Supporting earlier cancer diagnosis and efficient referral pathways in general practice
General Practice plays a key role in early cancer diagnosis both through improving uptake of cancer screening and through appropriate assessment of patients with symptoms suggestive of cancer. Victoria has very high rates of gastrointestinal endoscopic procedures, especially colonoscopy, which may be partly due to poor case selection in primary care. Currently certain regions in Victoria, including the Western district, have relatively poor cancer outcomes, and significant waiting times.
In response to this, Western Health developed a fast track referral pathway - Rapid Access for Gastrointestinal Endoscopy pathway (RAGE), to assist GPs with the urgent screening of high risk patients, and to promote the appropriate use of cancer diagnostic services in the public health care system, particularly GI endoscopy. An implementation project with The University of Melbourne was designed based on Prof Emery’s experience of leading the WA Improving Rural Cancer Outcomes trial.
The project included academic detailing visits to GP clinics by Cancer Council Victoria nurse educators, resource cards with symptom risk assessment tools and information on the RAGE pathway at Western Health. As part of the evaluation we conducted a comprehensive audit of GP uptake and outcomes of endoscopy procedures at Western Health sites for 21 months. The project demonstrated a statistically significant change over time in the proportion of GP referrals triaged as urgent but no changes in conversion rates suggesting improved selection of patients for urgent referral. This was consistent with a significant increase in the number of symptoms reported in GP referrals over time. There was a significant reduction in the waiting time for urgent colonoscopies.
The project has informed the Victorian implementation of the Optimal Care Pathways and the development of State guidelines for gastrointestinal endoscopy.
Positive indicators from the GPs uptake of RAGE and their acceptance of the academic detailing visits, has encouraged the expansion of the implementation model. The Victorian Department of Health and Human Services, Cancer Council Victoria, and The University of Melbourne, are collaborating on the implementation of the Optimal Care Pathways (OCPs) for specific tumour types into the primary care setting.
Implementing PAthways for Cancer Early Diagnosis (I-PACED), a multi-pronged education and training program, in collaboration with the North Western Melbourne Primary Health Network, aims to improve GPs awareness of prevention and early cancer detection and the current recommended care referral pathways. Following on from the RAGE project, comprehensive information sessions and resource packages on colorectal and lung tumour streams have been delivered to GPs in the North Western Melbourne. We are currently working with Cancer Council Victoria to develop new educational resources to implement the OCPs for prostate and oesophagogastric cancers.
Professor Jon Emery, Herman Professor of Primary Care Cancer Research
(RAGE & I-PACED ME) Mary Kyriakides
(RAGE & I-PACED) Natalie Appleby
(I-PACED) Merima Murathodzic
(RAGE) Associate Professor Alan Moss, Director of Endoscopic Services, Western Health
(RAGE & I-PACED) Department of Health and Human Services
(RAGE & I-PACED) Cancer Council Victoria – Dr Anna Boltong, Katherine Lane, Amber Kelaart, Claire Sutton, Robyn Tucker, Carole Arbuckle, Jeanne Potts
(RAGE & I-PACED) North Western Melbourne Primary Health Network