Patient and physician perspectives of maximum acceptable waiting times for cataract surgery

Abstract

Background: Lengthy waiting times for cataract surgery are an important issue in countries with publicly funded health care systems. To improve the fairness, timeliness, and certainty of waiting-time management, the Western Canada Waiting List Project has developed priority criteria scores (PCSs) related to urgency and linked to maximum acceptable waiting times (MAWTs). The purpose of our study was to compare patient and physician perspectives of MAWT for different levels of urgency. A second aim was to assess the determinants of patient and surgeon perspectives on MAWT. Methods: Ophthalmologists assessed consecutive patients waitlisted for cataract surgery. Data included a MAWT, a visual analogue scale of urgency (VAS urgency), and the cataract PCS. Patients were mailed questionnaires to assess their perspectives of MAWT and VAS urgency. They were also sent a measure of visual function called the Visual Function Assessment. We used hierarchical linear regression to assess the determinants of MAWT. Results: The mean age of the 213 patients was 73.9 years; 56.8% were female and 71.8% were booked for first eye surgery. Physician-rated MAWT was significantly longer than patient-rated MAWT (mean 15.1 vs. 9.9 weeks). Median physician MAWTs ranged from 12 (most urgent) to 20 (least urgent) weeks, and patient MAWTs, from 4 to 8 weeks. A 3-step hierarchical linear regression model showed that, after adjusting for age and sex, the priority criteria added significantly to the surgeon model ( R 2 change = 0.22). Significant predictors were ocular comorbidity, impairment in visual function, and ability to work or live independently or care for dependents. After the addition of VAS urgency, the final model explained 42% of the variance in surgeon MAWT. Significant predictors were age-related macular degeneration and VAS urgency. A 4-step hierarchical regression model for patient MAWT showed that after step 2, sex and visual acuity in the nonsurgery eye were significant predictors. The final model accounted for 11% of the variance in patient MAWT. Significant predictors were sex (males had lower MAWT) and VAS urgency. Interpretation: Patient and physician views on MAWT differ, yet both are critical to a fair process for developing standardized waiting times related to levels of urgency. Results from this study provide initial inputs to the formulation of benchmark waiting times for different levels of the cataract PCS.