The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario
Autor: | Claire Bombardier, Jessica Widdifield, Raquel Sweezie, Mary J. Bell, Vandana Ahluwalia, Sydney Lineker, Tetyana Kendzerska |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty Time Factors Referral Waiting Lists Inflammatory arthritis Immunology Primary care Health Services Accessibility 03 medical and health sciences 0302 clinical medicine Rheumatology Chart review Internal medicine Rheumatic Diseases medicine Immunology and Allergy Humans 030212 general & internal medicine Prospective Studies Referral and Consultation Aged Retrospective Studies 030203 arthritis & rheumatology Ontario business.industry Arthritis Middle Aged medicine.disease Triage Wait time Usual care Emergency medicine Female Rheumatologists business |
Zdroj: | The Journal of rheumatology. 47(3) |
ISSN: | 0315-162X |
Popis: | Objective.We evaluated the influence of triage assessments by extended role practitioners (ERP) on improving timeliness of rheumatology consultations for patients with suspected inflammatory arthritis (IA) or systemic autoimmune rheumatic diseases (SARD).Methods.Rheumatologists reviewed primary care providers’ referrals and identified patients with inadequate referral information, so that a decision about priority could not be made. Patients were assessed by an ERP to identify those with IA/SARD requiring an expedited rheumatologist consult. The time from referral to the first consultation was determined comparing patients who were expedited to those who were not, and to similar patients in a usual care control group identified through retrospective chart review.Results.Seven rheumatologists from 5 communities participated in the study. Among 177 patients who received an ERP triage assessment, 75 patients were expedited and 102 were not. Expedited patients had a significantly shorter median (interquartile range) wait time to rheumatologist consult: 37.0 (24.5–55.5) days compared to non-expedited patients [105 (71.0–135.0) days] and controls [58.0 (24.0–104.0) days]. Accuracy comparing the ERP identification of IA/SARD to that of the rheumatologists was fair (κ 0.39, 95% CI 0.25–0.53).Conclusion.Patients triaged and expedited by ERP experienced shorter wait times compared to usual care; however, some patients with IA/SARD were missed and waited longer. Our findings suggest that ERP working in a triage role can improve access to care for those patients correctly identified with IA/SARD. Further research needs to identify an ongoing ERP educational process to ensure the success of the model. |
Databáze: | OpenAIRE |
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