Abstract
BackgroundOutpatient preoperative assessment clinics were developed to provide an efficient assessment of surgical patients prior to surgery, and have demonstrated benefits to patients and the health care system. However, the centralization of preoperative assessment clinics may introduce geographical barriers to utilization that are dependent on where a patient lives with respect to the location of the preoperative assessment clinic.MethodsThe association between geographical distance from a patient's place of residence to the preoperative assessment clinic, and the likelihood of a patient visit to the clinic prior to surgery, was assessed for all patients undergoing surgery at a tertiary health care centre in a major Canadian city. The odds of attending the preoperative clinic were adjusted for patient characteristics and clinical factors.ResultsPatients were less likely to visit the preoperative assessment clinic prior to surgery as distance from the patient's place of residence to the clinic increased (adjusted OR = 0.52, 95% CI 0.44–0.63 for distances between 50–100 km, and OR = 0.26, 95% CI 0.21–0.31 for distances greater than 250 km). This 'distance decay' effect was remarkable for all surgical specialties.ConclusionThe present study demonstrates that the likelihood of a patient visiting the preoperative assessment clinic appears to depend on the geographical location of patients' residences. Patients who live closest to the clinic tend to be seen more often than patients who live in rural and remote areas. This observation may have implications for achieving the goals of equitable access, and optimal patient care and resource utilization in a single universal insurer health care system.
Highlights
Outpatient preoperative assessment clinics were developed to provide an efficient assessment of surgical patients prior to surgery, and have demonstrated benefits to patients and the health care system
Prior to the development of preoperative assessment clinics, patients were typically admitted to the hospital before the day of surgery to undergo a medical evaluation by an anesthesiologist and when necessary, medical internists
We examined the association between geographical distance from a patient's residence to the preoperative assessment clinic located at a university-affiliated tertiary care centre, and the likelihood of a patient visit to this clinic prior to surgery
Summary
Outpatient preoperative assessment clinics were developed to provide an efficient assessment of surgical patients prior to surgery, and have demonstrated benefits to patients and the health care system. The ultimate goal of the preoperative assessment clinic is to provide an efficient assessment of surgical patients prior to surgery. This is accomplished through a decrease in average costs associated with unnecessary laboratory tests, cancelled or delayed surgery, additional cost associated with intraoperative complications, and extended post-operative patient length of hospital stay [1,2,3,4,5]. Access could be compromised for patients who must travel long distances to receive centralized preoperative assessment clinic services. It is possible that access to preoperative assessment clinics may depend on where a patient lives, thereby leading to restricted access for those living further away
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