Posted on Aug 31, 2021
Specialists and family physicians alike have long advocated for a more timely referral process for patients waiting to access speciality consult and care. When faced with long wait times for diagnosis and treatment, patients can experience increased anxiety, pain and a risk of worsening health.
In 2018, to support specialist-led change, the SSC launched the Enhancing Access Initiative (EAI). The goal of the program is to improve patient access to specialist consult and care in BC, by providing funding and support to groups of interested specialists to implement Single Entry Models (i.e. central intake/pooled referral).
The patient is referred to a group of specialists practicing the same specialization, and who have agreed to collectively manage and coordinate referrals. The patient has the option to see the first available specialist appropriate for their health concern in the ‘pool,’ or to wait for a specific specialist of their choosing. If they choose to see the first available and one specialist in the pool is at full capacity, the patient will flow to another. This balances the physician workload and shortens the time for the patient to receive a specialist consult.
“It definitely has improved our productivity,” said one specialist involved. Another noted, “Effectively, it has balanced the waitlists of the surgeons.”
In March of 2021, the EAI underwent its first formal evaluation to examine the impact of the program on patients, specialists, and referring providers as well as to provide insights and areas for improvement. This was completed by interviewing physicians, MOAs and Project Managers from two of the three cohorts undertaking this work as well as referring providers within the province. Information gathered from Ministry of Health databases and individual specialist electronic health records was also used to inform the evaluation.
How is the program making a difference to BC’s health care system? The evaluation showed that encouraging progress was made to strengthen the referral system as a result of changing to a single entry model. Notably, specialist groups who had completed their projects through their participation in the EAI showed a decrease of Wait 1 times by an average of 69% or 75 days.
Additional findings included improved provider experiences among specialists. Specialists reported positive impacts stemming from the completeness and appropriateness of referrals, communication, collaboration, and collegiality with other specialists and referring providers; reduced multiple referrals on behalf of a single patient; more appropriate triaging; and reduced financial risk concerns.
Improved experiences were also reported among referring providers, who were generally supportive of the pooled referral model. Additionally, several potential reductions in per capita costs were noted, including improved efficiencies gained from appropriate and more complete referral information; reduced duplication of appointments; and the migration to a common electronic medical record (EMR).
The EAI evaluation also looked at the potential for sustainability and spread; and finally, system level impacts – which were ‘yet to be realized.’
Overall, the EAI program was found to be making progress towards achieving its intended goal of helping specialists improve patient access to their services through the implementation of single entry models. The evaluation’s findings and recommendations will be reviewed to further consider the cost-effectiveness, sustainability, and spread of the EAI program.
The Enhancing Access Initiative is a program of the Specialist Services Committee, one of four joint collaborative committees that represent a partnership of the Government of BC and Doctors of BC.
Initiative
Enhancing Access Initiative
