http://www.nejm.org/doi/full/10.1056/NEJMoa1702090
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Family physician access to specialist advice by telephone
Reduction in unnecessary specialist consultations and emergency department visits
Abstract
Problem addressed Timely access to specialist care is an important issue for patients with mild to moderate symptoms, and wait times for referrals are currently quite long.
Objective of program To provide FPs with quick telephone access to other specialists for treatment advice for patients with nonserious conditions that they would otherwise refer to specialist care.
Program description The RACE (Rapid Access to Consultative Expertise) program is a telephone hot-line providing FPs and nurse practitioners in the Vancouver, BC, area with timely access to specialist consultations. An evaluation of data from RACE found 60% of RACE calls prevented patients from visiting a specialist and 32% of calls prevented FP referrals to hospital emergency departments.
Conclusion Supported by RACE, FPs can more effectively remain the locus of patient care, calling on other specialist expertise when appropriate and providing better coordination of care for their patients. Evaluations to date suggest RACE helps reduce system costs by reducing unnecessary emergency department visits and face-to-face specialist consultations.
Timely access to specialist care is an important issue for patients, especially for those with mild to moderate symptoms. Results from the 2014 Commonwealth Fund report show 24% of older adults in British Columbia (BC) waited for at least 2 months to see specialists.1 In BC, a survey of physicians found the wait time from FP referral to psychiatric care for patients with mild mood disorders, such as anxiety or depression, was longer than 5 months.2 These wait times result in unnecessary delays in the delivery of patient care.