Background Rheumatic diseases occur more frequently in females. Females are also more often referred to a consultation by a specialist in rheumatology than men. Delay in referral from the general practitioners has been observed in females with early rheumatoid arthritis (1). No studies have focused neither on waiting time in all types of first referrals nor to which extent the information of the patient history in the referral letters may cause differences in waiting time between gender.
Objectives To compare the waiting time between gender in first referrals to an out-patient clinic of rheumatology. Additionally, to clarify to which extent the information of the patient history in the referral letter may contribute to prolonged waiting time in females.
Methods At the department of rheumatology, Hospital of Southern Norway Trust Kristiansand, in a random sample of first referral patients, the referral letters were evaluated by the physicians after the consultation. The physicians were requested to fill out a questionnaire. The questionnaire had four alternatives reflecting the information of patient history in each referral letter: Excellent, acceptable, deficient and unsatisfactory. Gender and age were noted and the number of days between the initial request and the day of the consultation was calculated for each patient. In statistical calculation Man-Whitney test was used.
Results Referral letters from 2264 patients (mean (SD) age 50.0 (16.1), 67.8 % females) were included in the study. The mean (95%CI) waiting time was calculated to 137.7 (131.7 – 143.6) days. In patients (6.4 %) with referral letter characterized as excellent, the waiting time was 92.9 (78.0 – 107.8) days. In patients with acceptable letter (69.0 %) waiting time was 132.1 (125.1 – 139.1) days. With deficient referral letter (21.5 %) waiting time was 163.9 (149.6 – 178.2) days, and with unsatisfactory letter (3.2 %) waiting time was 170.9 (131.4 – 210.4) days. In patients with unsatisfactory or deficient referral letter, the waiting time was significantly (p <0.05) longer in females (178.2 (160.9 – 195.6) days vs. 136.7 (117.2 – 156.3) days in men). In patients with acceptable referral letter, waiting time in females was 141.9 (133.1 – 150.8) days compared to 111.5 (100.7 – 122.3) days (p<0.001) in men. In patients with excellent referral letter, no significant (p=0.3) difference in waiting time was found between gender ((95.9 (78.1 – 113.6) vs. 86.4 (58.1 – 114.7)). In females aged between 18 and 50 years, the waiting time was 201.0 (175.0 – 227.1) days if the letter was incomplete compared to 144.5 (132.1 – 157.0) days (p< 0.001) in females with adequate referral letter.
Conclusions The information of the patient history in the referral letters to an out-patient rheumatology clinic in Norway is found to be acceptable in 75 % of them. The waiting time increased significantly in patients with incomplete referral letters and this tendency was most evident in younger females.
Acknowledgements The study was supported by grant from Norwegian Medical Association.
Disclosure of Interest None Declared