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Program to reduce wait times for patients with hip, knee and low back pain

Patients with hip/knee osteoarthritis and low back pain often have to wait months to meet with a surgeon for an initial consultation. But a new program with the South West LHIN will soon connect patients with a health provider within four weeks.

Patients will be quickly referred to health providers such as physiotherapists for a consultation

Rhonda Butler is the advance practice leader for the hip and knee program in the musculoskeletal (MSK) rapid access clini. (Submitted by Michele Martin)

Patients referred to see orthopedic and spine surgeons for hip and knee osteoarthritis and low back pain will soon have to wait just four weeks to see a health provider under a new system of Rapid Access Clinics (RACs) rolling out through the South West Local Health Integration Network (LHIN).

Right now, many patients wait in pain for months before they get an initial consultation with a surgeon. Some attend this appointment only to find out that they don't qualify for surgery at all, according to a news release from the South West LHIN.

"Rapid Access Clinics will improve access and avoid unnecessary utilization of resources by focusing on getting a patient assessed quickly and on the right treatment path," the news release said.

How it works

The RACs will help in two ways, according to Rhonda Butler, advance practice leader for the hip and knee program in the musculoskeletal RAC.

First, the RACs use a new central referral system that allows family doctors to send their referrals to one place and quickly find the first available surgeon. Until now, surgeons worked independently, Butler said.

Once they've entered the referral system, patients will be triaged to an "advance practice provider"—typically a physiotherapist, nurse practitioner, occupational therapist or chiropractor—within just four weeks.

"They'll have an opportunity to ask questions and get answers so they know what they're looking at, and what the best care can be," Butler said.

Many patients don't need surgery

So far, the hip and knee program has seen about 150 hip and knee patients and about 100 low back pain patients. (Paula Duhatschek/CBC)

The RACs started seeing patients from the current wait list in early 2019, and began accepting new referrals April 15. 

For now, four weeks to assessment is still the goal, not the reality, Butler said.

"We decided to start working with people who are on the waitlist to make it an equitable program for all people," Butler said.

"Ideally we'll get to the point of four weeks, but at this point while we finish working through the waitlist there will be wait times for some people."

So far, roughly 150 hip and knee patients and 100 low back pain patients have been seen, Butler said.

Of those, only about 60 per cent of hip and knee patients and just 20 per cent of low back pain patients go on to need surgery, Butler said.

"[We're] keeping the surgeons' appointment for the patients who are most likely to benefit," she said.

By cutting that initial wait time, Butler said the program can also cut down on unnecessary tests and MRIs, and help patients get treatment early on, when it has the greatest impact.

The program can also potentially prevent opioid misuse, Butler said.

Province says program a 'great example'

In February, the province announced it would dissolve all 14 LHINs as well as six provincial health agencies, and merge them into one super-agency called Ontario Health.

When asked if the RACs will continue under the new Ontario Health system, a spokesperson for the health minister called the RACs "great examples" of the kind of care the government is looking to implement.

"Rapid Access Clinics will continue to operate as we work to modernize the health care system," said Hayley Chazan, press secretary for Health Minister Christine Elliott. 

"It will take several years for Ontario Health Teams to be fully operational across the province, and the government will ensure that transitions are done over time to ensure seamless patient care."

There are currently 1301 patients waiting for hip replacements, and 2443 patients waiting for knee replacements in the South West LHIN, according to RenatoDiscenza, CEO of the South West LHIN.

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