Canadian Journal of Cardiology
Abstract session by date CCS highlighted poster mechanisms and management of CAD| Volume 28, ISSUE 5, SUPPLEMENT , S156, September 01, 2012

173 An Innovative Model For Shared Care - Rapid Access to Consultative Expertise (RACE)


      Ideally the locus of care for patients with chronic conditions should remain with family practitioners (FPs), with specialists and their teams in supporting roles. An innovative model of shared care was developed involving a telephone advice line where FPs call one number and choose from a selection of specialty services for real-time telephone advice. In the RACE model, the telephone call is routed directly to the cardiologist for just-in-time advice. Following a 7 month cardiology pilot in 2009 the RACE model was implemented and expanded to family physicians across Vancouver Coastal Health Region.


      Data on uptake of service, number of calls, response time, length of call, reason for call, recommendations, avoided face-to-face consults and emergency department visits were collected. Evaluation included surveys and interviews involving FP users and interviews of cardiologists who were answering the calls.


      The pilot included 118 calls over 7 months from 60 different FPs for 97 different patients with 81% of the calls returned within 1 hour. Following expansion, 270 calls were made in 2011 to cardiology RACE. Eighty percent of calls were returned within 10 minutes and 90% of calls were <15 minutes in length. More than 50% of calls were related to medication management, 20% for advice on diagnostics and 20% for advice on therapeutics. Cardiologist's recommendations varied with medication recommendation the most common, followed by reassurance of FP plan and need for additional testing. Results show a self-reported 50% reduction in face-to-face consults and 24% reduction in Emergency Department visits. Interviews indicated unanimous user satisfaction among FPs and cardiologists. All users would use the service again and 95% would recommend use to their colleagues. FP users recognized RACE as a very user-friendly “decision support system” to improve clinical judgments, receive medical education, and enhance overall practice efficiencies. Cardiologists reported that RACE is a necessary initiative that is helpful to FPs and has a positive impact on patient care.


      RACE addressed critical challenges faced between cardiologists and FPs with respect to collaboration and improved access to cardiology expertise. Data indicated RACE was viewed as a model that reduces costs by avoiding unnecessary emergency department visits and face-to-face consultation, supports FPs, and utilizes cardiology services more appropriately. The simplicity of RACE makes it a model for shared care that can be spread to other areas and tailored to the local context.