title: Access to orthopaedic spinal specialists in the Canterbury public health system: quantifying the unmet need.
abstract: OBJECTIVE
  The aim of this project was to determine the unmet need within the public health system for patients referred for elective Orthopaedic Specialist Spinal assessment and treatment in the Canterbury District Health Board (CDHB) region.
  
  
  METHODS
  Between January 2014 and January 2015 data was collected from all elective referrals to the CDHB Orthopaedic Spinal Service. During this period, the number of available outpatient appointments was set by the CDHB. Within this clinical capacity, patients were triaged by the four consultant surgeons into those of most need based on the referral letter and available radiological imaging. Those unable to be provided with a clinical appointment were discharged back to their GP for ongoing conservative care. Of those patients that received specialist assessment and were considered in need of elective surgical intervention, a proportion were denied treatment if the surgery was unable to be performed within the government determined four-month waiting time threshold.
  
  
  RESULTS
  During the study period, 707 patients were referred to the CDHB orthopaedic spinal team for elective specialist assessment. Of these, 522 (74%) were declined an outpatient appointment due to a lack of available clinical time. Of the 185 patients given a specialist assessment, 158 (85%) were recommended for elective surgery. Ninety-one (58%) were denied surgery and referred back for ongoing GP care due to unavailable operating capacity within the four-month waiting list threshold. Within this group of 91 patients, 16 patients were declined on multiple occasions (14 patients twice and two patients on three occasions).
  
  
  CONCLUSIONS
  This study quantifies the unmet need for both Spinal Orthopaedic Specialist assessment and, if warranted, surgical management of elective spine conditions within the Canterbury public health system. It highlights the degree of rationing within the public health system and its failure to adequately provide for the Canterbury Public.
authors.affiliation: Orthopaedic Trainee, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch.
authors.forename: Tom
authors.initials: T
authors.lastname: Inglis
authors.affiliation: Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch.
authors.forename: Rowan
authors.initials: R
authors.lastname: Schouten
authors.affiliation: Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch.
authors.forename: Kristian
authors.initials: K
authors.lastname: Dalzell
authors.affiliation: Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Evison
authors.affiliation: Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch.
authors.forename: Grahame
authors.initials: G
authors.lastname: Inglis
mesh_terms: D001071:Appointments and Schedules; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009520:New Zealand; D009985:Orthopedics / Q000592:standards*; D011634:Public Health / Q000592:standards*; D012017:Referral and Consultation; D014850:Waiting Lists