P084: Waiting makes me sick: is it time for formal triage in primary care?

Introduction: Patient morbidity and mortality are influenced by delay in access to care and lack of continuity of care. Patients frequently present to the emergency department (ED) for care despite being registered with a primary care (PC) provider. Advanced access is an open scheduling system promoted by the College of Family Physicians of Canada that triages primary care (PC) patients to be seen within 24 hours, reducing care delay. We wished to determine the prevalence of formal triage systems in PC appointment allocation. Methods: We performed linked cross sectional surveys to quantify the number of ambulatory patients presenting to a tertiary urban ED (with an annual census of 56,000 visits) who felt unable to access primary care. PC practices were also surveyed to assess use of formal triage methods and measure access using the metric of time to third next available appointment. Descriptive statistics were calculated. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 324 patients reported reasons for their ED visit. Perception that wait time for PC was “too long” was reported in 73/324 (23%); 86% reported wait times of greater than 48 hours. The PC practice response rate was 63.8% (46/ 72). The mean time to third next available appointment was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). No PC practice reported utilizing a formal triage system when booking appointments. Conclusion: No primary care practices in the surveyed region used a formal triage system to allocate appointments, despite a range of wait times that extended up to 50 days. The safety of primary care appointment allocation may be improved with introduction of a formal triage system, especially if overall wait times cannot be reduced.

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MP001: Low acuity emergency department access: are other options available?

CJEM ◽

10.1017/cem.2016.142 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S66-S66

Author(s):

J. MacKay ◽

P.R. Atkinson ◽

M. Howlett ◽

E. Palmer ◽

J. Fraser ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Wait Time ◽

Professional Associations ◽

Tertiary Hospital ◽

Patient Survey ◽

Eligibility Criteria ◽

Cross Sectional ◽

Family Doctors ◽

Access To Primary Care

Introduction: Patients with low-acuity (CTAS level IV and V) complaints often use the emergency department (ED) to access care. This has often been attributed to lack of a primary care (PC) provider. However, simply being registered with a primary care practitioner may not prevent low acuity ED presentation. There is some evidence that a lack of timely access to primary care may contribute to low acuity ED presentations. The Wait Time Alliance, a group of Canadian physicians and their respective professional associations, has recently set a benchmark of same day access to family doctors. It is unclear if this benchmark has been achieved in all jurisdictions. Methods: We performed linked cross sectional surveys to quantify the number of people presenting to a tertiary hospital ED (with 56,000 annual visits) with non-urgent problems who felt unable to access PC. PC practices were also surveyed to assess access using the metric of time to third next available appointment. Sample size calculations were completed. Descriptive statistics were reported. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 89 patients met eligibility criteria. 32 (35.9%) reported that the wait to see their PC provider was “too long”. 45 (50.5%) patients did not contact their PC office prior to ED presentation. 46 of 72 PC physician surveys were returned; a response rate of 63.8%. The mean time to third next available appointment in the region was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). Conclusion: Fifty percent of low acuity patients did not attempt to access their PC provider prior to ED presentation. The benchmark of same day access to primary care has not been achieved in many practices in this region. Initiatives to promote primary care access would benefit both patients and providers.

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

BMJ Open ◽

10.1136/bmjopen-2018-023578 ◽

2019 ◽

Vol 9 (3) ◽

pp. e023578 ◽

Cited By ~ 6

Author(s):

Doug Oliver ◽

Ken Deal ◽

Michelle Howard ◽

Helen Qian ◽

Gina Agarwal ◽

...

Keyword(s):

Primary Care ◽

Discrete Choice ◽

Choice Experiment ◽

Wait Time ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Trade Offs ◽

Timely Access ◽

Advanced Access ◽

Teaching Clinics

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 of providers’ appointment spots for same-day appointments and keep the number of prebooked appointments to a minimum. In the teaching clinic environment, continuity with the same provider can be a challenge. This study examines trade-offs that patients may consider during appointment bookings for six different clinical scenarios across a number of key access and continuity attributes using a discrete choice experiment (DCE) method.DesignCross-sectional survey.SettingTwo urban family medicine teaching clinics in Canada.ParticipantsConvenience sample of 430 patients of family medicine clinics aged 18 and older.InterventionDiscrete choice conjoint experiment survey.Primary outcome measuresPatient preferences on six attributes: appointment booking method, appointment wait time, time spent in the waiting room, appointment time convenience, familiarity with healthcare provider and position of healthcare provider. Data were analysed by hierarchical Bayes analysis to determine estimates of part-worth utilities for each respondent.ResultsPatients rated appointment wait time as the most highly valued attribute, followed by position of provider, then familiarity with the provider. Patients showed a significant preference (p<0.02) for their own physician for booking of routine annual check-ups and other logical preferences across attributes overall and by clinical scenario.ConclusionsPatients preferred timely access to their primary care team over other attributes in the majority of health state scenarios tested, especially urgent issues, however they were willing to wait for a check-up. These results support the notion that advanced access booking systems which leave the majority of appointment spots for same day access and still leave a few for continuity (check-up) bookings, align well with trends in patient preferences.

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Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

Journal of Patient Experience ◽

10.1177/23743735211007700 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110077

Author(s):

Daliah Wachs ◽

Victoria Lorah ◽

Allison Boynton ◽

Amanda Hertzler ◽

Brandon Nichols ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Waiting Times ◽

Wait Time ◽

Primary Care Providers ◽

Wait Times ◽

Care Providers ◽

Female Physicians ◽

Online Ratings ◽

And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

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Evaluating the Telehealth Experience of Patients With COVID-19 Symptoms: Recommendations on Best Practices

Journal of Patient Experience ◽

10.1177/2374373520952975 ◽

2020 ◽

Vol 7 (5) ◽

pp. 665-672

Author(s):

Saif Khairat ◽

Malvika Pillai ◽

Barbara Edson ◽

Robert Gianforcaro

Keyword(s):

Best Practices ◽

Wait Time ◽

Wait Times ◽

Major Drawback ◽

Cross Sectional ◽

Care Experience ◽

Adherence To Medication ◽

Patient Reported ◽

Visit Duration ◽

Virtual Visits

Positive patient experiences are associated with illness recovery and adherence to medication. To evaluate the virtual care experience for patients with COVID-19 symptoms as their chief complaints. We conducted a cross-sectional study of the first cohort of patients with COVID-19 symptoms in a virtual clinic. The main end points of this study were visit volume, wait times, visit duration, patient diagnosis, prescriptions received, and satisfaction. Of the 1139 total virtual visits, 212 (24.6%) patients had COVID-19 symptoms. The average wait time (SD) for all visits was 75.5 (121.6) minutes. The average visit duration for visits was 10.5 (4.9) minutes. The highest volume of virtual visits was on Saturdays (39), and the lowest volume was on Friday (19). Patients experienced shorter wait times (SD) on the weekdays 67.1 (106.8) minutes compared to 90.3 (142.6) minutes on the weekends. The most common diagnoses for patients with COVID-19 symptoms were upper respiratory infection. Patient wait times for a telehealth visit varied depending on the time and day of appointment. Long wait times were a major drawback in the patient experience. Based on patient-reported experience, we proposed a list of general, provider, and patient telehealth best practices.

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Wait Times for Sleep Apnea Care in Ontario: A Multidisciplinary Assessment

Canadian Respiratory Journal ◽

10.1155/2010/420275 ◽

2010 ◽

Vol 17 (4) ◽

pp. 170-174 ◽

Cited By ~ 30

Author(s):

Brian W Rotenberg ◽

Charles F George ◽

Kevin M Sullivan ◽

Eric Wong

Keyword(s):

Sleep Apnea ◽

Wait Time ◽

Simplified Model ◽

Wait Times ◽

Sleep Laboratory ◽

Time Data ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Survey Tool ◽

Obstructive Sleep

BACKGROUND: 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.OBJECTIVE: To characterize wait times for OSA care in Ontario.METHODS: 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.RESULTS: 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 r2of 0.046; less than 5% of the wait time variance could be explained by the simplified model.CONCLUSION: Patients experienced considerable wait times when undergoing management for OSA. This has implications for both individual patient care and public health in general.

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Severity and Criteria Based Prompting for Treatment of Depressed Patients

The International Journal of Psychiatry in Medicine ◽

10.2190/dh9k-meyu-9yhy-nekv ◽

2005 ◽

Vol 35 (2) ◽

pp. 149-159 ◽

Cited By ~ 1

Author(s):

Donald E. Nease ◽

Michael S. Klinkman ◽

James E. Aikens

Keyword(s):

Primary Care ◽

Symptom Severity ◽

Primary Care Physicians ◽

Routine Care ◽

Future Research ◽

Binomial Regression ◽

Care Appointment ◽

Depressive Symptom Severity ◽

Primary Care Practices ◽

The Impact

Purpose: Primary care physicians (PCPs) often do not respond to prompts based upon criteria-based depression screens, perhaps because these prompts do not account for depression severity. We conducted this pilot study to determine the feasibility of prompting for both diagnostic criteria and severity and to assess whether depression would be more attended to with positive “dual prompts” than prompts based on either criteria or symptom severity alone. Methods: Immediately prior to a routine care appointment, 87 adults from three primary care practices completed the PRIME-MD Clinician Evaluation Guide Mood Module (PRIME-MD; assesses depression criteria) and the Brief Depression Rating (BDR; assesses depressive symptom severity), and their results were issued in a salient PCP prompt on the chart. Immediately afterwards, patients reported the impact of the screening results upon treatment decisions during the encounter. Data were analyzed by χ2, analysis of variance, and binomial regression. Results: Compared to subjects screening positive on either depression criteria or severity alone ( n = 10), those patients on both ( n = 17) were more likely to report discussing depression, and agreement that the physician and patient decided treatment was needed and initiated or continued. There were no differences in patient satisfaction based on screening results. After accounting for PRIME-MD results, BDR scores predicted agreement with the physician and patient decided treatment was needed (OR = 22.03; 95% CI: 2.05–236.46). Conclusions: Supplementary severity-based depression screening is feasible, and might overcome the limitations of criteria-based screening alone. Future research could test this hypothesis in a large randomized trial.

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Keeping care connected: e-Consultation program improves access to nephrology care

Journal of Telemedicine and Telecare ◽

10.1177/1357633x17748350 ◽

2017 ◽

Vol 25 (3) ◽

pp. 142-150 ◽

Cited By ~ 7

Author(s):

Priscille Schettini ◽

Kevin P Shah ◽

Colin P O’Leary ◽

Malhar P Patel ◽

John B Anderson ◽

...

Keyword(s):

Primary Care ◽

Health Systems ◽

Wait Time ◽

Specialty Care ◽

Completion Rate ◽

Wait Times ◽

Pilot Program ◽

Completion Rates ◽

Face To Face ◽

Referral Completion

Introduction Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit. Methods We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program. Results For traditional nephrology referrals placed during the study period (July 2016–March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit. Discussion Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists.

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Specialist Wait Time Reporting Using Family Physicians’ Electronic Medical Record Data: A Mixed Method Study of Feasibility and Clinical Utility

10.21203/rs.3.rs-830261/v1 ◽

2021 ◽

Author(s):

Michelle Naimer ◽

Babak Aliarzadeh ◽

Chaim M. Bell ◽

Noah Ivers ◽

Liisa Jaakkimainen ◽

...

Keyword(s):

Primary Care ◽

Mixed Method ◽

Clinical Utility ◽

Family Physicians ◽

Wait Time ◽

Mixed Method Study ◽

Wait Times ◽

Specialist Care ◽

Time Data ◽

Time Information

Abstract Background: More than 50% of Canadian patients wait longer than four weeks to see a specialist after referral from primary care. Access to accurate wait time information may help primary care physicians choose the timeliest specialist to address a patient’s specific needs. We conducted a mixed-methods study to assess if primary to specialist care wait times can be extracted from electronic medical records (EMR), analyzed the wait time information, and used focus groups and interviews to assess the potential clinical utility of the wait time information. Methods: Two family practices were recruited to examine primary care physician to specialist wait times between 2016 and 2017, using EMR data. The primary outcome was the median wait time from physician referral to specialist appointment for each specialty service. Secondary outcomes included the physician and patient characteristics associated with wait times as well as qualitative analyses of physician interviews about the resulting wait time reports.Results: Wait time data can be extracted from the primary care EMR and converted to a report format for family physicians and specialists to review. After data cleaning, there were 7141 referrals included from 4967 unique patients. The 5 most common specialties referred to were Dermatology, Gastroenterology, Ear Nose and Throat, Obstetrics and Gynecology and Urology. Half of the patients were seen by a specialist within 42 days, 75% seen within 80 days and all patients within 760 days. There were few patient or provider differences amongst the wait times for referrals. Overall, wait time reports were perceived to be important since they could help family physicians decide how to triage referrals and might lead to system improvements. Conclusions: Wait time information from primary to specialist care can aid in decision-making around specialist referrals, identify bottlenecks, and help with system planning. This mixed method study is a starting point to review the importance of providing wait time data for both family physicians and local health systems. Future work can be directed towards developing wait time reporting functionality and evaluating if wait time information will help increase system efficiency and/or improve provider and patient satisfaction.

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Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA

BMJ Open ◽

10.1136/bmjopen-2021-053633 ◽

2021 ◽

Vol 11 (9) ◽

pp. e053633

Author(s):

Kevin P Fiori ◽

Caroline G Heller ◽

Anna Flattau ◽

Nicole R Harris-Hollingsworth ◽

Amanda Parsons ◽

...

Keyword(s):

Primary Care ◽

New York ◽

Electronic Health Records ◽

Social Care ◽

Social Needs ◽

Cross Sectional ◽

Health Records ◽

Care Practices ◽

Electronic Health ◽

Primary Care Practices

ObjectivesThere has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network.SettingAcademic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA).ParticipantsThis retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices.MethodsWe organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices.ResultsBetween April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient.ConclusionsThese findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.

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A Cross-Sectional Analysis of the BC Children’s Hospital Cleft Palate Program Waitlist

Plastic Surgery ◽

10.1177/2292550319876664 ◽

2019 ◽

Vol 27 (4) ◽

pp. 311-318 ◽

Cited By ~ 1

Author(s):

Leslie Tze Fung Leung ◽

Christine A. Loock ◽

Rebecca Courtemanche ◽

Douglas J. Courtemanche

Keyword(s):

Cleft Palate ◽

Plastic Surgery ◽

Wait Time ◽

Wait Times ◽

Service Needs ◽

Cross Sectional ◽

Clinical Assessments ◽

Children's Hospital ◽

Children’S Hospital ◽

Sectional Analysis

Objective: A 2016 review of the BC Children’s Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program’s care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic. Design: Cross-sectional. Setting: BC Children’s Hospital Cleft Palate—Craniofacial Program. Patients: Five hundred seventy-six waitlisted patients. Main Outcome Measures: Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines. Results: Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis ( P = .019), a need for formal speech assessments or evaluations ( P < .001), or a requirement to see multiple specialists ( P < .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment. Conclusion: Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.

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