Mylaine Breton1, Mélanie Ann Smithman2, Martin Sasseville3, Sara A Kreindler4, Jason M Sutherland5, Marie Beauséjour6, Michael Green7, Emily Gard Marshall8, Jalila Jbilou9, Jay Shaw10, Astrid Brousselle11, Damien Contandriopoulos12, Valorie A Crooks13, Sabrina T Wong14. 1. Department of Community Health Sciences, Université de Sherbrooke, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada. Electronic address: mylaine.breton@usherbrooke.ca. 2. Université de Sherbrooke, Longueuil, QC, Canada. 3. Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé - Université de Sherbrooke, Longueuil, QC, Canada. 4. Department of Community Health Sciences, and Manitoba Research Chair in Health System Innovation, University of Manitoba, Winnipeg, MB, Canada. 5. Centre for Health Services and Policy Research, University of British Columbia, Michael Smith Foundation for Health Research, Vancouver, BC, Canada. 6. Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada. 7. Departments of Family Medicine and Public Health Sciences, Queen's University, Centre for Health Services and Policy Research, Centre for Studies in Primary Care, Institute for Clinical Evaluative Sciences, Kingston, ON, Canada. 8. Department of Family Medicine, Dalhousie University, Halifax, NS, Canada. 9. Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB, Canada. 10. Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 11. School of Public Administration, University of Victoria, Victoria, BC, Canada. 12. School of Nursing, University of Victoria, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC, Canada. 13. Department of Geography, Simon Fraser University, Michael Smith Foundation for Health Research, Canada Research Chair in Health Service Geographies, Burnaby, BC, Canada. 14. School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, BC Primary Care Sentinel Surveillance Network, Vancouver, BC, Canada.
Abstract
CONTEXT: Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. AIM: To understand how CWLs' design and implementation influence their use and effect on access to healthcare. METHODS: We conducted a realist review (n = 21 articles), extracting context-intervention-mechanism-outcome configurations to identify demi-regularities (i.e., recurring patterns of how CWLs work). RESULTS: In implementing non-mandatory CWLs, acceptability to providers influences their uptake of the CWL. CWL eligibility criteria that are unclear or conflict with providers' role or judgement may result in inequities in patient registration. In CWLs that prioritize patients, providers must perceive the criteria as clear and appropriate to assess patients' level of need; otherwise, prioritization may be inconsistent. During patients' assignment to service providers, providers may select less-complex patients to obtain CWLs rewards or avoid penalties; or may select patients for other policies with stronger incentives, disregarding the established patient order and leading to inequities and limited effectiveness. CONCLUSION: These findings highlight the need to consider provider behaviours in the four sequential CWL design components: CWL implementation, patient registration, patient prioritization and patient assignment to providers. Otherwise, CWLs may result in limited effects on access or lead to inequities in access to services. Crown
CONTEXT: Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. AIM: To understand how CWLs' design and implementation influence their use and effect on access to healthcare. METHODS: We conducted a realist review (n = 21 articles), extracting context-intervention-mechanism-outcome configurations to identify demi-regularities (i.e., recurring patterns of how CWLs work). RESULTS: In implementing non-mandatory CWLs, acceptability to providers influences their uptake of the CWL. CWL eligibility criteria that are unclear or conflict with providers' role or judgement may result in inequities in patient registration. In CWLs that prioritize patients, providers must perceive the criteria as clear and appropriate to assess patients' level of need; otherwise, prioritization may be inconsistent. During patients' assignment to service providers, providers may select less-complex patients to obtain CWLs rewards or avoid penalties; or may select patients for other policies with stronger incentives, disregarding the established patient order and leading to inequities and limited effectiveness. CONCLUSION: These findings highlight the need to consider provider behaviours in the four sequential CWL design components: CWL implementation, patient registration, patient prioritization and patient assignment to providers. Otherwise, CWLs may result in limited effects on access or lead to inequities in access to services. Crown
Authors: Mylaine Breton; Emily Gard Marshall; Véronique Deslauriers; Mélanie Ann Smithman; Lauren R Moritz; Richard Buote; Bobbi Morrison; Erin K Christian; Madeleine McKay; Katherine Stringer; Claire Godard-Sebillotte; Nadia Sourial; Maude Laberge; Adrian MacKenzie; Jennifer E Isenor; Arnaud Duhoux; Rachelle Ashcroft; Maria Mathews; Benoit Cossette; Catherine Hudon; Beth McDougall; Line Guénette; Rhonda Kirkwood; Michael E Green Journal: BMC Health Serv Res Date: 2022-06-08 Impact factor: 2.908
Authors: Emily Gard Marshall; Mylaine Breton; Michael Green; Lynn Edwards; Caitlyn Ayn; Mélanie Ann Smithman; Shannon Ryan Carson; Rachelle Ashcroft; Imaan Bayoumi; Frederick Burge; Véronique Deslauriers; Beverley Lawson; Maria Mathews; Charmaine McPherson; Lauren R Moritz; Sue Nesto; David Stock; Sabrina T Wong; Melissa Andrew Journal: BMJ Open Date: 2022-03-07 Impact factor: 2.692