. 2020 Jun;66(6):434-444.

How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective

Clare Liddy¹, Isabella Moroz², Ewan Affleck³, Emma Boulay⁴, Sarah Cook⁵, Lois Crowe⁶, Neil Drimer⁷, Laurie Ireland⁸, Pamela Jarrett⁹, Susan MacDonald¹⁰, Derek McLellan¹¹, Ariana Mihan¹², Nico Miraftab¹³, Véronique Nabelsi¹⁴, Christopher Russell¹⁵, Alex Singer¹⁶, Erin Keely¹⁷

Affiliations

¹ Clinician Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute and Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario. cliddy@uottawa.ca.
² Research associate at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute at the time of the study.
³ Medical Director for Northwest Territories Health and Social Services in Yellowknife.
⁴ Project Support and Coordination Expert at the New Brunswick Department of Health in Fredericton.
⁵ Territorial Medical Director with Northwest Territories Health and Social Services.
⁶ Research Manager at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
⁷ Director of Programs with the Canadian Foundation for Healthcare Improvement in Ottawa.
⁸ Family physician with the Nine Circles Community Health Centre in Winnipeg, MB.
⁹ Physician Lead in the Department of Geriatric Medicine for the Horizon Health Network in Fredericton, NB.
¹⁰ Associate Professor in the Department of Family Medicine at Memorial University of Newfoundland in St John's.
¹¹ Family physician at the Riverside Medical Centre in Ottawa.
¹² Summer student at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
¹³ Project Lead for Fraser Health in British Columbia.
¹⁴ Professor in the Département des Sciences Administratives at the Université du Québec en Outaouais.
¹⁵ Family medicine resident at McMaster University in Hamilton, Ont.
¹⁶ Assistant Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg.
¹⁷ Professor in the Department of Medicine and the Department of Obstetrics and Gynecology at the University of Ottawa.

PMID: 32532727
PMCID: PMC7292524

How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective

Clare Liddy et al. Can Fam Physician. 2020 Jun.

. 2020 Jun;66(6):434-444.

Authors

Affiliations

¹ Clinician Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute and Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario. cliddy@uottawa.ca.
² Research associate at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute at the time of the study.
³ Medical Director for Northwest Territories Health and Social Services in Yellowknife.
⁴ Project Support and Coordination Expert at the New Brunswick Department of Health in Fredericton.
⁵ Territorial Medical Director with Northwest Territories Health and Social Services.
⁶ Research Manager at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
⁷ Director of Programs with the Canadian Foundation for Healthcare Improvement in Ottawa.
⁸ Family physician with the Nine Circles Community Health Centre in Winnipeg, MB.
⁹ Physician Lead in the Department of Geriatric Medicine for the Horizon Health Network in Fredericton, NB.
¹⁰ Associate Professor in the Department of Family Medicine at Memorial University of Newfoundland in St John's.
¹¹ Family physician at the Riverside Medical Centre in Ottawa.
¹² Summer student at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
¹³ Project Lead for Fraser Health in British Columbia.
¹⁴ Professor in the Département des Sciences Administratives at the Université du Québec en Outaouais.
¹⁵ Family medicine resident at McMaster University in Hamilton, Ont.
¹⁶ Assistant Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg.
¹⁷ Professor in the Department of Medicine and the Department of Obstetrics and Gynecology at the University of Ottawa.

PMID: 32532727
PMCID: PMC7292524

Abstract
in English, French

Objective: To calculate patient wait times for specialist care using data from primary care clinics across Canada.

Design: Retrospective chart audit.

Setting: Primary care clinics.

Participants: A total of 22 primary care clinics across 7 provinces and 1 territory.

Main outcome measures: Wait time 1, defined as the period between a patient's referral by a family physician to a specialist and the visit with said specialist.

Results: Overall, 2060 referrals initiated between January 2014 and December 2016 were included in the analysis. The median national wait time 1 was 78 days (interquartile range [IQR] of 34 to 175 days). The shortest waits were observed in Saskatchewan (51 days; IQR = 23 to 101 days) and British Columbia (59 days; IQR = 29 to 131 days), whereas the longest were in New Brunswick (105 days; IQR = 43 to 242 days) and Quebec (104 days; IQR = 36 to 239 days). Median wait time 1 varied substantially among different specialty groups, with the longest wait time for plastic surgery (159 days; IQR = 59 to 365 days) and the shortest for infectious diseases (14 days; IQR = 6 to 271 days).

Conclusion: This is the first national examination of wait time 1 from the primary care perspective. It provides a picture of patient access to specialists across provinces and specialty groups. This research provides decision makers with important context for developing programs and policies aimed at addressing the largely ignored stage of the wait time continuum from the time of referral to eventual appointment time with the specialist.

Objectif: Calculer les temps d’attente des patients pour des soins spécialisés à l’aide des données de cliniques de soins primaires au Canada.

Type d’étude: Vérification rétrospective des dossiers.

Contexte: Cliniques de soins primaires.

Participants: Un total de 22 cliniques de soins primaires dans 7 provinces et 1 territoire.

Principaux paramètres à l’étude: Temps d’attente 1, désignant la période entre la demande de consultation spécialisée par un médecin de famille et le rendez-vous du patient avec ledit spécialiste.

Résultats: Dans l’ensemble, 2060 demandes de consultation faites entre janvier 2014 et décembre 2016 ont été incluses dans l’analyse. Le temps d’attente 1 national médian était de 78 jours (écart interquartile [IQR] de 34 à 175 jours). Les attentes les plus courtes ont été observées en Saskatchewan (51 jours; IQR = 23 à 101 jours) et en Colombie-Britannique (59 jours; IQR = 29 à 131 jours), tandis que les plus longues se trouvaient au Nouveau-Brunswick (105 jours; IQR = 43 à 242 jours) et au Québec (104 jours; IQR = 36 à 239 jours). Le temps d’attente 1 médian variait considérablement selon les groupes de spécialistes, et cette attente était la plus longue en chirurgie plastique (159 jours; IQR = 59 à 365 jours) et la plus courte en maladies infectieuses (14 jours; IQR = 6 à 271 jours).

Conclusion: Il s’agit du premier examen national du temps d’attente 1 selon la perspective des soins primaires. L’étude dresse un portrait de l’accès à des spécialistes par les patients selon la province et les groupes de spécialistes. Cette recherche procure aux décideurs une importante contextualisation pour élaborer des programmes et des politiques visant à régler cette étape largement ignorée du continuum des temps d’attente du moment de la demande de consultation jusqu’à l’éventuel rendez-vous avec un spécialiste.

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Figures

**Figure 1.**
**Flow of referral data** OTN—Ontario Telemedicine Network.

**Figure 2.**
**Distribution of the 22 clinics participating in the national wait time 1 study** Map by E. Pluribus Anthony, transferred to Wikimedia Commons by Kaveh, optimized by Andrew pmk. Own work, public domain: https://commons.wikimedia.org/wiki/index.pho?curid=844714.

**Figure 3.**
**Median wait time 1 by province or territory**

**Figure 4.**
**Median wait time 1 by specialty**

**Figure 5.**
**Proportion of procedural referrals by specialty**

See this image and copyright information in PMC

References

1. Canadian Institute for Health Information. How Canada compares: results from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries—accessible report. Ottawa, ON: Canadian Institute for Health Information; 2017.
1. Harrington DW, Wilson K, Rosenberg MW. Waiting for a specialist consultation for a new condition in Ontario: impacts on patients’ lives. Healthc Policy. 2014;9(4):90. - PMC - PubMed
1. Sanmartin C, Pierre F, Tremblay S. Waiting for care in Canada: findings from the health services access survey. Healthc Policy. 2006;2(2):43–51. - PMC - PubMed
1. Ryu J, Lee TH. The waiting game—why providers may fail to reduce wait times. N Engl J Med. 2017;376(24):2309–11. - PubMed
1. Sanmartin C, Berthelot JM, Mcintosh CN. Determinants of unacceptable waiting times for specialized services in Canada. Healthc Policy. 2007;2(3):e140–54. - PMC - PubMed

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How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective

Affiliations

How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective

Authors

Affiliations

Abstract
in English, French

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Abstract in English, French

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Abstract
in English, French