Healthcare Policy

Healthcare Policy 8(4) May 2013 : 35-44.doi:10.12927/hcpol.2013.23375
Data Matters

Wait Time from Primary to Specialty Care: A Trend Analysis from Edmonton, Canada

Nguyen X. Thanh, Margaret Wanke and Leanne McGeachy

Abstract

Medical wait time is a top health policy issue in Canada. Reliable data on the referral wait time from primary to specialty care are limited. Existing data on referral wait times are generally self-reported by specialists. In 2008, the Edmonton North Primary Care Network (PCN) developed a Centralized Referral Program, including a specialist database that contains information on specialists' referral requirements, forms and protocols, and has the capability of tracking referrals that the PCN makes on behalf of its family physicians to specialty care. We performed a trend analysis of the referral wait time (defined as the time from referral by a family physician to an appointment date with a specialist) from 2009 to 2011 using the program database (n=33,281 referrals). The study provided a unique and comprehensive picture of wait times for 22 specialties. We identified a decrease in the overall wait time year over year, and improvement in the number of referrals that are accepted the first time. Additionally, specific opportunities for further improvement in referral wait time were noted.

Referral wait time refers to the wait time from referral by a family physician (FP) to appointment/consultation with a specialist. According to Barua and colleagues (2010), the median referral wait time in Canada, across 12 specialties (plastic surgery, gynaecology, ophthalmology, otolaryngology, general surgery, neurosurgery, orthopaedic surgery, cardiovascular surgery, urology, internal medicine, radiation oncology and medical oncology) and 10 provinces surveyed was 8.9 weeks in 2010. The referral wait time varies greatly by province, with the shortest being reported in Saskatchewan (6.7 weeks) and the longest in New Brunswick (24.6 weeks). In Alberta, the median wait time was 9.9 weeks (or 69.3 days), and reducing wait times is one of the priorities identified in Alberta's Five-Year Health Action Plan (established by the Government of Alberta and Alberta Health Services in 2010).

A primary care network (PCN) is an independent, stand-alone organization jointly owned by a group of FPs practising in a geographic area and Alberta Health Services. Formed by a trilateral agreement in 2003 among the Alberta Medical Association, Alberta Health and Alberta Health Services, Alberta's 40 PCNs are tasked with achieving five provincial objectives that include, among others, increasing the number of Albertans with access to primary care services and improving coordination of primary health services with other healthcare services including hospitals, long-term care and specialty care services (Primary Care Initiative 2012).

Edmonton North PCN, started in 2007, is one of the largest PCNs in the province both in terms of number of patients and number of member FPs. It is made up of 140 FPs working in over 45 clinics providing care to over 150,000 patients. The PCN employs over 90 staff to support the FPs in delivering primary care.

From its inception, improving links with specialists and reducing the referral wait time from family practice to specialty care has been a key priority for this PCN. The Centralized Referral Program, developed in 2008, maintains a customized specialist database with capacity for two data sets. The first involves a comprehensive list of over 800 specialists in and around Edmonton, including their referral requirements, forms and protocols. The second data set contains tracking information on the referrals the PCN makes on behalf of its participating FPs to specialists.

There are 6.8 full-time equivalent (FTE) coordinators who process referrals at the Edmonton North PCN. (Of note, PCN staff do not process urgent referrals as these are made directly by the FP.) The referral process involves seven milestones as shown in Figure 1. After receiving a referral request from the FP, PCN staff make an appointment request to the specialist office. If the referral is accepted by a specialist, the date of booking and date of appointment are noted. If a referral is declined, PCN staff continue to seek an appointment from subsequent specialists until an appointment is received. The advantages of the program are twofold in improving wait time. By tracking the wait time for each specialist, staff can refer patients to the one with the shortest wait list (unless the FP requests a certain specialist). Furthermore, PCN staff ensure that all forms and labs are completed and do relevant investigations to improve the quality and appropriateness of each referral, thus increasing the likelihood that the referral is accepted the first time.


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Anecdotal feedback on the program has been positive, and some other PCNs in the province are now using the Edmonton North PCN database; however, the impact of the Centralized Referral Program and its database has never been quantitatively reviewed. Partly to fill this gap, given the unavailability of both control data and baseline data, we performed a trend analysis of the referral wait time from 2009 to 2011 using data from the Edmonton North PCN database.

Methods

Because the referral wait time was calculated from the date of referral received by the PCN to the date of appointment with a specialist, referrals that had not yet received an appointment date were excluded from the study. We used both univariate and multivariate statistical techniques for describing and analyzing the referral wait time among referrals with an appointment date, in terms of mean, median, percentile 90% and percentage of referrals with a wait time of less than or equal to three months – a cut-off that was previously used by Carrière and Sanmartin (2010).

The univariate analysis was undertaken to describe the referral wait time by year (2009, 2010 and 2011) and by characteristics of patients (age and sex) and characteristics of referrals (seasons, referral modes, re-referrals and specialties). The multivariate analysis was used to compare the wait time in 2010 and 2011 to that of 2009, controlling for potential confounders, which were the characteristics of patients and the characteristics of referrals. We used a multiple linear regression for the mean, a multiple quantile regression for the median and for the percentile 90% (Hao and Naiman 2007), and a multiple logistic regression for the percentage of referrals with a wait time of less than or equal to three months.

In this study, male and female patients were categorized into three age groups representing children (0–18 years old), adults (19–64 years old) and seniors (65 years or older).

We grouped referrals with a referral date between February and April as spring, between May and July as summer, between August and October as fall, and between November and January as winter. Referral modes included telephone (where specialists accept referrals by telephone) or letter (where specialists do not make appointments over the telephone but first require a faxed letter). Re-referrals represented instances when a first referral is declined by the specialist, necessitating a subsequent referral to another specialist. Reasons for specialists' declining referrals included not accepting new patients, not assessing or treating the problem listed in the referral, failure to receive required laboratory findings, or the patient's having previously seen another doctor in the same specialty (and who thus should be referred back to that physician). Specialties refer to the medical specialties to which the patients were referred. We included 22 specialties and one "other" category, which comprised a number of specialties having a small number of referrals (this combination was for increasing the statistical power); all are listed in Table 3.


TABLE 3. Referral wait time (days) by year and specialties
Specialties   Year  
  Measures 2009 2010 2011 Total
Allergy & Clinical Immunology n 328 456 225 1,009
  Mean 79 107 181 114
  Median 48 98 180 87
  p90 113 200 276 229
  % ≤3 months 89% 45% 7% 51%
Cardiology n 438 492 359 1,289
  Mean 64 60 53 60
  Median 47 43 46 45
  p90 126 114 96 112
  % ≤3 months 84% 84% 89% 85%
Dermatology n 1,261 1,546 1,412 4,219
  Mean 62 46 39 48
  Median 53 33 27 36
  p90 104 92 86 95
  % ≤3 months 83% 90% 91% 88%
Gastroenterology n 664 788 567 2,019
  Mean 183 131 91 137
  Median 135 105 78 104
  p90 419 271 178 279
  % ≤3 months 33% 43% 59% 44%
General Surgery n 1,151 1,300 934 3,385
  Mean 101 71 57 77
  Median 64 56 49 55
  p90 220 126 102 142
  % ≤3 months 64% 80% 87% 77%
Internal Medicine n 431 525 480 1,436
  Mean 71 70 58 66
  Median 49 48 50 49
  p90 151 149 118 133
  % ≤3 months 78% 74% 79% 77%
Neurosurgery n 28 56 23 107
  Mean 175 158 79 146
  Median 114 108 68 98
  p90 400 322 190 318
  % ≤3 months 43% 43% 70% 49%
Neurology n 567 692 531 1,790
  Mean 73 93 97 88
  Median 71 85 97 81
  p90 132 161 183 161
  % ≤3 months 68% 53% 49% 57%
Nephrology n 87 104 80 271
  Mean 91 89 86 89
  Median 86 83 90 84
  p90 147 138 135 138
  % ≤3 months 55% 61% 51% 56%
Obstetrics and Gynaecology n 1,044 1,304 1,010 3,358
  Mean 106 92 77 92
  Median 82 69 63 69
  p90 202 199 143 189
  % ≤3 months 55% 66% 74% 65%
Ophthalmology n 495 514 491 1,500
  Mean 50 58 54 54
  Median 43 41 42 42
  p90 99 109 116 107
  % ≤3 months 86% 83% 83% 84%
Orthopaedics n 1,046 912 385 2,343
  Mean 122 150 116 132
  Median 91 138 106 108
  p90 243 296 215 252
  % ≤3 months 50% 33% 42% 42%
Otolaryngology/ENT n 929 928 727 2,584
  Mean 71 74 94 79
  Median 37 48 84 55
  p90 155 155 188 163
  % ≤3 months 74% 70% 53% 67%
Paediatrics N 135 152 157 444
  Mean 53 63 44 53
  Median 37 44 30 37
  p90 120 118 91 108
  % ≤3 months 80% 79% 90% 83%
Physical Medicine & Rehab n 182 119 52 353
  Mean 152 158 80 143
  Median 114 121 61 107
  p90 344 335 146 319
  % ≤3 months 43% 36% 67% 45%
Plastic Surgery n 310 333 287 930
  Mean 170 104 87 121
  Median 88 90 78 84
  p90 442 208 155 274
  % ≤3 months 51% 51% 58% 53%
Psychiatry n 127 217 132 476
  Mean 122 87 86 96
  Median 95 70 63 73
  p90 206 191 168 198
  % ≤3 months 48% 66% 70% 62%
Respirology n 144 199 151 494
  Mean 68 68 61 66
  Median 53 60 58 56
  p90 111 103 98 101
  % ≤3 months 85% 81% 89% 85%
Rheumatology n 288 434 357 1,079
  Mean 78 71 82 77
  Median 73 61 78 69
  p90 148 123 136 138
  % ≤3 months 72% 78% 57% 69%
Specialty Clinics n 498 643 369 1,510
  Mean 129 106 48 100
  Median 79 63 38 54
  p90 334 302 90 276
  % ≤3 months 53% 63% 90% 66%
Urology n 455 658 579 1,692
  Mean 81 100 98 94
  Median 57 96 83 76
  p90 173 173 189 181
  % ≤3 months 75% 49% 55% 58%
Vascular Surgery n 54 63 47 164
  Mean 112 138 73 110
  Median 90 140 52 90
  p90 234 261 186 228
  % ≤3 months 52% 37% 70% 51%
Other Specialties n 257 307 265 829
  Mean 89 88 53 77
  Median 57 50 37 46
  p90 215 202 111 179
  % ≤3 months 64% 67% 84% 72%

 

We used the 5% significance level and Stata MP 11.2 (StataCorp, College Station, Texas, USA) for data analyses.

This study and the Centralized Referral Program were approved by the North Edmonton PCN board of directors, which provides overall approval, oversight and accountability for all PCN programs, including their management, evaluation and research.

Results

In total, 33,281 referrals with an appointment date were included for analysis. Of these, 33% were received by the PCN in 2009, 38% in 2010 and 29% in 2011. The reduced number of referrals in 2011 may be explained by the exclusion of incomplete referrals (those still pending an appointment at year end). The number of referrals also varied greatly across the characteristics of patients and referrals, and across specialties. For example, the most frequent age group, sex, season and referral mode was "19–64," "female" (Table 1), "summer" and "letter" (Table 2), respectively. Re-referrals accounted for 10% of all referrals (Table 2). Regarding specialties, dermatology had the most (4,219 referrals, or 13%) and neurosurgery had the least (107 referrals, or 0.3%) number of referrals (Table 3).


TABLE 1. Referral wait time (days) by year and characteristics of patients
    Year  
  Measures 2009 2010 2011 Total
All referrals N 10,919 12,742 9,620 33,281
  Mean 96 88 73 86
  Median 63 63 56 61
  p90 209 185 154 181
  % ≤3 months 66% 66% 71% 67%
Characteristics of patients
Age groups          
   0–18 years old n 719 920 645 2,284
  Mean 93 95 74 89
  Median 65 7 55 63
  p90 181 202 168 87
  % ≤3 months 65% 60% 71% 64%
   9-64 years old n 7,834 9,097 6,864 23,795
  Mean 99 88 75 88
  Median 67 64 57 63
  p90 217 185 158 183
  % ≤3 months 65% 66% 70% 67%
   65+ years old n 2,366 2,725 2,111 7,202
  Mean 87 84 67 80
  Median 55 57 51 55
  p90 189 181 143 68
  % ≤3 months 71% 69% 75% 71%
Sex          
   Male n 2,783 4,840 3,791 11,414
  Mean 94 88 72 84
  Median 63 63 55 60
  p90 202 187 153 174
  % ≤3 months 67% 64% 71% 67%
   Female n 4,953 7,498 5,444 17,895
  Mean 103 87 74 87
  Median 69 63 57 62
  p90 227 185 156 184
  % ≤3 months 63% 67% 71% 67%
   Unknown sex n 3,183 404 385 3,972
  Mean 88 86 69 86
  Median 57 65 51 57
  p90 185 169 144 180
  % ≤3 months 69% 69% 74% 70%

 


TABLE 2. Referral wait time (days) by year and characteristics of referrals
Characteristics of referrals   Year  
  Measures 2009 2010 2011 Total
Season/months          
   Spring (Feb-Apr) n 2,572 3,196 2,835 8,603
  Mean 94 90 79 88
  Median 57 61 59 59
  p90 209 199 174 192
  % ≤3 months 68% 67% 68% 68%
   Summer (May-Jul) n 2,928 3,223 2,731 8,882
  Mean 104 92 80 92
  Median 68 69 63 67
  p91 229 192 162 189
  % ≤3 months 61% 63% 65% 63%
   Fall (Aug-Oct) n 2,818 3,185 2,215 8,218
  Mean 93 85 66 82
  Median 64.5 63 54 61
  p92 189 181 129 166
  % ≤3 months 68% 66% 76% 69%
   Winter (Nov-Jan) n 2,601 3,138 1,839 7,578
  Mean 93 83 63 82
  Median 63 62 45 57
  p93 205 165 141 168
  % ≤3 months 67% 68% 79% 70%
Modes of referrals          
   Phone n 3,561 3,446 2,964 9,971
  Mean 70 63 66 66
  Median 50 46 49 48
  p90 134 127 149 138
  % ≤3 months 77% 78% 74% 77%
   Letter n 7,114 8,991 6,583 22,688
  Mean 109 97 76 95
  Median 71 71 58 67
  p90 237 201 158 198
  % ≤3 months 61% 61% 70% 64%
   Unknown mode n 244 305 73 622
  Mean 105 80 74 89
  Median 77 48 68 62
  p90 217 204 143 200
  % ≤3 months 56% 68% 66% 63%
Re-referrals          
   No n 9,646 11,366 8,801 29,813
  Mean 82 80 70 78
  Median 58 58 54 56
  p90 170 165 148 161
  % ≤3 months 70% 69% 73% 71%
   Yes n 1,273 1,376 819 3,468
  Mean 203 150 106 159
  Median 145 118 90 118
  p90 468 309 204 332
  % ≤3 months 31% 38% 51% 38%

 

Tables 1, 2 and 3 show descriptive statistics of the wait time by year and by characteristics of patients, characteristics of referrals and specialties. For all referrals and years, the wait time mean, median and percentile 90% were 86 days, 61 days and 181 days, respectively. Referrals with a wait time of less than or equal to three months accounted for 67% of all referrals (Table 1).

The trend of wait times showed improvement over time. From 2009 to 2011, the mean decreased from 96 days to 73 days, median from 63 days to 56 days, percentile 90% from 209 days to 154 days and the percentage of referrals with a wait time of less than or equal to three months increased from 66% to 71% (Table 1). The trend of improvement seemed to be consistent among characteristics of patients and referrals, but varied greatly by specialties. For example, the generally positive trend was reversed in the specialties of allergy and clinical immunology, otolaryngology and rheumatology. Between 2009 and 2011 in allergy and clinical immunology, the mean increased from 79 days to 181 days, median from 48 days to 180 days, percentile 90% from 113 days to 276 days and the percentage of referrals with a wait time of less than or equal to three months decreased from 89% to 7%. The corresponding changes in otolaryngology were mean from 71 days to 94 days, median from 37 days to 84 days, percentile 90% from 155 days to 188 days and the percentage of referrals with a wait time of less than or equal to three months from 74% to 53%. In rheumatology, the trend was reversed for mean (from 78 days to 82 days), median (from 73 days to 78 days) and the percentage of referrals with a wait time of less than or equal to three months (from 72% to 57%), but percentile 90% dropped (from 148 days to 136 days) (Table 3 – available online at longwoods.com/content/23375).

Table 4 shows results from multiple regressions on the wait time. Controlling for characteristics of patients, referrals and specialties, the regressions show an improvement in the wait time over time. Compared to 2009, the mean (median; percentile 90%) of wait time was reduced by 11 days (2 days; 18 days) in 2010 and by 21 days (7 days; 27 days) in 2011. All the differences were statistically significant. The odd ratios of the logistic regression indicated that compared to 2009, the percentage of referrals with a wait time of less than or equal to three months increased by 6% in 2010 and by 23% in 2011. However, only the difference between 2009 and 2011 was significant.


TABLE 4. Results from the multiple regressions on referral wait time
Independent variables Linear regression for mean Quantile regression for median Quantile regression for p90 Logistic regression for %3 months
  Coef. p-value Coef. p-value Coef. p-value OR p-value
2009 for reference
2010 -11 0.000 -2 0.001 -18 0.000 1.06 0.084
2011 -21 0.000 -7 0.000 -27 0.000 1.23 0.000
Male for reference
Female 2 0.048 1 .036 4 0.035 0.99 0.615
Sex unknown -7 0.000 -3 0.001 -5 0.112 1.19 0.000
Age group 19–64 for reference
Age 0–18 12 0.000 12 0.000 16 0.000 0.66 0.000
Age 65+ -4 0.000 -4 0.000 -2 0.334 1.18 0.000
Summer for reference
Spring -4 0.000 -8 0.000 -7 0.002 1.31 0.000
Fall -11 0.000 -7 0.000 -18 0.000 1.43 0.000
Winter -12 0.000 -10 0.000 -18 0.000 1.51 0.000
One-time referrals for reference
Re-referrals 68 0.000 47 0.000 148 0.000 0.30 0.000
Phone for reference
Letter 23 0.000 16 0.000 28 0.000 0.57 0.000
Mode unknown 18 0.000 11 0.000 29 0.000 0.56 0.000
Paediatrics for reference
Allergy & Clinical Immunology 70 0.000 59 0.000 126 0.000 0.14 0.000
Cardiology 19 0.000 22 0.000 9 0.319 0.70 0.030
Dermatology 15 0.001 16 0.000 5 0.543 0.84 0.240
Gastroenterology 76 0.000 66 0.000 123 0.000 0.13 0.000
General Surgery 29 0.000 30 0.000 24 0.004 0.48 0.000
Internal Medicine 29 0.000 25 0.000 45 0.000 0.39 0.000
Neurosurgery 87 0.000 67 0.000 148 0.000 0.16 0.000
Neurology 52 0.000 56 0.000 75 0.000 0.14 0.000
Nephrology 46 0.000 60 0.000 34 0.005 0.16 0.000
Obstetrics & Gynaecology 45 0.000 42 0.000 72 0.000 0.26 0.000
Ophthalmology 22 0.000 23 0.000 18 0.043 0.55 0.000
Orthopaedics 77 0.000 76 0.000 118 0.000 0.11 0.000
Otolaryngology/ENT 32 0.000 27 0.000 48 0.000 0.28 0.000
Physical Medicine & Rehab 88 0.000 71 0.000 180 0.000 0.12 0.000
Plastic Surgery 87 0.000 66 0.000 160 0.000 0.11 0.000
Psychiatry 44 0.000 40 0.000 70 0.000 0.27 0.000
Respirology 22 0.000 31 0.000 -2 0.849 0.76 0.147
Rheumatology 35 0.000 44 0.000 33 0.000 0.29 0.000
Specialty Clinics 55 0.000 29 0.000 139 0.000 0.26 0.000
Urology 66 0.000 62 0.000 100 0.000 0.12 0.000
Vascular Surgery 68 0.000 66 0.000 112 0.000 0.13 0.000
Other Specialties 29 0.000 18 0.000 45 0.000 0.40 0.000

 

Regarding patient characteristics, there was a significant difference in wait time between men and women. However, the "unknown sex" group, which accounted for 12% of the sample, may bias this association. Compared to patients aged 19–64 years, patients aged 18 years or younger (referred to all specialties) had a significantly longer wait time, while patients aged 65 years or older had a significantly shorter wait time.

On average, referrals in summer had 4 days', 11 days' and 12 days' longer wait time than those in spring, fall and winter, respectively. This variance is likely explained by the summer vacation season.

Patients who needed to be re-referred waited 68 days longer than those whose initial referrals were accepted. Patients referred to specialists who required letters before an appointment could be made had to wait 23 days longer than those whose doctors accepted appointments over the telephone. These patterns held true for median and percentile 90% of the wait time and true for the percentage of referrals with a wait time of less than or equal to three months. All the differences were statistically significant.

The wait time varied substantially among specialties. Compared to paediatrics, the shortest wait time mean specialty (of note, only 54% of children aged 18 years or younger were referred to paediatricians), all other specialties had a significantly longer wait time and a significantly lower percentage of referrals with a wait time of less than or equal to three months. The exceptions were cardiology, dermatology and respirology for percentile 90%, and dermatology and respirology for the percentage.

Discussion

The main finding of this study is the trend of improvement in referral wait time from 2009 to 2011 at the Edmonton North PCN. It is possible that the Centralized Referral Program – by tracking and maintaining specialist data, striving to ensure referrals are accepted the first time and referring patients to specialists with shorter wait lists – has had a positive impact. However, this attribution is weakened by the absence of control data. During the study time period, some specialties in Edmonton implemented a number of strategies and activities to reduce their wait times (Alberta Health Services 2010, 2011), and it is possible these also had a positive impact on the wait time. In order to confirm whether the Centralized Referral Program has had a positive impact on wait times, control data are required.

In terms of related data, Alberta has a wait time registry where Albertans interested in treatment options can view wait time information (including trends over time) on medical procedures and diagnostic tests and then discuss their choices with their healthcare provider (Alberta Health and Wellness and Alberta Health Services 2012). However, the registry defines wait time as the interval between a patient's or specialist's decision that a procedure or test is required and the date the procedure or test is performed. Because this is different from the definition in the current study, outcomes cannot be directly compared. Another source of data showing the trend over time of referral wait times is the series of reports titled Waiting Your Turn: Wait Times for Health Care in Canada by the Fraser Institute (Barua et al. 2010, 2011). By surveying practitioners of 12 specialties, the reports show that the median referral wait times in Alberta in 2009, 2010 and 2011 were 10.0, 9.9 and 10.7 weeks, respectively. Compared to this self-reported trend, our results favour the Centralized Referral Program.

Several findings from this study have policy implications. First, the referral wait time and its trend over time vary substantially by specialty. More investigation is warranted to understand these differences and resolve any bottlenecks, especially for specialties with a long wait time and those with the reverse trend. Second, patients have to wait for more than two months longer if they need to be re-referred, suggesting that efforts to improve referral appropriateness, such as those attempted through the Centralized Referral Program, are warranted. Third, patients have to wait considerably longer if a specialist requires a letter of referral before a booking is made rather than making an appointment over the telephone (with a letter to follow). Simply eliminating this one step in the booking process could result in reducing wait times by over three weeks.

A limitation regarding the data that needs to be acknowledged is that, as the data were extracted in early January 2012, the referrals received by Edmonton North PCN in late 2011, or referrals in 2011 that needed a long time to receive an appointment date, were not included in the analysis (that is, only completed referrals were included). Such exclusions may bias the wait time results in 2011. However, the wait time improvement from 2009 to 2010 is unlikely to be biased. One may also argue that the wait time improvement between 2009 and 2011 is due to the reduction in the volume of referrals. However, this seems unlikely as there was also an improvement of the wait time between 2009 and 2010, when the volume increased. Finally, the wait time from the date on which a FP sees the patient and issues a referral to the date on which the PCN receives the referral was not available for this analysis.

In conclusion, this study demonstrates the potential value in tracking referral information from primary to specialty care. While there is not enough evidence to attribute the improvements directly to the Centralized Referral Program, the study findings are encouraging and further investigation, preferably through a controlled study, is recommended. Referral wait time from primary to specialty care is an immensely complex issue, and substantive improvement will likely require focused system-level attention. However, this study suggests that change is possible and that further improvements can be made.

 


 

Temps d'attente entre les services de première ligne et les soins d'un spécialiste : analyse de la tendance à Edmonton, Canada

Résumé

Les temps d'attente pour les services médicaux constituent un des principaux enjeux de politique de santé au Canada. Il y a peu de données fiables sur le temps d'attente entre les services de première ligne et l'aiguillage vers les soins d'un spécialiste. Les données sur ces temps d'attente sont généralement signalées par les spécialistes eux-mêmes. En 2008, le réseau Edmonton North Primary Care Network (PCN) a mis au point un programme centralisé d'aiguillage, doté d'une base de données spécialisée qui contient des renseignements sur les conditions, les formulaires et les protocoles d'aiguillage vers les spécialistes. Cette base de données permet d'assurer le suivi des aiguillages que le PCN fait au nom des médecins de famille vers les soins de spécialistes. Nous avons effectué une analyse de la tendance des temps d'attente pour l'aiguillage (défini comme étant le temps entre la recommandation de la part du médecin de famille et la date de rendez-vous chez le spécialiste), de 2009 à 2011, à l'aide de la base de données du programme (n=33 281 aiguillages). L'étude brosse un portrait unique et complet des temps d'attente pour 22 spécialités. Nous avons observé un déclin, d'année en année, du temps général d'attente ainsi qu'une amélioration du nombre d'aiguillages qui sont acceptés dès la première fois. De plus, nous avons dégagé des occasions précises pour améliorer davantage le temps d'attente pour les aiguillages.

About the Author

Nguyen X. Thanh, MD, PhD, MPH, Adjunct Associate Professor, Department of Public Health Sciences, University of Alberta, Health Economist, Institute of Health Economics, Edmonton, AB

Margaret Wanke, MHSA, President and CEO, Charis Management Consulting, Edmonton, AB

Leanne McGeachy, MBA, General Manager, Edmonton North Primary Care Network, Edmonton, AB

Correspondence may be directed to: Nguyen Xuan Thanh, MD, PhD, MPH, Institute of Health Economics, 1200 – 10405 Jasper Ave., Edmonton, AB T5J 3N4; tel.: 780-448-4881; fax: 780-4480018; e-mail: tnguyen@ihe.ca.

Acknowledgment

We would like to thank Lindsay Steward, Physician Administrative Services Manager, and Carly Strong, Executive Assistant at the Edmonton North PCN, for their input and assistance, as well as Nate Schmold and Katherine Thielmann, data management specialists at Lexi.net, for extracting the data.

Funding from the Edmonton North PCN for this independent, external study is gratefully acknowledged.

References

Alberta Health Services. 2011. 2011–2015 Health Plan. Retrieved April 13, 2013. <http://www.albertahealthservices.ca/Publications/ahs-pub-2011-2015-health-plan.pdf>.

Alberta Health and Wellness and Alberta Health Services. 2012. "Alberta Wait Times Reporting, Wait Time Trends." Retrieved April 13, 2013. <http://waittimes.alberta.ca/>.

Barua, B., M. Rovere and B.J. Skinner. 2010. Waiting Your Turn: Wait Times for Health Care in Canada (20th ed.). Retrieved April 13, 2013. <http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/waiting-your-turn-2010.pdf>.

Barua, B., M. Rovere and B.J. Skinner. 2011. Waiting Your Turn: Wait Times for Health Care in Canada (21st ed.). Retrieved April 13, 2013. <http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/waiting-your-turn-2011.pdf>.

Carrière, G. and C. Sanmartin. 2010. "Waiting Time for Medical Specialist Consultations in Canada, 2007." Health Reports 21(2): 1–8. Statistics Canada Catalogue no. 82-003-XPE.

Government of Alberta and Alberta Health Services. 2010. "Becoming the Best: Alberta's 5-Year Health Action Plan 2010–2015." Retrieved April 13, 2013. <http://www.health.alberta.ca/documents/Becoming-the-Best-2010.pdf>.

Hao, L. and D.Q. Naiman. 2007. Quantile Regression. Quantitative Applications in the Social Sciences Series 149. Thousand Oaks, CA: Sage Publications.

Primary Care Initiative. 2012. "About PCNs." Retrieved April 13, 2013. <http://www.albertapci.ca/AboutPCNs/Pages/default.aspx>.

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