Piggott Katrina L, Bell Chaim M
Resident, Department of Medicine, McMaster University, Hamilton, ON.
Department of Medicine, Mount Sinai Hospital, Faculty of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
Healthc Policy. 2013 Nov;9(2):65-75.
Extracorporeal shock wave lithotripsy (ESWL) is a definitive, ambulatory and non-invasive modality for treating kidney stones. ESWL is not available in all urban centres and many Canadians must either travel, sometimes out of province, or wait to have this procedure performed. We sought to evaluate the variability in access to ESWL treatment.
We compiled a comprehensive list of ESWL centres in Canada and contacted all centres in 2011 to assess their wait times, out-of-province patient fees, and roles and responsibilities of the referring physician.
We contacted all 23 ESWL facilities across Canada (100% response rate). Wait times for elective ESWL procedures ranged from one day to over one year, with a mean of 8.4 weeks (SD, 16.76 weeks). No centres refused out-of-province patients, although five discouraged travel to their centre owing to their prolonged wait times. No facilities charged extra fees for out-of-province patients. Ten (43%) facilities required a secondary consultation by a urolo-gist at the centre before booking. Twelve (52%) of the centres indicated the waiting time could be shortened if the referring physician were to advocate on the patient's behalf. Contact was repeated one year later in 2012 with five centres, and the results were similar.
There is marked variation in wait times across Canada for ESWL but there are few barriers to care. Patients' waits may be shortened by physician advocacy.
体外冲击波碎石术（ESWL）是一种治疗肾结石的确定性、非卧床且无创的方法。并非所有城市中心都能提供ESWL治疗，许多加拿大人必须前往其他地方，有时甚至是省外，或者等待进行该手术。我们试图评估ESWL治疗可及性的差异。
我们编制了一份加拿大ESWL中心的综合名单，并于2011年联系了所有中心，以评估其等待时间、省外患者费用以及转诊医生的职责。
我们联系了加拿大所有23家ESWL机构（回复率为100%）。择期ESWL手术的等待时间从一天到一年多不等，平均为8.4周（标准差为16.76周）。没有中心拒绝省外患者，尽管有五家中心因等待时间过长而不鼓励省外患者前往其中心。没有机构向省外患者收取额外费用。十家（43%）机构要求在预约前由中心的泌尿科医生进行二次会诊。十二家（52%）中心表示，如果转诊医生为患者进行沟通，等待时间可能会缩短。一年后的2012年，我们再次联系了五家中心，结果相似。
加拿大各地ESWL的等待时间存在显著差异，但医疗障碍较少。医生的沟通可能会缩短患者的等待时间。
