Investigation into the wait time for consultation in the psoriatic arthritis program

The 2014 Update of the Canadian treatment recommendations for the management of spondyloarthritis recommended that patients at risk of peripheral spondyloarthritis, including patients with psoriatic arthritis (PsA), be assessed by a rheumatologist within 6 weeks of referral. This study aimed to: (1) investigate the proportion of PsA patients who were assessed by a rheumatologist within 6 weeks of referral to the PsA Clinic at Toronto Western Hospital and (2) investigate the possible reasons for delays for consult with a rheumatologist. We identified patients with PsA who were seen by rheumatologists at the PsA Clinic between January 2013 and May 2019. We used retrospective chart reviews of medical records and referral letters to determine the number of days between referral and assessment by a rheumatologist. The causes for delays were identified as no spots in the clinic or patient rescheduling their appointment due to their inability to attend the scheduled appointment. Among 168 patients, 43 (25.6%) patients met the recommendation. The median wait time was 78.5 days (IQR 83.5). The most common cause of delay was the lack of available spots in the PsA clinic. The majority of PsA patients at the TWH PsA Clinic were not seen within the wait-time recommendation. The most common factor that prevented a timely consultation with a rheumatologist was the lack of spots in the PsA clinic. Greater access to rheumatologists can improve the timely and effective care of PsA patients. Key Points • Delay in diagnosis of psoriatic arthritis is detrimental to patient outcomes. • The recommended time for referral to consultation is 6 weeks. • A number of reasons result in delay in consultation. These need to be addressed.