Patient factors associated with waiting time to pediatric rheumatologist consultation for patients with juvenile idiopathic arthritis

Author:

Barber Claire E. H.ORCID,Barnabe CherylORCID,Benseler Susanne,Chin Ricky,Johnson Nicole,Luca Nadia,Miettunen Paivi,Twilt MarinkaORCID,Veeramreddy Dwaraka,Shiff Natalie J.,Schmeling Heinrike

Abstract

Abstract Background Early diagnosis and treatment of Juvenile Idiopathic Arthritis (JIA) is essential to optimize outcomes. Wait times (WTs) to consultation with a pediatric rheumatologist consultation is a Canadian quality measure, with benchmarks set at 7 days for systemic JIA (sJIA) and 4 weeks for other JIA categories. In this study we assess WTs for JIA at a single academic center and describe factors associated with longer WTs. Methods This was a retrospective cohort study of 164 patients enrolled in a pharmacogenetic study in Alberta between 2002 and 2018. Limited chart reviews were conducted to evaluate dates of referral and first rheumatology visit to calculate WTs for receipt of pediatric rheumatology care. Cox proportional hazard models identified factors associated with WTs considering variables at the first pediatric rheumatology visit including: JIA category, age, sex, distance to the pediatric rheumatology clinic, number of active joints, pain and C-reactive protein. Results The median age at diagnosis was 8.0 years (interquartile range, IQR 3.5, 12.0) and 46% of patients had oligoarticular JIA. Only 18 patients (11%) were from rural locations. The median WT for all patients met the national benchmark (22 days, IQR, 9, 44) with no statistically significant difference between WTs among JIA categories (p = 0.055). Importantly, the majority of sJIA cases met the 7-day benchmark (67%) with a median WT of 1.5 days. Older age was associated with longer WT (HR 0.94, 95% CI 0.89, 0.98, p = 0.005). Conclusion Median benchmarks were met, however delays in older patients highlight the need for monitoring WTs.

Publisher

Springer Science and Business Media LLC

Subject

Immunology and Allergy,Rheumatology,Pediatrics, Perinatology, and Child Health

Reference13 articles.

1. O’Donnell S, McRae L, Toews J, Pelletier L, CDDSS Arthritis Working Group. National surveillance of arthritis in Canada, results from the Canadian Chronic Disease Surveillance System (CCDSS). J Rheumatol. 2019;46(7):794.

2. Public Health Agency of Canada. Candian Chronic Disease Surveillance System (CCDSS). 2018. URL: https://infobase.phac-aspc.gc.ca/CCDSS-SCSMC/data-tool/.

3. Oen K, Tucker L, Huber AM, Miettunen P, Scuccimarri R, Campillo S, et al. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: results of a Canadian multicenter, prospective inception cohort study. Arthritis Rheum. 2009;61:1077–86.

4. Barber CE, Marshall DA, Mosher DP, Akhavan P, Tucker L, Houghton K, et al. Development of system-level performance measures for evaluation of models of care for inflammatory arthritis in Canada. J Rheumatol. 2016;43:530–40.

5. Wait Time Alliance (WTA). Time to close the gap: report card on WTs in Canada (2014). 2014. URL: http://www.waittimealliance.ca/wta-reports/2014-wta-report-card/.

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