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Rationing of hip and knee referrals in the public hospital: the true unmet need.

Abstract The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA).
PMID
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Authors

Mayor MeshTerms

Arthroplasty, Replacement, Hip

Arthroplasty, Replacement, Knee

Keywords
Journal Title the new zealand medical journal
Publication Year Start




PMID- 28337039
OWN - NLM
STAT- MEDLINE
DA  - 20170324
DCOM- 20170417
LR  - 20170417
IS  - 1175-8716 (Electronic)
IS  - 0028-8446 (Linking)
VI  - 130
IP  - 1452
DP  - 2017 Mar 24
TI  - Rationing of hip and knee referrals in the public hospital: the true unmet need.
PG  - 39-48
AB  - AIM: The aim of this paper is to outline the development of a triage system for
      elective hip and knee referrals to the Orthopaedic Department of the Canterbury
      District Health Board (CDHB), and to determine the unmet need within this
      population for accessing first specialist assessment (FSA). METHODS: Between 1
      August 2015 and 31 March 2016 data was collected from all elective hip and knee
      referrals that underwent triage for a FSA. The number of outpatient appointments 
      available according to the government four-month waiting time is set by the CDHB.
      Patients were triaged by two consultant surgeons on the basis of their referral
      letter and radiological imaging into one of five categories: accepted for FSA,
      insufficient information, no capacity, low priority or direct entry to waiting
      list (if already seen by a specialist). Those not accepted for an FSA were
      returned to general practitioner (GP) care. RESULTS: During the study period
      there were 1,733 referrals (838 hip related referrals and 895 knee related
      referrals) to the orthopaedic department with a request for FSA. All patients had
      failed conservative management. Of these referrals 43% of hip and 54% of knee
      related referrals could not be offered an FSA and were returned, following
      triage, to general practitioner care unseen. Only 8% and 9% respectively were
      declined for insufficient information in the referral letter or lack of need.
      CONCLUSION: This study details the implementation of a triage system for elective
      hip and knee referrals to the CDHB and with accurate data we have been able to
      determine the large number of patients unable to access a specialist opinion.
      These patients represent the unmet need within our community and highlights the
      degree of rationing taking place within the public hospital.
FAU - Inglis, Tom
AU  - Inglis T
AD  - Orthopaedic Trainee, Department of Orthopaedic Surgery and Musculoskeletal
      Medicine, University of Otago, Christchurch.
FAU - Armour, Paul
AU  - Armour P
AD  - Orthopaedic Surgeon, Department of Orthopaedic Surgery and Musculoskeletal
      Medicine, University of Otago, Christchurch.
FAU - Inglis, Grahame
AU  - Inglis G
AD  - Orthopaedic Surgeon, Department of Orthopaedic Surgery and Musculoskeletal
      Medicine, University of Otago, Christchurch.
FAU - Hooper, Gary
AU  - Hooper G
AD  - Professor of Orthopaedics, Department of Orthopaedic Surgery and Musculoskeletal 
      Medicine, University of Otago, Christchurch.
LA  - eng
PT  - Journal Article
DEP - 20170324
PL  - New Zealand
TA  - N Z Med J
JT  - The New Zealand medical journal
JID - 0401067
SB  - IM
MH  - *Arthroplasty, Replacement, Hip
MH  - *Arthroplasty, Replacement, Knee
MH  - Elective Surgical Procedures
MH  - General Practitioners
MH  - Health Care Rationing/*statistics & numerical data
MH  - Health Services Accessibility
MH  - Health Services Needs and Demand
MH  - Hospitals, Public
MH  - Humans
MH  - New Zealand
MH  - Orthopedic Surgeons
MH  - Osteoarthritis, Hip/*surgery
MH  - Osteoarthritis, Knee/*surgery
MH  - Patient Selection
MH  - Referral and Consultation/*statistics & numerical data
MH  - Triage/*methods
MH  - Waiting Lists
COI - All authors work within the orthopaedic department of the Canterbury District
      Health Board.
EDAT- 2017/03/25 06:00
MHDA- 2017/04/18 06:00
CRDT- 2017/03/25 06:00
PST - epublish
SO  - N Z Med J. 2017 Mar 24;130(1452):39-48.

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