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Patients' Perspectives on Wait Times for Gastroenterology Services Waiting for the scope: Patients’ perspectives on wait times for gastroenterology services. Jayseelan Naidu A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Internal Medicine Johannesburg, 2016 Declaration I, Jayseelan Naidu, (Student number: 0403907D), am a student registered for the degree of MMed in the academic year 2016. I hereby declare the following: - I am aware that plagiarism (the use of some else’s work without their permission and/or without acknowledging the original source) is wrong. - I confirm that the work submitted for assessment for the above degree is my own unaided work except where I have explicitly indicated otherwise. - I have followed the required conventions in referencing the thoughts and ideas of others. - I understand that the University of the Witwatersrand may take disciplinary action against me if there is a belief that this is not my own unaided work or that I have failed to acknowledge the source of ideas or words in my writing. - I have included as an appendix a report from “Turnitin” (or other approved plagiarism detection) software indicating the level of plagiarism in my research document. Signature: _____________________ Date: ____________________ ii Abstract INTRODUCTION: Wait times for patients requiring endoscopy have not been ascertained in a South African setting. Wait times for gastroenterology services in Canadian studies were found to be prolonged, necessitating a need to evaluate wait times and the effect these wait times have on patients in a South African setting. METHOD: A questionnaire was administered to all new patients attending the Gastroenterology clinic at an academic South African hospital between December 2014 and July 2015. RESULTS: A total of 193 respondents completed the questionnaire. Of the respondents 78.2% were referred for an endoscopic procedure. The median total wait time from seeking initial medical attention until procedure was 100 days (IQR50-243).The median total wait time in patients with alarm features was 87 days (IQR52-155).The most frequent alarm feature reported was weight loss (20%; median total wait time of 73 days).The shortest median total wait time was 69 days (anaemia-11%); 53% felt that the wait time was appropriate for their condition. Of the respondents 42% and 41% reported a noteworthy impact on quality of life and impact on their activities of daily living, respectively. High anxiety levels due to wait times, was reported by 56% of the respondents. CONCLUSIONS: Wait times for gastroenterology services were prolonged in this study. When compared to the Canadian target waiting times, patients with alarm features were generally not seen in the appropriate wait time. Further studies need to be undertaken in order to evaluate the reasons for this. iii Acknowledgements We gratefully acknowledge the Department of Gastroenterology at the Charlotte Maxeke Academic Hospital for permission to undertake this research in their establishment. The help of the medical practitioners who assisted with the data collection through the administration of the questionnaires is gratefully acknowledged. The patients who participated in the study. iv Table of Contents Declaration ............................................................................................................................ ii Abstract ................................................................................................................................. iii Acknowledgements............................................................................................................... iv Table of Contents .................................................................................................................. v List of Figures ........................................................................................................................ vii List of Tables ........................................................................................................................ viii 1. Introduction ....................................................................................................................... 1 1.1 Study Aim ................................................................................................................ 5 1.2 Study Objectives ..................................................................................................... 6 2. Methods ............................................................................................................................. 7 2.1 Study design................................................................................................................. 7 2.2 Study site ..................................................................................................................... 7 2.3 Sample size estimation ................................................................................................ 7 2.4 Inclusion and exclusion criteria ................................................................................... 8 2.5 Data collection ............................................................................................................. 8 2.6 Statistical analysis ........................................................................................................ 9 2.7 Ethics ............................................................................................................................ 9 3.0 Results ............................................................................................................................ 11 3.1 Demographics of patients attending the gastroenterology clinic ............................. 11 3.2 Reason for referral ..................................................................................................... 12 3.3 Wait times .................................................................................................................. 12 3.4 Patient perspective on wait time .............................................................................. 15 v 3.5 Procedure performed ................................................................................................ 16 3.6 Previous missed procedure ....................................................................................... 17 3.7 Features present ........................................................................................................ 18 3.8 Impact on patient and on work/school days missed ................................................ 19 4. Discussion ........................................................................................................................ 22 4.1 Limitations of the study ............................................................................................. 27 4.2 Recommendations ..................................................................................................... 27 5. Conclusion ........................................................................................................................ 28 6. References ....................................................................................................................... 29 Appendix A: Ethics Clearance Certificate ............................................................................. 31 Appendix B: Canadian standard against which findings will be measured ......................... 32 Appendix C: Information sheet and informed consent ........................................................ 34 Appendix D: Questionnaire on wait times experienced by patients attending gastrointestinal endoscopy at a Johannesburg Teaching Hospital. .................................... 38 Appendix E: Turn-it-in plagiarism report ............................................................................. 40 vi List of Figures Fig.1 Impact on respondents quality of life (n=193) ........................................................... 21 vii List of Tables Table 3.1 Patient Demographics (n=193) ............................................................................ 11 Table 3.2 Reason for referral (n=193) ................................................................................. 12 Table 3.3 Wait times (n=193) .............................................................................................. 13 Table 3.4 Wait time according to alarm features present (n=164) ..................................... 14 Table 3.5 Patient perspective on wait time......................................................................... 15 Table 3.6 Procedure performed .......................................................................................... 16 Table 3.7 Wait time according to procedure performed .................................................... 17 Table 3.8 Previous procedure missed ................................................................................. 18 Table 3.9 Features present (n=193) .................................................................................... 19 Table 3.10 Impact on the patient ........................................................................................ 20 Table 3.11 Work or school days missed .............................................................................. 21 viii 1. Introduction Gastrointestinal endoscopy has become an important investigation for gastrointestinal diseases. Gastrointestinal
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