Rapid Access to Consultative Expertise (RACE)

Rapid telephone access for physicians to specialist advice


The Rapid Access to Consultative Expertise program offers real-time telephone advice to family physicians (FPs), avoiding unnecessary referrals or face-to-face consultations. FPs call one number to speak to specialists in cardiology, endocrinology, gastroenterology, nephrology, psychiatry, respirology, rheumatology, cardiovascular risk and lipid management, geriatrics, geriatric psychiatry, heart failure, general internal medicine, child and adolescent psychiatry, chronic pain, and treatment resistant psychosis. The program is available to Vancouver Coastal Health (VCH) FPs, with some specialty areas available in Fraser Health.

Background

In February 2009, a pilot project ("Rapid Access to Cardiac Expertise") was initiated to enable "real-time" communication between VCH FPs and a cardiologist for the purpose of expediting problem solving in ambulatory patient care of acute and chronic cardiovascular conditions. The project came out of a partnership between Providence Health Care and the Shared Care Committee.

Motivation

Motivation for the pilot came out of challenges in identifying and managing cardiovascular disease within the primary care setting. These challenges include accurate diagnoses, appropriate investigations, establishment of urgency, and triage to acute and/or specialty care. FPs have a number of diagnostic modalities at their disposal; however, forming a definitive diagnosis may require discussion and/or evaluation by a cardiologist. In the current system, a patient may wait several months for an evaluation appointment with a cardiologist, which may potentially result in previously stable cardiovascular disease patients developing new management problems, including arrhythmias, congestion or ischemia. Facilitating timely access to general cardiology consultations was essential. Feedback from the initial program called for expansion of access to speciality areas other than cardiology.

Objectives

The goals of the project were to improve care for patients with complex chronic conditions through:

  • Access to very early attention for high-risk patients
  • Support on choice and timing of investigations
  • Advice on treatment adjustments
  • Reduction in low-priority office referrals
  • Ongoing information transfer and continuing education
  • Promotion of ambulatory health and reduction in hospital admissions
     

Methodology

For the pilot, VCH FPs were able to telephone a single number and receive a return call from an on-duty cardiologist within two hours. Queries regarding treatment, investigations or referrals, urgent or elective, could be discussed to accelerate care plans and rapid cardiology follow-up when indicated. The Ministry of Health Special Services Committee helped to finance the specialists’ time and administrative costs. To record the frequency, nature and outcome of these contacts, Dr. Scott Lear organized a Palm PC data entry system. Data was downloaded to desktop software for storage. FPs were asked to fax back tick-box evaluations, from which the project usefulness was assessed. New MSP billing codes for FPs and specialists made it possible to launch the working, and now-expanded, RACE program. Evaluations were subsequently conducted in three phases via questionnaires, interviews and online surveys.

Outcome

Since successful completion of the pilot project, RACE has been implemented in VCH and Fraser Health regions, and has expanded to include access to a greater variety of specialists. Evaluations of the program showed that in many cases, it eliminated the need for specialist referrals (60% avoided face-to-face consults) and provided physicians with access to timely advice (77% of call answered within 10 minutes). Telus reports were used to calculate these findings; Between Sep. 2010 and Dec. 2011, a total of 2031 calls made.

External Links

www.raceconnect.ca
BCMA Shared Care Committee RACE webpage
Providence Health Care RACE report