Lewis Annie K, Harding Katherine E, Snowdon David A, Taylor Nicholas F
Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.
La Trobe University, Bundoora, VIC, 3086, Australia.
BMC Health Serv Res. 2018 Nov 20;18(1):869. doi: 10.1186/s12913-018-3669-6.
Many people wait long periods for community outpatient services. However little is known about the impact of waiting from referral to first visit on patient outcomes. The aim of this systematic review is to investigate whether waiting for community outpatient services is associated with adverse effects on patient outcomes.
Medline, Embase, Psych Info and CINAHL databases were searched, combining the key concepts of waiting for healthcare and patient outcomes. Studies were included if they reported data comparing health outcomes for patients with different waiting times for the same period. Three reviewers applied inclusion and exclusion criteria to identified studies and assessed quality using the McMaster Critical Review Forms. Levels of evidence were assessed using National Health and Medical Research Council guidelines. Included studies were analysed using a descriptive synthesis, and summarised according to levels of evidence and clinical significance for key outcomes.
Fourteen studies that included 69,606 adult patients were selected. Selected studies included patients referred for treatment for musculoskeletal disorders (n = 28,722) or to cardiac rehabilitation (n = 40,884). There was low-level evidence that reduced wait time is associated with moderate improvement in workplace participation for patients seeking care for musculoskeletal conditions; and moderate improvement in exercise tolerance for patients referred to cardiac rehabilitation. There was inconsistent evidence that improvements in quality of life, patient satisfaction and psychological symptoms may be associated with shorter wait times. Pain, function and physical activity outcomes were not associated with wait time.
This review found low-level evidence suggesting an association between early access to community outpatient services and improvement of some patient outcomes. Specifically, shorter wait times from referral to first visit for musculoskeletal pain services may improve patient work participation. Shorter wait times for cardiac rehabilitation may improve patient exercise capacity. The effects of a short wait time for other patient conditions and patient outcomes, including quality of life, psychological symptoms and patient experience, are inconclusive. The modest benefits in health outcomes observed in reducing wait time for community outpatient services suggest that other possible benefits such as increasing patient flow should be explored.
PROSPERO registration no: CRD42016047003.
许多人等待社区门诊服务的时间很长。然而，对于从转诊到首次就诊的等待时间对患者预后的影响知之甚少。本系统评价的目的是调查等待社区门诊服务是否会对患者预后产生不良影响。
检索了Medline、Embase、Psych Info和CINAHL数据库，将等待医疗服务和患者预后的关键概念相结合。如果研究报告了同期不同等待时间患者的健康结局比较数据，则纳入研究。三位评审员对纳入的研究应用纳入和排除标准，并使用麦克马斯特批判性评价表评估质量。使用澳大利亚国家卫生与医学研究委员会指南评估证据水平。对纳入的研究进行描述性综合分析，并根据证据水平和关键结局的临床意义进行总结。
选取了14项研究，共纳入69606例成年患者。所选研究包括因肌肉骨骼疾病接受治疗转诊的患者（n = 28722）或接受心脏康复转诊的患者（n = 40884）。有低水平证据表明，缩短等待时间与寻求肌肉骨骼疾病治疗的患者工作参与度的适度改善有关；与接受心脏康复转诊的患者运动耐量的适度改善有关。关于生活质量、患者满意度和心理症状的改善可能与较短等待时间相关的证据并不一致。疼痛、功能和身体活动结局与等待时间无关。
本评价发现低水平证据表明早期获得社区门诊服务与某些患者预后的改善之间存在关联。具体而言，从转诊到首次就诊的等待时间较短，对于肌肉骨骼疼痛服务而言，可能会改善患者的工作参与度。心脏康复的等待时间较短，可能会提高患者的运动能力。等待时间较短对其他患者病情和患者预后（包括生活质量、心理症状和患者体验）的影响尚无定论。在减少社区门诊服务等待时间方面观察到的健康结局方面的适度益处表明，应探索其他可能的益处，如增加患者流量。
PROSPERO注册号：CRD42016047003。
