Waiting times in healthcare: equal treatment for equal need?

BACKGROUND: In many universal health systems, waiting times act as a non-monetary rationing mechanism, one that should be based on clinical need rather than the ability to pay. However, there is growing evidence that among patients with similar levels of need, waiting times often differ according to socioeconomic status. The mechanisms underlying inequality in access remain unclear. METHODS: Using data for Spain, we study whether waiting times for primary and specialist care depend on patients' socioeconomic status (SES). Additionally, we make use of the continuous nature of our data to explore whether the SES-related differences in waiting times found for specialist consultations vary among different points of the waiting time distribution. RESULTS: Our results reveal the presence of a SES gradient in waiting times for specialist services explained on the basis of education, employment status and income. In addition, for primary care, we found evidence of a slightly more moderate SES gradient mostly based on employment status. Furthermore, although quantile regression estimates indicated the presence of a SES gradient within the distribution of waiting times for specialist visits, the SES differences attenuated in the context of longer waiting times in the public sector but did not disappear. CONCLUSION: Our findings suggest the principle of equal treatment for equal need, assumed to be inherent to national health systems such as the Spanish system, is not applied in practice. Determining the mechanism(s) underlying this selective barrier to healthcare is of crucial importance for policymakers, especially in the current COVID-19 health and economic crises, which could exacerbate these inequalities as increasing numbers of treatments are having to be postponed.

The impact of Gender Identity Clinic waiting times on the mental health of transitioning individuals

Introduction: Waiting times for gender identity services, even before the Covid-19 pandemic, have been a cause of concern. Despite the waiting time standard for planned elective care in the NHS being a maximum of 18 weeks, the average waiting time for a first appointment with a gender identity clinic is 18 months. This study aims to analyse the effect that these timings have on the transgender community, and whether they impact the risk of developing mental health conditions such as depression or anxiety. Objective(s): This study's main aim is to analyse the correlation between waiting times and mental health burden in the transgender community. Method(s): A literature review and analysis on a transgender individual's mental health and waiting times for Gender Identity Clinics;looking at any key themes and conclusions. Research papers were taken from MEDLINE, The International Journal of Transgender Health, Oxford Academic, SpringerLink and Emerald Insight, with studies publishing date ranging from 2014 - 2021. Result(s): The transgender population were found to have higher rates of suicidal ideation, depression and self harm compared to the general population. Longer waiting times were found to contribute to feelings of low mood and suicidal ideation, as well as decreasing overall quality of life. Conclusion(s): Longer waiting times can decrease a transgender individual's quality of life and impact their overall mental wellbeing: especially with the impact of COVID-19 and the rise in referrals.

Impact of the COVID-19 pandemic on outpatient psychotherapy for children and adolescents

Background Since the start of the COVID-19 pandemic there is a growing body of evidence showing its negative impact on the mental health of children and adolescents. However, little is known about whether and how this impacts the psychotherapeutic care for children and adolescents. Objective The mental health of children and adolescents as well as their psychotherapeutic care since the onset of the COVID-19 pandemic were investigated from the perspective of child and adolescent psychotherapists (CAPs). Material and methods We conducted an online survey with 324 CAPs from all over Germany. Participants were asked to compare the last 6 months with a 6-month period 2 years ago. The survey used 5-point and 7-point Likert scales, questions with single and multiple choice options as well as numeric and open answer formats. Results Since the beginning of the pandemic waiting times have nearly doubled. CAPs offered more treatment sessions and, in particular, more initial consultations were carried out. Therapy extensions were more frequent and therapy terminations occurred less often. In about half of the patients, a pandemic-associated aggravation of symptoms occurred. All of the reported mental disorders occurred more often, in particular depression, anxiety disorders, media addiction, sleep, adjustment, obsessive-compulsive and eating disorders. More telephone and video sessions were carried out than before the pandemic. The pandemic resulted in a closer cooperation with parents but a decreased cooperation with other disciplines. Conclusion The pandemic had a significant impact on the mental health of and the psychotherapeutic care for children and adolescents in Germany. An adaptation of the mental health system to the increased need for therapy is proposed in order to limit future mental and economic harm.

SARS-CoV-2 Testing and Patient Waiting Times in the Emergency Department.

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

Modeling the Recovery of Elective Waiting Lists Following COVID-19: Scenario Projections for England.

OBJECTIVES: A significant indirect impact of COVID-19 has been the increasing elective waiting times observed in many countries. In England's National Health Service, the waiting list has grown from 4.4 million in February 2020 to 5.7 million by August 2021. The objective of this study was to estimate the trajectory of future waiting list size and waiting times up to December 2025. METHODS: A scenario analysis was performed using computer simulation and publicly available data as of November 2021. Future demand assumed a phased return of various proportions (0%, 25%, 50%, and 75%) of the estimated 7.1 million referrals "missed" during the pandemic. Future capacity assumed 90%, 100%, and 110% of that provided in the 12 months immediately before the pandemic. RESULTS: As a worst-case scenario, the waiting list would reach 13.6 million (95% confidence interval 12.4-15.6 million) by Autumn 2022, if 75% of missed referrals returned and only 90% of prepandemic capacity could be achieved. The proportion of patients waiting under 18 weeks would reduce from 67.6% in August 2021 to 42.2% (37.4%-46.2%) with the number waiting over 52 weeks reaching 1.6 million (0.8-3.1 million) by Summer 2023. At this time, 29.0% (21.3%-36.8%) of patients would be leaving the waiting list before treatment. Waiting lists would remain pressured under even the most optimistic of scenarios considered, with 18-week performance struggling to maintain 60%. CONCLUSIONS: This study reveals the long-term challenge for the National Health Service in recovering elective waiting lists and potential implications for patient outcomes and experience.

An observational study on IAPT waiting times before, during and after the COVID-19 pandemic using descriptive time-series data

Purpose: The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them. Design/methodology/approach: IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned. Findings: There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning. Practical implications: This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research. Originality/value: To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally. © 2022, Emerald Publishing Limited.

The Impact of COVID-19 on the Orthopaedic Patient in Slovenia: Hip and Knee Replacement Surgery, 90-Day Mortality, Outpatient Visits and Waiting Times.

Introduction: The purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits. Methods: The Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test. Results: All operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR. Conclusion: There was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.

The Use of Lifts in Offices in Social Distancing Environments

This paper addresses the potential remaining lift capacity for high-rise office buildings when limiting the number of passengers per car to only two persons due to social distancing restrictions in the COVID-19 era. It describes an array of measures that have to be taken to guarantee personal safety and sufficient distance, namely by eliminating crossing traffic and optimising the potential use of the lift system. Both the waiting time and the lobby capacity can be decisive when searching for the optimum. Without proper measures only about 20-30% of the original population can usually be served. With major measures and by successfully reducing peak flows the new maximum population can be increased to about 40-60% or the original population. © 2020, Lift and Escalator Symposium Educational Trust. All rights reserved.

Implementation of Lean Six Sigma to Lessen Waiting Times in Public Emergency Care Networks: A Case Study

Emergency Care Networks (ECNs) are integrated healthcare systems comprised of emergency departments (EDs). ECNs are called to be the primary response of healthcare authorities to deal with the expected uptick in the future demands for emergency care during the current Covid-19 pandemic. Lean Six Sigma (LSS) has been proposed to address this challenge since it allows managers to detect factors contributing to the extended waiting times (WT) throughout the patient journey. The suggested framework follows the DMAIC cycle that was initiated with the project charter definition;in the meantime, a SIPOC diagram was drawn to analyze the emergency care process and pinpoint critical process variables. Following this, a nested Gage R&R study was undertaken to study the measurement system performance;subsequently, a normal-based capability analysis was carried out to determine how well the ECN process satisfies the specifications. The next step was to identify the potential causes separating the ECN nodes from the desired target. Afterwards, improvement strategies were devised to lessen the average WT. After suitable data collection, a before-and-after analysis was performed to verify the effectiveness of the implemented strategies. Ultimately, a control plan containing an I-MR control chart was designed to maintain the improvements achieved with the LSS implementation. The results revealed that the average WT of the showcased node passed from 190.02 min to 103.1 min whereas the long-term sigma level increased from −0.06 to 0.11. The proposed framework was validated through a case study including the involvement of a medium-sized hospital from the public sector. © 2021, Springer Nature Switzerland AG.

Careful return to elective orthopaedic surgery in an acute hospital during the COVID-19 pandemic shows no increase in morbidity or mortality.

AIMS: Elective orthopaedic surgery was cancelled early in the COVID-19 pandemic and is currently running at significantly reduced capacity in most institutions. This has resulted in a significant backlog to treatment, with some hospitals projecting that waiting times for arthroplasty is three times the pre-COVID-19 duration. There is concern that the patient group requiring arthroplasty are often older and have more medical comorbidities-the same group of patients advised they are at higher risk of mortality from catching COVID-19. The aim of this study is to investigate the morbidity and mortality in elective patients operated on during the COVID-19 pandemic and compare this to a pre-pandemic cohort. Primary outcome was 30-day mortality. Secondary outcomes were perioperative complications, including nosocomial COVID-19 infection. These operations were performed in a district general hospital, with COVID-19 acute admissions in the same building. METHODS: Our institution reinstated elective operations using a "Blue stream" pathway, which involves isolation before and after surgery, COVID-19 testing pre-admission, and separation of ward and theatre pathways for "blue" patients. A register of all arthroplasties was taken, and their clinical course and investigations recorded. RESULTS: During a seven-month period, 340 elective arthroplasties were performed. There was zero mortality. One patient had a positive swab for COVID-19 while an inpatient, but remained asymptomatic. There were two readmissions within a 12-week period for hip dislocation. Patients had a mean age of 68 years (28 to 90), mean BMI of 30 kg/m2 (19.0 to 45.6), and mean American Society of Anesthesiologists grade of 2 (1 to 3). CONCLUSION: Results show no increased morbidity or mortality in this cohort of patients compared to the same hospital's morbidity and mortality pre-COVID-19. The screened pathway for elective patients is effective in ensuring that patients can be safely operated on electively in an acute hospital. This study should reassure clinicians and patients that arthroplasties can be carried out safely when the appropriate precautions are in place. Cite this article: Bone Jt Open 2021;2(11):940-944.

Risk, demand, capacity and outcomes in adult specialist eating disorder services in South-East of England before and since COVID-19.

AIMS AND METHOD: This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021. RESULTS: There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment. CLINICAL IMPLICATIONS: Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.