Evaluation of the Effects of the COVID-19 Pandemic on Electronic Consultation Use in Primary Care

Background: Headache is one of the most frequent complaints in primary care. We reviewed headache questions submitted to an electronic consultation service in Ontario to classify the types of headaches and describe the questions being asked. We also identified reasons why answers were not retrievable within UpToDate, an online clinical resource. Methods: 65 headache eConsults were further divided into 85 questions and categorized by headache type and question theme. Questions were manually searched within UpToDate to determine if they could be answered using this resource. The intent to refer the patient for a face-to-face referral after the eConsult was collected. Results: The top classifications were migraine, unclassified headache, and exertional and/or coital headache. The themes -identified were medication questions (41.7%), investigation questions (33.3%), clinical concerns despite normal neurologic exam and/or imaging (15.5%); and abnormal imaging findings (9.5%). Answers to 40.1% of the questions were not retrievable in UpToDate. The main reason for irretrievability was an unusual presentation. Only 33.8% of eConsults resulted in a face-to-face referral to a specialist. Conclusions: Although electronic resources may be useful in some cases, clinical nuances cannot be accounted for. By providing physicians with rapid access to specialists, eConsult services may obviate the need for formal, face-to-face referrals.

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Evaluation of an electronic consultation service in psychiatry for primary care providers

BMC Psychiatry ◽

10.1186/s12888-018-1701-3 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 7

Author(s):

Douglas Archibald ◽

Julia Stratton ◽

Clare Liddy ◽

Rachel E. Grant ◽

Douglas Green ◽

...

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Care Providers ◽

Consultation Service ◽

Electronic Consultation

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Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

JMIR Medical Informatics ◽

10.2196/13042 ◽

2019 ◽

Vol 7 (4) ◽

pp. e13042 ◽

Cited By ~ 23

Author(s):

Freda Mold ◽

Jane Hendy ◽

Yi-Ling Lai ◽

Simon de Lusignan

Keyword(s):

Systematic Review ◽

Primary Care ◽

Health Care ◽

The United States ◽

Care Staff ◽

Cochrane Library ◽

Small Scale ◽

Care Providers ◽

Long Term Conditions ◽

Electronic Consultation

Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

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Electronic Consultation Between Primary Care Providers and Radiologists

American Journal of Roentgenology ◽

10.2214/ajr.19.22270 ◽

2020 ◽

Vol 215 (4) ◽

pp. 929-933 ◽

Cited By ~ 1

Author(s):

Daniel Walker ◽

D. Blair Macdonald ◽

Carole Dennie ◽

Amir Afkham ◽

Clare Liddy ◽

...

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Care Providers ◽

Electronic Consultation

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Evaluation of an electronic consultation service for transgender care

BMC Family Practice ◽

10.1186/s12875-021-01401-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jatinderpreet Singh ◽

Allison Lou ◽

Michael Green ◽

Erin Keely ◽

Mary Greenaway ◽

...

Keyword(s):

Primary Care ◽

Response Time ◽

Access To Care ◽

Hormone Therapy ◽

Primary Care Providers ◽

Care Providers ◽

Face To Face ◽

Electronic Consultation ◽

Clinical Questions ◽

Insight Into

Abstract Background Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. Methods This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. Results The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. Conclusions This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.

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Electronic consultation impact from the primary care clinician perspective: Outcomes from a national sample

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18784416 ◽

2018 ◽

Vol 25 (8) ◽

pp. 493-498 ◽

Cited By ~ 5

Author(s):

J. Nwando Olayiwola ◽

Anna Potapov ◽

Alden Gordon ◽

Jaime Jurado ◽

Candy Magana ◽

...

Keyword(s):

Primary Care ◽

National Sample ◽

Care Plan ◽

Web Based ◽

Educational Value ◽

Educational Benefits ◽

Quadruple Aim ◽

Electronic Consultation ◽

Primary Care Clinicians ◽

Store And Forward

Introduction Electronic consultations (eConsults) provide asynchronous, store-and-forward communication between primary care clinicians (PCCs) and specialists using web-based platforms, electronic health records or mobile applications. eConsults have demonstrated benefits in many areas of the Quadruple Aim, including educational value for PCCs. In this study, we explored the connection between eConsults and the Quadruple Aim using a unique national dataset of PCC-reported eConsult outcomes. Methods We conducted a retrospective study analysing registry data from the RubiconMD electronic consultation platform used by PCCs in 34 US states. We analysed PCC-reported outcomes from eConsults that took place between March 2017 and January 2018. PCCs were asked to select one or more of the following options after each eConsult: improved care plan, educational, avoided unnecessary diagnostics/procedures, avoided referral altogether or to wrong specialty, or no effect. Results PCCs reported an outcome for 3872 eConsults. eConsults for dermatology, endocrinology, and haematology-oncology were most common. Over one in four PCCs reported that the eConsult avoided a referral altogether or to the wrong specialty (26.3%) and avoided unnecessary diagnostics/procedures (26.1%). In 75% of eConsults, PCCs reported an improved care plan. Fifty percent reported that the eConsult was educational. Discussion PCCs in diverse practice settings reported substantial benefits from eConsults. In over half of eConsults, PCCs reported that the eConsult avoided unnecessary diagnostics/procedures, avoided a referral altogether or avoided a referral to the wrong specialty. Findings suggest that eConsults demonstrate important educational benefits, but may also influence PCC decision-making in a way that yields tremendous cost-saving potential and improved patient experience.

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Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry

Journal of Medical Internet Research ◽

10.2196/jmir.7921 ◽

2017 ◽

Vol 19 (8) ◽

pp. e279 ◽

Cited By ~ 8

Author(s):

Margaret Lowenstein ◽

Olusinmi Bamgbose ◽

Nathaniel Gleason ◽

Mitchell D Feldman

Keyword(s):

Primary Care ◽

Descriptive Analysis ◽

Psychiatric Consultation ◽

Electronic Consultation

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eConsults and Learning Between Primary Care Providers and Specialists

Family Medicine ◽

10.22454/fammed.2019.407574 ◽

2019 ◽

Vol 51 (7) ◽

pp. 567-573 ◽

Cited By ~ 3

Author(s):

Clare Liddy ◽

Tala Abu-Hijleh ◽

Justin Joschko ◽

Douglas Archibald ◽

Erin Keely

Keyword(s):

Primary Care ◽

Qualitative Content Analysis ◽

Primary Care Providers ◽

Free Text ◽

Care Providers ◽

Specialist Care ◽

Educational Tools ◽

Educational Value ◽

Electronic Consultation ◽

Poor Access

Background and Objectives: Patients in many countries face poor access to specialist care. Electronic consultation (eConsult) improves access by allowing primary care providers (PCPs) and specialists to communicate electronically. As more countries adopt eConsult services, there has been growing interest in leveraging them as educational tools. Our study aimed to assess PCPs’ perspectives on eConsult’s ability to improve collegiality between providers and serve as an educational tool. Methods: We conducted a qualitative content analysis of free-text comments left by PCPs using the Champlain BASE eConsult service based in Eastern Ontario, Canada. All responses provided between January 1, 2015 and January 31, 2017 that mentioned education or collegiality were included. Results: PCPs completed 16,712 closeout surveys during the study period, of which 3,601 (22%) included free-text comments. Of these, 223 (6%) included references to education or collegiality. Three prominent themes emerged from the data: building provider relationships, teaching incorporated into answer, and prompting further learning. Conclusions: PCPs described eConsult’s ability to foster stronger relationships with specialists, deliver responses that provided teaching in multiple areas of their practice, and support further learning that extended beyond the case at hand and into their overall practice. The Champlain BASE eConsult service has educational value for providers. Further study is underway to explore how questions and replies submitted through eConsult can be used to facilitate reflective learning and promote feedback to providers.

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Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review (Preprint)

10.2196/preprints.13042 ◽

2018 ◽

Author(s):

Freda Mold ◽

Jane Hendy ◽

Yi-Ling Lai ◽

Simon de Lusignan

Keyword(s):

Systematic Review ◽

Primary Care ◽

Health Care ◽

The United States ◽

Care Staff ◽

Cochrane Library ◽

Small Scale ◽

Care Providers ◽

Long Term Conditions ◽

Electronic Consultation

BACKGROUND Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. OBJECTIVE This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. METHODS A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. RESULTS This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. CONCLUSIONS E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

Download Full-text