Telephone advice line links specialist and family physicians together for better patient care

Issue: BCMJ, vol. 56, No. 1, January February 2014, Pages 31,34 Shared Care Committee
By: Gary Mazowita, MD,

Rapid Access to Consultative Expertise (RACE) is a telephone hotline that provides family physicians in the Vancouver Coastal Health region with timely access to specialist consultation. RACE enables family physicians to phone a single number and request a telephone consultation with an on-duty specialist from one of 18 medical specialties. Calls are returned within a maximum of 2 hours and often sooner, with over 75% of calls returned within 10 minutes. 

RACE is a project of the joint BCMA/Ministry of Health Shared Care Committee, Providence Health Care (PHC), and Vancouver Coastal Health (VCH). It is one of many projects of the Shared Care Committee’s Partners in Care initiative, which in turn is 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 a 2008 pilot project between the PHC Department of Family Medicine and Division of Cardiology. Funding from the joint BCMA/Ministry of Health Specialist Services Committee provided the financial support for cardiologists’ time spent answering calls. Funding from the Shared Care Committee enabled PHC 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, and compensation for specialists’ time is funded by the Specialist Services Committee.

The award-winning service enriches family practice by providing a collegial and CME-eligible educational experience that directly links physician learning to practise in real time (see www.cfpc.ca/Linking_Learning_to_Practice for details). For specialists, RACE reduces wait lists by potentially eliminating consultations involving easily answered clinical questions. There have been more than 8000 calls to the hotline since it was launched, many of which have enabled patients to receive timely care from their family physician instead of waiting to see a specialist.

Recent formal evaluations of RACE reflect the success of this innovative program. In a 2012 survey, all RACE users reported high satisfaction with the service. Sixty percent of family practitioners said RACE helped avoid 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, resulting in estimated cost savings to the health care system of up to $200 per call. All family physicians surveyed said they would use the service again, and 95% would recommend it to their colleagues. 

Based on its success, RACE is the model for a number of Partners in Care telephone consult projects elsewhere in the province, including Northern BC, Surrey/North Delta, Kootenay Boundary, and South Vancouver Island.

RACE is intended to fill a gap in communication between family and specialist physicians (rather than interfere with existing referral patterns and relationships), and family physicians are encouraged to access local specialists where they can. If they do not have access to those specialists, they may want to consider using RACE. The program does not provide appointment bookings, arrangements for transfers, laboratory or diagnostic investigations, or arrangement for a hospital bed. It is also not intended for referrals, nor does it expedite the referral process. 

RACE is available to all family physicians in the VCH region, Monday to Friday from 8 a.m. to 5 p.m. (see sidebar for fee code information). Family physicians in the Fraser Health region can also access select specialty advice (i.e., cardiology and rheumatology) through RACE, which also provides province-wide access to a number of specialty services. Visit RACEconnect.ca for a complete listing of specialties engaged, available resources, and summary information about the program, including “RACE in a Box,” a toolkit with step-by-step instructions for setting up a RACE-like structure. 

For information on Shared Care Committee initiatives, visit www.sharedcarebc.ca.
—Garey Mazowita, MD
Shared Care Committee member

Additional reading
Araki Y, Lear S. Program evaluation of the PHC Shared Care partnership: Final report. British Columbia Alliance Telehealth Policy and Research, Simon Fraser University. 31 March 2012. (Revised 10 August 2012.)

 

RACE billing codes
Family physicians 
•    G14018 General Practice Urgent Telephone Conference with a Specialist: $40 

Specialist physicians 
•    G10001 Specialist Telephone Advice, response within 2 hours: $60 
•    G10002 Specialist Telephone Patient Management, per 15 minutes or portion thereof: $40
•    Initiated by a nurse practitioner, per 15 minutes or portion thereof: $40

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This article is the opinion of the Shared Care Committee and has not been peer reviewed by the BCMJ Editorial Board.

Gary Mazowita, MD,. Telephone advice line links specialist and family physicians together for better patient care. BCMJ, Vol. 56, No. 1, January, February, 2014, Page(s) 31,34 - Shared Care Committee.


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