An examination of difficulties accessing surgical care in Canada from 2005-2014: Results from the Canadian Community Health Survey

Jordana Liyat Sommer; Edward Noh; Eric Jacobsohn; Chris Christodoulou; Renée El-Gabalawy

doi:10.1371/journal.pone.0240083

Peer Review History

Original SubmissionMay 15, 2020
13 Jul 2020 Decision Letter - Itamar Ashkenazi, Editor PONE-D-20-14535 An Examination of Difficulties Accessing Surgical Care in Canada from 2005-2014: Results from the Canadian Community Health Survey PLOS ONE Dear Dr. El-Gabalawy, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Though only one reviewer out of many approached has agreed to review the paper, I agree with the comments provided. Please submit your revised manuscript by Aug 27 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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Thank you for stating the following in the Funding Section of your manuscript: "This work was supported by University of Manitoba Start-Up Funding (El-Gabalawy), and the Max Rady College of Medicine and Rady Faculty of Health Sciences, University of Manitoba BSc(Med) program (Noh)." We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: "The authors received no specific funding for this work." 3. We note that you have indicated that data from this study are available upon request. 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Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This well written manuscript examining the difficulties associated with accessing surgical care in Canada from 2005-2014. The study is strong as it presents a decade data from Canadian community health survey, however, is cross sectional and is limited by the nature of data (self -reported by patients). The authors analyzed data using Chi-square and t-test to show the differences in factors associated with difficulties accessing surgical care and ran a regression analysis of the factors in the final model. They showed the factors (males, orthopedic surgery, and surgery cancelled by the surgeon or hospital) had the highest rates of difficulty, but not in their final regression model. However, they have provided a lengthy discussion on each individual factor. For example, in page 11, authors stating that males have a higher incidence of difficulty accessing surgical care vs female, in spite that women are higher users of the health care system. The authors need to consider that the type of surgery may be different between male and female. Maybe it is easier to have hysterectomy compared to hip surgery (with the longest wait time). The regression model did not show any significant effect of Sex of difficulties accessing surgical care. This is true for other factors except staying overnight in hospital. The discussion part is very lengthy, I suggest the authors make it more summarized and to the point. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0240083.r001
Revision 1
9 Sep 2020 Author Response Journal Requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: We have now modified the manuscript formatting and file naming in accordance with the specified guidelines. 2. Thank you for stating the following in the Funding Section of your manuscript: "This work was supported by University of Manitoba Start-Up Funding (El-Gabalawy), and the Max Rady College of Medicine and Rady Faculty of Health Sciences, University of Manitoba BSc(Med) program (Noh)." We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: "The authors received no specific funding for this work." Response: We have now removed funding information from the manuscript document (i.e., on the title page). We will change the Funding Statement within the online submission form to reflect the funding received from the Max Rady College of Medicine and Rady Faculty of Health Sciences, University of Manitoba BSc(Med) program for this project. 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. Response: There are restrictions on sharing a de-identified dataset, imposed by Statistics Canada. The CCHS data utilized in the current study may be accessed via submitting a proposal and receiving security clearance through a Canadian Research Data Centre (this is now clarified in the methods section). Restrictions are in place to protect the privacy of survey respondents. Please see application and guidelines website for information on applying to access Research Data Centre protected data. Additional Clarifications: Thank you for requesting to update your Financial Disclosure: "This work was supported by Max Rady College of Medicine and Rady Faculty of Health Sciences, University of Manitoba BSc(Med) program." We note the following funder that was mentioned in your manuscript is not included in this statement: "This work was supported by University of Manitoba Start-Up Funding (El-Gabalawy)." Please explain why this funder was removed from your funding disclosure statement and whether you did indeed receive funding from them during the course of your study. If they were a source of funding for your study, please confirm this and we will add them to your Financial Disclosure statement. Response: We initially removed the University of Manitoba Start-Up Funding (El-Gabalawy) as it was unclear whether or not to include funding received by an investigator that is not specific to this study. The BSc(Med) funding was allocated specifically to support the current study, which is why that funding source was retained. Please add the University of Manitoba Start-Up Funding back in. The funding statement should now read, “This work was supported by University of Manitoba Start-Up Funding (El-Gabalawy) and Max Rady College of Medicine and Rady Faculty of Health Sciences, University of Manitoba BSc(Med) program.” Reviewer 1 Reviewer #1: This well written manuscript examining the difficulties associated with accessing surgical care in Canada from 2005-2014. The study is strong as it presents a decade data from Canadian community health survey, however, is cross sectional and is limited by the nature of data (self -reported by patients). The authors analyzed data using Chi-square and t-test to show the differences in factors associated with difficulties accessing surgical care and ran a regression analysis of the factors in the final model. They showed the factors (males, orthopedic surgery, and surgery cancelled by the surgeon or hospital) had the highest rates of difficulty, but not in their final regression model. However, they have provided a lengthy discussion on each individual factor. For example, in page 11, authors stating that males have a higher incidence of difficulty accessing surgical care vs female, in spite that women are higher users of the health care system. The authors need to consider that the type of surgery may be different between male and female. Maybe it is easier to have hysterectomy compared to hip surgery (with the longest wait time). The regression model did not show any significant effect of Sex of difficulties accessing surgical care. This is true for other factors except staying overnight in hospital. Response: Thank you for your positive feedback. Regarding the sex difference, although it is possible this could be influenced by type of surgery, we included type of surgery in our multivariable regression and it did not emerge as a significant correlate of endorsing difficulty accessing surgical care. However, we have now added to our discussion on this matter. Page 19 now reads, “future research should aim to understand factors that may be driving the emergent sex difference (e.g., healthcare utilization, type and complexity of surgery)” The discussion part is very lengthy, I suggest the authors make it more summarized and to the point. Response: We have now shortened the length of the discussion. Sincerely, Renée El-Gabalawy PhD Assistant Professor at the University of Manitoba Departments of Anesthesiology, Perioperative and Pain Medicine and Clinical Health Psychology E-mail: renee.el-gabalawy@umanitoba.ca https://doi.org/10.1371/journal.pone.0240083.r002
21 Sep 2020 Decision Letter - Itamar Ashkenazi, Editor An Examination of Difficulties Accessing Surgical Care in Canada from 2005-2014: Results from the Canadian Community Health Survey PONE-D-20-14535R1 Dear Dr. El-Gabalawy, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Itamar Ashkenazi Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0240083.r003
Formally Accepted
25 Sep 2020 Acceptance Letter - Itamar Ashkenazi, Editor PONE-D-20-14535R1 An examination of difficulties accessing surgical care in Canada from 2005-2014: Results from the Canadian Community Health Survey Dear Dr. El-Gabalawy: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Itamar Ashkenazi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0240083.r004

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