Predictors of Patient Acceptability of Wait Times for Cataract Surgery in Montreal, Quebec

Abstract

Purpose: : Due to public frustration with wait times for cataract surgery, in 2004, the governments of Canada enacted legislation to reduce wait times. The goals of this analysis were to 1) assess the current level of acceptance of wait times and 2) determine what factors (demographic, medical, actual wait time, or visual) were related to a lack of patient acceptance.

Methods: : Patients undergoing first-eye cataract surgery were recruited from Maisonneuve-Rosemont Hospital in Montreal, Quebec from 2006 to 2007. 163 patients agreed to participate. Date of entry onto the hospital waiting list and date of cataract surgery were recorded. Patients were interviewed in person approximately two weeks before surgery. Patients were asked to rate the acceptability of their wait time (very acceptable, acceptable, not acceptable). The French versions of the VF-14, SF-36, and Cataract Symptom Scale (CSS) were given. Demographic and medical history information were also collected. Best corrected visual acuity of the eye before surgery was measured. Kruskal-Wallis tests and multinomial logistic regression (very acceptable as reference category) were performed.

Results: : Of the 163 patients, 33% rated their wait time as very acceptable, 55% as acceptable, and 12% as not acceptable. Those who described their wait time as not acceptable had worse visual acuity than those who described their wait time as acceptable or very acceptable (Mean LogMAR acuity=0.76, 0.45, 0.38 respectively; p=0.009). Also, VF-14 scores were worse in those who described their wait time as not acceptable compared to those who described their wait time as acceptable or very acceptable (Mean VF-14 scores=62, 80, 79 respectively; p=0.006). Using multinomial logistic regression to adjust for age and actual wait time, worse visual acuity (OR=1.14 per 0.1 logMAR, p=0.003) and better VF-14 scores (OR=0.86 per 5-unit difference, p=0.028) were significantly associated with wait times that were reported to be not acceptable. Gender, living alone, comorbidity, SF-36, and CSS scores were not significant.

Conclusions: : The large majority of patients reported that their wait time was acceptable. However, regardless of actual wait time, worse visual acuity and more reported difficulty on the VF-14 were associated with less acceptance of the wait time. Acceptability of wait times may improve if patients are prioritized for cataract surgery according to visual acuity and VF-14 scores.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • cataract • visual acuity