Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disorder that is associated with significant patient morbidity and societal burden. In general, wait times for health care in Ontario are believed to be lengthy; however, many diseases lack specific corroborative wait time data. To characterize wait times for OSA care in Ontario. Cross-sectional survey. A survey tool was designed and validated to question physicians involved in OSA care about the length of the wait times their patients experience while traversing a simplified model of OSA care. The survey was sent to all otolaryngologists and respirologists in the province, as well as to a random sample of provincial family physicians. Patients waited a mean of 11.6 months to initiate medical therapy (continuous positive airway pressure), and 16.2 months to initiate surgical therapy. Sleep laboratory availability appeared to be the major restriction in the patient management continuum, with each additional sleep laboratory in a community associated with a 20% decrease in overall wait times. Smaller community sizes were paradoxically associated with shorter wait times for sleep studies (P<0.01) but longer wait times for OSA surgery (P<0.05). Regression analysis yielded an r2 of 0.046; less than 5% of the wait time variance could be explained by the simplified model. Patients experienced considerable wait times when undergoing management for OSA. This has implications for both individual patient care and public health in general.
Highlights
BACKGROund: Obstructive sleep apnea (OSA) is a highly prevalent disorder that is associated with significant patient morbidity and societal burden
The primary objective of the present study was to gather data describing the pattern of wait times for OSA treatment in Ontario and to describe the overall wait time a patient with OSA experiences during their health care management process
Wait time data were collected via cross-sectional survey of the main physician groups involved in OSA care: family physicians (FPs), respirologists (RESPs) and otolaryngologists (ENTs)
Summary
Brian W Rotenberg MD MPH FRCSC1, Charles F George MD FRCPC2, Kevin M Sullivan PhD MPH MHA3, Eric Wong MD MClSc(FM) CCFP4. The primary objective of the present study was to gather data describing the pattern of wait times for OSA treatment in Ontario and to describe the overall wait time a patient with OSA experiences during their health care management process. Wait time data were collected via cross-sectional survey of the main physician groups involved in OSA care: family physicians (FPs), respirologists (RESPs) and otolaryngologists (ENTs). Survey tool development and validation For study purposes, a simplified model of the typical OSA care pathway was developed, reflecting the time points patients encounter during their management (Figure 1). Wait time estimates for each step of the study model were compared with actual wait times assessed via formal chart review Both construct validity and test-retest reliability were assessed by comparing means and SDs for each parameter pair and by calculating Cronbach’s alpha (a), with a>0.70 set as the a priori threshold for acceptability. The provincial sample pool consisted of approximately 228 RESPs, 226 ENTs and 10,328 FPs
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