The Effect of Demand and Supply Imbalance on Access to Gastroenterology Specialty Care

Abstract

Introduction: Demand for gastroenterology care has increased over time and encompasses many services, from endoscopic procedures to office consultations. Effectively matching supply to demand can improve access, operational efficiency, quality of care, and patient satisfaction. The aim of this study was to quantify and compare supply and demand for outpatient services, as well as to determine whether the wait time for specialty care is influenced by the gap between supply and demand. Methods: 43 gastroenterology providers across 5 different sites of a large multispecialty group were included in the study. Data on incoming referrals and scheduled appointments, for May 2018, was collected and sorted into three major categories: consultations, office-based testing (liver elastography, manometry, capsule endoscopy, sigmoidoscopy, pH testing, and hydrogen breath testing), and outpatient procedures (colonoscopy and endoscopy). Average time to third next available appointment (3NA), a standardized metric for provider accessibility,was used to determine wait time for a new consult appointment. Crude differences, between active referrals and scheduled appointments, and proportions for each category, were calculated. Two-proportion z tests were performed; P-values < 0.05 were considered significant. Spearman correlation was performed between 3NA and the crude difference (incoming referrals minus scheduled appointments) of consultations (consult gap) and outpatient procedures (procedure gap) was calculated at each site. Results: A total of 4843 referrals and 5575 scheduled appointments were analyzed. Consultations made up 55.9% of active referrals, but only 35.6% of scheduled appointments. In contrast, procedures made up 40.2% of active referrals, but 60.1% of scheduled appointments. The differences in proportions of consultation and procedure referrals and scheduled appointments were statistically significant for each site, as well as overall (Table 1).1093_A Figure 1 No Caption available.We did not find significant association between 3NA and consult gap (?=0.9, P-value 0.083) or between 3NA and procedure gap (?=0.5, P-value 0.45) (Table 2). Conclusion: There is a disproportionate allocation of scheduled appointments to procedures rather than consultations, creating a relative shortage in the supply of consultative services. However, average 3NA was not significantly correlated with consult or procedure gap, suggesting that other factors may influence access. Follow-up studies are needed to understand this issue in greater detail.1093_B Figure 2 No Caption available.