There is nothing more frustrating than waiting – particularly when it comes to your health. In many parts of the country, Canadians find themselves facing long wait times for an appointment with a specialist, even though evidence shows that patients face the greatest risk in the earlier phases of care, before formal diagnosis and a care plan is prescribed.
Calgary is no exception.
Between 2010 and 2016, referrals to Calgary-area gastroenterologists increased from 900 amonth to more than 1600 requests a month. Patients with “routine” referrals waited more than two years, with some never seen as the number of referrals coming in each month exceeded the available slots for patients to be assessed. This resulted in a burgeoning wait list, patient safety incidents, and health care gaps increasing between acute care and primary care. Similar access concerns were also noted in neurology, rheumatology, mental health, chronic pain and many more specialty areas within the Calgary Zone.
Seeing a need for action, family physicians and gastroenterologists began a dialogue on how to address the growing pressure. At the time, face-to-face referral to specialty care was the only option available for a patient to receive a formal consultation. But family physicians felt they could manage their gastroenterology patients in primary care well with support and easy access to collaborate with specialists, such as receiving quick advice by phone. The problem was, the supportive structures to connect family physicians and specialists were not in place.
From this, Specialist LINK, a non-urgent phone advice line and agreed on enhanced clinical pathways was developed. Specialist LINK connects Calgary Zone family physicians with specialists through a phone call returned within 1 hour. Alongside Specialist LINK is a provincial program called Alberta Netcare eReferral Advice Request. eReferral Advice Request provides primary care providers with access to electronic specialist advice within 5 days of request via the provincial electronic health record.
“These programs have been doing similar work, but they haven’t been integrated. The funding and development for each has been out of sync,” said Bronwyn White, Calgary Zone Specialty Integration Team Lead.
In comes CFHI’s Connected Medicine: Enhancing Primary Care Access to Specialist Consult collaborative, which is supporting the Calgary Zone Specialty Integration team’s improvement project. With the support of the collaborative, Primary Care Networks in the Calgary area and Alberta Health Services are working to facilitate better and swifter communication between primary care providers and specialists by better integrating Specialist LINK and eReferral Advice Request and increasing the number of specialties available through each tool.
“Funding has been part of the problem, but it is also education around informing physicians,” adds Dr. Monica Sargious, a physician champion in Calgary. “There is some learning that needs to go along with eReferral. Part of it is encouraging physicians to get a handle on the process, and to reassure them around privacy.”
By linking family physicians and specialists through two different methods for general advice, the team hopes to improve access to specialty care, support stronger professional relationships, expand knowledge bases, and improve the quality of referrals.
Yolanda Martens - Vanhilst, Specialist LINK program manager, says that physicians are incredibly enthusiastic about both tools.
“Family physicians tells us that they help them support their patients and they truly appreciate it,” she adds. “But some have said that Specialist Link, for example, is not as supportive, because their practice is set-up in a way that they can’t take calls, while eReferral Advice is easy to integrate in their practice style; others have expressed the opposite and feel that calls can easily be taken within their clinic hours.”
As a result, the team has been developing shared communications materials to raise awareness and to educate frontline physicians on how to use the non-urgent advice modalities. As well, both programs are developing and implementing a shared recruitment and evaluation strategy.
“We want to promote both resources as complementary modalities that meet different needs,” says Jodi Glassford, eReferral director. “And we also want to be sure that providers understand how to use them as part of their practice to improve patient outcomes. Patients spend a lot of time waiting to see a specialist so getting advice can support them to receive care in the community.”
As the programs expand, the team is also realizing they will need to address the reality that the services may outgrow existing IT structures and electronical platforms.
“CFHI truly brought us to together. Historically we have had opportunities to work together, but we haven’t traditionally been very aligned. CFHI has provided the platform to start aligning the objectives and openly share our experiences and move forward in quality improvement,” says Yolanda.