Table 3.

Local provider factors challenging continuity of care

Challenges to continuity	Case scenario	Potential solutions
Closure of local hospitals	Family doctor not able to provide acute care or visit patient in hospital	Co-ordinators required to ensure proper transfer of information to and from tertiary centres
Communication breakdown	Confusion about whom to call in case concerns and complications	Develop standards or procedures for communication to and from tertiary centres
		Communication of most responsible provider
Turnover of physicians and nurses in local Centres	Locum physicians	Access to electronic health records for medical history
Lack of understanding of medication rationale	Lack of personnel or time for patient education	Provide resources for education in transfer
		Provide internet access to central medication list
		Provide access to central pharmacy
Disagreement with treatment recommended by regional providers	Lack of familiarity with evidence for warfarin therapy	Provide guidelines on which treatment decisions are based in transfer documentation
		Telephone contact for discussion between local providers and consultants