scholarly journals Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study (Preprint)

2019 ◽  
Author(s):  
Véronique Nabelsi ◽  
Annabelle Lévesque-Chouinard ◽  
Clare Liddy ◽  
Maxine Dumas Pilon
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Rural Communities ◽  
Social Services ◽  
Primary Care Providers ◽  
Referral Process ◽  
Care Providers ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Electronic Consultation

BACKGROUND Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. OBJECTIVE The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). METHODS We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. RESULTS For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. CONCLUSIONS The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority.

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 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 ADVANCE CARE PLANNING COMMUNICATION: AN INTERACTIVE WORKSHOP WITH ROLE-PLAY FOR STUDENTS AND PRIMARY CLINICIANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S846-S846
Author(s):  
Ben A Blomberg ◽  
Catherine Quintana ◽  
Jingwen Hua ◽  
Leslie Hargis-Fuller ◽  
Jeff Laux ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Advance Care Planning ◽  
Role Play ◽  
Primary Care Providers ◽  
Care Planning ◽  
Care Providers ◽  
Clinician Training ◽  
Primary Care Clinics ◽  
Advance Care

Abstract There is a need for increased clinician training on advance care planning (ACP). Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication. There is evidence that multimodality curricula are effective in teaching ACP, and may be simultaneously targeted to trainees and practicing clinicians with success. We developed a 3-hour workshop incorporating lecture, patient-oriented decision aids, prognostication tools, small group discussion, and case-based role-play to communicate a values-based approach to ACP. Cases included discussion of care goals a patient with severe COPD and one with mild cognitive impairment. The workshop was delivered to 4th year medical students, then adapted in two primary care clinics. In the clinics, we added an interprofessional case applying ACP to management of dental pain in advanced dementia. We evaluated the workshops using pre-post surveys. 34 medical students and 14 primary care providers participated. Self-reported knowledge and comfort with ACP significantly improved; attitudes toward ACP were strongly positive both before and after. The workshop was well received. On a seven-point Likert scale, (1=Unacceptable, 7=Outstanding), the median overall rating was 6 (“Excellent”). In conclusion, we developed an ACP workshop applicable to both students and primary clinicians. We saw improvements in self-reported knowledge and comfort with ACP, though long-term effects were not studied. Participants found the role-play especially valuable. Most modifications for primary care clinics focused on duration rather than content. Future directions include expanding the interprofessional workshop content.

scholarly journals A Pilot Study Describing Knowledge and Practices in the Health Care of Men Who Have Sex With Men by U.S. Air Force Primary Care Providers

2013 ◽  
Vol 178 (2) ◽  
pp. e248-e254 ◽  
Author(s):  
Robert L. Tong ◽  
Jason Lane ◽  
Patrick McCleskey ◽  
Brian Montenegro ◽  
Katherine Mansalis
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Pilot Study ◽  
Air Force ◽  
Primary Care Providers ◽  
Care Providers ◽  
Sex With Men

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

2018 ◽  
Vol 18 (1) ◽  
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

scholarly journals Improving gout education from patients’ perspectives: a focus group study of Māori and Pākehā people with gout

2018 ◽  
Vol 10 (3) ◽  
pp. 194 ◽  
Author(s):  
Cassandra J. Rolston ◽  
Tamlin S. Conner ◽  
Lisa K. Stamp ◽  
Tia Neha ◽  
Suzanne Pitama ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Patient Education ◽  
Primary Care Providers ◽  
Care Providers ◽  
Multiple Sources ◽  
Focus Group Study ◽  
Face To Face ◽  
Gout Patient ◽  
Education Interventions

ABSTRACT INTRODUCTION Gout is a common form of arthritis that is typically managed in primary care. Gout management guidelines emphasise patient education for successful treatment outcomes, but there is limited literature about the educational experiences of people living with gout in New Zealand, particularly for Māori, who have higher gout prevalence and worse gout outcomes than Pākehā. AIM To explore gout patient education in primary care from the perspectives of Māori and Pākehā people with gout. METHODS In total, 69 people with gout were recruited through primary care providers in three locations across New Zealand. Nine semi-structured focus groups were run with Māori and Pākehā participants in separate groups. RESULTS Thematic analysis yielded two themes in relation to gout education: (i) ‘Multiple sources of gout education’; and (ii) ‘Gaps in gout knowledge’. Participants received education from general practitioners, educational resources, family and friends, and their own experiences. Māori participants preferred information to be kanohi-ki-te-kanohi (face-to-face) and with significant others present where necessary. Participants disclosed gaps in gout’s epidemiology and management. Pākehā and Māori participants reported limited understanding of the genetic basis of gout or the biological underpinnings of the condition and its treatments, but learned treatment adherence through experience. DISCUSSION Despite improved gout patient education, knowledge gaps remain and may contribute to poor medication adherence. Gout patient education interventions need to be tailored to culture and incorporate suitable methods of disseminating information about gout management.

Diagnosis of retinal detachments by a tele-ophthalmology screening program

2018 ◽  
Vol 25 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Sarah A McCord ◽  
Mary G Lynch ◽  
April Y Maa
Keyword(s):  
Primary Care ◽  
Screening Program ◽  
Medical Center ◽  
Case Reports ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Eye Care ◽  
Primary Care Clinics ◽  
The Usa

In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.

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.

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