Abstract
BackgroundEarly referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology.MethodsWe sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated.ResultsIn 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients.ConclusionsAn integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.
Highlights
Referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis
Representative nephrologists and administrators from all 5 Health Authorities sit on the BC Provincial Renal Agency (BCPRA) Executive and Medical Advisory Committees (MAC), which meet regularly
Since the hire of additional nephrologists might be expected to reduce wait times, through diluting the demand for services among more physicians, we examined wait times within health authorities that both added and did not add nephrologists
Summary
Referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. In Canada, 57% of patients waited more than four weeks for a specialist appointment in 2004, which is worst among Australia (46%), the United Kingdom (40%), Germany (23%) and New Zealand (22%) [1]. Such barriers within the primary to specialist care-continuum may prolong exposure to timesensitive disease in the absence of expert management. The Canadian Medical Association and Health Canada began efforts to address waiting time I in 2010. A toolkit for streamlining referral processes was developed, and a resource to highlight current referral reform projects has been compiled (http://www.cma.ca/referrals)
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