Background: Cardiovascular disease is known to constitute a significant health concern in rural and remote regions, where access to cardiology specialist services tends to be more limited relative to urban centres. The Thunder Bay Regional Health Sciences Centre (TBRHSC) On-Call Cardiology Support Service serves a geographically vast region across Northwestern Ontario. The objective of this study was to analyze the utilization of this service to identify the locations, determine the reason for consultation and the corresponding recommended interventions, and identify barriers to cardiology care in rural and remote areas. Methods: In this six-month prospective study, five cardiologists recorded data on calls received from rural and remote providers within the TBRHSC catchment area using a standardized survey completed during 24 h on-call shifts. Descriptive statistics were used to summarize call characteristics. Associations between variables were assessed using Fisher’s exact test, with post hoc pairwise comparisons performed for significant results. Multiple comparisons were controlled using the Benjamini–Hochberg correction, and a two-sided adjusted p-value of <0.05 was considered statistically significant. Results: A total of 206 survey responses reporting service utilization from 19 distinct locations across the region were collected. The most frequent findings included reasons for calls—chest pain, dyspnea, and atrial fibrillation; interventions—medical recommendations, general education, and transfer recommendations; and barriers—knowledge of personnel and physical tools and infrastructure. Significant transfer-related findings revealed that compared with other consultation reasons, heart block was 7.12 times more likely to require transfer (OR = 7.12, 95% CI = 1.91–29.45; 61.5% transferred), whereas atrial fibrillation was significantly less likely to require transfer (OR = 0.08, 95% CI = 0–0.54; 2.7% transferred; both adjusted p = 0.0195). Significant barrier-related findings revealed that chest pain consultations were 3.72 times more likely to be associated with infrastructure limitations (OR = 3.72, 95% CI = 1.83–7.66; adjusted p = 0.003). Conclusions: Understanding service utilization in this context provides valuable insights that can be used to inform educational initiatives, improve diagnostic access, develop standardized transfer pathways, and create opportunities for leadership to drive initiatives and system planning across the region, ultimately improving patient care and support for rural physicians. Hopefully, this study can serve as a framework for evaluating and optimizing on-call service utilization, supporting its replication across other regions and specialty services to improve care delivery and resource planning.
Author Contributions
Conceptualization, J.A.-A. and P.S.; methodology, J.A.-A., P.S. and K.T.; software, K.T.; validation, J.A.-A., P.S. and K.T.; formal analysis, J.A.-A., P.S. and K.T.; investigation, P.S.; resources, J.A.-A.; data curation, K.T.; writing—original draft preparation, J.A.-A., P.S. and K.T.; writing—review and editing, J.A.-A., P.S. and K.T.; visualization, P.S. and K.T.; supervision, J.A.-A.; project administration, J.A.-A. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Ethical review and approval were waived by the Research Ethics and Authorization Review Board at the Thunder Bay Regional Health Science Centre because this project falls under TCPS2 2022 Article 2.5, as a quality improvement activity; therefore, it does not fall under the jurisdiction of REB review.
Informed Consent Statement
Patient consent was waived as the study involved a quality improvement evaluation of de-identified service utilization data, with no direct patient information collected.
Data Availability Statement
The data presented in this study are not publicly available due to institutional privacy and ethical restrictions related to clinical service data. This information may be available from the corresponding author upon reasonable request and with appropriate approval.
Conflicts of Interest
The authors declare no conflicts of interest.
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