CMAJ • August 12, 2008; 179 (4). doi:10.1503/cmaj.071659.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

Willingness of patients to change surgeons for a shorter waiting time for joint arthroplasty

Barbara Conner-Spady, PhD, Claudia Sanmartin, PhD, Geoffrey Johnston, MD MBA, John McGurran, MSc, Melissa Kehler, MA and Tom Noseworthy, MD MPH

From the Department of Community Health Sciences (Conner-Spady, Sanmartin, Noseworthy), University of Calgary, Calgary, Alta.; the Western Canada Waiting List Project (Conner-Spady, McGurran, Noseworthy), Calgary, Alta.; Statistics Canada (Sanmartin), Ottawa, Ont.; the Department of Surgery (Orthopaedics) (Johnston), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; the Department of Public Health Sciences (McGurran), University of Toronto, Toronto, Ont.; and the Department of Psychology, University of Regina (Kehler), Regina, Sask.

Correspondence to: Dr. Barbara Conner-Spady, University of Calgary, Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary AB T2N 4N1; barbara.spady{at}ualberta.net

Background: To improve access to care, many jurisdictions have proposed waiting-time benchmarks and guarantees. We assessed the willingness of patients to consider changing their surgeon to one with a shorter waiting time for arthroplasty.

Methods: We mailed a questionnaire to 2 random samples of patients who either were awaiting hip or knee replacement arthroplasty or had had one of these procedures within the preceding 3–12 months. We used logistic regression to assess the determinants of patients' likelihood to consider changing surgeons.

Results: Of 1200 responses from a sample of 2000, 557 (46%) were from patients awaiting surgery and 643 (54%) were from people who had undergone surgery. The mean age of respondents was 69.9 years (standard deviation 10.8), and 682 (57%) were women. The median waiting time for surgery was 8 months. Overall, 753 (63%) of the patients were unlikely to consider changing surgeons. Increased likelihood of changing surgeons was associated with male sex (adjusted odds ratio [OR] 1.49, 95% confidence interval [CI] 1.10–2.02), a high school education or higher (OR 1.73, 95% CI 1.15–2.62) and having already undergone surgery (OR 1.71, 95% CI 1.19–2.46). Decreased likelihood was associated with preference for a particular surgeon before referral (OR 0.57, 95% CI 0.42–0.79), a better score on the EuroQol (EQ-5D) index (a measure of health-related quality of life) (OR 0.39, 95% CI 0.24–0.66), perception that the waiting time to see the surgeon was acceptable (OR 0.50, 95% CI 0.36–0.70), perception that the waiting time to surgery was acceptable (OR 0.62, 95% CI 0.43–0.91) and perceived fairness of treatment (OR 0.53, 95% CI 0.36–0.78).

Interpretation: Despite long waits for surgery, most patients, if given the choice, would be unlikely to change their surgeon to one with a shorter waiting time.


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Can. Med. Assoc. J. 2008 179: 297. [Full Text] [PDF]

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