Ontario wait times for arthritis-related joint surgeries increase by up to 9 weeks

Between 1994 and 2002, wait times for Ontario arthritis patients increased by 9 weeks for knee replacements and 4 weeks for hip replacements. This is one of many findings released today in a new report from the Institute for Clinical Evaluative Sciences (ICES) on the impact of arthritis and related conditions across the province.

The ICES Research Atlas Arthritis and Related Conditions in Ontario covers a broad spectrum of topics associated with the disease, including emerging issues, the burden of arthritis in Ontario, availability of services, primary and specialty care, medication use, surgical services, and rehabilitation for total joint replacement (TJR). It also updates information presented in the 1998 ICES Research Atlas Patterns of Healthcare in Ontario: Arthritis and Related Conditions.

“With the number of 45 to 54 year-olds diagnosed with arthritis expected to double between 1991 and 2031, and the number of 55 to 64 year-olds diagnosed with the disease more than doubling during the same period, the findings of our report paint a comprehensive picture that can help us to better manage the challenge of meeting the growing demand for arthritis care and treatment, now and in the future,” said Atlas lead author and ICES senior adjunct scientist Dr. Elizabeth Badley.

"There has been a 23% increase in the number of people living with arthritis in Ontario from 1994 to 2001. The ICES Atlas shows that over 1.6 million Ontarians are living with the daily pain of arthritis. The ICES Atlas provides detailed insights into where support services, patient care, and educational services should be focused to benefit Ontarians with arthritis and their families," said Jo-Anne Sobie, executive director of The Arthritis Society, Ontario Division.

Overview of Key Findings & Recommended Actions:

Key Findings

• Between 1994 and 2002, average wait times for total knee replacement (TKR) increased from 20 to 29 weeks. Wait times for total hip replacement (THR) increased from 16 to 20 weeks.
• 20% of patients with primary THRs and 29% of patients with primary TKRs waited more than a year for surgery.
• The total cost of arthritis-related prescriptions increased by 224% to $60 million between 1998 and 2001. This was mainly due to the increased use and higher cost of COX-2 inhibitors, a type of non-steroidal anti-inflammatory drug (NSAID), released in 1999.
• Although disease-modifying antirheumatic drugs (DMARDs) are recommended for all rheumatoid arthritis (RA) patients, the number receiving them is much less than the estimated number of people with RA.
• In 2001, arthritis and rheumatism affected over 1.6 million Ontarians aged 15 and over. This number is expected to reach 2.8 million by 2026.
• In 2001, two-thirds of people with arthritis were women, and nearly 3 out of 5 were younger than 65.
• Access to arthritis-related services and specialists varies across Ontario.
• Health professional services (i.e. specialists, orthopaedic surgeons, physiotherapists, occupational therapists, and chiropractors) have remained relatively static since 1997. This will translate into declining levels of service per individual as the number of people with arthritis rises.
• The majority of the 2.8 million physician visits for arthritis and related conditions in 2001 were to primary care physicians.

Recommended Actions

• Implement methods to reduce wait times for surgery, such as prioritizing patients waiting for joint replacements, and focus on increasing the recruitment and training of orthopaedic surgeons.
• Ensure people with arthritis have access to necessary drugs on the Ontario Drug Benefit (ODB) Formulary and that drugs are prescribed appropriately.
• Work with physicians across Ontario to ensure effective prescribing of COX-2 inhibitors.
• Ensure people with inflammatory arthritis have access to DMARDs and biologics through specialist care, particularly rheumatologists and internal medicine physicians.
• Target an intensive public education program about the prevention and management of osteoarthritis.
• Develop, implement and evaluate a chronic disease model of care for arthritis that includes prevention, health promotion, and self-management.
• Step up the recruitment and training of specialists to address the shortage of orthopaedic surgeons and rheumatologists, and ensure access and equity in care throughout the province.
• Provide targeted training and education in arthritis care to allied health professionals to facilitate specialization and increase their role in the treatment of arthritis.
• Improve the education and training of arthritis care for primary care physicians to enhance patient management, increase appropriate referrals and encourage effective relationships with rheumatologists.

Independently researched by ICES and the Arthritis Community Research and Evaluation Unit (ACREU), the ICES Research Atlas Arthritis and Related Conditions in Ontario is a joint initiative of ICES, ACREU, and The Arthritis Society, Ontario Division.

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.

The Arthritis Society is Canada's not-for-profit organization dedicated to providing and promoting arthritis education, community support, and research-based solutions to the more than four million Canadians living with arthritis. Since its inception in 1948, The Society has funded arthritis research to develop better treatments for arthritis and ultimately, to find a cure. The Society is also committed to providing diversified programs to help those living with this disabling disease.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• ICES
• Julie Argles
• Media Relations Officer
• (416) 480-4780 or cell (416) 432-8143
• [email protected]

• Arthritis Society
• Deirdre Lall
• Communications and Marketing
• (416) 979-7228 x. 351 or cell (416) 460-8017
• [email protected]