Leddin D, Armstrong D, Barkun A Ng, Chen Y, Daniels S, Hollingworth R, Hunt R H, Paterson W G
Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Gastroenterol. 2008 Feb;22(2):161-7. doi: 10.1155/2008/479684.
Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases.
Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations.
Total wait times for 1903 patients who were undergoing investigation exceeded targets for those with probable cancer (median 26 days [25th to 75th percentiles eight to 56 days] versus target of two weeks); probable inflammatory bowel disease (101 days [35 to 209 days] versus two weeks); documented iron deficiency anemia (71 days [19 to 142 days] versus two months); positive fecal occult blood test (73 days [36 to 148 days] versus two months); dyspepsia with alarm symptoms (60 days [23 to 140 days] versus two months); refractory dyspepsia without alarm symptoms (126 days [42 to 225 days] versus two months); and chronic constipation and diarrhea (141 days [68 to 264 days] versus two months). A minority of patients were seen within target times: probable cancer (33% [95% CI 20% to 47%]); probable inflammatory bowel disease (12% [95% CI 1% to 23%]); iron deficiency anemia (46% [95% CI 37% to 55%]); positive occult blood test (41% [95% CI 28% to 54%]); dyspepsia with alarm symptoms (51% [95% CI 41% to 60%]); refractory dyspepsia without alarm symptoms (33% [95% CI 19% to 47%]); and chronic constipation and diarrhea (21% [95% CI 14% to 29%]).
Total wait times for the seven indications exceeded the consensus targets; 51% to 88% of patients were not seen within the target wait time. Multiple interventions, including adoption of evidence-based management guidelines and provision of economic and human resources, are needed to ensure appropriate access to digestive health care in Canada. Outcomes can be evaluated by the 'point-of-care', practice audit methodology used for the present study.
监测等待时间并确定护理目标，已被提倡用于改善与癌症、心脏病、诊断成像、关节置换和视力恢复相关的医疗服务。尽管在加拿大，消化系统疾病造成的经济负担比癌症或心脏病更大，但关于获得消化系统疾病护理的数据却很少。本研究将专科胃肠病护理的等待时间与一系列消化系统疾病近期基于证据的、共识定义的基准等待时间进行了比较。
通过胃肠病学实践审计项目，测量了7种消化系统疾病指征从初级保健转诊到进行检查的总等待时间，并与共识建议进行了对比。
1903例正在接受检查的患者的总等待时间超过了可能患有癌症患者的目标时间（中位数26天[第25至75百分位数为8至56天]，而目标时间为两周）；可能患有炎症性肠病的患者（101天[35至209天]，而目标时间为两周）；记录在案的缺铁性贫血患者（71天[19至142天]，而目标时间为两个月）；粪便潜血试验呈阳性的患者（73天[36至148天]，而目标时间为两个月）；有警示症状的消化不良患者（60天[23至140天]，而目标时间为两个月）；无警示症状的难治性消化不良患者（126天[42至225天]，而目标时间为两个月）；以及慢性便秘和腹泻患者（141天[68至264天]，而目标时间为两个月）。少数患者在目标时间内得到诊治：可能患有癌症的患者（33%[95%置信区间20%至47%]）；可能患有炎症性肠病的患者（12%[95%置信区间1%至23%]）；缺铁性贫血患者（46%[95%置信区间37%至55%]）；潜血试验呈阳性的患者（41%[95%置信区间28%至54%]）；有警示症状的消化不良患者（51%[95%置信区间41%至60%]）；无警示症状的难治性消化不良患者（33%[95%置信区间19%至47%]）；以及慢性便秘和腹泻患者（21%[95%置信区间14%至29%]）。
这7种指征的总等待时间超过了共识目标；51%至88%的患者未在目标等待时间内得到诊治。需要采取多种干预措施，包括采用基于证据的管理指南以及提供经济和人力资源，以确保在加拿大能够适当获得消化系统疾病护理。可通过本研究中使用的“即时护理”实践审计方法来评估结果。
