Patiently Waiting

Researchers at the Schroeder Arthritis Institute have uncovered key reasons why patients are often unable to see a rheumatologist at the Toronto Western Hospital Psoriatic Arthritis Clinic within the recommended time from their referral.

Psoriatic arthritis is a severe form of arthritis that is linked to psoriasis, a chronic inflammatory skin disease. The Canadian Rheumatology Association and the Spondyloarthritis Research Consortium of Canada recommend that individuals with symptoms of psoriatic arthritis be assessed by a rheumatologist within six weeks of their referral.

“Even short delays in diagnosing psoriatic arthritis can lead to worse outcomes for patients, including the development of irreversible joint damage,” explains Dr. Dafna Gladman, a Senior Scientist at the Schroeder Arthritis Institute and the senior author of the study. “Patients regularly face long wait times to see specialists in Toronto, and this is a major issue for the Toronto Western Hospital Psoriatic Arthritis Clinic. We wanted to get a clear picture of the percentage of our patients that are seen within the recommended time frame and identify reasons for delays.”

The team reviewed medical records and referral letters for 168 patients who were seen at the clinic between January 2013 and May 2019. “Using these data, we dug deep to examine what happens from the time that a referral is received at the Clinic to when the patient first sees a rheumatologist,” explains Dr. Gladman.

The team discovered that the average time from referral to rheumatologist consult was approximately 11 weeks. Only one quarter of patients were seen within the recommended six-week period.  

The team determined that the primary cause of delays was a lack of spots at the clinic, suggesting a lack of resources and availability of clinicians who specialize in psoriatic arthritis.

The researchers also found that there was a disparity in wait times related to the location of referring physicians. Patients whose physician worked closer to the hospital were more likely to see a rheumatologist within six weeks from their referral than those whose physicians worked farther away. One reason for this might be because, if a patient lives further away, they may have less flexibility in terms of when they can make a scheduled appointment. This finding highlights the inequities and barriers to accessing care faced by individuals in rural communities.

“The Psoriatic Arthritis Clinic is a leader in arthritis care in Canada, but we need to do better to ensure that patients can access our services in a timely fashion,” says Dr. Gladman. “Our findings support the value of ongoing efforts to reduce wait times, such as implementing alternative models of care including specialized physiotherapy assessment, telehealth or establishing early arthritis clinics as intermediate points of care.”

This work was supported by the Canadian Institutes of Health Research, the Krembil Foundation and the UHN Foundation. Dr. Dafna Gladman is a Professor in the Faculty of Medicine at the University of Toronto. She is also the Director of the Psoriatic Arthritis Program, Co-Director of the Lupus Clinic and Deputy Director of the Centre for Prognosis Studies in Rheumatic Diseases at the Toronto Western Hospital.

Park S, Silverberg OM, Moez E, Chandran V, Gladman DD. Investigation into the wait time for consultation in the psoriatic arthritis program. Clin Rheumatol. 2022 Jul 22. doi: 10.1007/s10067-022-06288-8.