Median wait time benchmarks were met for most pediatric patients with systemic juvenile idiopathic arthritis (JIA); however, older age was associated with longer wait times, according to study results published in Pediatric Rheumatology.
In this retrospective cohort study, investigators evaluated wait times for patients with JIA at a single academic center in Alberta, Canada, who were participating in a pharmacogenetics study. Researchers also described the factors associated with longer wait times. Of the 336 patients enrolled in the pharmocogenetics study, 164 children (71% girls; median age at diagnosis, 8.0 years) were eligible for this study, from whom disease-related data were prospectively collected between 2002 and 2018. To calculate wait times, a limited chart review was conducted to investigate date of referral and first rheumatology visit. Referrals were categorized as urgent, semiurgent, or routine, and their target wait times were 1 week, 4 to 6 weeks, and no specific benchmarks, respectively.
The primary outcome was the percentage of patients with JIA seen within the benchmark wait times, which included 7 days for systemic JIA and 4 weeks (28 days) for all other JIA categories. Factors assessed for their association with wait times included JIA category, sex, age, distance to clinic (calculated using the network method), number of active joints, pain, and C-reactive protein at the first pediatric rheumatology clinic visit.
Study results revealed that most of the patients had oligoarticular JIA (46%) or rheumatoid factor (RF)-negative polyarticular JIA (29%). The majority of patients were from Calgary (62%), and only 11% lived in rural areas. In addition, the median network distance for patients from their home to the clinic was 14.1 miles (22.8 km). There was no statistical difference between wait times among JIA categories (P =.055), and the median wait times for all patients met the national benchmark (22 days; interquartile range, 9-45 days). High rates of benchmark adherence were observed in patients with oligoarticular JIA (69%) and RF-positive JIA (71%). Of note, most of the systemic JIA cases hit the target 7-day benchmark (67%) with a median wait time of 1.5 days.
In a sensitivity analysis, longer wait times were associated with older age (hazard ratio 0.94; 95% CI, 0.89-0.98; P =.005). No other variables were statistically associated with wait times. Overall, 62% of JIA cases were seen within the established wait time benchmarks.
Study limitations included selection bias, incomplete chart data, small sample size in several JIA categories limiting statistical significance, lack of information about symptom onset, parental education and household income, and lack of generalizability because of patients primarily being Caucasian.
“[Wait times] are important system level measures of quality of care,” noted the researchers. “In [the] future, additional measures including monitoring the number of pediatric rheumatology visits per year (new and follow-up), total number of referrals for JIA, number of pediatric rheumatologists, trainees and other allied healthcare providers may be important to track to better understand factors influencing [wait time] measures,” they concluded.
Barber CEH, Barnabe C, Benseler S, et al. Patient factors associated with waiting time to pediatric rheumatologist consultation for patients with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2020;18(1):22.