Background/Purpose:

The Calgary zone of Alberta Health Services serves a population of almost 2million Canadians over a wide geographical area and is underserved in terms of rheumatology specialists. Furthermore, the quality of referral information is variable, and wait times are prolonged, especially for routine appointments. Thus, there is a high rate of inappropriate use of acute services for patients with rheumatic conditions.

The Division of Rheumatology at the University of Calgary chose to partner with the Primary Care Network Specialist Link telephone advice service (operating 8am to 5pm Monday to Friday) to provide real time telephone non-urgent advice to improve efficiency and enhance the co-ordination of patient care delivery.

Methods:

The rheumatologists were asked to complete a survey after each phone consult in the initial launch period for the first year. Similarly, Primary Care doctors who had used the service were invited for their feedback. Direct costs, and direct savings were calculated based on the fee for service billing schedule, and a conservative cost effective analysis was performed based on the avoidance of relevant and known direct variable costs only.

Results:

Data from a period of 13 months were collected. A total of 209 out of a potential 615 (34%) surveys were received from n=12 rheumatologists. Feedback forms from n=49 individual family physicians were also analysed. 68% of the phone calls avoided an emergency room visit and 46% avoided a consult altogether. Further diagnostic imaging and laboratory testing was avoided after 16% and 15% of calls, respectively. Both specialist and family physicians expressed a satisfaction rating of greater than 90% with mutual collegial support (89%), education (87%) and enhanced patient care (77%) identified as subjective benefits on qualitative analysis, while 29% of calls resulted in management being initiated in the primary care setting before seeing the rheumatologist. Opportunity cost analyses revealed an average net savings of CAN$133 per phone call.

Conclusion:

Empowering primary care doctors to provide care for non-urgent rheumatology patients with the specialist support of real time telephone advice is both efficient and cost effective. Furthermore, improved doctor to doctor communication enhances patient care, improves collegiality and prevents unnecessary use of acute services for patients identified as having a real or potential rheumatic disease.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/specialist-link-telephone-advice-cost-effectively-enhances-rheumatology-patient-care-in-alberta-canada/