Ask the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system

Introduction The Champlain BASE (Building Access to Specialists through eConsultation) eConsultation service was designed to address the limited access to specialist care in Canada, which can lead to long waiting times and, subsequently, negative patient outcomes. Our primary objective was to perform an in-depth analysis of the use, content, and perceived value of haematology electronic consults (eConsults) submitted by primary care providers (PCPs) to the eConsult service. Methods We conducted a cross-sectional study using descriptive statistics to examine post-eConsult surveys for PCPs and other collected data including PCP designation, time for specialist to complete the eConsult, specialist response time, perceived value of the eConsult by the PCP, and the need for a face-to-face referral following the eConsult. A medically-trained author reviewed all haematology eConsults from April 2011 to January 2015, and categorized them by clinical topic and question type using validated taxonomies. Results Haematology accounted for 436 out of 5601 (7.8%) total eConsults, making it the third most popular service utilized. In 66% of haematology eConsults, a face-to-face consultation was not needed. Anaemia, neutropenia, and hyperferritinemia were the most common clinical queries. Most eConsult question types concerned the management of haematological disorders or the interpretation of laboratory tests. Most eConsults were answered within three days, using less than 15 minutes of the specialists’ time. PCPs highly valued the service. Discussion This initiative increases access to haematology care and has the potential to reduce the long waiting times for non-urgent traditional consultation, along with the benefit of cost savings to the healthcare system.

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Content, Utilization and Impact of a Hematology e-Consultation Service

Blood ◽

10.1182/blood.v126.23.42.42 ◽

2015 ◽

Vol 126 (23) ◽

pp. 42-42 ◽

Cited By ~ 1

Author(s):

Karima Khamisa ◽

Adam Fogel ◽

Clare Liddy ◽

Erin Keely ◽

Amir Afkham

Keyword(s):

Primary Care ◽

Medical Education ◽

Response Time ◽

Continuing Medical Education ◽

Primary Care Providers ◽

Care Providers ◽

Specialist Care ◽

Face To Face ◽

Course Of Action ◽

Clinical Content

Abstract Background Limited access to specialist care remains a major barrier to health care in Canada. The Champlain BASE (Building Access to Specialists through eConsultation) eConsult service is a secure web-based tool that gives primary care providers (PCPs) expedited access to specialist advice for their patients in Ontario, Canada. Hematology is the third most commonly consulted specialty in the eConsult service, accounting for 8% of all cases. The purpose of this study is to perform an in-depth analysis to describe the types of questions, content, utilization, and impact of hematology eConsults submitted by PCPs. Additionally, the results will inform future continuing medical education activities for PCPs. Methods All Hematology eConsults completed between April 1, 2011 and January 31, 2015 were included. We analyzed and categorized each consultation by: (1) clinical content (up to two per case) using a modification of the International Classification for Primary Care (ICPC-2); and (2) type of questions asked by the PCP based on a validated taxonomy. Other data including PCP designation, time for specialist to complete the eConsult, specialist response time, perceived value of the eConsult by the PCP, and the need for a face-to-face referral following the eConsult was collected in real time via the eConsult service and a survey completed by the initiating PCP at the closure of each eConsult. Results There were a total of 436 Hematology eConsults submitted, 87% from physicians and 13% from Nurse Practitioners. Most cases were answered within 3 days. The most common types of questions being asked pertained to management of hematologic disorders (25%), interpretation of a laboratory test (22%) and appropriate further investigative tests (18%). Common clinical content categories were anemia (22%), neutropenia (13%), high ferritin (11%), monoclonal gammopathy of undetermined significance or an abnormal protein electrophoresis (10%) and thrombocytopenia (10%). Two clinical content categories were included in 19% of cases. Self-reported response time by hematologists was under 10 minutes in >75% of cases. Over 66% of cases did not require a face-to-face visit with the specialist following an eConsult; in fact, in 46% of cases an unnecessary referral was avoided. In 4% of cases, a face-to-face consultation was initiated where one was not originally contemplated. PCPs gained new or additional advice for a course of action in 58% of eConsults, and were able to confirm their original course of action in 39% of cases. PCPs rated the value of the eConsult service as ≥4/5 for both themselves and patients in >90% of cases. Impact The hematology eConsult service has significantly increased access to specialist care in a timely manner compared to traditional face-to-face consultations. The service allowed a significant proportion of patients to avoid traditional consultations leading to the potential of cost savings and increased patient safety. Identifying the most common questions and content being asked via the eConsult service will allow for more informed continuing medical education programs for PCPs so that patients can be better served in the primary care setting. Disclosures Khamisa: Amgen: Speakers Bureau.

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SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2789 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1279.1-1279

Author(s):

Z. Rutter-Locher ◽

J. Galloway ◽

H. Lempp

Keyword(s):

Rheumatoid Arthritis ◽

Health Care ◽

Health Care Providers ◽

Unmet Need ◽

Primary Care Providers ◽

Sub Saharan Africa ◽

Care Providers ◽

Specialist Care ◽

Sub Saharan ◽

The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

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Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

Journal of Patient Experience ◽

10.1177/23743735211007700 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110077

Author(s):

Daliah Wachs ◽

Victoria Lorah ◽

Allison Boynton ◽

Amanda Hertzler ◽

Brandon Nichols ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Waiting Times ◽

Wait Time ◽

Primary Care Providers ◽

Wait Times ◽

Care Providers ◽

Female Physicians ◽

Online Ratings ◽

And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

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Primary Care of Opioid use Disorder: The End of “the French Model”?

European Addiction Research ◽

10.1159/000506630 ◽

2020 ◽

Vol 26 (6) ◽

pp. 346-354 ◽

Cited By ~ 1

Author(s):

Julie Dupouy ◽

Sandy Maumus-Robert ◽

Yohann Mansiaux ◽

Antoine Pariente ◽

Maryse Lapeyre-Mestre

Keyword(s):

Primary Care ◽

Private Practice ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Care Providers ◽

Opioid Use ◽

Access To Treatment ◽

Cross Sectional ◽

Number Of Patients ◽

French Model

Background: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. Objectives: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. Materials and Methods: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. Results: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. Conclusions: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

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Electronic Consultation Services Worldwide: Environmental Scan (Preprint)

10.2196/preprints.11112 ◽

2018 ◽

Author(s):

Justin Joschko ◽

Erin Keely ◽

Rachel Grant ◽

Isabella Moroz ◽

Matthew Graveline ◽

...

Keyword(s):

Health Care ◽

Literature Review ◽

Literature Search ◽

Primary Care Providers ◽

Care Providers ◽

Patient Anxiety ◽

Specialist Care ◽

Environmental Scan ◽

Gray Literature ◽

Electronic Consultation

BACKGROUND Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many health care systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists through a secure platform to facilitate discussion of patients’ care. OBJECTIVE This study aims to examine different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different health care contexts. METHODS We conducted an environmental scan comprising 3 stages as follows: literature review; gray literature search; and targeted, semistructured key informant interviews. We searched MEDLINE and EMBASE (literature review) and Google (gray literature search). Upon completing the search, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, physicians, and decision makers. The maximum variation sampling was used to ensure sufficient breadth of participant experience. In addition, we conducted semistructured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach. RESULTS A total of 53 services emerged from the published and gray literature. Respondents from 10 services participated in telephonic interviews. The following 4 major themes emerged from the analysis: service structure; benefits of eConsult; implementation challenges; and implementation enablers. CONCLUSIONS eConsult services have emerged in a variety of countries and health system contexts worldwide. Despite differences in structure, platform, and delivery of their services, respondents described similar barriers and enablers to the implementation and growth and reported improved access and high levels of satisfaction.

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Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

MDM Policy & Practice ◽

10.1177/2381468319868216 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831986821

Author(s):

Claire E. Kendall ◽

Janessa E. Porter ◽

Esther S. Shoemaker ◽

Rachel Seoyeon Kang ◽

Michael Fitzgerald ◽

...

Keyword(s):

At Risk ◽

Primary Care Providers ◽

Question Type ◽

Hiv Care ◽

People Living With Hiv ◽

Local Health ◽

Care Providers ◽

Patients At Risk ◽

Survey Responses ◽

Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

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Stressors Facing Home-Based Primary Care Providers

Geriatrics ◽

10.3390/geriatrics4010017 ◽

2019 ◽

Vol 4 (1) ◽

pp. 17 ◽

Cited By ~ 1

Author(s):

Katherine O’Brien ◽

Sara Bradley ◽

Vanessa Ramirez-Zohfeld ◽

Lee Lindquist

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

The United States ◽

Care Providers ◽

Cross Sectional ◽

Home Setting ◽

Caregiver Support ◽

Qualitative Survey ◽

Home Based Primary Care ◽

Home Based

The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.

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Contemporary perceptions of human papillomavirus and penile cancer: Perspectives from a national survey

Canadian Urological Association Journal ◽

10.5489/cuaj.5366 ◽

2018 ◽

Vol 13 (2) ◽

Author(s):

Michael E. Zavaski ◽

Julian Hanske ◽

Björn Löppenberg ◽

Alexander P. Cole ◽

Nawar Hanna ◽

...

Keyword(s):

Human Papillomavirus ◽

Race And Ethnicity ◽

Penile Cancer ◽

Preventive Measure ◽

Primary Care Providers ◽

Care Providers ◽

Cancer Knowledge ◽

Cross Sectional ◽

Health Insurance Status ◽

The U.S

Introduction: We aimed to assess the contemporary knowledge of human papillomavirus (HPV) and its association with penile cancer in a nationwide cohort from the U.S. Methods: We used the Health Information National Trends Survey (HINTS), a cross-sectional telephone survey performed in the U.S. initiated by the National Cancer Institute. The most recent iteration, HINTS 4 Cycle 4, was conducted in mail format between August 19 and November 17, 2014. Primary endpoints included knowledge of HPV and its causal relationship to penile cancer. Baseline characteristics included sex, age, education, race and ethnicity, income, residency, personal or family history of cancer, health insurance status, and internet use. Multivariable logistic regression assessed predictors of HPV and penile cancer knowledge. Results: An unweighted sample of 3376 respondents was extracted from the HINTS 4, Cycle 4. Whereas 64.4% of respondents had heard of HPV, only 29.5% of these were aware that it could cause penile cancer. Men were significantly less likely to have heard of HPV than women (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.24–0.43). Older age; African-American, Asian, and “other race”; being married; from a lower education bracket; having a personal cancer history; and those without internet access were significantly less likely to have heard of HPV. None of our examined variables were independent predictors for the knowledge of the association of penile cancer and HPV. Conclusions: Our analysis of a large, nationally representative survey demonstrates that the majority of the American public is familiar with HPV, but lack a meaningful understanding between this virus and penile cancer. Primary care providers and specialists should be encouraged to intensify counselling about this significant association as a primary preventive measure of this potentially fatal disease.

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Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare

BMC Health Services Research ◽

10.1186/s12913-019-4628-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Fabienne N. Jaeger ◽

Nicole Pellaud ◽

Bénédicte Laville ◽

Pierre Klauser

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Primary Care Providers ◽

Care Providers ◽

Key Factors ◽

Cross Sectional ◽

Interpreter Use ◽

Health Authorities ◽

Professional Interpreter ◽

Paediatric Primary Care

Abstract Background The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. Methods Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. Results 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. Conclusions Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.

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Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review

Medical Care Research and Review ◽

10.1177/1077558719888427 ◽

2019 ◽

Vol 77 (5) ◽

pp. 387-401 ◽

Cited By ~ 1

Author(s):

Cilgy M. Abraham ◽

Katherine Zheng ◽

Lusine Poghosyan

Keyword(s):

United States ◽

Primary Care ◽

Primary Care Providers ◽

The United States ◽

Organizational Level ◽

Care Practice ◽

Practice Environment ◽

Care Providers ◽

Cross Sectional ◽

Study Designs

Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute’s critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.

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