewal: mapping primary health care in British Columbia. September 2009, Vancouver (BC): Centre for Health Services and Policy Research
44.
go back to reference Hutchison B, Levesque JF, Strumpf E, Coyle N: Primary health care in Canada: systems in motion. Millbank Q. 2011, 89 (2): 256-288. 10.1111/j.1468-0009.2011.00628.x.CrossRef Hutchison B, Levesque JF, Strumpf E, Coyle N: Primary health care in Canada: systems in motion. Millbank Q. 2011, 89 (2): 256-288. 10.1111/j.1468-0009.2011.00628.x.CrossRef
47.
go back to reference Health Services Research and Development Center: Bloomberg School of Health. The Johns Hopkins ACG System. Excerpt from Technical Reference Guide. Version 9.0. 2009, Baltimore, Maryland USA: John Hopkins University Health Services Research and Development Center: Bloomberg School of Health. The Johns Hopkins ACG System. Excerpt from Technical Reference Guide. Version 9.0. 2009, Baltimore, Maryland USA: John Hopkins University
48.
go back to reference Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ. 2003, 327 (7425): 1219-1221. 10.1136/bmj.327.7425.1219.CrossRefPubMedPubMedCentral Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ. 2003, 327 (7425): 1219-1221. 10.1136/bmj.327.7425.1219.CrossRefPubMedPubMedCentral
49.
go back to reference van Walraven C, Oake N, Jennings A, Foster AJ: The association between continuity of care and outcomes: a systematic and critical review. J Eval Clin Pract. 2010, 16 (5): 947-956. 10.1111/j.1365-2753.2009.01235.x.CrossRefPubMed van Walraven C, Oake N, Jennings A, Foster AJ: The association between continuity of care and outcomes: a systematic and critical review. J Eval Clin Pract. 2010, 16 (5): 947-956. 10.1111/j.1365-2753.2009.01235.x.CrossRefPubMed
50.
go back to reference Kralj B: Measuring “rurality” for purposes of health-care planning: an empirical measure for Ontario. Ont Med Rev. 2000, 67: 33-52. Kralj B: Measuring “rurality” for purposes of health-care planning: an empirical measure for Ontario. Ont Med Rev. 2000, 67: 33-52.
51.
go back to reference Simunovic M, Thériault ME, Paszat L, Coates A, Whelan T, Holowaty E, Levine M: Using administrative databases to measure waiting times for patients undergoing major cancer surgery in Ontario, 1993–2000. Can J Surg. 2005, 48 (2): 137-142.PubMedPubMedCentral Simunovic M, Thériault ME, Paszat L, Coates A, Whelan T, Holowaty E, Levine M: Using administrative databases to measure waiting times for patients undergoing major cancer surgery in Ontario, 1993–2000. Can J Surg. 2005, 48 (2): 137-142.PubMedPubMedCentral
52.
go back to reference SAS software, Version 9.1 of the SAS System for Unix. Copyright ©: SAS Institute Inc. SAS and all other SAS Institute. 2004, Cary, NC, USA: Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc SAS software, Version 9.1 of the SAS System for Unix. Copyright ©: SAS Institute Inc. SAS and all other SAS Institute. 2004, Cary, NC, USA: Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc
53.
go back to reference SAS/STAT 9.2 User Guide: The GLM Procedure (Book Excerpt). Copyright ©. 2008, SAS Institute Inc. Cary, NC, USA: SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc SAS/STAT 9.2 User Guide: The GLM Procedure (Book Excerpt). Copyright ©. 2008, SAS Institute Inc. Cary, NC, USA: SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc
56.
go back to reference Vanhuyse M, Bedard PL, Sheiner J, Fitzgerald B, Clemons M: Transfer of follow-up care to family physicians for early-stage breast cancer. Clin Oncol (R Coll Radiol). 2007, 19 (3): 172-176. 10.1016/j.clon.2007.01.115.CrossRef Vanhuyse M, Bedard PL, Sheiner J, Fitzgerald B, Clemons M: Transfer of follow-up care to family physicians for early-stage breast cancer. Clin Oncol (R Coll Radiol). 2007, 19 (3): 172-176. 10.1016/j.clon.2007.01.115.CrossRef
Metadata
Title
Waiting to see the specialist: patient and provider characteristics of wait times from primary to specialty care
Authors
Liisa Jaakkimainen
Richard Glazier
Jan Barnsley
Erin Salkeld
Hong Lu
Karen Tu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2014
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-15-16

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