ACC GP MRI Service Background

ACC - GP MRI Service Background In 2017 ACC, Mercy Radiology, and ProCare (PHO) co-designed new pathways that give patients direct access to MRI referral for certain knee, shoulder and back (cervical and lumbar spine) injuries via their GP, instead of requiring referral to a specialist before an MRI can be ordered.

GPs have only been able to refer for a low-tech imaging X-ray or ultrasound but with this new pathway, GPs who attend training and become accredited can make direct referrals for high tech images (MRI scans) by following referral guidelines for knee, shoulder and back (cervical and lumbar spine) injuries covered by ACC. Currently, patients referred via traditional pathways requiring a specialist appointment for access to an MRI can wait up to 30 days for an appointment (Auckland average). By empowering GPs to request HTI and manage the results, patients can initiate treatment as much as two months faster than the current situation.

In 2021, ACC has contracted ProCare to utilise the same referral pathway in general practices across the regions nationally in partnership with Pinnacle Midlands Health Network. This new contract has been amended to reflect following changes: • •

Accreditation now at individual GP level (previously at practice level whereas one accredited GP enables the whole practice to use the pathway) Removal of shoulder option

Key messages • • • • • •

The objective is to streamline the patient journey by reducing waiting times from injury to definite diagnosis, enabling a quicker start to appropriate treatment, faster recovery and improved outcomes.

Clinical guidelines and audit and governance frameworks have been developed in a collaborative effort between orthopaedic surgeons, GPs, and radiologists.

There has been an upskill in primary care for management of musculoskeletal conditions involving active rehabilitation as an alternative to surgery.

The new referral pathways have been designed together with GPs, specialists, and radiologists.

The pathways are focused on user needs – primary care oriented clinical pathways for decision support with technology-enabled referrals and booking.

The pathways are focused on GP needs – supported navigator role, consult support, and practical education.

GPs are well placed to make the clinical decision on whether an HTI is required. They can then determine treatment plans more efficiently, whether that be active rehabilitation or referral to a specialist. This allows GPs to triage patients and ensure referrals to orthopaedic specialists are more informed and appropriate so that specialist time is focused on patients who are most in need. It strengthens relationships between primary care and specialists, integrating health providers to deliver the best outcome for patients.

Education Safety and quality are paramount in all new models of care and changes to referral practice.

Musculoskeletal injury assessment training and referral decision guidelines, focused on the most effective assessments for a busy general practice, are provided for participating GPs over two inperson sessions at night, supported by online training.

Referral decision guidelines have been developed with clinical input from GPs, radiologists, and specialists leveraging existing guidance across New Zealand and Australia. The programme is overseen by a steering group representing partner organisations with ongoing input from a clinical reference group. Referral patterns and outcomes are continuously monitored.

What GPs say about HTI referral Dr Thye Leow, Church Street Clinic, comments: “Where necessary, the ACC MRI Service has truly sped up the process of referral to specialists.

For example, a patient had an acutely locked knee and was discharged from a 24-hour clinic with a plan to ‘see your GP in a couple of weeks if not better’. Fortunately, the patient’s husband was prudent enough to bring her in to see us after the weekend. An x-ray was done straightaway to fulfil the criteria of referral for MRI. The MRI was done the very next day showing a bucket handle tear. The orthopaedic surgeon could see her very quickly rather than leaving her on the waiting list which could take up to a month.

Another benefit of the service is the annual training provided. It’s a good opportunity to refresh our skills on examining the musculoskeletal system and to share ideas with other GPs.” Dr Tony Moyle, Swanson Medical Centre, comments: “I would really support any widening of this service. It ultimately benefits the patients a great deal, through improved access, speed of referral, and importantly up-skilled GPs, via the training and accreditation. Every day we have to talk patients through the waiting process for secondary services.

I’ve found it very empowering to have acknowledgment of our skills and using them to the top of our scope. I think we are on the whole very mindful of resource allocation and don’t tend to over-order unnecessary tests. The audit/feedback cycle with this programme has been invaluable to further education. If only this sort of programme could be widened into other spheres of our practice.”

Research supports quality GP MRI referral The paper titled ‘Guidelines, training and quality assurance: influence on general practitioner MRI referral quality’ is has been published in the Journal of Primary Health Care.

To read this study visit : http://www.publish.csiro.au/HC/pdf/HC19034

In the media - references • •

NZ Doctor - IMAGEine that: National rollout next for GP imaging. April 2019. https://www.nzdoctor.co.nz/article/news/imageine-national-rollout-next-gp-imaging NZ Doctor – MRI referral project shows patients benefit when you teach docs new tricks. April 2018. https://www.nzdoctor.co.nz/article/print-archive/mri-referral-project-shows-patientsbenefit-when-you-teach-docs-new-tricks

OLD PATHWAY vs NEW PATHWAY