Many specialties use “primary care pathways” as a strategy to address high numbers of referrals and long wait times for patients with lower risk conditions, and to ensure that patients receive the care they need, right away, from their family physician. Pathways provide evidence-based guidance on assessment and care for patients without the need for specialist referral.

If a family physician refers a patient with a “pathway condition” to specialist care, the triage team assesses the referral. If there are no high risk symptoms and if the assessment/treatment recommendations in the pathway have not already been tried, the referral is closed and returned back to the family physician for management in line with pathway recommendations. Patients can be re-referred if high risk symptoms develop or if the pathway does not address the patient’s symptoms.Primary care pathways have been used in digestive health for years.

Recent evaluations show that there are some challenges with patient care and experience:
– Approximately 50% of patients do not receive timely follow-up from their family physician after the referral is closed
– Patients are concerned they will not get the right care from their family physician
– Family physicians face barriers in delivering pathway-based care (e.g. time to promote self-management, lack of education resources, limited multi-disciplinary team support)
– Many patients use emergency departments and access endoscopy even after their referrals are assessed as low risk and closed. Further analysis is required, but data suggests that this is often not warranted.

Our team is applying for five-year grant funding from the Canadian Institutes of Health Research (CIHR) to study and address these issues with patient care and experience. We are seeing patient partners to join our research team and offer the patient perspective and insights to the grant application process (October -November 2022).

If the application is successful, patient partners can expect to collaborate on all phases of the project from planning to implementation, evaluation and knowledge translation and dissemination of the results. One area that will particularly benefit from patient partner insight and perspective is designed and leading the implementation of the qualitative evaluation of patient experience (survey/interviews/focus groups).

During the grant development phase, virtual meetings will be held ~weekly for one hour.

If the grant is funded the start date would be Spring 2023. The research team, including the patient partners, will co-develop a structure (i.e. TOR) for planning and governance that includes a meeting schedule. It is anticipated that meetings will occur more frequently during the planning stage and most likely reduce to quarterly once the project is underway. Most meetings will be virtual with the potential for periodic in-person meetings.

There is no compensation available for the grant development phase.

If the grant is funded, an honorarium will be offered. Any direct expenses for in-person meetings will be reimbursed.