Priority-setting tools for improving access to medical specialists

Poster Presentation, 6th Health Technology Assessment International Annual Meeting, Singapore, 2009, Annals, Academy of Medicine, Singapore 38, S78

T Noseworthy (1), C De Coster (1) & R Naden (2)
(1) University of Calgary, Canada, (2) New Zealand Health Ministry, New Zealand

Background: While access to surgery and associated long waiting times occupy the attention of policy makers and the public, access to medical specialties is no less challenging and long waiting times are the norm in Canada. We collaborated to improve access to four specialties, each of which had a triage system, single point of entry and a high urgency clinic.

Purpose: To formulate and test standardised referral tools for use by primary care providers for improving access to Rheumatology, Nephrology, Geriatrics and Gastroenterology.

Methods: Clinical panels were assembled in each specialty consisting of five specialists of academic/community balance. Additionally three to five family physicians and one nursepractitioner were included in the deliberative process lasting 4 to 5 days, in two to three meetings. Case scenarios (25 to 33), drawn from referral letters, were developed for each panel. A comprehensive literature review preceded the deliberative process and informed it of any existing scores or prioritysetting tools. In a highly iterative, facilitated process, clinicians discussed cases and developed a wide set of elements indicative of urgency and reason for referral. These divergent elements were coalesced into mutually exclusive criteria (6 to 8/ tool), each with two or more levels, broadly representing current state of patient, threat of disease progression and potential for benefit. Using pair-wise comparisons and discrete choice simulation software (1000minds®) weights were developed for all criteria/levels leading to a 100-point score, the highest scores representing most urgent need for referral. Tools are at various stages of testing for inter- and intra-rater reliability and validity by the four specialties and family physicians.

Summary: Priority Referral Scores for rating relative urgency for referral from primary care providers to Rheumatology, Nephrology, Geriatrics and Gastroenterology are formulated and are being tested and implemented as a means of improving access from primary care providers to medical specialists.