As healthcare providers, policy makers and planners wrestle with the complex task of addressing timely and appropriate access to health care in the province, Albertans are increasingly waiting well beyond the recommended wait time targets for elective hip and knee arthroplasty (26 weeks from the booking date to the date the patient receives the procedure, Canadian Institute for Health Information), including “Four Months in Four Years” as outlined in the current government’s election platform.
The Alberta Bone and Joint Health Institute has prepared a White Paper on behalf of the Bone and Joint Health Strategic Clinical Network detailing the history and current state of care for those afflicted with osteoarthritis (OA) in Alberta, forecasting future demand scenarios for elective hip and knee arthroplasty, and outlining strategies to address demand for treatment and factors that contribute to Albertans developing OA. For over a decade, a province-wide integrated and multidisciplinary team of healthcare professionals has developed, and continues to refine, an evidence-based care pathway for hip and knee arthroplasty. While tremendous strides have been made in the quality of care received by these patients, access remains an area of conflict. In addition to those that require an invasive procedure such as surgery, a much greater percentage of those with OA are not appropriate for surgery and have need for other treatments and supports. In fact, around half of the hip and knee referrals to specialist clinics every year in Alberta are determined to be “non-surgical” (around 10,000 patients).
The White Paper highlights that “without a significant increase in the level of funded surgery, about 1,066 new Albertans will be added to the [hip and knee arthroplasty] wait list every year”. In 2017/2018, 43.5% of patients exceeded the clinically recommended 26-week surgical benchmark. In addition to the wait for surgery, there is also a significant time period spent waiting to consult with the specialist. More than half of patients referred for surgeon consultation in 2017/18 waited more than 26 weeks.
The answer is not just to match annual surgical demand. Due to the backlog, this approach is forecasted to only reduce the wait time for surgery to 36 weeks by 2027/28. The White Paper concludes that, in addition to clearing the backlog of the wait list, demand in the long-term must be addressed. As the hip and knee arthroplasty professionals work to sustain the strong quality improvement processes associated with the surgical care pathway, attention has turned towards prevention strategies and conservative management of those with early OA. It is through combined approaches and tactics for OA care that the burden of disease and demand on the healthcare system will find middle ground, while maintaining highest quality standards in the long term.
Access the White Paper here: The Osteoarthritis Crisis in Alberta: Access, Quality, and Long-term Planning.