Many musculoskeletal illnesses are self-limiting. Most are benign although pain rarely feels benign, because the normal human response to pain is to feel protective and prepare for the worst (i.e., catastrophic thinking). Delaying treatment for benign musculoskeletal conditions may allow patients to learn self-efficacy and develop coping strategies, leading to less medical intervention and reduced costs. We tested the hypothesis that time from booking until appointment is not associated with healthcare costs. We further tested the secondary hypothesis that time from booking to appointment is not associated with specific healthcare utilizations.
Our study identified 16,750 patients making first clinic visits to hand surgeons at a hospital between January 1, 2003 and December 31, 2012. Booking time was defined as the time between the scheduling of an appointment and the actual visit. Imaging procedures, injections, nerve conduction studies, occupational therapy visits, surgery, and referrals were determined up until the patient’s second visit with the surgeon, or 90 days.
It was found that the duration between booking the appointment and the actual office visit was not associated with higher costs (1). However, the duration between booking and the office visit was associated with a higher rate of nerve conduction studies and a lower rate of occupational therapy. Booking duration was not associated with imaging procedures, injections, surgery, referrals, or second opinions. There was also substantial variation between surgeons.
In a setting with relatively short wait times, our findings do not support a therapeutic effect of a longer time between scheduling an appointment and seeing a hand surgeon. Rather, our data raises the possibility that when access is readily available, there may be differences between people that schedule appointments several weeks in advance and those that take the first available appointment. Since data on patient preferences for appointment time are not available, determining this would necessitate an additional study.
References
- Kuntz M, Teunis T, Blauth J, Ring D. Time from Booking Until Appointment and Healthcare Utilization in Hand Surgery Patients with Discretionary Conditions. J Hand Microsurg. 2015 Dec;7(2):268-275.Epub 2015 Aug 14. PubMed PMID: 26578829; PubMed Central PMCID: PMC4642469.