Unhealthy Waits?

One of the limitations of a publicly funded health system is extended wait times, not least for individuals, who struggle with severe obesity.

How do such wait times affect these patients’ health and how do they feel about it?

This is the topic of a paper we now publish in BMC Health Services Research.

In order to better understand wait-listed patients’ health status and perceptions regarding the consequences of prolonged wait times, we used a cross-sectional study design nested within a prospective cohort study.

Participants were 150 consecutive consenting subjects wait-listed for a tertiary care multi-disciplinary bariatric assessment in an Alberta population-based medical/surgical bariatric program.

We measured health status using a visual analogue scale and used the Waiting List Impact Questionnaire (WLIQ) to look at the impact on employment, physical stress, social support, frustration, quality of life, and satisfaction with care.

All analyses were adjusted for age, sex and BMI identified independent predictors of lower VAS scores.

Over 90% of participants were women with a mean age of 43, mean BMI of 50 and an average waiting time (at the time of assessment) of 64 days.

The mean health VAS score was 53/100), whereby independent predictors of lower VAS scores included a higher BMI, unemployment and depression (sleep apnea just missed statistical significance in this analysis).

This level of VAS score is markedly lower than the average score of 85 previously reported in a random sample of community-dwelling adults drawn from the same population as our study sample and even considerably lower than those reported other chronic medical conditions such as diabetes and COPD with VAS scores of 66 and 65 respectively.

Physical limitations were common, with 85% reporting reduced activity, 83% reporting activity limitations compared to previous activity levels and 69% reporting worsening physical limitations over time.

The majority of subjects expressed concern over wait times (65%) and felt that waiting was very stressful (53%) and physically, emotionally and mentally taxing (62%).

According to the WLIQ, 47% of subjects agreed or strongly agreed that waiting affected their quality of life, 65% described wait times as ‘concerning’ and 81% as ‘frustrating’.

Of the respondents, 81% of subjects indicated that the wait for care was frustrating, 73% worried about the consequences of extended wait times on their health, 68% were frustrated with the allocation of resources and 59% felt that they should not have to wait for obesity treatment.

Surprisingly, however, only 31% were dissatisfied/very dissatisfied with their overall medical care.

Thus, we found that patients wait-listed for bariatric care in Alberta self-reported a concerningly marked impaired health status. In addition, there were other important negative consequences of protracted wait times.

These data may help benchmark the level of health impairment in this population, better understand the physical and mental toll of waiting, and assist with wait list management.

Edmonton, Alberta

ResearchBlogging.orgPadwal RS, Majumdar SR, Klarenbach S, Birch DW, Karmali S, McCargar L, Fassbender K, & Sharma AM (2012). Health status, quality of life, and satisfaction of patients awaiting multidisciplinary bariatric care. BMC health services research, 12 (1) PMID: 22681857