title: Access to pediatric rheumatology subspecialty care in British Columbia, Canada.
abstract: OBJECTIVE
  Early recognition and treatment of pediatric rheumatic diseases is associated with improved outcome. We documented access to pediatric rheumatology subspecialty care for children in British Columbia (BC), Canada, referred to the pediatric rheumatology clinic at BC Children's Hospital, Vancouver.
  
  
  METHODS
  An audit of new patients attending the outpatient clinic from May 2006 to February 2007 was conducted. Parents completed a questionnaire through a guided interview at the initial clinic assessment. Referral dates were obtained from the referral letters. Patients were classified as having rheumatic disease, nonrheumatic disease, or a pain syndrome based on final diagnosis by a pediatric rheumatologist.
  
  
  RESULTS
  Data were collected from 124 of 203 eligible new patients. Before pediatric rheumatology assessment, a median of 3 healthcare providers were seen (range 1-11) for a median of 5 visits (range 1-39). Overall, the median time interval from symptom onset to pediatric rheumatology assessment was 268 days (range 13-4989), and the median time interval from symptom onset to referral to pediatric rheumatology was 179 days (range 3-4970). Among patients ultimately diagnosed with rheumatic diseases (n = 53), there was a median of 119 days (range 3-4970) from symptom onset to referral, and 169 days (range 31-4989) from onset to pediatric rheumatology assessment.
  
  
  CONCLUSIONS
  Children and adolescents with rheumatic complaints see multiple care providers for multiple visits before referral to pediatric rheumatology, and there is often a long interval between symptom onset and this referral.
authors.affiliation: Division of Rheumatology, BC Children's Hospital, Room K4-120, 4480 Oak Street, Vancouver, BC V6H 3V4. nshiff@cw.bc.ca
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Shiff
authors.forename: Reem
authors.initials: R
authors.lastname: Abdwani
authors.forename: David A
authors.initials: DA
authors.lastname: Cabral
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Houghton
authors.forename: Peter N
authors.initials: PN
authors.lastname: Malleson
authors.forename: Ross E
authors.initials: RE
authors.lastname: Petty
authors.forename: Victor M
authors.initials: VM
authors.lastname: Espinosa
authors.forename: Lori B
authors.initials: LB
authors.lastname: Tucker
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D001955:British Columbia; D002648:Child; D002675:Child, Preschool; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data / Q000639:trends; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data* / Q000639:trends; D009313:National Health Programs / Q000706:statistics & numerical data / Q000639:trends; D010290:Parents; D010372:Pediatrics / Q000706:statistics & numerical data* / Q000639:trends; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D013038:Specialization; D011795:Surveys and Questionnaires; D013997:Time Factors