Linking Specialists & Family Physicians

A BUFFET of PEARLS: How one evening can foster the family physician-specialist connection

It's a good thing that the ancient practice of diving for pearls is practically obsolete: the work was difficult and dangerous and divers' careers short-lived.

Today, health care is diving for "pearls of clinical care".  A recent "Diving for Pearls" event held in Victoria proved to be fun, collegial and professionally rewarding for the both participating specialists and family physicians. Best of all, nobody got wet.

In a version of "speed-dating," a dozen specialists, from cardiology to psychiatry to imaging, each spent 20 minutes at six tables of family physicians, sharing pearls of knowledge about best practices in their area of expertise and answering questions.

More than 100 participants from the South Island & Victoria Divisions enjoyed the evening which included a buffet dinner, networking, and the opportunity for small-group discussions. The aim, as with all Partners in Care work, was to close any gaps in care, reduce the need for a referral or ER visit, and help family physicians feel more comfortable providing appropriate care in their own offices. Invitations were also extended to 13 new specialists to town to provide them with the opportunity to connect with their new colleagues.

Results? The doctors involved overwhelmingly rated the CME-credit event as one of the best they had attended.

Comments such as "well-done," "great," "fantastic" dotted the evaluation forms. "Thank you: a great way to meet specialists and interact with our colleagues," wrote one. "Slam dunk awesome event: perfectly organized, great venue, excellent speakers …and so much better than a conference," wrote another. Almost all survey respondents said they found the "pearls" approach a great way to learn and reported they would put many of the tips into practice.

Those tips included:

• a new medication (Visannne/dianogest) is available to treat endometriosis, but is not effective for birth control — Dr. Hayley Bos (ob/gyn)
• a Dual Energy CT can diagnose gout 10 years earlier than before by specifically analysing chemical composition and showing uric acid crystals in the soft tissues — Dr. Kevin Forkheim (imaging)
• daily bathing and moisturizing can be very effective in managing mild to moderate atopic dermatitis —  Dr. Peter Lee (Allergy/Immunology)
• learn the anxiety equation: more coping skills = less anxiety; fewer coping skills = more anxiety — Dr. Rivian Weinerman (psychiatry)
• exercise is the only proven neuro-protective therapy — Dr. Kristen Attwell-Pope (neurologist)

Thirty-seven pearls were shared in advance of the event, with many more shared spontaneously during the session. See details here.

Organized by the South Island Division of Family Practice, and funded by the Shared Care Committee (a joint committee of Doctors of BC and Ministry of Health), the event, organizers hope, will be offered annually. Given that 100% of the family physicians in attendance agreed that the "pearls" approach is effective for knowledge transfer, and 100% felt that that the event satisfied their expectations, the committee is optimistic that the next one will be even better attended. Note: No Speedos or snorkels required.

Read the full report here

Rapid Access to Consultative Expertise (RACE): One phone call; 15 specialties

Timely access to a specialist consultation can make a world of difference for family physicians and their patients, whether it is to confirm a diagnosis, interpret test results, or obtain treatment advice. With the Rapid Access to Consultative Expertise (RACE) service, family physicians are able to phone a single number and request a telephone consultation with an on-duty specialist from one of 15 medical specialties. Calls are returned within a maximum of two hours and often sooner, with over 75% returned within 10 minutes.

"It is fantastic to be able to get answers almost immediately, and often while the patient is still in my office," says Vancouver family physician Daniel Dodek. "Without access to RACE, I would sometimes wait months to consult with a specialist, or I might look up my question online but not be confident of the answer." He adds that RACE helps foster positive communication between specialists and family physicians because of the personal dialogue and interaction.

RACE is a joint project of the Shared Care Committee — a committee of Doctors of BC and Ministry of Health (MoH)—Providence Health Care (PHC), and Vancouver Coastal Health (VCH). It is one of many projects comprising the Shared Care Committee's Partners in Care initiative, one of several committee initiatives enabling family and specialist physicians to work together to improve health outcomes and the patient journey through the health care system.

RACE grew from what was originally a pilot project in 2008 between the PHC Department of Family Medicine and Division of Cardiology; funding from the joint Doctors of BC/MoH Specialist Services Committee provided the financial support for cardiologists' time spent answering calls. With funding from the Shared Care Committee, PHC was able to expand the service and formally launch RACE with a broader range of specialists in June 2010. New specialties are added based on the needs of family physicians, including the addition of addiction medicine planned for summer 2013. Compensation for specialists' time is provided by the Specialist Services Committee.

The award-winning service is a "triple win" for patients, family physicians, and specialists. RACE allows patients to receive timely care from their family physician instead of waiting to see a specialist. It enriches family practice by providing a collegial and CME-eligible educational experience that directly links physician learning to practice in real time (see www.cfpc.ca/Linking_Learning_to_Practice for details). For specialists, RACE reduces waiting lists by potentially eliminating those consultations characterized by easily answered clinical questions.

"I like RACE because it allows me to answer a family physician's questions directly," says Dr Andrew Ignaszewski, who is Head of the Division of Cardiology, Physician Program Director of the PHC Heart Centre at St. Paul's Hospital, and one of the founders of RACE.

"It gives me great pleasure to be able to help my colleagues. It is satisfying to be able to give reassurance, to provide helpful advice in real time, and to share my knowledge," says Dr Ignaszewski. "I would happily participate, even without compensation."

He says being a RACE specialist fits easily into his workday. "Some days I receive no calls, other times I may receive four or five calls a day. About 50% of the calls I answer are to confirm a treatment or management approach already planned by the family doctor, and where I often offer reassurance. Many others are questions about the new procedures or medications where the knowledge transfer takes place." On average, most specialists spend five to 15 minutes per call.

Recent formal evaluations of RACE reflect the success of this innovative program and its alignment with the Institute for Healthcare Improvement's Triple Aim framework to provide a positive heath care experience for both physicians and patients, improve the health of the population, and reduce the per capita cost of care.

In a 2012 survey, all RACE users reported high satisfaction with the service. Sixty per cent of family practitioners said RACE avoided unnecessary face-to-face patient consultations with specialists, and 32% of respondents said using the service helped them avoid sending patients to the emergency department. All family physicians surveyed said they would use the service again and 95% would recommend it to their colleagues.

Christy Sutherland is a Vancouver family physician who works extensively in addiction medicine. Among RACE's many advantages, she says, the service provides her with reassurance to effectively manage patient referrals to a specialist.

"As a relatively new practitioner, I often use RACE to discuss interesting cases. It is so helpful to be able to identify any tests or procedures I should complete in advance so that I can provide the specialist I refer to with as complete a picture as possible."

Margot Wilson, also a founding team member of RACE and Director, Chronic Disease Management Strategy, Providence Health Care, says that RACE is meant to fill a gap in communication between family and specialist physicians, rather than interfere with existing referral patterns and relationships.

"We encourage family physicians to access local specialists where they can. If they do not have access to those specialists, then they may want to consider using RACE," says Wilson.