Patient-ly Waiting: A Review of Patient-Centered Access to Inflammatory Bowel Disease Care in Canada

Abstract

Canada has one of the highest prevalence estimates of inflammatory bowel disease (IBD) in the world. Like other chronic illnesses, access to specialist care is required for disease management. Traditionally, access to care is evaluated through wait times (actual access); however, new patient-oriented definitions of access (perceived access) highlight other equally important facets of access to care (e.g., appropriateness). Aim: How does access to gastroenterology speciality care influence disease-related outcomes for IBD patients in Canada? A comprehensive literature review was undertaken. Cochrane, PubMed and CINHAL databases were searched for peer-reviewed English language articles published between 2006 and 2016. Inclusion/exclusion criteria focussed on access to IBD care in Canada. Included articles were classified using Levesque et al.’s patient-centered access framework (e.g., affordability, accessibility, appropriateness, acceptability, availability and accommodation). Eight articles were found, including six which addressed patient-centered access. Most of the articles addressed issues of availability (e.g., wait times), appropriateness and affordability. Only one article addressed approachability and acceptability of IBD care. All articles emphasized a need for greater patient-centered measures (e.g., multidisciplinary clinics) with a goal to improve patient access and, ultimately, patient outcomes. Understanding patient-centered access to IBD care is important for managing IBD and improving patient outcomes. Literature examining access to gastroenterology services is limited. Increased investment in patient-oriented research should be made to better understand the relationship between access to specialist care and patient outcomes.

Stakeholder Perspectives on Access to IBD Care: Proceedings From a National IBD Access Summit

“…Community supports can include community-based allied health professionals with knowledge and expertise in IBD, improved access in the community to nursing support for education, as well as interventions for mental health, nutrition and chronic pain management. The need for community support development for those diagnosed with IBD and their care providers has been well documented ( 2 , 15 , 23 ).…”

Follow-up Care in Inflammatory Bowel Disease

“…could prevent new referral delays and redundant testing while allowing more fruitful encounters with IBD specialists. This will allow timely evaluation, diagnosis, and treatment within appropriate therapeutic windows by IBD specialists (Mathias et al, 2018).…”

“…According to Mathias et al (2018) in a retrospective study, 80% of the new patient referrals lacked basic information (e.g., reason for referrals) or pertinent diagnostic studies (e.g., endoscopy reports and imaging studies) resulting in delay of a clinic appointment by an average of 12 weeks. In an effort to make the referral process efficient, an IBD committee recently developed a referral algorithm to guide non-IBD specialists on stratifying new IBD patients by disease risks and referring to the right level of clinician in a timely fashion (Kinnucan et al, 2019).…”

“…In an effort to make the referral process efficient, an IBD committee recently developed a referral algorithm to guide non-IBD specialists on stratifying new IBD patients by disease risks and referring to the right level of clinician in a timely fashion (Kinnucan et al, 2019). These findings shed light on the impact of a quality referral process on timeliness of clinic appointments, diagnoses, and treatments and importance of improving the efficiency of the referral process to avoid unnecessary wait times from lack of care coordination (Kinnucan et al, 2019;Mathias et al, 2018).…”

Improving Follow-ups With Gastroenterologists Utilizing an Appointment Scheduling Protocol in Inflammatory Bowel Disease

“…Local data reveal even less favorable patterns of GI follow-ups. In the IBD center in Nova Scotia, canada, the wait time for a new GI consultation averages 184.8 days (Mathias, van Zanten, Kits, Heisler, & Jones, 2018). Additionally, at the project site, a tertiary academic center in Maryland, the preliminary data in July 2019 showed that the average time of next available appointments for 8 gastroenterologists was 71.8 and 78.6 days for new and existing patients with IBD, respectively.…”