February 07, 2017
Physio Can Help Wait Times

British Columbians in need of joint-replacement surgery face some of the longest wait times in Canada.

According to the Canadian Institute for Health Information (CIHI), just 61 per cent of BC patients who require hip-replacements receive treatment within six months of scheduling their operations. The wait is even longer for those British Columbians who need knee-replacements, as just 47 per cent meet the six-month benchmark deadline.

Both numbers put BC in ninth place among Canada’s 10 provinces. Even more worrisome, the situation in the province appears to be deteriorating.

In 2010, 90 per cent of all British Columbians waiting for hip-replacements received surgery within 195 days. By 2015, again referencing the latest data from CIHI, it took a stunning 359 days for 90 per cent of hip-replacement patients to receive treatment.

For knee-replacements, the time for 90 per cent of BC patients to receive surgery between 2010 and 2015 skyrocketed from 236 days, to a dismal 382 days.

To a great extent, wait times for surgery are a consequence of an imbalance between supply and demand for surgical services. And there can be no doubt that, because of BC’s aging population, the demand for joint-replacement surgery is growing year by year, almost inexorably.

Hips and knees over time receive a lot of wear and tear, and not surprisingly the majority of people who have joint-replacement surgery are over the age of 65. The average age of Canadian women who have hip-replacements is 72.3 years, and for knee-replacements, 67.6 years. For Canadian men, the numbers are 67.3 years and 67.4 years respectively.

Thirty years ago, (the year of Expo ’86) British Columbia was home to 358,100 seniors – individuals age 65 years and older. Last year, in 2016, that number grew to an estimated 853,400. Within two decades, in 2036, it is expected to reach nearly 1.5 million.

Clearly, it is reasonable to expect British Columbians will see an ever-increasing demand for orthopaedic surgery. Viewed in this light, is it inevitable that British Columbians will face ever-greater wait times for hip- and knee-replacements? Will BC soon have the longest orthopaedic surgery wait times in Canada?

Fortunately, academic studies published in recent years in Canada, the United Kingdom and elsewhere suggest a better alternative. In most jurisdictions, patients with hip and knee challenges visit their general practitioner physician (GP), who makes an initial assessment before referring to a specialist surgeon. Academic researchers have found that at least one-third (and possibly up to three-quarters) of those GP referrals are unnecessary; the surgeon, upon examining the patient, finds that they do not require surgery, but rather some alternative treatment.

Is there a better way? A way orthopaedic surgeons can focus on those patients who need surgery and we can still take good care of those who do not?

The academics confirm by research that physiotherapists have the requisite skills to perform triage: i.e. screening GP referrals and assessing those patients who need surgery and those who do not.

As a team of BC researchers recently concluded, “The triage system ... has the potential to reduce the wait time for patients who need to see an orthopaedic surgeon by screening out those who do not.”

The Physiotherapy Association of British Columbia looks forward to discussing a number of public policy issues as we approach the provincial general election on May 9, and to that end we are presenting a series of position papers on a number of topics.

The full text of our first paper, Physio Can Help: Physiotherapy Can Reduce Orthopaedic Surgery Wait Times, is currently available here.