Factors Associated with Waiting Time for a First Consultation in Rheumatology from a Centralized Referral System

Objectives In Québec, general practitioners are required to submit patient referrals for initial rheumatology consultations through the regional centralized referral system (CRDS). This system assigns appointments based on the reason for consultation and priority level indicated by the GP, using a standardized referral form. This study aims to identify the factors associated with the waiting time for CRDS-assigned rheumatology appointments. Methods We conducted a retrospective analysis using data from 2 regional CRDS over 4 4-month periods, over 4 consecutive years (n=1768 referrals). We examined the characteristics of rheumatology referrals, including system delays calculated as the interval between the referral receipt date at the CRDS and the date of first appointment allocation. Cox regression models were used to identify factors associated with these delays. Waiting times for initial consultations were compared against CRDS target wait time benchmarks. Results Median waiting times were 7 days [3-14] for priority B referrals (target wait time <10 days), 31 days [17-70] for priority C (target <28 days), 286 days [128-464] for priority D (target <90 days), and 548 days [347-548] for priority E (target <365 days). Beyond priority level (p<0.001), several factors were associated with delays in accessing an initial rheumatology consultation. These included the period (p<0.001), with the pandemic year (2020-21) showing longer delays in comparison to the reference year (2019-20); the source of the referral (p<0.001), as referrals originating from family medicine groups having longer waits than those from other practice settings; reason for consultation (p=0.021), with fibromyalgia linked to longer delays and vasculitis and connective tissue disease to shorter ones; sex assigned at birth (p<0.001), with female patients facing longer delays than men; and age (p=0.021), older individuals experiencing longer waits. In the multivariable model, the low priority level, the pandemic period, the referrals from family medicine groups and older age were significantly associated with longer delays. Conclusion These results suggest that, beyond medical priority, both patient- and system-level factors may influence delays for rheumatology consultations. The next phase of the study will investigate the circumstances under which these inequities in access arise, by analyzing CRDS demand and supply data, and conducting a comprehensive classification analysis of the additional clinical background and personal history information included in individual referral forms. The findings will inform triage and prioritization strategies in centralized referral systems, including potential extensions and refinements to the standardized referral forms, to support efforts aimed at reducing disparities and promoting equitable access to care. Supported by a CIORA grant