scholarly journals Wait Times for Gastroenterology Consultation in Canada: The Patients’ Perspective

2010 ◽  
Vol 24 (1) ◽  
pp. 28-32 ◽  
Author(s):  
WG Paterson ◽  
AN Barkun ◽  
WM Hopman ◽  
DJ Leddin ◽  
P Paré ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Gastrointestinal Symptoms ◽  
Wait Time ◽  
Wait Times ◽  
Canadian Association ◽  
Serious Disease ◽  
One Year ◽  
Patients Experience ◽  
Impaired Quality

Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology’s Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as ‘far too long’; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms.

scholarly journals Wait Time for Endoscopic Evaluation at a Canadian Tertiary Care Centre: Comparison with Canadian Association of Gastroenterology Targets

2008 ◽  
Vol 22 (7) ◽  
pp. 621-626 ◽  
Author(s):  
Derek Yu ◽  
Wilma M Hopman ◽  
William G Paterson
Keyword(s):  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Wait Time ◽  
Final Diagnosis ◽  
Screening Colonoscopy ◽  
Deficiency Anemia ◽  
Wait Times ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Canadian Association

BACKGROUND: In recent years, there has been considerable concern regarding wait times for Canadian health care, which led the Canadian Association of Gastroenterology (CAG) to develop specific wait time targets.OBJECTIVES: To quantify wait times for endoscopic procedures at a tertiary care centre and correlate these with clinical presentation, impact on quality of life (QOL) and final diagnosis; and to determine how well the CAG wait time targets are being met.METHODS: Patients completed a 12-item questionnaire regarding wait times and their impact on QOL. A blind review was performed of the endoscopic results, with a specific focus on correlating wait time with a final diagnosis of serious and treatable diseases.RESULTS: The average total wait time for the 417 participants in the present study was 229 days; 78.6% did not meet CAG wait time targets. The wait time for screening colonoscopy was longer, and the proportion of patients meeting wait time targets was significantly smaller, than for patients referred with iron deficiency anemia or a positive fecal occult blood test result. The 41 patients deemed to have a high-impact diagnosis established by endoscopy had a median wait time of 115 days, and only 23.5% met wait time targets. Overall, 38.4% of patients believed that their wait was too long, 13.9% missed school or work in the preceding month because of gastrointestinal symptoms and 23% reported being very worried about having a serious disease.CONCLUSIONS: The majority of patients waiting for endoscopy did not meet CAG wait time targets, with the screening colonoscopy group faring the worst. Many of these patients await a definitive diagnosis of serious diseases that negatively impact QOL.

scholarly journals Wait Times for Diagnostic Colonoscopy among Outpatients with Colorectal Cancer: A Comparison with Canadian Association of Gastroenterology Targets

2012 ◽  
Vol 26 (12) ◽  
pp. 894-896 ◽  
Author(s):  
Michael Sai Lai Sey ◽  
Jamie Gregor ◽  
Paul Adams ◽  
Nitin Khanna ◽  
Chris Vinden ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Significant Proportion ◽  
Wait Time ◽  
Wait Times ◽  
Cancer Stage ◽  
Exclusion Criteria ◽  
Diagnostic Colonoscopy ◽  
Canadian Association ◽  
Timely Access ◽  
Colorectal Cancer Patients

BACKGROUND: Timely access to colonoscopy is a nationally recognized issue in Canada, with previous studies documenting significant wait times for a variety of indications. However, specific wait times for colonoscopy among patients diagnosed with colorectal cancer remain unknown.METHODS: A review of all outpatient cases of colorectal cancer diagnosed at colonoscopy in London, Ontario, in 2010 was performed. Wait times from the date of referral to colonoscopy were reviewed and compared with maximal wait times established by the Canadian Association of Gastroenterology (CAG) stratified according to indication. Cancer stage at the time of diagnosis was compared with colonoscopy wait times.RESULTS: A total of 106 colorectal cancer patients meeting the inclusion and exclusion criteria were included in the study. Forty-six per cent of patients waited longer than CAG targets, with a mean (± SD) wait time of 79±101 days. Higher cancer stage was associated with shorter wait time, likely as a result of triaging.CONCLUSION: Long wait times for diagnostic colonoscopy among patients with colorectal cancer remain an issue, with a significant proportion of cases not meeting maximal CAG wait time targets.

scholarly journals Whipple's disease: rare disorder and late diagnosis

2012 ◽  
Vol 54 (5) ◽  
pp. 293-297 ◽  
Author(s):  
Viviane Plasse Renon ◽  
Marcelo Campos Appel-da-Silva ◽  
Rafael Bergesch D'Incao ◽  
Rodrigo Mayer Lul ◽  
Luciana Schmidt Kirschnick ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Disease Diagnosis ◽  
Endoscopic Biopsy ◽  
Upper Gastrointestinal Endoscopy ◽  
Whipple’S Disease ◽  
Whipple's Disease ◽  
Polymerase Chain ◽  
One Year ◽  
Infectious Disorder

Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.

The Nature of Insomnia

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S10) ◽  
pp. 3-5 ◽  
Author(s):  
Thomas Roth
Keyword(s):  
Behavioral Therapy ◽  
Clinical Information ◽  
Negative Results ◽  
Behavioral Therapies ◽  
Insomnia Treatment ◽  
Treatment Use ◽  
Patients Experience ◽  
Pharmacologic Agents ◽  
Impaired Quality

AbstractInsomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.

scholarly journals Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes

2017 ◽  
Vol 24 (5) ◽  
pp. 302 ◽  
Author(s):  
G. Kasymjanova ◽  
D. Small ◽  
V. Cohen ◽  
R.T. Jagoe ◽  
G. Batist ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Wait Time ◽  
Treatment Modalities ◽  
Wait Times ◽  
Model Of Care ◽  
Time Intervals ◽  
Lung Cancer Patients

Background Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival.Methods Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre.Results We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory.Interpretation It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

scholarly journals Time to Endoscopy in Patients with Colorectal Cancer: Analysis of Wait-Times

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Renée M. Janssen ◽  
Oliver Takach ◽  
Estello Nap-Hill ◽  
Robert A. Enns
Keyword(s):  
Colorectal Cancer ◽  
Retrospective Chart Review ◽  
Wait Time ◽  
Office Visit ◽  
Distant Metastases ◽  
Endoscopic Examination ◽  
Wait Times ◽  
Canadian Association ◽  
The Mean ◽  
Current Guidelines

Objective. The Canadian Association of Gastroenterology Wait Time Consensus Group recommends that patients with symptoms associated with colorectal cancer (CRC) should have an endoscopic examination within 2 months. However, in a recent survey of Canadian gastroenterologists, wait-times for endoscopy were considerably longer than the current guidelines recommend. The purpose of this study was to evaluate wait-times for colonoscopy in patients who were subsequently found to have CRC through the Division of Gastroenterology at St. Paul’s Hospital (SPH).Methods. This study was a retrospective chart review of outpatients seen for consultation and endoscopy ultimately diagnosed with CRC. Subjects were identified through the SPH pathology database for the inclusion period 2010 through 2013. Data collected included wait-times, subject characteristics, cancer characteristics, and outcomes.Results. 246 subjects met inclusion criteria for this study. The mean wait-time from primary care referral to first office visit was 63 days; the mean wait-time to first endoscopy was 94 days. Patients with symptoms waited a mean of 86 days to first endoscopy, considerably longer than the national recommended guideline of 60 days. There was no apparent effect of length of wait-time on node positivity or presence of distant metastases at the time of diagnosis.Conclusion. Wait-times for outpatient consultation and endoscopic evaluation at the St. Paul’s Hospital Division of Gastroenterology exceed current guidelines.

scholarly journals Wait times in prostate cancer diagnosis and radiation treatment

2013 ◽  
Vol 4 (4) ◽  
pp. 243
Author(s):  
Christiaan Stevens ◽  
Susan J. Bondy ◽  
D. Andrew Loblaw
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Radiation Treatment ◽  
Wait Time ◽  
Diagnosis And Treatment ◽  
Prise En Charge ◽  
Wait Times ◽  
Treatment Area ◽  
Canadian Association ◽  
Definitive Therapy

Introduction: Wait times for cancer diagnosis and treatment area significant concern for Canadians. Men with prostate cancerexperience longer waiting times for diagnosis and treatment thanthose observed for other cancers. Longer waits are associated withboth patient and family psychosocial distress and may be associatedwith worse prognosis.Methods: Men referred for treatment of prostate cancer at a singleCanadian cancer centre were interviewed. The intervals from suspicionto definitive therapy were calculated, factors associated withdelays along this pathway were identified, and common causes ofdelay identified by patients were described.Results: A total of 41 consecutive patients participated. The medianinterval from suspicion to the first fraction of radiotherapy forall patients was 247 days (interquartile range [IQR] 168-367 d).The median diagnostic interval was 53 days (IQR 28-166 d). Themedian treatment interval was 127 days (IQR 100-180 d). Patientsunder 70 years old and patients with <T2c disease had shorterintervals from suspicion to treatment. From diagnosis to start ofradiotherapy, patients with low-risk disease had longer intervals.Seventy percent of patients perceived a delay in their care, ofwhich 45%, 31% and 24% of patients felt the delays were due tothe health care system, patient or physician factors, respectively.Interpretation: In this study, 12% and 0% of patients met CanadianStrategy for Cancer Control and Canadian Association of RadiationOncologists wait time recommendations, respectively. A large componentof wait time is patient driven. Alternate strategies shouldbe developed and measured to shorten the intervals between thesuspicion and treatment of prostate cancer.Introduction : Les temps d’attente pour recevoir un diagnosticde cancer et un traitement constituent une source importante depréoccupation pour les Canadiens. Les hommes atteints de cancerde la prostate attendent encore plus longtemps que les patientsatteints d’autres types de cancer pour obtenir un diagnostic etentreprendre un traitement. Ces attentes plus longues se traduisentpour le patient et sa famille par un stress psychosocial et peuventêtre liés à un pronostic plus sombre.Méthodologie : Des hommes aiguillés vers le même centre decancérologie au Canada pour la prise en charge d’un cancer dela prostate ont été interviewés. L’intervalle entre le soupçon decancer et le début réel du traitement a été calculé; on a cernéles facteurs liés aux retards le long du processus, et les causes deretards signalées par les patients ont été décrites.Résultats : Au total, 41 patients consécutifs ont participé. La duréemédiane de l’intervalle entre le soupçon de cancer et la premièreséance de radiothérapie pour tous les patients était de 247 jours(écart interquartile [EIQ], 168 à 367 jours). La durée médianede l’intervalle avant le diagnostic était de 53 jours (EIQ, 28 à166 jours). La durée médiane de l’intervalle avant le début dutraitement était de 127 jours (EIQ, 100 à 180 jours). Les patients deplus de 70 ans et les patients porteurs d’une tumeur T2c ou moinsavancée signalaient des intervalles plus courts entre les premierssoupçons de cancer et le traitement. Entre le diagnostic et le débutde la radiothérapie, les patients présentant une maladie à faiblerisque avaient des intervalles plus longs. Soixante-dix pour centdes patients ont perçu un retard dans leur prise en charge, parmilesquels 45 % croyaient ce retard lié au système de santé, 31 %, àdes facteurs liés au patient, et 24 %, à des facteurs liés au médecin.Interprétation : Dans cette étude, 12 % et 0 % des patients,respectivement, ont présenté des temps d’attentes conformes auxrecommandations de la Stratégie canadienne de lutte contre lecancer et de l’Association canadienne de radio-oncologie. Letemps d’attente est déterminé en grande partie par des facteurs liésau patient. D’autres stratégies devraient être élaborées et évaluéesafin de réduire les intervalles entre les premiers soupçons de cancerde la prostate et le début du traitement.

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