Waiting Time For Appointment Research Articles

Wait Times in Musculoskeletal Patients: What Contributes to Patient Satisfaction.

Introduction:The purpose of this study was to determine how wait time duration is associated with patient satisfaction and how appointment characteristics relate to wait time duration and patient satisfaction in the orthopedic surgery clinic.Methods:Two hundred sixty-four patients visiting one of 3 ambulatory orthopedic surgery clinics were asked to estimate their wait time and to rate their satisfaction with the visit. The associations between appointment characteristics, wait time, and satisfaction were analyzed using t tests, 1-way analysis of variance, and Pearson correlation coefficients.Results:Wait times were significantly different based on visit type, appointment time, whether an X-ray was required, and whether a trainee was involved (P < .001). Patients with wait times less than 30 minutes had higher satisfaction scores (P < .001). Satisfaction ratings were significantly different based on the surgeon’s management recommendation (P = .0211), but were not significantly different based on sex, age, office location, visit type, appointment time subsection, or time spent with the physician (P > .05).Conclusion:Wait times negatively correlated with satisfaction. New patient visits, appointment times in the later third of the day, appointments requiring an X-ray, and appointments involving a trainee had significantly longer wait times. Care should be taken to inform patients with visits involving these characteristics that they may experience longer than average wait times.

Low and Higher Wage Workers Report No Differences in Four Barriers to Primary Care Access.

Lower wage workers, known to seek more care in the emergency department (ED), may encounter more barriers to timely outpatient primary care. This study aimed to identify differences in self-reported delays in care related to 4 modifiable barriers (phone availability, appointment wait time, in-clinic wait time, and limited service hours) across self-reported wage and to examine the relationship between these care delays and self-reported ED use. The authors examined data from the 2011-2015 National Health Interview Surveys for 58,298 self-identified full-time workers. Multivariable logistic models with geographical region and year fixed effects were used to test the association of wage group and barriers to care. In addition, the multiplicative and additive interaction effects upon self-reported ED use were tested. No association was observed between wage level and barrier to timely care. Lower wage workers (<$25,000 vs. >$75,000/yr.; OR 1.53, 95% CI 1.20-1.94, P = 0.001) and those reporting any of the 4 barriers to care (OR 1.99, 95% CI 1.71-1.94, P < 0.001) were more likely to report 2 or more ED visits in the past year. Multiplicative effects were not statistically significant. Additive interaction effects of wage and barriers were only significant among workers with wages $35,000-$44,999 annually (vs. >$75,000: relative excess risk coef. 1.23, 95% CI 0.07-2.38, P = 0.037) for 2 or more ED visits in past year. Although these modifiable barriers may explain the differences in repeat ED use for workers earning $35,000-$44,999 annually, these barriers do not explain disparities in ED use between highest and lowest wage workers.

A Qualitative Investigation of Barriers to Seeking Treatment for Suicidal Thoughts and Behaviors Among Army Soldiers with a Deployment History

This study aimed to identify barriers to treatment seeking and service utilization among previously deployed Army soldiers who recently experienced a suicidal crisis. Confidential interviews were conducted on a psychiatric inpatient unit with 12 Army soldiers with a deployment history following a suicidal crisis. Qualitative analysis focused on statements coded as “barriers to seeking help” and “explicit recommendations.” Suicidal Army soldiers with a deployment history experienced different barriers to seeking help, including stigma and logistical challenges (e.g., long wait times for appointments). Negative and positive perceptions of support were reported for various resources – for example, family, crisis hotlines, chaplains, and command. Suicidal Army soldiers, interviewed in this study, experienced a number of challenges and frustrations associated with various helping resources. This study highlights the need for greater attention toward understanding these challenges and subsequently addressing them through appropriate resource allocation and additional training for those working directly with Army soldiers at risk for suicide.

Many buprenorphine prescribers don't take Medicaid or uninsured patients

In a survey in which callers seeking buprenorphine treatment for opioid use disorder (OUD) posed as patients with either Medicaid or no insurance, researchers found that few were offered an appointment with the possibility of buprenorphine induction at the first visit. The calls were conducted in Massachusetts, Maryland, New Hampshire, West Virginia, Ohio and the District of Columbia, all of which have a high burden of OUD. The callers found that out of 546 clinicians on the buprenorphine prescriber database maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), new appointments were offered to 54% of Medicaid callers and 62% of uninsured (meaning cash‐paying) patients, but that only 27% of Medicaid and 41% of uninsured callers had a possibility of buprenorphine treatment, and not all would get it right away. In fact, the median wait time for the first appointment was six days.

Regional Planning Model for Cancer Screening with Imperfect Patient Adherence

The effectiveness of cancer screening and adherence to cancer screening guidelines can be inhibited by long wait times for screening appointments. In this article, the authors develop a queueing network model of screening for a disease within a population of patients with imperfect adherence to screening guidelines to characterize the relationship between the screening request frequency rate and the wait time for screens. They first use their model to derive the capacity needed by a given system or the population size a given system can serve to guarantee a certain service level, and then analyze routine screening for average-risk patients as well as the additional capacity required for diagnostic screening and surveillance of high-risk patients. Finally, the authors perform a numerical study using national public health data for colorectal cancer (CRC) screening in the United States and provide insights for public health officials, providers, and policy makers, showing how queueing models can be applied to regional planning decisions for determining CRC screening capacity requirements.

Kaiser's mental health crisis continues to worsen, new union survey finds

A new survey released by the National Union of Healthcare Workers (NUHW) has found that Kaiser Permanente's capacity to deliver clinically appropriate care to its enrollees has been “seriously compromised.” According to the survey, Kaiser's mental health clinicians report that wait times for treatment appointments have grown longer over the past two years.

Cardiology Clinic Access: How Does RN Supervised Stress Testing Affect Cardiology Clinic Access Appointment Wait Times, and the Number of Rescheduled Appointments?

Access to clinical care in specialty services is challenging in today's ever-changing and complex world of health promotion. Typically, physicians (MD) and nurse practitioners (NP) provide many specialty cardiology services at the Veterans Health Administration (VA) where the study was conducted, while the registered nurses (RN) remain underutilized. These healthcare providers are tasked with supervising cardiac stress tests, which decreases appointment availability for new consults and follow-up visits in the cardiology clinic. Delegating the cardiac stress test supervision to nurses may improve access to cardiac care. The purpose of this study was to determine if RN supervised stress testing affects access to cardiology care. The study utilized a quantitative, comparative design to evaluate if a change in the role of the cardiology RN affected access to cardiology care. The number of cardiology appointments before the intervention were compared to those after the intervention. The appointments were divided into four categories for analysis: 1) appointments scheduled greater than 30 days, 2) appointments referred to community physicians, 3) the number of rescheduled appointments, and 4) the total number of appointments scheduled. The results indicate the number of appointments scheduled over the 30-days was significantly reduced (p = .02) and the total number of appointments (p = .04), but community referrals and rescheduled appointments were not (p =.26, p =.36, respectively). During the data collection, one of the healthcare providers was no longer available to provide care for two out of the three months included in the study. Therefore, the number of appointments after the intervention were not a reflective comparison of cardiology clinic access. Despite the discrepancy in the number of healthcare providers, delegating the stress test supervision to nurses significantly reduced the number of patients scheduled over 30-days and the total number of scheduled appointments. Increasing the skill set of the cardiology RN in the procedural setting can amplify the benefits of team-based care, safe delivery of care, the development of best practices, and most importantly access to cardiology care.

847 Teledermatology can optimize treatment of cutaneous disease in under-resourced clinics

Teledermatology is a powerful tool that can increase access to care by connecting primary care providers (PCPs) to remote dermatologists, who can review photographs and provide specialist advice. Our research aims to assess the ability of teledermatology to improve care delivery to under-served patients, who may receive sub-optimal care for cutaneous disease from non-specialists. Using the American Academy of Dermatology program, AccessDerm, we provided asynchronous teledermatology consults to PCPs at a community health clinic serving uninsured Latino immigrants. Supporting teledermatology feasibility in this context, retrospective analysis of 131 consults revealed a 97% completion rate with rare failures due to photograph omission. We calculated a 37-hour mean teledermatology response time versus a 14-day appointment wait-time (p<0.00001). For 82 consults (65%), teledermatologists recommended a definitive plan of care without in-person evaluation, which increased availability of in-person appointments. In 15 cases, PCPs were given an interim treatment to initiate while awaiting appointments. Thus, teledermatology allowed more rapid care delivery in 97 cases (76%). In 72 cases, PCPs reported a tentative treatment plan prior to receiving a consult reply; teledermatologist-recommended management differed 82% of the time, emphasizing the importance of specialist input. Following teledermatologist recommendations would have changed the clinical course in 70% of all cases, permitting avoidance of sub-optimal outcomes including delayed care, under-treatment (e.g. missed infections), over-treatment (e.g. unnecessary antibiotics), and healthcare over-utilization (e.g. preventable ER visits). In sum, our results show teledermatology can accelerate care delivery and improve management of cutaneous disease in under-resourced clinics, including the potential to promote more judicious use of antimicrobial agents. Moreover, our research underscores the promise of teledermatology to increase access to specialty-level consultation and to reduce healthcare disparities for disadvantaged populations.

Early arthritis clinic is cost-effective, improves outcomes and reduces biologic use.

There is good evidence that dedicated early arthritis clinics (EACs) improve referral lag time and reduce delay in establishing disease-modifying therapy. However, it remains arguable whether such clinics improve relevant disease outcomes. Nationally, only 57% of units have dedicated EACs. Our rheumatology department established a centralised, patient-focused and multidisciplinary EAC to achieve key financial and clinical outcome targets the department was failing to meet. The EAC aimed to increase the department's capacity to accommodate referrals from general practitioners (GPs) and other sources, decrease the time between diagnosis and starting therapy, establish standardised treatment algorithms and reduce biologic use. The EAC was established in January 2016 and comprised the introduction of a dedicated referral pro forma and an EA educational programme for GPs, pooling of all sources of referral, running of six EACs per week with availability of ultrasound and introduction of a standardised approach to the early initiation of therapy and timely review of treatment outcomes. The introduction of the EAC was associated with improved clinical outcomes (EA patients achieving a Disease Activity Score 28 (DAS28) < 3.2 in 2015, 38.0% [N= 113] vs. 78.5% [N= 220] in 2016) and overall patient experience (mean waiting time for EA patients' first appointment in 2015: 12weeks vs. 2.5weeks in 2016; 94% [N= 167] of patients recommended the rheumatology service in 2016 vs. 74% [N= 100] in 2015). The total costs associated with introducing the EAC were ~ £201,362. Use of biologics decreased from 26.0 to 5.6% between 2015 and 2016, resulting in a cost saving of ~ £394,942. Other cost savings associated with the EAC included reductions in the overall cost/patient seen (2015, £198.88; 2016, £74.98) and not running any premium rate initiative clinics (saving ~ £26,500 in 2016) to meet waiting list targets. Efficiency gains from the introduction of the EACs have improved patients' health and overall satisfaction with their treatment, whilst saving costs for healthcare.

Patient trade-offs between continuity and access in primary care interprofessional teaching clinics in Canada: a cross-sectional survey using discrete choice experiment

ObjectiveTimely access to care and continuity with a specific provider are important determinants of patient satisfaction when booking appointments in primary care settings. Advanced access booking systems restrict the majority...

Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers

Concerns have been raised about the adequacy of health care access among patients cared for within the United States Department of Veterans Affairs (VA) health care system. To determine wait times for new patients receiving care at VA medical centers and compare wait times in the VA medical centers with wait times in the private sector (PS). A retrospective, repeated cross-sectional study was conducted of new appointment wait times for primary care, dermatology, cardiology, or orthopedics at VA medical centers in 15 major metropolitan areas in 2014 and 2017. Comparison data from the PS came from a published survey that used a secret shopper survey approach. Secondary analyses evaluated the change in overall and unique patients seen in the entire VA system and patient satisfaction survey measures of care access between 2014 and 2017. The outcome of interest was patient wait time. Wait times in the VA were determined directly from patient scheduling. Wait times in the PS were as reported in Merritt Hawkins surveys using the secret shopper method. Compared with the PS, overall mean VA wait times for new appointments in 2014 were similar (mean [SD] wait time, 18.7 [7.9] days PS vs 22.5 [7.3] days VA; P = .20). Department of Veterans Affairs wait times in 2014 were similar to those in the PS across specialties and regions. In 2017, overall wait times for new appointments in the VA were shorter than in the PS (mean [SD], 17.7 [5.9] vs 29.8 [16.6] days; P < .001). This was true in primary care (mean [SD], 20.0 [10.4] vs 40.7 [35.0] days; P = .005), dermatology (mean [SD], 15.6 [12.2] vs 32.6 [16.5] days; P < .001), and cardiology (mean [SD], 15.3 [12.6] vs 22.8 [10.1] days; P = .04). Wait times for orthopedics remained longer in the VA than the PS (mean [SD], 20.9 [13.3] vs 12.4 [5.5] days; P = .01), although wait time improved significantly between 2014 and 2017 in the VA for orthopedics while wait times in the PS did not change (change in mean wait times, increased 1.5 days vs decreased 5.4 days; P = .02). Secondary analysis demonstrated an increase in the number of unique patients seen and appointment encounters in the VA between 2014 and 2017 (4 996 564 to 5 118 446, and 16 476 461 to 17 331 538, respectively), and patient satisfaction measures of access also improved (satisfaction scores increased by 1.4%, 3.0%, and 4.0% for specialty care, routine primary care, and urgent primary care, P < .05). Although wait times in the VA and PS appeared to be similar in 2014, there have been interval improvements in VA wait times since then, while wait times in the PS appear to be static. These findings suggest that access to care within the VA has improved over time.

Disparities in Healthcare Utilization Among Adults with Obesity in the United States, Findings from the NHIS: 2006–2015

Few studies of disparities consider logistical hurdles faced by adults with obesity in obtaining needed healthcare. This study compared adults with obesity to adults without obesity on self-reported practical aspects of receiving healthcare including ease of seeing a doctor and wait times for appointments. Serious psychological distress and chronic health conditions are prevalent in adults with obesity. Because serious psychological distress and number of chronic health conditions can act as confounders in any observed differences between the adults with and without obesity in their use of healthcare, we have examined these differences independent of serious psychological distress and chronic health conditions. Adults 18 to 64 years sampled from the 2006–2015 National Health Interview Survey (NHIS) (n = 74,598) were examined on five self-reported indicators: does not need a doctor, waited too long in the doctor’s office, and to get an appointment, year since having seen a doctor, and saw a doctor ten times or more in the last 12 months. Multivariable models adjusted for serious psychological distress, chronic health conditions, gender, age, race/ethnicity, income, health coverage, and survey year demonstrated that adults with obesity were more likely to wait too long to get an appointment, and in the waiting room. Adults with obesity report not needing doctors despite seeing doctors frequently. Greater attention is needed to understand barriers to health care utilization in adults with obesity.

Mental Health Treatment Quality, Access, and Satisfaction: Optimizing Staffing in an Era of Fiscal Accountability.

Mental health treatment access and quality are influenced by the interplay of structural, organizational, and performance factors-including the number of mental health staff providing direct clinical care relative to patients treated (i.e., staffing ratio), mental health staff productivity, and wait times for scheduled mental health appointments. With no industry standards to follow, the Veterans Health Administration (VHA) developed an outpatient mental health staffing model and a recommended minimum total staffing ratio. At the level of VHA health care facility (N=140), we conducted cross-sectional regression analyses to examine the relative importance of outpatient mental health staffing and productivity and mental health patient wait times in predicting measures of mental health treatment access and quality. Outpatient mental health staffing ratios (especially total and therapist staffing ratios) had substantial, positive relationships with overall mental health treatment access and quality, broadly and in specific domains. Staffing ratios generally had stronger relationships with treatment access and quality than did staff productivity and patient wait times. Mental health staffing ratios should be a primary consideration when trying to improve mental health treatment access and quality at the facility level. Having more mental health staff of all types is associated with better overall access to and quality of mental health services, and multiple staff types are needed to provide high-quality mental health care. Knowledge gained may guide efforts to address challenges in improving access to and quality of mental health services within and outside of VHA.

Mammography facilities serving vulnerable women have longer follow-up times.

ObjectiveTo investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis.Data SourcesProspectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012.Study DesignWe examined time to biopsy for 17 750 abnormal mammogram results (BI‐RADS 4/5), categorizing eight facilities as short or long follow‐up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced‐stage (≥IIb) cancer diagnosis by facility follow‐up group.Data Extraction MethodsMerged SFMR, Cancer Registry and facility survey data.Principal FindingsFacilities (N = 4) with short follow‐up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow‐up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow‐up facilities. The long follow‐up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow‐up facility was associated with higher adjusted odds of advanced‐stage cancer (OR 1.45; 95% CI 1.10‐1.91).ConclusionsProviding mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.

Pediatric dermatology workforce in the United States.

Studies have suggested there is a shortage of pediatric dermatologists in the United States, but the workforce has not been well defined. The Society for Pediatric Dermatology (SPD) Workforce Committee sought to characterize the US pediatric dermatology workforce with a nine-question survey, sent to all 484 US SPD members in December 2016. The response rate was 30%. Most pediatric dermatologists were practicing in major metropolitan markets, seeing an average of 80 patients a week with an average 6-week wait time. These findings indicate that geographic maldistribution and long wait times for new patient appointments remain substantial hurdles for adequate access to subspecialty pediatric dermatology care.

Mental Health Service Preferences and Utilization Among Women Veterans in Crisis: Perspectives of Veterans Crisis Line Responders.

Women military veterans are at increased risk of suicide compared to non-veterans, but little is known about the mental health service preferences and needs of women veterans in crisis. This study used qualitative, secondary source key informant interviews to ascertain the experiences of women veterans in crisis from 54 responders working at the Veterans Crisis Line. Responders indicated that women veterans reported different experiences with Veterans Administration (VA) and non-VA care, though drivers of satisfaction or dissatisfaction were similar. Availability of specialty care, sensitivity to veterans' issues or Military Sexual Trauma, strong provider relationships, and continuity of care contributed to satisfaction; lengthy appointment wait times, limited service options, and insensitivity to veterans' issues contributed to dissatisfaction. Responders suggested that barriers limiting VA access for women veterans are perceived as similar to non-VA care. Findings suggest that caller experiences with providers drive satisfaction with VA and non-VA mental health services.

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

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.

Transitioning Patients From Specialty Care to Primary Care: What We Know and What We Can Do.

Growing demand for specialty care has resulted in longer wait times for appointments, particularly at US academic referral centers. A proportion of specialty visits are for routine follow-up care of stable problems, and there is evidence that primary care providers are willing and able to take responsibility for a significant proportion of these patients. However, little is known about how to transition care back to a referring primary care clinician in a manner that is acceptable to everyone involved. In this article, we describe social, legal, and financial barriers to effective care transition and propose communication strategies to overcome them.

Use of Advanced Practice Providers to Improve Patient Access in Urology

Increasing the use of advanced practice providers in urological practices is a potential strategy to decrease the effect of national urologist shortages. Advanced practice providers may fill various roles in urological practices including the evaluation of new and established patients, thereby improving patient access to specialty care. The metric "next third available appointment" has been established as a reliable benchmark for patient access. We hypothesized that the addition of advanced practice providers to a urological practice would improve patient access and we sought to determine if patient access benchmarks could be included in an evaluation of overall advanced practice provider productivity. We examined patient access and productivity data for physicians and advanced practice providers in a single academic urology department from 2013 to 2017. We evaluated various access markers including new patient appointment wait time and third available appointment, and productivity data including appointment booking ratios to determine if hiring advanced practice providers helped improve patient access while maintaining adequate booking ratios. We identified 2 advanced practice providers hired in 2014 to 2015 who worked in the outpatient setting. The addition of these advanced practice providers helped decrease the median new patient appointment wait time by 15 days and improved the department's time to third available appointment by approximately 5 days. Our department's advanced practice providers have an average booking ratio of 80.2% compared to 82.0% for our physicians. Advanced practice providers can help improve patient access to urological care by decreasing the lag time for patients to see a provider in a subspecialty clinic while maintaining adequate booking ratios for our providers.

WED 080 Experiences of specialist referral and GP access to MRI for headache

IntroductionWhen General Practitioners (GPs) refer patients with headache to neurologists, it is often because the patient and/or doctor want imaging. Some GPs now access Magnetic Resonance Imaging (MRI) directly. We aimed to describe patients’ experience of GPs using direct access, compared to patients who saw a specialist first.MethodsWe invited participants to semi-structured Interviews about two months after imaging. Interviews were audio-recorded, transcribed, and analysed using thematic analysis in Nvivo.ResultsWe interviewed 10 patients from each pathway in South London, eleven women, median age 41, range 20–72. We found more similarities than differences between groups. Ten said they received a clear scan result explanation, while six had difficulty understanding results. Eleven participants felt relief once results were received, while five still wanted an answer on the underlying cause for symptoms. Seven felt the specialist appointment wait time was long. Those using the direct-access pathway were more likely to report MRI results delay.ConclusionPatient reassurance was linked closely with results receipt and worry linked with wait times. Some felt MRI results did not provide sufficient explanation for symptoms. Improvement in both pathways can be achieved, providing results are delivered in a clear, timely manner.