Katz Steven J, Ye Carrie
Division of Rheumatology, University of Alberta, Edmonton, Canada.
Musculoskeletal Care. 2024 Dec;22(4):e70026. doi: 10.1002/msc.70026.
To examine the effect of biological sex on wait-times to first rheumatology appointment in a central triage system before, during and after the COVID-19 pandemic.
De-identified data of patients referred to one centralised Rheumatology referral centre between November 2019 and December 2023 were extracted from the electronic medical record. Variables collected and analysed included time from referral to first appointment, biological sex, referral period, triage urgency, age, and geographic location.
19,681 referrals were identified. In the pre-COVID period, there was no significant difference in wait-times by biological sex or age. After adjusting for triage level, age and geographic location, females waited significantly longer in the peri-COVID period versus males (10.2 days, 95% CI 7.1, 13.3), which persisted in the post-COVID period (7.5 days, 95% CI 4.0, 11.1). Similarly, younger patients waited longer than older patients in the peri-COVID period (4.7 fewer days per decade increase in age (95% 3.9, 5.6)). This age discrepancy persisted through the post-COVID period (2.3 days, 95% CI 1.6, 3.5). Geographic location was a significant predictor of wait-times in the post-COVID period, with those outside of Edmonton waiting longer than in Edmonton. Once the change in referral pattern from Northwest Territories was accounted for, this discrepancy ceased.
Female and younger patients have been disproportionately impacted by wait-time increases during the COVID-19 pandemic, with minimal improvements observed during the post-COVID period. These findings should prompt further investigation into the underlying causes of these observed inequities in access to rheumatology care to identify solutions.
研究生物性别对COVID-19大流行之前、期间和之后中央分诊系统中首次风湿病门诊等待时间的影响。
从电子病历中提取2019年11月至2023年12月期间转诊至一个集中的风湿病转诊中心的患者的去识别化数据。收集和分析的变量包括从转诊到首次就诊的时间、生物性别、转诊时期、分诊紧急程度、年龄和地理位置。
共识别出19681例转诊病例。在COVID-19大流行之前，生物性别或年龄对等待时间没有显著差异。在调整了分诊级别、年龄和地理位置后，女性在COVID-19大流行期间的等待时间明显长于男性（10.2天，95%置信区间7.1，13.3），这一情况在COVID-19大流行之后仍然存在（7.5天，95%置信区间4.0，11.1）。同样，在COVID-19大流行期间，年轻患者的等待时间比老年患者更长（年龄每增加十岁等待时间减少4.7天（95%置信区间3.9，5.6））。这种年龄差异在COVID-19大流行之后仍然存在（2.3天，95%置信区间1.6，3.5）。地理位置是COVID-19大流行之后等待时间的一个重要预测因素，西北地区以外的患者等待时间比埃德蒙顿的患者更长。一旦考虑到西北地区转诊模式的变化，这种差异就消失了。
在COVID-19大流行期间，女性和年轻患者受到等待时间增加的影响尤为严重，在COVID-19大流行之后改善甚微。这些发现应促使进一步调查这些在获得风湿病护理方面观察到的不平等现象的根本原因，以确定解决方案。
