Silvestre Jason, Bess Christina R, Nguyen John T, Ibrahim Ahmed M S, Patel Priti P, Lee Bernard T
From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2014 Jul;73(1):16-8. doi: 10.1097/SAP.0b013e318276d902.
Patients seeking cosmetic or reconstructive procedures in plastic surgery typically face significant wait times for consultations. Little attention has been given to potential disparities in wait times between elective cosmetic and reconstructive procedures. In this initial pilot study, we audited a broad sample of plastic surgery offices within a single state for wait times in initial consultations for both breast reconstruction and breast augmentation.
A sample of board-certified plastic surgeons was audited from the American Society of Plastic Surgeons (ASPS) Web site that listed both cosmetic and reconstructive breast surgery. Scripted patient telephone calls were made to 67 plastic surgery clinics within a single state on May 2012. Two calls separated by 7 days were made to each office by the same actor seeking an initial appointment for either breast reconstruction or breast augmentation. Wait times were calculated from the date of the call until the date of appointment offered.
There were 72 paired calls completed on 36 plastic surgery clinics. Significant disparities in appointment wait times existed between elective cosmetic versus reconstructive procedures (P = 0.02). Mean wait times for breast reconstruction consultation (26.1 days) were significantly longer than mean consultation wait times for breast augmentation (20.9 days). Interestingly, 17.9% of offices contacted no longer perform certain procedures currently advertised on the ASPS Web site.
Disparities exist in access to care between patients seeking elective breast augmentation and reconstruction after mastectomy. Patients seeking breast augmentation have more rapid access to plastic surgeons. This study did not evaluate possible explanations for the observed differences. Potential causes may include physician preference and compensation benefits for cosmetic procedures.
寻求整形手术中的美容或重建手术的患者通常要面临较长的咨询等待时间。对于选择性美容手术和重建手术之间等待时间的潜在差异,人们关注较少。在这项初步试点研究中,我们对一个州内广泛的整形外科诊所样本进行了审计,以了解乳房重建和隆胸初次咨询的等待时间。
从美国整形外科医师协会(ASPS)网站上抽取了一批获得委员会认证的整形外科医生样本,该网站列出了美容和重建乳房手术。2012年5月,由同一人向该州的67家整形外科诊所拨打了模拟患者电话。每隔7天向每个诊所拨打两次电话,寻求乳房重建或隆胸的初次预约。等待时间从打电话之日起计算至提供预约之日。
对36家整形外科诊所完成了72次配对电话。选择性美容手术与重建手术之间的预约等待时间存在显著差异(P = 0.02)。乳房重建咨询的平均等待时间(26.1天)明显长于隆胸咨询的平均等待时间(20.9天)。有趣的是,17.9%的被联系诊所不再进行ASPS网站上目前宣传的某些手术。
在寻求选择性隆胸手术的患者与乳房切除术后进行重建手术的患者之间,获得医疗服务的机会存在差异。寻求隆胸手术的患者能更快地见到整形外科医生。本研究未评估观察到的差异的可能解释。潜在原因可能包括医生的偏好以及美容手术的薪酬福利。