Direct access to specialist care at UCalgary Shoulder Clinic

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.

Of course he needed medical attention, specialist care specifically, and he knows now that time was of the essence. If a pectoralis major tendon repair is not performed in a timely fashion, tendon and muscles begin to scar and shorten and restoring arm function is less successful.

McEwen found his way to the University of Calgary’s Sport Medicine Centre in the Faculty of Kinesiology and was referred for surgery, where his tendon was reattached to his humerus bone. Today, his arm is strong.

But he saw how easily things could have gone differently. He saw the ways in which just one wrong turn, one slight misdirect might have delayed the medical attention he needed. With clarity he saw the importance of direct access to specialist care. 

It’s what motivated him to take part in the Sport Medicine Centre’s newly launched Shoulder Care Access Project (SCAP) Clinic, where he now serves as a patient researcher.

“I think people often feel helpless in these situations,” says McEwen, 35. “We have this very complicated system with a ton of qualified professionals who want the best outcome for patients, but there’s so many disconnects in communication which make it difficult to access the appropriate resources. It’s a huge problem.”

But it’s a problem for which the SCAP Clinic may have a solution, offering patients the opportunity to connect directly with specialists, without needing the usual referrals from other healthcare providers.

The clinic employs a web-based self-referral questionnaire to gather information on a patient’s shoulder pain and injuries prior to a visit.

“We’ve created a new and far more efficient avenue for patients to access shoulder care,” explains Dr. Nick Mohtadi, MD, clinical professor in the Cumming School of Medicine’s Department of Surgery and an adjunct professor in the Faculty of Kinesiology who leads the initiative. “For at least two-thirds of our patients, we know what we’re dealing with before they even walk into the clinic. We can then manage them effectively and move them down whichever path is appropriate. All with a 15-minute questionnaire.

“It’s brilliantly simple.”

Along with the significant benefits it offers patients, SCAP is also an important research initiative led by Mohtadi with an aim to study and evaluate this innovative care pathway.

A large grant from the Institute for Improved Health Outcomes and additional philanthropic support has provided the funding for the project.

Mohtadi says SCAP is a “logical extension” of the Acute Knee Injury Clinic (AKIC) which he established 15 years ago. Similarly housed in the Sport Medicine Centre, AKIC also uses a web-screening questionnaire which helps to prioritize clinic visits, diagnose patients, and provide direct access to specialist care.

AKIC has been a great success. 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.

“So many cost savings have been realized,” says Mohtadi. “These include reducing the need for emergency room visits, a significant reduction in the use of expensive MRIs, and a decrease in the total number of patient visits.”

Mohtadi believes that the AKIC model of care could also benefit patients with shoulder injuries. “The basis of both programs is self-referral access, and access is probably the number one concern in our health-care system,” he says.

Mohtadi notes that clearing the path to surgery is not the SCAP Clinic’s primary goal. “We know that 75 per cent of patients with rotator cuff tears, which is very common, will not require surgery.”

Indeed, shoulder injuries vary greatly in severity from dislocations and fractures to instability, inflammation and minor to major tissue tears. They may occur from a fall, everyday wear and tear, or overuse. They can be sport related or simply the toll of aging. Sometimes a bad sleep on an uncomfortably bent arm will cause problems.

Treatments at the clinic may include such avenues as physiotherapy, injections, home exercise programs, or referrals to other specialists.

McEwen believes that the SCAP Clinic will do for shoulder patients what AKIC has done for so many Calgarians with knee injuries.

As he’s seen firsthand, with so many resources available to treat shoulder pain and injuries, finding the right help can sometimes be a challenge. The SCAP Clinic may illuminate the path offering patients a customized diagnosis and treatment plan.

“Sometimes people with shoulder injuries just need to be pointed in the right direction for treatment,” says McEwen. “The SCAP Clinic offers a pathway which can streamline that process.”