A16 SUCCESS OF ENHANCED PRIMARY CARE PATHWAYS IN MANAGING ROUTINE GI REFERRALS.

GI Central Access and Triage in Calgary is a single point of entry for referrals. As in most Canadian centres, there has been a sharp increase in demand for GI consultation services resulting in prolonged wait times, especially for non-urgent referrals. In order to address this care gap (currently >24 months), evidence-based Enhanced Primary Care Pathways (EPCPs) were developed as a unique collaboration between the GI Division and Primary Care Network leaders in the Calgary Zone in an effort to provide optimized care in the medical home without a one-on-one GI consultation. EPCPs were developed for GERD, dyspepsia, chronic constipation, IBS and refractory H. pylori. A phased launch was conducted with the GERD and dyspepsia pathways implemented first. Specific criteria were developed to guide which patients were suitable for these pathways. If an EPCP was enacted, a formal GI consultation visit was not planned, however, a dedicated telephone hotline (GI Specialist Link) was simultaneously launched to provide access to a GI specialist for management advice during business hours. These patients were tracked prospectively in a database for future health system encounters. As part of the EPCP, if the suggested management failed or there was a change in symptomatology, re-referral to GI was prompted. From January 2015-June 2016, 667 cases were triaged to an EPCP thus the referral was sent back for management in the medical home. Over this time period, 54 EPCP patients (7.9%) had an emergency room visit in the Calgary zone. Of the 667 EPCP patients, the re-referral rate to GI was 9.6% (64 cases). The reasons for re-entry back into the system are shown in Table 1. All 64 patients went on to have an endoscopic procedure (EGD=47, colonoscopy=17). Forty-one of the 64 endoscopies (64%) were reported as normal. Significant findings included esophagitis (n=7), non-dysplastic Barrett’s esophagus (n=3) and moderate left-sided ulcerative colitis (n=1). No malignancies were detected. The majority of non-urgent GI referrals were successfully managed in a primary care setting using EPCPs thus providing an alternative to traditional queue-based GI consultations. This process has served as a template for other specialty groups in Calgary looking to address similar care gaps. Future plans include physician/patient satisfaction surveys and focus groups to determine if any additional supports are needed to aid the medical homes in caring for these patients. Reasons for re-referral to GI after EPCP pathway enacted (n=64) None

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