Does waiting matter? A randomized controlled trial of new non-urgent rheumatology out-patient referrals

Objective. To examine the effect of waiting times on the health status of p atients referred For a non-urgent rheumatology opinion. Methods. The study was a randomized controlled clinical study evaluating a 'fast track' appointment with a 6-week target waiting time against an 'ordi nary' appointment in the main city out-patient clinic of the rheumatology s ervice for the Lothian and Borders region (population similar to 1 million) . Health status was measured using the SF12 physical and mental summary com ponent T-scores and pain was measured with a 100 mm visual analogue pain sc ale. Secondary outcomes were health utility and perceived health both measu red with the EuroQol instrument, mental health measured with the Hospital A nxiety and Depression scale, disability with the modified Health Assessment Questionnaire and economic costs measured from a societal perspective. Results. Mean waiting times were 43 days (sigma = +/-16) and 105 days (sigm a = +/-51) for 'fast track' and 'ordinary' appointments, respectively. Both groups showed significant improvements in mean [95% confidence interval (C I)] scores for pain: 11 (7, 16)(P < 0.001); physical health status: 4 (2, 5 ) (P < 0.001); mental health status: 2 (0.1, 4) (P < 0.02); and health util ity: 0.11 (0.07, 0.16) (P < 0.001) by the end of the 15-month period of the study, but there was no significant difference between either arm of the s tudy. Conclusions. Rationing by delay was not detrimental to either mental or phy sical health and patients in both arms of the study showed significant and similar improvement in health by 15 months. Expenditure of resources on wai ting times without regard to clinical outcomes is likely to be wasteful and additional resources should be directed at achieving the greatest clinical benefit. More research into effective methods of controlling demand and be tter identification of those who would benefit from access to specialist ca re is needed.