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Ontarians waiting too long to see specialists for arthritis care


Most Ontarians with rheumatic diseases such as rheumatoid arthritis wait nearly a year from onset of symptoms to their first consult with a rheumatologist, which is more than twice as long as patients wait in comparable European health systems. This is among the findings of a new study from the Institute for Clinical Evaluative Sciences (ICES) that was published today in the journal CMAJ Open.

Rheumatologists are specialist physicians trained to diagnose and treat patients affected by the many types of rheumatic disease that cause pain and swelling in the joints and muscles. These diseases are a leading cause of disability in Canada, affecting more than 4.2 million Canadians aged 15 years and older. In the case of arthritis, early treatment is recommended to minimize joint damage and to decrease the need for surgical interventions.

The study researchers say that the year-long delay from when a patient first experiences symptoms to their first specialist consult is partly attributable to long rheumatology wait lists, which are longer than for most other medical subspecialties. But they say it may also be due to a lack of awareness on the part of patients and their primary care providers that help could be available through faster referral to a rheumatologist, and that faster care leads to better outcomes.

“We found that two thirds of patients who have been referred to a rheumatologist for symptoms of inflammatory arthritis end up waiting longer than the recommended guideline of four weeks, which is the benchmark set by the Canadian Medical Association’s Wait Time Alliance and developed and endorsed by the Canadian Rheumatology Association and Arthritis Alliance of Canada,” says Jessica Widdifield, lead author of the study and a post-doctoral fellow at ICES and McGill University. “However, the longest delay consistently occurred before the referral even happened, whether in the lead up to the primary care visit, or in the gap between that visit and the eventual referral. As early treatment is often crucial to minimize damage and ensure better patient outcomes, we suggest that the reasons for this additional delay should be addressed.”

The researchers looked at wait times and patterns of referral for rheumatologists throughout Ontario, using anonymized patient health records held at ICES. They examined a sample consisting of 2,430 first-time rheumatology referrals from 168 family physicians in Ontario between 2000 – 2013, with most of the referrals taking place after 2005.

The study’s findings include:

  • The main reasons for referral were osteoarthritis (caused by wear and tear on the joints) and systemic inflammatory diseases such as rheumatoid arthritis.
  • Wait times varied by diagnoses and geographic region. Overall, the mean time from physician referral to rheumatologist consultation was 74 days.
  • The median wait from the onset of symptoms to the first rheumatologist referral added up to nearly one year. The researchers note that in 10 comparable European centres, this total wait is only 24 weeks.

“Our study shows that Ontario patients are not getting access to rheumatologists in a timely fashion,” says Dr. Karen Tu, the senior scientist on the paper who is a senior core scientist at ICES and associate professor in the Department of Family and Community Medicine at the University of Toronto. “Many rheumatic diseases are most effectively managed if treatment is begun early, at the start of symptoms and before further damage occurs. Given that the burden of these diseases can be quite heavy, both for the individual and also for the population at large as Ontario ages, we suggest that it is vital to educate health providers and their patients about the specialized help that is available through rheumatology referrals, in addition to ensuring shorter wait times once that referral is made.”

The study “Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data” was published today in CMAJ Open. It was funded in part by the Canadian Initiative for Outcomes in Rheumatology cAre (CIORA).

Author Block: Widdifield J, Bernatsky S, Thorne JC, Bombardier C, Jaakkimainen L, Wing L, Paterson JM, Ivers N, Butt D, Lyddiatt A, Hofstetter C, Ahluwalia V, Tu K.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: ICESOntario


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