A new shoulder clinic at the University of Calgary aims to give patients with pain or injuries the opportunity to connect directly with specialists more efficiently and cut out red tape to fast-track access to care.
The recently launched Shoulder Care Access Project Clinic (SCAP) in the Faculty of Kinesiology’s Sport Medicine Centre requires no referral from health-care providers, but instead employs a web-based self-referral questionnaire prior to a visit.
The initiative, led by Dr. Nick Mohtadi, seeks to use information from the questionnaires for research purposes and evaluate more innovative and efficient care pathways offered by the Shoulder Clinic.
“So, we’ve created an opportunity for patients to bypass parts of the system, rather than going through the usual process, which tends to be very circuitous, slow and sometimes ineffective. It’s a new and far more efficient avenue for patients to access care,” he said.
The usual process involves what Mohtadi calls “red tape,” in which referrals from health-care providers can cost hundreds or thousands of dollars.
He says that many patients in Alberta are referred to see a shoulder surgeon for their pain, but wait times can be long and most injuries or shoulder problem don’t require surgery in the first place.
“We know that 75 per cent of patients with rotator cuff tears, which is very common, will not require surgery, so many cost savings can be realized,” Mohtadi said.
“If you injure your shoulder and go to the emergency room, and it isn’t really an emergency, then the cost to the taxpayer is twice what it would be if you engaged with our clinic.”
He adds that multiple referrals and wait times also tax the system.
“If you go to a general practitioner, be it your family doctor or a walk-in clinic, they have to know where to send you and there are many possible avenues and specialists. These can run the gamut from physiotherapists and chiropractors to orthopedic surgeons.”
Mohtadi’s aim is instead to research and evaluate more innovative care pathways offered by the Shoulder Clinic, which include physiotherapy programs and regular examinations to manage pain.
The initiative has largely been funded through philanthropic support, significantly a $55K donation from the Alberta Bone and Joint Health Institute.
The Shoulder Clinic is modeled after the successes of the Acute Knee Injury Clinic (AKIC), also started by Mohtadi, which similarly takes the online screening, self-referral approach.
Since its 2010 launch, the knee clinic has seen over 25,000 patients. Less than one third of those required a referral to a surgeon. Research conducted on 8,404 knee patients identified 2,210 with a confirmed diagnosis of an Anterior Cruciate Ligament (ACL) tear in their knee. About 85 per cent of those patients were diagnosed using only web-based information.
“The basis of both programs is self-referral access, and access is probably the number one concern in our health-care system.”
Patient with injured shoulder advocates for faster care
Alex McEwen will never forget the unnerving snap he heard mid bench press as the major tendon connecting his pectoralis muscle to his right shoulder tore away from the bone completely.
He felt his arm buckle before his training partner took control of the bar, loaded with over 325 pounds.
“I just heard a loud snap and felt my arm buckle, and it was pretty clear in that moment something had either torn or broken.”
An immediate trip to a hospital emergency room confirmed that McEwen had indeed sustained a shoulder injury, but the busy doctor on staff couldn’t be sure about the extent of the damage.
McEwen was sent home with a requisition form to book an ultrasound, which he learned later would not provide conclusive evidence.
A friend in the health-care community recommended a private MRI and, fortunately, he had the funds to pay for the service, which cost around $650.
Had he not, McEwen says it’s likely he would have been stuck on a waiting list for several months.
His friend also directed him to the U of C’s Sports Medicine Centre in the Faculty of Kinesiology, where it was determined he needed surgery to reattach the tendon to the humerus bone, which he underwent three weeks later.
“If it wasn’t repaired within about a month, it could have been irreparable,” McEwen said. “So time was of the essence.”
Two years later, McEwen’s arm is now much stronger, but he says things could have gone differently if he hadn’t had the resources, connections and wherewithal to navigate through the health-care system himself.
“You feel helpless,” he said. “You certainly feel lost, because most people don’t have to navigate the health care system until there’s a crisis and so initiatives like this are needed.”
“Having access to a system where you can clearly identify with a certain degree of accuracy, the severity of your injury and then gain access to specialists if needed, is a game changer, especially if it can be done online within 15 minutes. It’s revolutionary when it comes to these types of injuries.”
12 to 18 months wait
Jeff McDougall had been attending the University of Calgary’s Sport Medicine Centre for physio appointments, but recently learned his referral for shoulder surgery was just received about a week ago.
“I phone this new shoulder clinic, they told me they have my referral – which is great – but that I should expect to get a call back to receive surgery within the next 12 to 18 months,” he said.
“It’s a frustrating experience for sure. I had been trying to a get a referral already for around a year and now, and it’s going to take a least another year until I can actually speak to somebody about it.”
McDougall suffered a torn rotator cuff and potentially a ruptured ligament in his shoulder.
“There’s no physio for it, it just needs repair,” he said. “If I try to lift it or move it the wrong way, I can’t. I have no mobility and I can’t move my arm very high.”
“I’m happy to be waiting versus not waiting, but I wish I knew what the answer was. I don’t know what the answer is to reduce wait times, I’d just sure like to get my shoulder fixed. I’d like to sleep through the night without having to wake up with shoulder pain. A good night sleep would be amazing.”
McDougall says a doctor from the Shoulder Clinic at U of C will be able to look at his shoulder in about a year’s time when he’s eligible for surgery.
“I have a referral, but I just can’t tell you if this new imitative at the University of Calgary will expedite the process.”
CTV News has reached out to the province regarding long wait times for shoulder surgeries and ways to provide faster care for patients in debilitating pain, but a response has not been received.
