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Patients with chronic conditions often navigate multiple care interfaces and may experience fragmented care. Ideally care should be centred around the patient and family physician with support from specialty care.
In 2010, Providence Health Care partnered with the Shared Care Committee and Vancouver Coastal Health to facilitate collaboration between specialists and family physicians. The result was Rapid Access to Consultative Expertise (RACE) – an innovative model of shared care that lets family physicians phone one number, choose from a selection of specialty services and be routed to a specialist for “just-in-time” advice.
The prototype began with five specialty areas and, based on the needs of family physicians, has grown to include 17 specialty areas. Additional specialty areas will continue to be recruited in response to the requests of family physicians.
RACE is available Monday to Friday from 0800-1700 to provide support to family physicians while they are seeing patients. 75% of the calls are returned within 10 minutes, and 90% of the calls are under 15 minutes long.
Feedback has been very positive. One family physician described how, since he knows that the process will be quick, he asks the patient to wait in reception. When the specialist calls, he brings the patient back to the exam room and puts the phone on “speaker mode” so that they can listen to the specialist’s care suggestions together.
A data collection tool shows that the family physicians would have referred 39% of their patients to a face-to-face consultation with a specialist. 80% of those patients have not needed the face-to-face consultation after RACE has been used; the program has also prevented 72% of referrals to an emergency department that otherwise would have been made.
Over 95% of family physicians would recommend RACE, and 83% of them believe that it helped manage care for their patients.
Ongoing resources required for RACE are minimal. The cost for the telephone line structure is $120 per month and administrative support of approximately 1 day per month is required to ensure coverage schedules are in place and to re-route the phone numbers to the correct specialist.
www.RACEconnect.ca was launched in June 2013 along with a communication plan in order to ensure all family physicians across Vancouver Coastal Health are aware of the program.
Many of the province’s other health authorities are determining how a RACE-like model can fit their needs. The RACE team regularly receives inquiries from across Canada about the program, and shares all information and resources to help other organizations implement similar services.