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

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 42-42 ◽  
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.

scholarly journals eConsultations to Infectious Disease Specialists: Questions Asked and Impact on Primary Care Providers’ Behavior

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Ruchi Murthy ◽  
Gregory Rose ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Erin Keely
Keyword(s):  
Infectious Disease ◽  
Primary Care ◽  
Infectious Diseases ◽  
Primary Care Providers ◽  
Clinical Test ◽  
Care Providers ◽  
Face To Face ◽  
Course Of Action ◽  
Timely Access ◽  
Infectious Disease Specialists

Abstract Background Since 2010, the Champlain BASE (Building Access to Specialist Advice through eConsultation) has allowed primary care providers (PCPs) to submit clinical questions to specialists through a secure web service. The study objectives are to describe questions asked to Infectious Diseases specialists through eConsultation and assess impact on physician behaviors. Methods eConsults completed through the Champlain BASE service from April 15, 2013 to January 29, 2015 were characterized by the type of question asked and infectious disease content. Usage data and PCP responses to a closeout survey were analyzed to determine eConsult response time, change in referral plans, and change in planned course of action. Results Of the 224 infectious diseases eConsults, the most common question types were as follows: interpretation of a clinical test 18.0% (41), general management 16.5 % (37), and indications/goals of treating a particular condition 16.5% (37). The most frequently consulted infectious diseases were as follows: tuberculosis 14.3% (32), Lyme disease 14.3% (32), and parasitology 12.9% (29). Within 24 hours, 63% of cases responded to the questions, and 82% of cases took under 15 minutes to complete. In 32% of cases, a face-to-face referral was originally planned by the PCP but was no longer needed. In 8% of cases, the PCP referred the patient despite originally not planning to make a referral. In 55% of cases, the PCP either received new information or changed their course of action. Conclusions An eConsult service provides PCPs with timely access to infectious disease specialists’ advice that often results in a change in plans for a face-to-face referral.

scholarly journals Evaluation of an electronic consultation service for transgender care

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.

scholarly journals The Influence of a Continuing Medical Education Campaign on New Strategies to Improve Appropriate Use of Antibiotics

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Brenda A. Bucklin ◽  
Ronald S. Gibbs ◽  
Carolyn Wieber ◽  
Leslie Myers
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Continuing Medical Education ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Dose Effect ◽  
Drug Resistant ◽  
Care Providers ◽  
Appropriate Use ◽  
Antibiotic Overuse

Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of drug-resistant infections. A continuing medical education (CME) campaign was used to improve antibiotic use among primary care providers. Methods. The Office of CME and Professional Development at the University of Colorado School of Medicine produces a semiannual, week-long course for primary care providers. A 2-year multifaceted CME campaign consisted of course content on antibiotic use, a practice audit, and two surveys to measure perceptions of the problem of antibiotic overuse, potential barriers to achieving appropriate use, and strategies to overcome barriers. Results. The overall response rate in the 2nd part of the campaign was 68.4%. Sixty-six percent of respondents had implemented at least one strategy to reduce antibiotic overuse. The rate was significantly higher among those who had attended previous reviews (81.0%) compared with those who had attended neither (54%, p=0.0002). However, there was no “dose effect” on the rate of implementing a new strategy. Conclusions. Overuse of antibiotic therapy has important public health implications. Results suggest that mixed interactive and didactic CME program was effective in increasing awareness of antibiotic overuse and strategies for reducing antibiotic administration.

scholarly journals Impact of a Provincial Asthma Guidelines Continuing Medical Education Project: The Ontario Asthma Plan of Action’s Provider Education in Asthma Care Project

2007 ◽  
Vol 14 (2) ◽  
pp. 111-117 ◽  
Author(s):  
M Diane Lougheed ◽  
Dilshad Moosa ◽  
Shelagh Finlayson ◽  
Wilma M Hopman ◽  
Mallory Quinn ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Education Program ◽  
Continuing Medical Education ◽  
Primary Care Providers ◽  
Action Plans ◽  
Care Providers ◽  
Asthma Care ◽  
Medical Education Program ◽  
Case Discussions

BACKGROUND: The Ontario Ministry of Health and Long-Term Care funded the Ontario Lung Association to develop and implement a continuing medical education program to promote implementation of the Canadian asthma guidelines in primary care.OBJECTIVES: To determine baseline knowledge, preferred learning format, satisfaction with the program and reported impact on practice patterns.METHODS: A 3 h workshop was developed that combined didactic presentations and small group case discussions. Outcome measures included a workshop evaluation, baseline assessment of asthma management knowledge and three-month postreflective evaluations.RESULTS: One hundred thirty-seven workshops were delivered to 2783 primary care providers (1313 physicians, 1470 allied health) between September 2002 and March 2005. Of the 2133 participants, 1007 physicians and 1126 allied health professionals submitted workshop evaluations. Most (98%) of the attendees indicated they would recommend the workshop to a colleague. The majority preferred the combination of didactic lecture plus interactive case discussions. A subset of physicians provided consent to use these data for research (n=298 pediatric and 288 adult needs assessments; n=349 postreflective evaluations). Important needs identified included appropriate medication for chronic asthma and development of written action plans. On the postreflective evaluations, 88.7% remained very satisfied, 95.5% reported increased confidence, 91.9% reported an influence on practice and 67.2% reported using a written action plan.CONCLUSIONS: This continuing medical education program addresses identified needs of primary care providers. Participants reported improvements in asthma care, including prescribing practices, use of spirometry and written action plans. Similar programs should be considered as part of multifaceted asthma guidelines dissemination and implementation initiatives in other provinces and nationally.

scholarly journals MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Carlos Herrero Berron ◽  
Carolina Lentisco ◽  
Aniana Oliet ◽  
Andrea Suso ◽  
Irene Onate Alonso ◽  
...  
Keyword(s):  
Primary Care ◽  
Response Time ◽  
Primary Care Providers ◽  
Care Providers ◽  
Median Response ◽  
Face To Face ◽  
Problem Resolution ◽  
Day Range ◽  
Electronic Consultation

Abstract Background and Aims Due to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit. Objective To analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital. Method Retrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up. Results Of 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult. Conclusion The eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.

scholarly journals Ask a neurologist

2018 ◽  
Vol 8 (3) ◽  
pp. 186-191 ◽  
Author(s):  
Ana C. Bradi ◽  
Lucian Sitwell ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Erin Keely
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Face To Face ◽  
Education Planning ◽  
Course Of Action ◽  
Rapid Responses ◽  
Timely Access ◽  
Symptom Interpretation ◽  
Time Required

BackgroundAccess to neurology consultation is limited by high demand and urgency of the presentation. Champlain BASETM (Building Access to Specialists through eConsultation) (eConsult service) aims to increase access through direct communication between primary care providers (PCPs) and specialists. Rapid responses to PCP questions can guide management and sometimes relieve the need for a formal consultation. We reviewed which topics were frequently addressed, the types of questions asked, and the effect on primary care for the patient.MethodsThis is a retrospective review of 387 consecutive questions submitted to the Champlain BASETM service between May 2011 and January 2015 and the data generated from routine use and PCP exit surveys. Questions were categorized by topic and type and analyzed quantitatively. This included time required to answer each question and effect on plans for traditional referral and clinical course of action.ResultsThe top 5 topics were headache (17%), incidental imaging findings (11%), numbness/tingling (11%), seizure (9%), and cerebrovascular disease (CVD) (9%). Fifty-one percent were related to diagnosis (choice of test, imaging interpretation, symptom interpretation), 23% to drug treatment (choice, adverse effects, prescribing instructions), and 17% to management (general, need for referral). Eighty-eight percent of questions took less than 10 minutes of specialist time to answer, and 80% were answered within 1 day. eConsults decreased face-to-face referrals by 50%. In 54% of cases, the PCP received information for a new course of action.ConclusionsWe found that an eConsult service provides timely access to neurologists and can divert half of intended face-to-face consultations. The most common questions posed by PCPs regarded diagnosis and drug therapy for headaches, seizures, altered sensation, and CVD. eConsult services could provide guidance for continuing medical education planning in neurology.

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