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Schneider T, Farrell B, Karunananthan S, Afkham A, Keely E, Liddy C, McCarthy LM. Classification system for primary care provider eConsults about medications for older adults with frailty. BMC Prim Care 2024; 25:104. [PMID: 38565981 PMCID: PMC10985926 DOI: 10.1186/s12875-024-02340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Providing primary care for people with frailty can be challenging due to an increased risk of adverse outcomes and use of potentially inappropriate medications which may exacerbate characteristics of frailty. eConsult is a service where primary care providers can receive timely specialist advice for their patients through a secure web-based application. We aimed to develop a classification system to characterize medication-focused eConsult questions for older adults with frailty and assess its usability. METHODS A classification system was developed and refined over three cycles of improvement through a cross-sectional study of 35 cases categorized as medication-focused from cases submitted in 2019 for patients aged 65 or older with frailty through the Champlain BASE eConsult service (Ontario, Canada). The final classification system was then applied to each case. RESULTS The classification system contains 5 sections: (1) case descriptives; (2) intent and type of question; (3) medication recommendations and additional information in the response; (4) medication classification; and (5) potentially inappropriate medications. Among the 35 medication-focused cases, the most common specialties consulted were endocrinology (9 cases, 26%) and cardiology (5 cases, 14%). Medication histories were available for 29 cases (83%). Many patients were prescribed potentially inappropriate medications based on explicit tools (AGS Beers Criteria®, STOPPFall, Anticholinergic Cognitive Burden Scale, ThinkCascades) yet few consults inquired about these medications. CONCLUSION A classification system to describe medication-related eConsult cases for patients experiencing frailty was developed and applied to 35 eConsult cases. It can be applied to more cases to identify professional development opportunities and enhancements for eConsult services.
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Affiliation(s)
- T Schneider
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - B Farrell
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - S Karunananthan
- Bruyère Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - A Afkham
- Ontario Health East, Ottawa, Canada
| | - E Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - C Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - L M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
- Bruyère Research Institute, Ottawa, Canada.
- School of Pharmacy, University of Waterloo, Waterloo, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada.
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Staykov E, Helmer-Smith M, Fung C, Tanuseputro P, Liddy C. Development of the electronic consultation long-term care utilization and savings estimator tool to model the potential impact of electronic consultation for residents living in long-term care. J Telemed Telecare 2024; 30:597-603. [PMID: 35073207 PMCID: PMC10988991 DOI: 10.1177/1357633x221074500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 02/21/2024]
Abstract
Ageing populations have resulted in more patients living in long-term care or nursing homes, where they face challenges to accessing prompt specialist care exacerbated in many cases by physical or cognitive decline. Electronic consultation has demonstrated an ability to improve access to specialist care for vulnerable groups and offers a potential solution to this gap in care. To support electronic consultation's uptake among long-term care homes, we created the electronic consultation long-term care utilization and savings estimator, an Excel-based tool that estimates the number of off-site appointments that patients in a long-term care home could avoid through electronic consultation, along with the consequent time and cost savings. In this brief report, we discuss the electronic consultation long-term care utilization and savings estimator's creation and function, and provide a case study using long-term care data to demonstrate its potential impact. We anticipate the electronic consultation long-term care utilization and savings estimator will be a highly impactful tool and intend to test it in real-world conditions following the relaxation of COVID-19 restrictions.
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Affiliation(s)
- Emiliyan Staykov
- Department of Biology, University of Ottawa, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Canada
- Ottawa Hospital Research Institute, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Canada
- Department of Family Medicine, University of Ottawa, Canada
| | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Canada
- St Patrick’s Home of Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Canada
- Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Canada
- Department of Family Medicine, University of Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
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Gill G, Zankar S, Goulet D, Liddy C, Afkham A, Keely E. Characterizing Types of Diabetes Clinical Questions and Answers Provided via eConsults. Can J Diabetes 2024:S1499-2671(24)00024-8. [PMID: 38290662 DOI: 10.1016/j.jcjd.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Gurleen Gill
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sarah Zankar
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danica Goulet
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Karunananthan S, Bonacci G, Fung C, Huang A, Robert B, McCutcheon T, Houghton D, Hakimjavadi R, Keely E, Liddy C. What do primary care providers want to know when caring for patients living with frailty? An analysis of eConsult communications between primary care providers and specialists. BMC Health Serv Res 2024; 24:76. [PMID: 38225619 PMCID: PMC10790473 DOI: 10.1186/s12913-024-10542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Frailty is a complex condition that primary care providers (PCPs) are managing in increasing numbers, yet there is no clear guidance or training for frailty care. OBJECTIVES The present study examined eConsult questions PCPs asked specialists about patients with frailty, the specialists' responses, and the impact of eConsult on the care of these patients. DESIGN Cross-sectional observational study. SETTING ChamplainBASE™ eConsult located in Eastern Ontario, Canada. PARTICIPANTS Sixty one eConsult cases closed by PCPs in 2019 that use the terms "frail" or "frailty" to describe patients 65 years of age or older. MEASUREMENTS The Taxonomy of Generic Clinical Questions (TGCQ) was used to classify PCP questions and the International Classification for Primary Care 3 (ICPC-3) was used to classify the clinical content of each eConsult. The impact of eConsult on patient care was measured by PCP responses to a mandatory survey. RESULTS PCPs most frequently directed their questions to cardiology (n = 7; 11%), gastroenterology (n = 7; 11%), and endocrinology (n = 6; 10%). Specialist answers most often pertained to medications (n = 63, 46%), recommendations for clinical investigation (n = 24, 17%), and diagnoses (n = 22, 16%). Specialist responses resulted in PCPs avoiding referral in 57% (n = 35) of cases whereas referrals were still required in 15% (n = 9) of cases. Specialists responded to eConsults in a median 1.11 days (IQR = 0.3-4.7), and 95% (n = 58) of cases received a response within 7 days. Specialists recorded a median of 15 min to respond (IQR = 10-20), with a median cost of $50.00 CAD (IQR = 33.33 - 66.66) per eConsult. CONCLUSIONS Through the analysis of questions and responses submitted to eConsult, this study provides novel information on PCP knowledge gaps and approaches to care for patients living with frailty. Furthermore, these analyses provide evidence that eConsult is a feasible and valuable tool for improving care for patients with frailty in primary care settings.
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Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, 200 Lees Ave #516F, Ottawa, ON, Canada.
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
| | | | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- St Patrick's Home of Ottawa, Ottawa, ON, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
| | - Allen Huang
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Benoit Robert
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care™, Ottawa, ON, Canada
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Deanne Houghton
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Ramtin Hakimjavadi
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
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Karunananthan S, Rahgozar A, Hakimjavadi R, Yan H, Dalsania KA, Bergman H, Ghose B, LaPlante J, McCutcheon T, McIsaac DI, Abbasgholizadeh Rahimi S, Sourial N, Thandi M, Wong ST, Liddy C. Use of Artificial Intelligence in the Identification and Management of Frailty: A Scoping Review Protocol. BMJ Open 2023; 13:e076918. [PMID: 38154888 PMCID: PMC10759108 DOI: 10.1136/bmjopen-2023-076918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to support the early identification and management of frailty. In order to provide a comprehensive overview of current evidence regarding the development and use of AI technologies including machine learning and deep learning for the identification and management of frailty, this protocol outlines a scoping review aiming to identify and present available information in this area. Specifically, this protocol describes a review that will focus on the clinical tools and frameworks used to assess frailty, the outcomes that have been evaluated and the involvement of knowledge users in the development, implementation and evaluation of AI methods and tools for frailty care in clinical settings. METHODS AND ANALYSIS This scoping review protocol details a systematic search of eight major academic databases, including Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ageline, Web of Science, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore using the framework developed by Arksey and O'Malley and enhanced by Levac et al and the Joanna Briggs Institute. The search strategy has been designed in consultation with a librarian. Two independent reviewers will screen titles and abstracts, followed by full texts, for eligibility and then chart the data using a piloted data charting form. Results will be collated and presented through a narrative summary, tables and figures. ETHICS AND DISSEMINATION Since this study is based on publicly available information, ethics approval is not required. Findings will be communicated with healthcare providers, caregivers, patients and research and health programme funders through peer-reviewed publications, presentations and an infographic. REGISTRATION DETAILS OSF Registries (https://doi.org/10.17605/OSF.IO/T54G8).
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Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Arya Rahgozar
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramtin Hakimjavadi
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hui Yan
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kunal A Dalsania
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bishwajit Ghose
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Québec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Manpreet Thandi
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Sethuram C, Brown W, Gill G, Liddy C, Afkham A, Keely E. Improving Access to Osteoporosis Specialists Using Electronic Consultations. Endocr Pract 2023; 29:955-959. [PMID: 37722596 DOI: 10.1016/j.eprac.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To identify the types of osteoporosis-related questions being asked by primary care providers (PCPs) and describe the impact of the advice provided by osteoporosis specialists using eConsult. METHODS We performed a cross-sectional study of osteoporosis-related eConsults submitted to endocrinologists between January 2018 and December 2020 on the Champlain eConsult BASE™ Service in Ontario, Canada. Each eConsult was coded according to clinical question and answer type through consensus between 2 authors, based on predetermined taxonomies. We analyzed eConsult utilization data, including response times, PCP satisfaction, and referral outcomes (collected via PCP surveys). RESULTS Of the 2,528 eConsults sent to endocrinologists during the study period, 408 (16%) were specific to osteoporosis. The most common questions asked by PCPs were regarding whether or not to start treatment (35%), the initial therapy choice (25%), and how often to complete bone mineral density scans (15%). The most common responses from specialists included recommendations for bone mineral density scanning (34%), recommendation to start therapy (24%), and recommendation to treat using a bisphosphonate without the dose specified (23%). The median response interval was 3.1 days. Most cases (84%) were resolved without requiring an in-person referral. Clear advice for a new course of action for PCPs to implement was provided in 54% of cases. CONCLUSION Osteoporosis eConsults provide timely access to valuable specialist advice while avoiding unnecessary face-to-face clinic visits. We identified commonly recurring osteoporosis questions asked by PCPs, which can be used to inform planning of future continuing professional development events.
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Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Warren Brown
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gurleen Gill
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Keely E, Guglani S, Mitchell E, Sethuram C, Afkham A, Liddy C. Specialists accessing specialty advice: Evaluating utilization, benefits, and impact of care of an e-consultation service. J Telemed Telecare 2023:1357633X231211352. [PMID: 37936407 DOI: 10.1177/1357633x231211352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The usual referral pathway is from a primary care provider (PCP) to a specialist; however, specialists also refer to and consult with other specialists. Electronic consultation (eConsult) allows clinicians to submit questions on behalf of patients to specialists to receive timely advice. Most eConsult studies in the past have examined questions asked from PCPs to specialists. This study investigates the utilization of specialists submitting clinical questions to other specialists through the Ontario eConsult Service and identifies use-case scenarios where specialist-to-specialist eConsult may be beneficial. METHODS A retrospective, descriptive, cross-sectional analysis of eConsults submitted by specialists through the Ontario eConsult Service for 24 months (March 2019 to February 2021). Utilization data is collected automatically by the service, including specialty referred to, time billed, region, and results from a closeout survey which includes the referral outcome of the eConsult and the utility to the submitting clinician. RESULTS 4% (n = 3285) of all eConsults sent within the study period were specialist-to-specialist, with the others being sent by a PCP. The number of specialist-to-specialist eConsults grew 120% following the onset of the COVID-19 pandemic. The top three specialties that submitted eConsults were pediatrics, internal medicine, and endocrinology. The top three specialties that specialists submitted to were dermatology, neurology, and hematology. A face-to-face referral was avoided in 69% of referrals. CONCLUSION Evaluating the utilization patterns of specialist-to-specialist eConsults allows us to better understand and expand the scope of eConsult services, which have traditionally been thought of as a workflow between a PCP and a specialist.
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Affiliation(s)
- Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheena Guglani
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- C.T. Lamont Primary Healthcare Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Erik Mitchell
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Claire Sethuram
- C.T. Lamont Primary Healthcare Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Clare Liddy
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- C.T. Lamont Primary Healthcare Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Breton M, Smithman MA, Lamoureux-Lamarche C, Keely E, Farrell G, Singer A, Dumas Pilon M, Bush PL, Nabelsi V, Gaboury I, Gagnon MP, Steele Gray C, Hudon C, Aubrey-Bassler K, Visca R, Côté-Boileau É, Gagnon J, Deslauriers V, Liddy C. Strategies used throughout the scaling-up process of eConsult - Multiple case study of four Canadian Provinces. Eval Program Plann 2023; 100:102329. [PMID: 37329836 DOI: 10.1016/j.evalprogplan.2023.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada. METHODS We conducted a multiple case study with four cases (ON, QC, MB, NL). Data collection methods included document review (n = 93), meeting observations (n = 65) and semi-structured interviews (n = 40). Each case was analyzed based on Milat's framework. RESULTS The first scaling-up phase was marked by the rigorous evaluation of eConsult pilot projects and the publication of over 90 scientific papers. In the second phase, provinces implemented provincial multi-stakeholder committees, institutionalized the evaluation, and produced documents detailing the scaling-up plan. During the third phase, efforts were made to lead proofs of concept, obtain the endorsement of national and provincial organizations, and mobilize alternate sources of funding. The last phase was mainly observed in Ontario, where the creation of a provincial governance structure and strategies were put in place to monitor the service and manage changes. CONCLUSIONS Various strategies need to be used throughout the scaling-up process. The process remains challenging and lengthy because health systems lack clear processes to support innovation scaling-up.
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Affiliation(s)
- Mylaine Breton
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada.
| | - Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | | | - Erin Keely
- Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gerard Farrell
- Department of Family Medicine, Memorial University, St-John, NFL, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Maxine Dumas Pilon
- Collège Québécois des Médecins de Famille, Family Medicine Center, St-Mary's Hospital, McGill University, Montréal, QC, Canada
| | - Paula Louise Bush
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | | | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Catherine Hudon
- Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Regina Visca
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Élizabeth Côté-Boileau
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | - Justin Gagnon
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Véronique Deslauriers
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, ON, Canada
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Kessler D, McCutcheon T, Rajachandrakumar R, Lees J, Deyell T, Levy M, Liddy C. Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review. Patient Educ Couns 2023; 115:107885. [PMID: 37473604 DOI: 10.1016/j.pec.2023.107885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs. METHODS A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team. RESULTS Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics. CONCLUSIONS Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs. PRACTICE IMPLICATIONS Including community members and service users in design and implementation may enhance CDSM program access.
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Affiliation(s)
- Dorothy Kessler
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jodie Lees
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Tracy Deyell
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Marisa Levy
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
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10
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Breton M, Lamoureux-Lamarche C, Smithman MA, Keely E, Pilon MD, Singer A, Farrell G, Bush PL, Hudon C, Cooper L, Nabelsi V, Côté-Boileau É, Gagnon J, Gaboury I, Gray CS, Gagnon MP, Visca R, Liddy C. Scaling-Up eConsult: Promising Strategies to Address Enabling Factors in Four Jurisdictions in Canada. Int J Health Policy Manag 2023; 12:7203. [PMID: 38618827 PMCID: PMC10590220 DOI: 10.34172/ijhpm.2023.7203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Effective healthcare innovations are often not scaled up beyond their initial local context. Lack of practical knowledge on how to move from local innovations to large-system improvement hinders innovation and learning capacity in health systems. Studying scale-up processes can lead to a better understanding of how to facilitate the scale-up of interventions. eConsult is a digital health innovation that aims to connect primary care professionals with specialists through an asynchronous electronic consultation. The recent implementation of eConsult in the public health systems of four Canadian jurisdictions provides a unique opportunity to identify different enabling strategies and related factors that promote the scaling up of eConsult across jurisdictions. METHODS We conducted a narrative case study in four Canadian provinces, Quebec, Ontario, Manitoba, and Newfoundland & Labrador, over a 3-year period (2018-2021). We observed provincial eConsult committee meetings (n=65) and national eConsult forums (n=3), and we reviewed internal documents (n=93). We conducted semi-structured interviews with key actors in each jurisdiction (eg, researchers, primary care professionals, specialists, policy-makers, and patient partners) (n=40). We conducted thematic analysis guided by the literature on factors and strategies used to scale up innovations. RESULTS We identified a total of 31 strategies related to six key enabling factors to scaling up eConsult, including: (1) multi-actor engagement; (2) relative advantage; (3) knowledge transfer; (4) strong evidence base; (5) physician leadership; and (6) resource acquisition (eg, human, material, and financial resources). More commonly used strategies, such as leveraging research infrastructure and bringing together various actors, were used to address multiple enabling factors. CONCLUSION Actors used various strategies to scale up eConsult within their respective contexts, and these helped address six key factors that seemed to be essential to the scale-up of eConsult.
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Affiliation(s)
- Mylaine Breton
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
| | | | - Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Maxine Dumas Pilon
- Collège québécois des médecins de famille, Family Medicine Center, St-Mary’s Hospital, McGill University, Montréal, QC, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MN, Canada
| | - Gerard Farrell
- Department of Family Medicine, Memorial University, St. John, NL, Canada
| | - Paula Louise Bush
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Catherine Hudon
- Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay, ON, Canada
| | - Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | | | - Justin Gagnon
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | | | - Regina Visca
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, ON, Canada
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11
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Lai AT, Keely E, McCutcheon T, Liddy C, Afkham A, Frost DW. A retrospective analysis of the use of electronic consultation in general internal medicine. Intern Med J 2023; 53:1642-1647. [PMID: 36308455 DOI: 10.1111/imj.15940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND General internists in Canada are subspecialty providers in the inpatient and outpatient settings. Electronic consultations (eConsult) allow primary care providers (PCPs) to virtually consult specialists to address clinical questions. There is a paucity of literature examining the utility and benefits of eConsults by general internists. AIMS To determine how an eConsult service is used to access general internists. METHODS A retrospective cross-sectional analysis of internal medicine cases was completed between 1 January 2016 and 31 December 2019 via the ChamplainBASE eConsult service. Two authors derived and validated a general internal medicine (GIM)-specific taxonomy using the validated: (i) Taxonomy of Generic Clinical Questions; and (ii) Internal Classification for Primary Care. Two hundred seventy-six cases were coded following taxonomy validation. ChamplainBASE utilisation summary and closeout survey data were also analysed. RESULTS eConsults were responded to in a median of 3.1 days and took 15 min to complete. The eConsult's helpfulness and educational value were rated as 4 to 5/5 and often provided advice for a new or additional course of action. In-person referral was avoided in 40% of cases. The majority of eConsults consisted of a single question (88%) related to diagnostic clarification. The median remuneration per eConsult was $50. CONCLUSIONS The majority of eConsults to general internists sought diagnostic clarification and confirmed the view of general internists as expert diagnosticians. eConsults cost less than an in-person consultation and were viewed favourably by PCPs. Further research can consider the eConsult provider experience and whether eConsults should become a required part of GIM ambulatory practice.
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Affiliation(s)
- Alison T Lai
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, Ottawa, Ontario, Canada
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Ontario eConsult Centre of Excellence, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Toronto, Ontario, Canada
| | - David W Frost
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
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12
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Walter G, Jeimy S, Liddy C, Guglani S, Ellis AK, Blair A, Kobayaa H, Chad Z, Keely E. Utility of eConsults for COVID-19 vaccine-related concerns in Ontario: a cross-sectional analysis. Allergy Asthma Clin Immunol 2023; 19:38. [PMID: 37143148 PMCID: PMC10158700 DOI: 10.1186/s13223-023-00789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored. METHODS We performed a cross-sectional descriptive analysis of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly sample of 499 total cases. Data regarding whether external resources were required to answer each eConsult, impact on primary care provider referral decisions, and allergy consultant response times were collected. A 2-question survey was completed by primary care providers following eConsultation and results were collected. RESULTS 41.08% of eConsults received involved safety concerns regarding COVID-19 vaccine administration in the setting of prior allergic disease and another 36.1% involved a potential reaction the first dose of a COVID-19 vaccine. 72.1% of eConsults were answered by specialist without needing external resources, and only 9.8% of all eConsults received resulted in a recommendation for formal in-person referral to Clinical Immunology & Allergy specialist or another subspecialty. Average time to complete eConsult was 16.4 min, and 79.7% of PCP eConsult queries which would have traditionally resulted in formal consultation were resolved based on advice provided in the eConsult without need for in-person assessment. CONCLUSIONS Our study demonstrates the utility of the eConsult service as it pertains to COVID-19 vaccine-related concerns. The eConsult platform proved an effective tool in diverting the need for in-person assessment by an Allergist or other medical specialty. This is significant given the large volume of eConsults completed by Allergists, and demonstrates the impact of an effective electronic delivery of care model during a time of strained resources and public health efforts directed at mass vaccination.
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Affiliation(s)
- Graham Walter
- Department of Medicine, University of Western Ontario, London, ON, Canada.
- Divison of Clinical Immunology & Allergy, University of Western Ontario, London, ON, Canada.
| | - Samira Jeimy
- Department of Medicine, University of Western Ontario, London, ON, Canada
- Divison of Clinical Immunology & Allergy, University of Western Ontario, London, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Amy Blair
- Division of Pediatric Clinical Immunology & Allergy, University of Toronto, Toronto, ON, Canada
| | | | - Zave Chad
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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13
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Hakimjavadi R, Karunananthan S, Levi C, LeBlanc K, Guglani S, Helmer-Smith M, Keely E, Liddy C. Electronic consultation use by advanced practice nurses in older adult care-A descriptive study of service utilization data. Nurs Open 2023; 10:2240-2248. [PMID: 36373892 PMCID: PMC10006590 DOI: 10.1002/nop2.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS AND OBJECTIVES To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults. BACKGROUND Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns. METHODS This is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data. RESULTS Of 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational. CONCLUSIONS Through eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system. RELEVANCE TO CLINICAL PRACTICE There is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce. PATIENT OR PUBLIC CONTRIBUTION Current APN eConsult users were involved in the study design and interpretation of results.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kimberly LeBlanc
- Nurses Specialized in Wound, Ostomy, and Continence, Ottawa, Ontario, Canada.,Advanced Practice Nurse (Wound, Ostomy, and Continence), KDS Professional Consulting, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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14
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Petrovic B, Bender JL, Liddy C, Afkham A, McGee SF, Morgan SC, Segal R, O’Brien MA, Julian JA, Sussman J, Urquhart R, Fitch M, Schneider ND, Grunfeld E. Implementation of a Web-Based Communication System for Primary Care Providers and Cancer Specialists. Curr Oncol 2023; 30:3537-3548. [PMID: 36975482 PMCID: PMC10047665 DOI: 10.3390/curroncol30030269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to examine PCPs' experiences of implementing eOncoNote and how access to the system influenced communication between PCPs and cancer specialists. As part of a larger study, we collected and analyzed system usage data and administered an end-of-discussion survey to understand the perceived value of using eOncoNote. eOncoNote data were analyzed for 76 shared patients (33 patients receiving treatment and 43 patients in the survivorship phase). Thirty-nine percent of the PCPs responded to the cancer specialist's initial eOncoNote message and nearly all of those sent only one message. Forty-five percent of the PCPs completed the survey. Most PCPs reported no additional benefits of using eOncoNote and emphasized the need for electronic medical record (EMR) integration. Over half of the PCPs indicated that eOncoNote could be a helpful service if they had questions about a patient. Future research should examine opportunities for EMR integration and whether additional interventions could support communication between PCPs and cancer specialists.
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Affiliation(s)
- Bojana Petrovic
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Jacqueline L. Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Clare Liddy
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, ON K1J 1J8, Canada
| | - Sharon F. McGee
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Scott C. Morgan
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Roanne Segal
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Mary Ann O’Brien
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Jim A. Julian
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Jonathan Sussman
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
- Department of Surgery, Nova Scotia Health, Halifax, NS B3H 2Y9, Canada
| | - Margaret Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- CanIMPACT Patient Advisory Committee, Toronto, ON M5G 1V7, Canada
| | | | - Eva Grunfeld
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M7, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 1N8, Canada
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15
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Hakimjavadi R, Karunananthan S, Fung C, Levi C, Helmer-Smith M, LaPlante J, Gazarin M, Rahgozar A, Afkham A, Keely E, Liddy C. Using electronic consultation (eConsult) to identify frailty in provider-to-provider communication: a feasibility and validation study. BMC Geriatr 2023; 23:136. [PMID: 36894892 PMCID: PMC9999527 DOI: 10.1186/s12877-023-03870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Frailty is a complex age-related clinical condition that increases vulnerability to stressors. Early recognition of frailty is challenging. While primary care providers (PCPs) serve as the first point of contact for most older adults, convenient tools for identifying frailty in primary care are lacking. Electronic consultation (eConsult), a platform connecting PCPs to specialists, is a rich source of provider-to-provider communication data. Text-based patient descriptions on eConsult may provide opportunities for earlier identification of frailty. We sought to explore the feasibility and validity of identifying frailty status using eConsult data. METHODS eConsult cases closed in 2019 and submitted on behalf of long-term care (LTC) residents or community-dwelling older adults were sampled. A list of frailty-related terms was compiled through a review of the literature and consultation with experts. To identify frailty, eConsult text was parsed to measure the frequency of frailty-related terms. Feasibility of this approach was assessed by examining the availability of frailty-related terms in eConsult communication logs, and by asking clinicians to indicate whether they can assess likelihood of frailty by reviewing the cases. Construct validity was assessed by comparing the number of frailty-related terms in cases about LTC residents with those about community-dwelling older adults. Criterion validity was assessed by comparing clinicians' ratings of frailty to the frequency of frailty-related terms. RESULTS One hundred thirteen LTC and 112 community cases were included. Frailty-related terms identified per case averaged 4.55 ± 3.95 in LTC and 1.96 ± 2.68 in the community (p < .001). Clinicians consistently rated cases with ≥ 5 frailty-related terms as highly likely of living with frailty. CONCLUSIONS The availability of frailty-related terms establishes the feasibility of using provider-to-provider communication on eConsult to identify patients with high likelihood of living with this condition. The higher average of frailty-related terms in LTC (versus community) cases, and agreement between clinician-provided frailty ratings and the frequency of frailty-related terms, support the validity of an eConsult-based approach to identifying frailty. There is potential for eConsult to be used as a case-finding tool in primary care for early recognition and proactive initiation of care processes for older patients living with frailty.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Celeste Fung
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,St. Patrick's Home of Ottawa, Ottawa, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, Canada
| | - Mary Helmer-Smith
- School of Population and Public Health, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - James LaPlante
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Mohamed Gazarin
- Centre of Excellence for Rural Health and Education, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Arya Rahgozar
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada. .,Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada.
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16
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Sethuram C, McCutcheon T, Liddy C. An environmental scan of Ontario Health Teams: a descriptive study. BMC Health Serv Res 2023; 23:225. [PMID: 36890556 PMCID: PMC9993364 DOI: 10.1186/s12913-023-09102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Ontario Health Teams (OHTs) are an integrated care system introduced in Ontario, Canada in 2019 after the 14 Local Health Integrated Networks (LHINs) were dissolved. The objective of this study is to give an overview of the current state of the OHT model's implementation, and what priority populations and transitions of care models were identified by OHTs. METHODS This scan involved a structured search for each approved OHT of publicly available resources with three main sources: the full application submitted by the OHT, the OHT website, and a Google search with the name of the OHT. RESULTS As of July 23, 2021, there were 42 approved OHTs and nine transitions of care programs were identified across nine OHTs. Of the approved OHTs, 38 had identified ten distinct priority populations, and 34 reported partnerships with organizations. CONCLUSIONS While the approved OHTs currently cover 86% of Ontario's population, not all OHTs are at the same stage of activity. Several areas for improvement were identified, including public engagement, reporting, and accountability. Moreover, OHTs' progress and outcomes should be measured in a standardized manner. These findings may be of interest to healthcare policy or decision-makers looking to implement similar integrated care systems and improve healthcare delivery in their jurisdictions.
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Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada. .,Department of Family Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada. .,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, K1H 7W9, Canada.
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17
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Hakimjavadi R, Karunananthan S, Alexander G, Fung C, Gazarin M, Houghton D, Hsu AT, LaPlante J, Levi C, Tanuseputro P, Liddy C. What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol. BMJ Open 2023; 13:e064745. [PMID: 36764709 PMCID: PMC9923326 DOI: 10.1136/bmjopen-2022-064745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The number of Canadians 75 years and older is expected to double over the next 20 years, putting continuing care systems such as long-term care (LTC) homes under increasing pressure. Health information technology (IT) has been found to improve the quality, safety and efficiency of care in numerous clinical settings and could help optimise LTC for residents. However, the level of health IT adoption in Ontario's LTC homes is unknown and, as a result, requires an accurate assessment to provide a baseline understanding for future planning. METHODS AND ANALYSIS We will use a cross-sectional design to investigate the level of IT maturity in Ontario's LTC homes. IT maturity will be assessed with the LTC IT Maturity Instrument, a validated survey examining IT capabilities, the extent of IT use and degree of internal/external IT integration across the domains of resident care, clinical support and administrative activities. All LTC homes in Ontario will be invited to participate. The Director of Care for each home will be directly contacted for recruitment. The survey will be distributed online (or by paper, if preferred) to LTC homes and completed by a staff member designated by the LTC to be knowledgeable about its IT systems. Analyses will consist of descriptive statistics characterising IT maturity across LTC homes and inferential statistics to examine the association between key facility-level characteristics (size, ownership, rurality) and IT maturity. ETHICS AND DISSEMINATION This study was reviewed by the Ottawa Health Science Network Research Ethics Board and was exempt from full ethics review. Findings will be disseminated through peer-reviewed publication and presentations to the scientific community and stakeholders. Dissemination of our findings will not only inform provincial planning for harnessing the potential of technology in LTC but may also enable quality improvement initiatives in individual LTC homes.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Celeste Fung
- St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohamed Gazarin
- Centre of Excellence for Rural Health and Education, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Deanne Houghton
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Amy T Hsu
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - James LaPlante
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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18
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Singer A, Ireland L, Sepehri Z, Brown K, Turner K, Liddy C, Keely E, Oppenheimer L. Evaluation of BASE eConsult Manitoba: patient perspectives on the use of electronic consultation to improve access to specialty advice in Manitoba. BMC Health Serv Res 2023; 23:131. [PMID: 36755243 PMCID: PMC9909129 DOI: 10.1186/s12913-022-08913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The burden of waiting to access specialist expertise may contribute to poorer health outcomes and causes distress for patients and providers. One solution to improve access to specialist care is to use innovative tools such as remote asynchronous electronic consultation (eConsult). Modeled after the Champlain BASE™ (Building Access to Specialist Advice) eConsult service, BASE™ eConsult Manitoba was launched in 2017 to help address long waits for patients to access specialist advice. OBJECTIVE We aimed to evaluate patients' experiences after obtaining a BASE™ eConsult Manitoba service in their primary care setting. METHODS Patients whose Primary Care Providers (PCPs) used BASE™ eConsult as part of their care were asked to participate and complete a telephone-based or online 29-question survey between January 2021 and October 2021. The survey questions were created in consultation with patient partners and based on questions asked in studies done in other jurisdictions. RESULTS Of the 36 patients who chose to participate, 29 completed the entire survey (80%). Two-thirds (n = 22) agreed that eConsult has been helpful in their situation, and over 80% (n = 24) of participants agreed that eConsult was an acceptable way to access specialist care. During the visit when their PCP sent the eConsult, 7 patients were expecting to be referred to a specialist for a face-to-face consultation. Over half of all respondents (n = 15) reported that before the eConsult occurred, their PCP asked them what questions they wanted to be answered by the specialist. Almost all of these respondents' questions were fully answered by the eConsult. All of the respondents were satisfied with the experience of receiving an eConsult. CONCLUSION Using eConsult is an acceptable way to improve access to specialist advice from patients' perspectives. Consideration should be given to expanding the use of eConsult services to improve access to specialist expertise for PCPs and their patients.
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Affiliation(s)
- Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., MB, Winnipeg, R3E 0W2, Canada.
| | - Laurie Ireland
- grid.21613.370000 0004 1936 9609Department of Family Medicine, University of Manitoba, D009-780 Bannatyne Ave., MB Winnipeg, R3E 0W2 Canada ,grid.422680.aNine Circles Community Health Centre, 705 Broadway Ave. , Winnipeg, MB R3G 0X2 Canada
| | - Zahra Sepehri
- grid.444944.d0000 0004 0384 898XDepartment of Internal Medicine, Zabol University of Medical Sciences, Zabol, Iran ,grid.21613.370000 0004 1936 9609Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, P219 – 780 Bannatyne Ave, MB Winnipeg, R3E 0W2 Canada
| | | | - Kevin Turner
- grid.21613.370000 0004 1936 9609eConsult Centre of Excellence, University of Manitoba Alumni, Winnipeg, MB R33 0W2 Canada
| | - Clare Liddy
- grid.418792.10000 0000 9064 33337 C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Family Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON Canada
| | - Erin Keely
- grid.412687.e0000 0000 9606 5108eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, ON Canada
| | - Luis Oppenheimer
- grid.21613.370000 0004 1936 9609Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, MB Canada
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19
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Kukafka R, Julian JA, Liddy C, Afkham A, McGee SF, Morgan SC, Segal R, Sussman J, Pond GR, O'Brien MA, Bender JL, Grunfeld E. Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial. J Med Internet Res 2023; 25:e40725. [PMID: 36652284 PMCID: PMC9892983 DOI: 10.2196/40725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists. OBJECTIVE This study aimed to examine whether a web- and text-based asynchronous system (eOncoNote) could facilitate communication between PCPs and cancer specialists (oncologists and oncology nurses) to improve patient-reported continuity of care among patients receiving treatment or posttreatment survivorship care. METHODS In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to either the intervention group (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or a control group (usual communication only), including 104 (60.1%) patients in the survivorship phase (breast and colorectal cancer) and 69 (39.9%) patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team and cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression, and Picker Patient Experience Questionnaire. Patients completed the questionnaires at baseline and at 2 points following randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month and at either 4 months (patients with prostate cancer) or 6 months following randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months and at 12 months following randomization. RESULTS The results did not show an intervention effect on the primary outcome of team and cross-boundary continuity of care or on the secondary outcomes of depression and patient experience with their health care. However, there was an intervention effect on anxiety. In the treatment phase, there was a statistically significant difference in the change score from baseline to the 1-month follow-up for GAD-7 (mean difference -2.3; P=.03). In the survivorship phase, there was a statistically significant difference in the change score for GAD-7 between baseline and the 6-month follow-up (mean difference -1.7; P=.03) and between baseline and the 12-month follow-up (mean difference -2.4; P=.004). CONCLUSIONS PCPs' and cancer specialists' access to eOncoNote is not significantly associated with patient-reported continuity of care. However, PCPs' and cancer specialists' access to the eOncoNote intervention may be a factor in reducing patient anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785.
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Affiliation(s)
| | - Jim A Julian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Clare Liddy
- Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Scott C Morgan
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Roanne Segal
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacqueline L Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
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20
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Archibald D, Grant R, Tuot DS, Liddy C, Sewell JL, Price DW, Grad R, Shipman SA, Campbell C, Guglani S, Wood TJ, Keely E. Development of eConsult reflective learning tools for healthcare providers: a pragmatic mixed methods approach. BMC Prim Care 2023; 24:15. [PMID: 36647016 PMCID: PMC9841624 DOI: 10.1186/s12875-022-01948-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Electronic consultation (eConsult) programs are crucial components of modern healthcare that facilitate communication between primary care providers (PCPs) and specialists. eConsults between PCPs and specialists. They also provide a unique opportunity to use real-world patient scenarios for reflective learning as part of professional development. However, tools that guide and document learning from eConsults are limited. The purpose of this study was to develop and pilot two eConsult reflective learning tools (RLTs), one for PCPs and one for specialists, for those participating in eConsults. METHODS We performed a four-phase pragmatic mixed methods study recruiting PCPs and specialists from two public health systems located in two countries: eConsult BASE in Canada and San Francisco Health Network eConsult in the United States. In phase 1, subject matter experts developed preliminary RLTs for PCPs and specialists. During phase 2, a Delphi survey among 20 PCPs and 16 specialists led to consensus on items for each RLT. In phase 3, we conducted cognitive interviews with three PCPs and five specialists as they applied the RLTs on previously completed consults. In phase 4, we piloted the RLTs with eConsult users. RESULTS The RLTs were perceived to elicit critical reflection among participants regarding their knowledge and practice habits and could be used for quality improvement and continuing professional development. CONCLUSION PCPs and specialists alike perceived that eConsult systems provided opportunities for self-directed learning wherein they were motivated to investigate topics further through the course of eConsult exchanges. We recommend the RLTs be subject to further evaluation through implementation studies at other sites.
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Affiliation(s)
- Douglas Archibald
- grid.28046.380000 0001 2182 2255Department of Family Medicine, C.T. Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, Canada ,grid.28046.380000 0001 2182 2255Faculty of Education, University of Ottawa, Ottawa, Canada
| | - Rachel Grant
- grid.28046.380000 0001 2182 2255Faculty of Education, University of Ottawa, Ottawa, Canada
| | - Delphine S. Tuot
- grid.266102.10000 0001 2297 6811Department of Medicine, Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
| | - Clare Liddy
- grid.28046.380000 0001 2182 2255Department of Family Medicine, C.T. Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, Canada ,grid.412687.e0000 0000 9606 5108Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Justin L. Sewell
- grid.266102.10000 0001 2297 6811Department of Medicine, Division of Gastroenterology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
| | - David W. Price
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO USA ,The American Board of Family Medicine, Lexington, KY USA
| | - Roland Grad
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, Montreal, Canada
| | - Scott A. Shipman
- grid.414000.10000 0000 8652 9597Association of American Medical Colleges, Washington, DC USA ,grid.254748.80000 0004 1936 8876Creighton University, Omaha, NE USA
| | - Craig Campbell
- grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Sheena Guglani
- grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, Canada ,grid.412687.e0000 0000 9606 5108Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Timothy J. Wood
- grid.28046.380000 0001 2182 2255Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
| | - Erin Keely
- grid.412687.e0000 0000 9606 5108Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada ,grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, Canada
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21
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Keely E, Mitchell R, Guglani S, Archibald D, Afkham A, Liddy C. Benefits of Providing Feedback and Utilisation Metrics to Specialists on Their Participation in eConsult. J Eur CME 2022; 11:2116193. [PMID: 36081595 PMCID: PMC9448361 DOI: 10.1080/21614083.2022.2116193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our study evaluates the impact of feedback sent to specialists participating in eConsult services. eConsult Specialists from two eConsult services in Ontario, Canada, received feedback on their use of eConsult via bi-annual specialist reports. An 11-item survey was developed to evaluate the impact, content, and distribution process of these specialist reports. We distributed 742 specialist reports in March 2021 and surveyed the specialists in July 2021. Our findings show that specialists largely felt that the feedback received validated their efforts (83%) and that receiving the report made them more likely to continue to participate in the eConsult service (59%). Most did not feel judged (74%) or distressed (79%) by the reports, and 72% said that reporting the median self-reported billing time did not impact their own billing times. Overall, eConsult services can capture, report and aggregate data valuable to specialists and is useful for Continuing Professional Development. Benefits and lack of risk implementing this type of feedback should encourage other services to consider similar processes.
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Affiliation(s)
- Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rhea Mitchell
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheena Guglani
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | | | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Clare Liddy
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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22
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Fung C, Liddy C. ECONSULT IMPROVES ACCESS TO SPECIALIST ADVICE FOR PRIMARY CARE PROVIDERS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Dr. Liddy will present an overview of the Champlain BASE™ eConsult service, with a focus on its implementation in long-term care (LTC). eConsult is a secure web-based tool that enables providers to communicate electronically with specialists concerning a patient’s care. Evaluation of over 100,000 cases has consistently demonstrated positive impacts on access to care: PCPs receive responses in a median of 0.9 days, and two-thirds of cases are resolved without the patient needing a face-to-face specialist visit. A cross-sectional analysis of eConsult cases sent from LTC settings in 2018 demonstrated similar response times and referral avoidance to the larger sample (a median response time of 0.6 versus 0.9 days; proportion of cases resolved without a specialist visit 70% versus 67%). These findings, coupled with eConsult’s proven success at improving access to and equity of care, demonstrate the importance of supporting eConsults expansion.
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Affiliation(s)
- Celeste Fung
- University of Ottawa, Department of Family Medicine , Ottawa, Ontario , Canada
| | - Clare Liddy
- University of Ottawa , Ontario, Ontario , Canada
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23
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Sakanovic A, Hadden WJ, Guglani S, Afkham A, Liddy C, Keely E, Meulenkamp B. The effect of eConsult on the provision of orthopaedic services in Nunavut. Int J Circumpolar Health 2022; 81:2151551. [PMID: 36451521 PMCID: PMC9718551 DOI: 10.1080/22423982.2022.2151551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To assess the effect of eConsultation in providing Orthopaedic Surgery specialist service to patients in Nunavut. A cross-sectional study of 161 Orthopaedic Surgery consultations received from primary care providers (PCPs) in Nunavut via the Champlain Building Access to Specialist service through eConsult (BASETM) service over the 2-year period from January 2017 to December 2018. Data captured were: reason for consultation, impact of advice on referral, perceived value to the PCPs and time spent. eConsult avoided unnecessary in-person consultation 62% of the time while catching 5% of the referrals that would have otherwise been missed. PCP referral behaviour was modified 48% of the time. 94% of eConsults were rated as valuable to PCPs in their practice and 100% of eConsults resulted in actionable advice. Further, eConsults took an average of 15.4 minutes of specialist time to complete, and the mean time from referral to response was 1.4 days. eConsultation spares unnecessary consultation to Orthopaedic Surgery, catches important referrals that would have otherwise been missed, decreases wait time, and may reduce cost in remote healthcare systems such as Nunavut.
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Affiliation(s)
- Alenko Sakanovic
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - William J Hadden
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Amir Afkham
- Enabling Technologies, The Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Department of Medicine University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brad Meulenkamp
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,CONTACT Brad Meulenkamp Faculty of Medicine, University of Ottawa; 1053 Carling Ave. Suite J129, OttawaK1Y 4E9, ON, Canada
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24
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McCutcheon T, LaPlante J, Bibeau C, Cooper L, Hammond J, Helmer-Smith M, Houghton D, Burns KK, Mastin D, Turner K, Liddy C. Building patient-oriented research capacity by co-designing a research handbook for patient partners. Patient Educ Couns 2022; 105:3331-3333. [PMID: 35817634 PMCID: PMC9258416 DOI: 10.1016/j.pec.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/06/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - James LaPlante
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Lynn Cooper
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jessika Hammond
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Deanne Houghton
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Katharina Kovacs Burns
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
| | - Donald Mastin
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada.
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25
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Hadden WJ, Guglani S, Sakanovic A, Liddy C, Keely E, Meulenkamp B. Access to orthopedic specialist service in Ontario via eConsult. Can J Surg 2022; 65:E643-E649. [PMID: 36170983 PMCID: PMC9529564 DOI: 10.1503/cjs.005820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Increasing strain on public health resources in Canada, in particular with respect to accessing specialist care, necessitates the exploration of alternative models of care. The aim of this study was to assess the efficacy of electronic consultation (eConsult) in providing orthopedic surgery specialist service to patients in the Champlain Local Health Integration Network (LHIN) of Ontario. Methods: This was a cross-sectional review of all 564 Champlain LHIN orthopedic surgery referral requests received via the Champlain Building Access to Specialist service through the eConsult (BASE) system in 2017. Primary outcome measures were impact on primary care provider (PCP) referral pattern and time to receive orthopedic consultation. Results: eConsult prevented unnecessary in-person consultation 64% of the time, while PCP referral decisions were modified 51% of the time. Of all eConsults, 94% were rated as valuable to PCPs in their practice and 97% of eConsults resulted in actionable advice. eConsults took an average of 14.5 minutes of specialist time to complete, and the mean time from referral to response was 3.7 days. Conclusion: The eConsult system spares unnecessary consultation to orthopedic surgery; catches important referrals that would have otherwise been missed; saves time for patients, PCPs and orthopedic surgeons; and improves efficiency in a socialized health care system.
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Affiliation(s)
- William J Hadden
- Division of Orthopaedic Surgery (Hadden, Sakanovic, Meulenkamp), the Ottawa Hospital; The University of Ottawa (Hadden, Sakanovic, Liddy, Keely, Meulenkamp); C.T. Lamont Primary Health Care Research Centre (Guglani, Liddy), Bruyère Research Institute; Departments of Family Medicine (Liddy) and Internal Medicine (Keely), The Ottawa Hospital; The Ottawa Hospital Research Institute (Keely), Ottawa, Ont.
| | - Sheena Guglani
- Division of Orthopaedic Surgery (Hadden, Sakanovic, Meulenkamp), the Ottawa Hospital; The University of Ottawa (Hadden, Sakanovic, Liddy, Keely, Meulenkamp); C.T. Lamont Primary Health Care Research Centre (Guglani, Liddy), Bruyère Research Institute; Departments of Family Medicine (Liddy) and Internal Medicine (Keely), The Ottawa Hospital; The Ottawa Hospital Research Institute (Keely), Ottawa, Ont
| | - Alenko Sakanovic
- Division of Orthopaedic Surgery (Hadden, Sakanovic, Meulenkamp), the Ottawa Hospital; The University of Ottawa (Hadden, Sakanovic, Liddy, Keely, Meulenkamp); C.T. Lamont Primary Health Care Research Centre (Guglani, Liddy), Bruyère Research Institute; Departments of Family Medicine (Liddy) and Internal Medicine (Keely), The Ottawa Hospital; The Ottawa Hospital Research Institute (Keely), Ottawa, Ont
| | - Clare Liddy
- Division of Orthopaedic Surgery (Hadden, Sakanovic, Meulenkamp), the Ottawa Hospital; The University of Ottawa (Hadden, Sakanovic, Liddy, Keely, Meulenkamp); C.T. Lamont Primary Health Care Research Centre (Guglani, Liddy), Bruyère Research Institute; Departments of Family Medicine (Liddy) and Internal Medicine (Keely), The Ottawa Hospital; The Ottawa Hospital Research Institute (Keely), Ottawa, Ont
| | - Erin Keely
- Division of Orthopaedic Surgery (Hadden, Sakanovic, Meulenkamp), the Ottawa Hospital; The University of Ottawa (Hadden, Sakanovic, Liddy, Keely, Meulenkamp); C.T. Lamont Primary Health Care Research Centre (Guglani, Liddy), Bruyère Research Institute; Departments of Family Medicine (Liddy) and Internal Medicine (Keely), The Ottawa Hospital; The Ottawa Hospital Research Institute (Keely), Ottawa, Ont
| | - Brad Meulenkamp
- Division of Orthopaedic Surgery (Hadden, Sakanovic, Meulenkamp), the Ottawa Hospital; The University of Ottawa (Hadden, Sakanovic, Liddy, Keely, Meulenkamp); C.T. Lamont Primary Health Care Research Centre (Guglani, Liddy), Bruyère Research Institute; Departments of Family Medicine (Liddy) and Internal Medicine (Keely), The Ottawa Hospital; The Ottawa Hospital Research Institute (Keely), Ottawa, Ont
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26
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Carroll JC, Liddy C, Afkham A, Keely E, Goh ES, Graham GE, Permaul JA, Allanson J, Heisey R, Makuwaza T, Manca DP, O'Brien MA, Grunfeld E. Use of eConsult to enhance genetics service delivery in primary care: A multimethod study. Genet Med 2022; 24:2034-2041. [PMID: 35947109 DOI: 10.1016/j.gim.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Electronic consultation (eConsult) is a freely-available secure online platform connecting primary care providers (PCPs) to geneticists. Our purpose was to determine whether eConsult is effective in improving genetics service delivery in primary care. METHODS PCP questionnaires regarding eConsult's utility, geneticists' tracking form assessments of eConsult type and appropriateness, and geneticists' interviews on implementing eConsult were carried out. RESULTS In 2 regions of Ontario, Canada, from January 2019 to June 2020, there were 305 genetics eConsults. For 169 (55%), PCPs indicated receiving good advice for a new course of action; for 110 (36%), referral was now avoided; and for 261 (86%), eConsult was perceived valuable for patient management. Of the 131 geneticist-completed tracking forms, cancer questions were most common (68, 52%). For 63 (48%), geneticists disagreed/strongly disagreed PCPs should know the answer to the referral question. From the interview data, it was observed that geneticists described eConsult positively and suggested how it might improve access and efficiencies if integrated into genetic service delivery. Dealing with eConsults virtually could reduce waitlists, and suggesting appropriate investigations for PCPs could improve efficiencies. CONCLUSION eConsult offers a potential solution for receiving timely genetics advice and avoiding unnecessary patient referrals, however, greater effect on access and wait times will need systematic integration into PCP and geneticist practice.
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Affiliation(s)
- June C Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Ontario, Canada.
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Endocrinology & Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Elaine S Goh
- Laboratory Medicine and Genetics and Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada
| | - Gail E Graham
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Judith Allanson
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ruth Heisey
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Tutsirai Makuwaza
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Donna P Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Ann O'Brien
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Sethuram C, Helmer-Smith M, Karunananthan S, Keely E, Singh J, Liddy C. Electronic consultation in correctional facilities worldwide: a scoping review. BMJ Open 2022; 12:e055049. [PMID: 35922103 PMCID: PMC9352998 DOI: 10.1136/bmjopen-2021-055049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To provide an overview of the use of and evidence for eConsult in correctional facilities worldwide. DESIGN Scoping review. DATA SOURCES Three academic databases (MEDLINE, Embase and CINAHL) were searched to identify papers published between 1990 and 2020 that presented data on eConsult use in correctional facilities. The grey literature was also searched for any resources that discussed eConsult use in correctional facilities. Articles and resources were excluded if they discussed synchronous, patient-to-provider or unsecure communication. The reference lists of included articles were also hand searched. RESULTS Of the 226 records retrieved from the academic literature search and 595 from the grey literature search, 22 were included in the review. Most study populations included adult male offenders in a variety of correctional environments. These resources identified 13 unique eConsult services in six countries. Six of these services involved multiple medical specialties, while the remaining services were single specialty. The available evidence was organised into five identified themes: feasibility, cost-effectiveness, access to care, provider satisfaction and clinical impact. CONCLUSIONS This study identified evidence that the use of eConsult in correctional facilities is beneficial and avoids unnecessary transportation of offenders outside of the facilities. It is feasible, cost-effective, increases access to care, has an impact on clinical care and has high provider satisfaction. Some gaps in the literature remain, and we suggest further research on patient satisfaction, enablers and barriers to implementation, and women, youth and transgender populations in this setting to inform service providers and stakeholders. Despite some gaps, eConsult is evidently an important tool to provide timely, high-quality care to offenders.
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Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jatinderpreet Singh
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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Yan H, Rahgozar A, Sethuram C, Karunananthan S, Archibald D, Bradley L, Hakimjavadi R, Helmer-Smith M, Jolin-Dahel K, McCutcheon T, Puncher J, Rezaiefar P, Shoppoff L, Liddy C. Correction: Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e40454. [PMID: 35749727 PMCID: PMC9270704 DOI: 10.2196/40454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hui Yan
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Arya Rahgozar
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Claire Sethuram
- Bruyère Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sathya Karunananthan
- Bruyère Research Institute, Ottawa, ON, Canada.,Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Lindsay Bradley
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ramtin Hakimjavadi
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mary Helmer-Smith
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Jeffrey Puncher
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Parisa Rezaiefar
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Lina Shoppoff
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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Yan H, Rahgozar A, Sethuram C, Karunananthan S, Archibald D, Bradley L, Hakimjavadi R, Helmer-Smith M, Jolin-Dahel K, McCutcheon T, Puncher J, Rezaiefar P, Shoppoff L, Liddy C. Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e34575. [PMID: 35499861 PMCID: PMC9112078 DOI: 10.2196/34575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learning needs of trainees. Objective This scoping review will aim to explore and organize the breadth of knowledge regarding digital learning tools in family medicine training. Methods This scoping review follows the 6 stages of the methodological framework outlined first by Arksey and O’Malley, then refined by Levac et al, including a search of published academic literature in 6 databases (MEDLINE, ERIC, Education Source, Embase, Scopus, and Web of Science) and gray literature. Following title and abstract and full text screening, characteristics and main findings of the included studies and resources will be tabulated and summarized. Thematic analysis and natural language processing (NLP) will be conducted in parallel using a 9-step approach to identify common themes and synthesize the literature. Additionally, NLP will be employed for bibliometric and scientometric analysis of the identified literature. Results The search strategy has been developed and launched. As of October 2021, we have completed stages 1, 2, and 3 of the scoping review. We identified 132 studies for inclusion through the academic literature search and 127 relevant studies in the gray literature search. Further refinement of the eligibility criteria and data extraction has been ongoing since September 2021. Conclusions In this scoping review, we will identify and consolidate information and evidence related to the use and effectiveness of existing digital learning tools in postgraduate family medicine training. Our findings will improve the understanding of the current landscape of digital learning tools, which will be of great value to educators and trainees interested in using existing tools, innovators looking to design digital learning tools that meet current needs, and researchers involved in the study of digital tools. Trial Registration OSF Registries osf.io/wju4k; https://osf.io/wju4k International Registered Report Identifier (IRRID) DERR1-10.2196/34575
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Affiliation(s)
- Hui Yan
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Arya Rahgozar
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Claire Sethuram
- Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sathya Karunananthan
- Bruyère Research Institute, Ottawa, ON, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Lindsay Bradley
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ramtin Hakimjavadi
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mary Helmer-Smith
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Jeffrey Puncher
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Parisa Rezaiefar
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Lina Shoppoff
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
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Liddy C, Mitchell R, Guglani S, Mihan A, Sethuram C, Miville A, Keely E. The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years. Ann Fam Med 2022; 20:262-265. [PMID: 35606133 PMCID: PMC9199054 DOI: 10.1370/afm.2812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/13/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
This paper reports on a multimethod cross-sectional study of the Ontario electronic consultation (eConsult) service. Utilization and closeout survey data from July 2018 through June 2020 were analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Requesting clinicians submitted 60,474 eConsults, and monthly cases increased from 1,487 in July 2018 to 4,179 in June 2020. The median specialist response time was 1 day. An originally contemplated referral was avoided in 51% of cases. Ontario eConsult showed successful uptake across Ontario, demonstrating continued spread and scale, and offering a template for trailblazers looking to implement digital health innovations in their own jurisdictions.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada .,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rhea Mitchell
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ariana Mihan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Andrea Miville
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
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Singh J, Garber GE, Keely E, Guglani S, Liddy C. Evaluation of an Electronic Consultation Service for COVID-19 Care. Ann Fam Med 2022; 20:220-226. [PMID: 35606132 PMCID: PMC9199057 DOI: 10.1370/afm.2807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/14/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input.
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Affiliation(s)
- Jatinderpreet Singh
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada .,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Gary E Garber
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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Petrovic B, Morgan S, Afkham A, O'Brien MA, Sussman J, Fitch M, McGee S, Liddy C, Schneider N, Grunfeld E. Cancer specialist perspectives on implementing an online communication system with primary care providers. Ann Fam Med 2022; 20:3246. [PMID: 36696651 PMCID: PMC10549028 DOI: 10.1370/afm.20.s1.3246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Context: The Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) is a group of researchers, primary care providers (PCPs), cancer specialists, patients and caregivers working to improve cancer care coordination between PCPs and cancer specialists. Previous research by CanIMPACT and others has identified problems related to communication, coordination, and continuity of care. Objective: Describe findings from qualitative interviews with cancer specialists on implementation of an online communication system with PCPs. Study Design: Hybrid type I effectiveness-implementation study that included a qualitative research component and a pragmatic RCT. Setting: Ottawa Hospital Cancer Program and primary care practices in the Champlain region. Population Studied: Cancer specialists (nurses, medical and radiation oncologists, program administrators). Interviews conducted with 12 cancer specialists. Intervention: Cancer-specific adaptation of Champlain BASE™ eConsult, an online communication system for PCPs and cancer specialists called "eOncoNote". For patients receiving treatment for prostate or breast cancer, cancer specialists had an opportunity to participate in eOncoNote discussion with PCP for 4-6 months; for breast and colorectal cancer survivors, the eOncoNote discussion lasted for 1 year post discharge to the patient's PCP. Results: Cancer specialists described limited PCP involvement in cancer care while patients received active treatment, with one-way communication and notes being "sent into a vacuum". There was more communication with PCPs regarding patients with metastatic disease, comorbid conditions, after patients have completed treatment, or during palliative care. Patients and caregivers play a critical role in coordinating cancer care, helping to facilitate coordination. Lack of access to the same electronic medical record (EMR) among healthcare providers poses a barrier to cancer care coordination. eOncoNote had the potential to be useful tool but it was not used extensively. Conclusions: Accessing eOncoNote as a separate system was challenging to incorporate into the workflow, and cancer specialists highlighted the need for integration with their EMR. eOncoNote did not affect information sharing with PCPs, as there was limited uptake within primary care.
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Hakimjavadi R, Levi C, LeBlanc K, Guglani S, Helmer-Smith M, Joschko J, Karunananthan S, Keely E, Liddy C. Electronic Consultation by Advanced Practice Nurses to Improve Access to Specialist Care for Older Adults. J Gerontol Nurs 2022; 48:33-40. [PMID: 35343843 DOI: 10.3928/00989134-20220307-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults face several challenges when accessing specialist care. Advanced practice nurses (APNs) can perform an important role in primary care for older adults, particularly when bolstered with digital tools. In the current study, we conducted a multiple case study of electronic consultations (eConsults) involving APNs to assess how these practitioners use the service to improve access to care. All eConsults submitted by or to an APN in 2019 on behalf of patients aged ≥65 years were reviewed to identify examples from six settings representative of the range of advanced nursing practices. For each setting, a final case was chosen using an iterative process and stratified by specialty and type of advice. Included cases were assessed using a conceptual framework for health care access. Selected cases illustrate how APNs can be effective users of eConsults in a diversity of health care settings. The framework allowed for an in-depth study of access over the range of interactions that take place among patients, caregivers, providers, and the health care system. [Journal of Gerontological Nursing, 48(4), 33-40.].
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Cooper L, Ahmed S, Bibeau C, Buckley N, Crowe L, Decoste J, Keely E, McCutcheon T, Singer AG, Visca R, Liddy C. Impact of patient partner co-design on survey development in primary care research: Case study. Can Fam Physician 2022; 68:235-236. [PMID: 35292463 PMCID: PMC9833185 DOI: 10.46747/cfp.6803235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Lynn Cooper
- Patient Advisor in the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute in Ottawa, Ont, Education and Research Advisor for the Canadian Injured Workers Alliance, and a member of the Steering Committee for the Chronic Pain Network
| | - Sara Ahmed
- Professor in the School of Physical and Occupational Therapy in the Faculty of Medicine and Health Sciences at McGill University in Montreal, Que, and Clinical Investigator in the Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation at the McGill University Health Centre
| | - Christine Bibeau
- Patient Advisor in the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute
| | - Norman Buckley
- Associate Professor in the Department of Anesthesia in the Faculty of Health Sciences at McMaster University in Hamilton, Ont, and Clinical Investigator at the Michael G. DeGroote Institute for Pain Research and Care
| | - Lois Crowe
- Program Manager of Strategic Planning and Implementation in the Office of Social Accountability in the Faculty of Medicine at the University of Ottawa
| | - Jocelyn Decoste
- Patient Advisor in the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute, a practising lawyer in workplace health and safety, and a member of the Board of Directors for the Association québécoise de la douleur chronique
| | - Erin Keely
- Endocrinologist at The Ottawa Hospital, Professor in the Department of Medicine at the University of Ottawa, and Co-Executive Director of the Ontario eConsult Centre of Excellence
| | - Tess McCutcheon
- Research Associate in the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute
| | - Alexander G Singer
- Associate Professor and Director of Research and Quality Improvement in the Department of Family Medicine at the University of Manitoba in Winnipeg
| | - Regina Visca
- Administrative Director of the McGill RUISSS Centre of Expertise in Chronic Pain and a doctoral candidate in the Department of Family Medicine at McGill University
| | - Clare Liddy
- Chair and Full Professor in the Department of Family Medicine at the University of Ottawa, Clinician Investigator in the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute, and Co-Executive Director of the Ontario eConsult Centre of Excellence
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Liddy C, Guglani S, Ratzlaff T, Campbell RJ, Cranston L, Miville A, Hove MT, Keely E. Expanding the scope of an eConsult service: acceptability and feasibility of an optometry–ophthalmology pilot project. Canadian Journal of Ophthalmology 2022; 58:204-211. [PMID: 35131208 DOI: 10.1016/j.jcjo.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/29/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the feasibility and acceptability of connecting optometrists to ophthalmologists on an eConsult service. DESIGN Descriptive analysis of utilization data and an anonymous survey. PARTICIPANTS All eConsult cases sent by optometrists between March 2019 and February 2020 (utilization data); optometrists and ophthalmologists participating in the eConsult Vision Pilot Project (survey). METHODS Utilization data for the study period were collected automatically and underwent descriptive analysis. Participating optometrists and ophthalmologists received an email invitation to a survey assessing the project. RESULTS Thirteen optometrists from 5 clinics in the southeast region and 7 ophthalmologists were recruited to participate in the pilot project. Optometrists sent 109 eConsults in a 13-month period, representing 33% of all cases submitted to ophthalmology through the eConsult service provincially (March 2019-March 2020). Sixty-eight percent of respondents to an anonymous online survey valued the recruitment and engagement of eye care professionals from the same health region. The influence of the eConsult service was reported to have a "somewhat positive" (27%) to "very positive" (50%) influence on the relationship between the two professional groups. CONCLUSION The eConsult Vision Pilot Project fills a gap in service and provides an opportunity for patients to get access to specialty advice. We demonstrated that allowing optometrists to solicit specialist advice from ophthalmologists was acceptable and feasible.
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Affiliation(s)
- Clare Liddy
- C. T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, ON; Department of Family Medicine, University of Ottawa, Ottawa, ON; eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON.
| | - Sheena Guglani
- C. T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, ON; eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON
| | - Timothy Ratzlaff
- Department of Ophthalmology, Queens University and Kingston Health Sciences Centre, Kingston, ON
| | - Robert J Campbell
- Department of Ophthalmology, Queens University and Kingston Health Sciences Centre, Kingston, ON
| | - Lacey Cranston
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON
| | - Andrea Miville
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON
| | - Martin Ten Hove
- Department of Ophthalmology, Queens University and Kingston Health Sciences Centre, Kingston, ON
| | - Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON; Department of Medicine, University of Ottawa, Ottawa, ON; Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON
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Singh J, Keely E, Guglani S, Garber G, Liddy C. The Utilization of an Electronic Consultation Service During the Coronavirus Disease 2019 Pandemic. Telemed J E Health 2021; 28:994-1000. [PMID: 34861116 DOI: 10.1089/tmj.2021.0497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The coronavirus disease 2019 (COVID-19) pandemic forced many clinicians to rapidly adopt changes in their practice. In this study, we compared patterns of utilization of Ontario eConsult before and after the onset of the COVID-19 pandemic, to assess COVID 19's impact on how eConsult is used. Materials and Methods: We conducted a longitudinal analysis of registration and utilization data for Ontario eConsult. All primary care providers (PCPs) and specialists who joined the service between March 2019 and November 2020, and all eConsult cases closed during the same period were included. The data were divided into two timeframes for comparison: prepandemic (March 2019-February 2020) and pandemic (March 2020-November 2020). Results: In total, 5,925 PCPs joined during the study period, more than doubling total enrollment to 11,397. The average monthly number of eConsults increased from 2,405 (standard deviation [SD] = 260) prepandemic to 3,906 (SD = 420) pandemic. Case volume jumped to 24.3% in the first month of the pandemic, and increased by 71% during the COVID-19 pandemic timeframe. The median response time was similar in both timeframes (prepandemic: 1.0 days; pandemic: 0.9 days). The proportion of cases resulting in new/additional information (prepandemic: 55%, pandemic: 57%) or avoidance of a contemplated referral (prepandemic: 52%, pandemic: 51%) remained consistent between timeframes. Conclusions: Registration to and usage of eConsult increased during the pandemic. Metrics of the service's impact, including response time, percentage of cases resulting in new or additional information, and avoidance of originally contemplated referrals were all consistent between the prepandemic and COVID-19 pandemic timeframes, suggesting scalability.
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Affiliation(s)
- Jatinderpreet Singh
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism and The Ottawa Hospital, Ottawa, Ontario, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Liddy C, Boulay E, Crowe L, Dumas-Pilon M, Drimer N, Farrell G, Ireland L, Kirvan CK, Nabelsi V, Singer A, Wilson M, Keely E. Impact of the Connected Medicine collaborative in improving access to specialist care: a cross-sectional analysis. CMAJ Open 2021; 9:E1187-E1194. [PMID: 34906995 PMCID: PMC8687491 DOI: 10.9778/cmajo.20200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2017, the Canadian Foundation for Healthcare Improvement launched the Connected Medicine collaborative to support the implementation, spread and adaptation of 2 innovative remote consult solutions - the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service and the Rapid Access to Consultative Expertise (RACE) service - across Canada. We evaluated the impact of the programs implemented through the collaborative. METHODS We conducted a cross-sectional analysis of data from provincial teams that participated in the Connected Medicine collaborative, which took place between June 2017 and December 2018 in 7 provinces across Canada (British Columbia, Alberta, Saskatchewan, Manitoba, Quebec, New Brunswick, Newfoundland and Labrador). Data included utilization data collected automatically by the BASE and RACE services and, where available, responses to surveys completed by primary care providers at the end of each case. We assessed programs on the following outcomes: usage (i.e., number of cases completed, average specialist response time), number of specialties available, impact on primary care provider's decision to refer and impact on emergency department visits. We performed descriptive analyses. RESULTS Ten provincial teams participated in the collaborative and implemented or adapted either the RACE service (4 teams), the BASE service (5 teams) or a combination of the 2 services (1 team). Average monthly case volume per team ranged from 14.7 to 424.5. All programs offered multispecialty access, with specialists from 5 to 37 specialty groups available. Specialists responded to eConsults within 7 days in 80% (n = 294/368) to 93% (n = 164/176) of cases. Six programs provided survey data on avoidance of referrals, which occurred in 48% (n = 667/1389) to 76% (n = 302/398) of cases. Two programs reported on the avoidance of potential emergency department visits, noting that originally considered referrals were avoided in 28% (n = 138/492) and 74% (n = 127/171) of cases, respectively. INTERPRETATION The 2 innovative virtual care solutions implemented through the Connected Medicine collaborative received widespread usage and affected primary care providers' decisions to refer patients to specialists. The impact of these models of care in multiple settings shows that they are an effective means to move beyond the pilot stage and achieve spread and scale.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Emma Boulay
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Lois Crowe
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Maxine Dumas-Pilon
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Neil Drimer
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Gerard Farrell
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Laurie Ireland
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Christine Kirby Kirvan
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Veronique Nabelsi
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Alexander Singer
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Margot Wilson
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
| | - Erin Keely
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine (Liddy, Crowe), Department of Medicine (Keely), University of Ottawa; eConsult Centre of Excellence (Liddy, Keely), The Ottawa Hospital; Bruyère Research Institute (Crowe); Canadian Foundation for Healthcare Improvement (Drimer, Kirvan), Ottawa, Ont.; New Brunswick Medical Society (Boulay), Fredericton, NB; Department of Family Medicine (Dumas-Pilon), McGill University, Montréal, Que.; Department of Family Medicine (Farrell), Memorial University of Newfoundland, St. John's, NL; Nine Circles Community Health Centre (Ireland) and Department of Family Medicine (Singer), University of Manitoba, Winnipeg, Man.; Université du Québec en Outaouais (Nabelsi), Gatineau, Que.; Providence Health Care (Wilson), Vancouver, BC
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Fung C, Shah S, Helmer-Smith M, Levi C, Keely E, Liddy C. Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study. Gerontol Geriatr Med 2021; 7:23337214211032055. [PMID: 34471649 PMCID: PMC8404619 DOI: 10.1177/23337214211032055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction eConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs. Methods A descriptive, retrospective study of eConsults submitted through the Champlain BASE™ eConsult Service between January 1, 2017, and December 31, 2018, by LTC PCPs was conducted. Cases were classified using validated taxonomies. Descriptive statistics were generated for content and question type classifications, service utilization data, and close-out survey responses. Results 22 LTC PCPs submitted 113 eConsults. They sought advice about drug treatment (58%), diagnosis (44%), and management (38%) in a breadth of clinical areas, often skin-related (39%). Long-term care PCPs frequently asked more than one question type (42%). They received advice within 1 week (91%) and rated eConsult as very helpful and educational. Three case examples are presented. Conclusion This study demonstrates the type of advice LTC PCPs are seeking through eConsult and its usefulness in this setting. Long-term care stakeholders are encouraged to consider implementing eConsult in other regions, as a means to improve access to timely specialist advice, support clinical decision-making, and improve residents’ quality of life.
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Affiliation(s)
- Celeste Fung
- St. Patrick's Home of Ottawa, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
| | - Soha Shah
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mary Helmer-Smith
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
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Leduc JG, Keely E, Liddy C, Afkham A, Marovac M, Guglani S. Improving primary care access to respirologists using eConsult. Int J Qual Health Care 2021; 33:6322794. [PMID: 34270723 DOI: 10.1093/intqhc/mzab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/20/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients and primary care providers (PCPs) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. METHODS This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of questions asked by the referring provider and by the clinical content of the referral. Specialists' response time and time spent answering the clinical question were analyzed. Referring providers' close-out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. RESULTS Of the 26 679 cases submitted to the Champlain BASE TM eConsult service, 268 were respirology cases (1%). 91% were sent by family physicians and 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 min. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), chronic obstructive pulmonary disease (8.6%) and dyspnea Not Yet Diagnosed (NYD) (7.8%). The most common types of questions asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%) and drug of choice (6.3%). In 23% of cases, the PCP indicated they were planning to refer the patient for an in-person consultation but no longer needed to after receiving the eConsult advice (avoided referrals). On the other hand, in 13% of cases, the PCP was not going to refer but did after the eConsult (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases, the PCP suggested the clinical topic would be well suited to a CME event. CONCLUSIONS Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visits and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of questions for CME planning should be considered. Future research may include a cost analysis and provider perspectives on the role of eConsult in respirology care.
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Affiliation(s)
- Jean-Grégoire Leduc
- Montfort Hospital, University of Ottawa, 713 Montreal Rd, Ottawa, ON K1K 0T2, Canada
| | - Erin Keely
- The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Clare Liddy
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
| | - Amir Afkham
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
| | - Misha Marovac
- Queensway-Carleton Hospital, 3045 Baseline Rd, Ottawa, ON K2H 8P4, Canada
| | - Sheena Guglani
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
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Guglani S, Liddy C, Afkham A, Mitchell R, Keely E. One Service, Two Models: a comparison of direct-to-specialist and managed specialty models in a provincial eConsult service (Preprint). JMIR Form Res 2021; 6:e32101. [PMID: 35451985 PMCID: PMC9077515 DOI: 10.2196/32101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/22/2021] [Accepted: 02/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)–managed specialty service, where PCPs choose a specialty group and are assigned a specialist from a qualified pool based on availability. Objective The aim of this study is to examine patterns of use between the 2 models of eConsult delivery. Methods We conducted a cross-sectional analysis of utilization data collected from eConsults completed between October 2018 and September 2019. Cases were grouped based on the model used for submission (ie, BASE or DTS). Each model was assessed for the number of cases over time, specialty distribution, proportion resulting in new or additional information, impact on PCPs’ decisions to refer, and billing time. Results PCPs submitted 26,121 eConsults during the study period. The monthly case volume increased by 43% over the duration of the study, primarily in the BASE model (66% compared to 6% for DTS). PCPs were able to confirm a course of action that they originally had in mind in 41.4% (6373/15,376) of BASE cases and 41.3% (3363/8136) of DTS cases and received advice for a new or additional course of action in 54.7% (8418/15,376) of BASE cases and 56.3% (4582/8136) of DTS cases. A referral was originally contemplated but avoided in 51.3% (7887/15,376) of BASE cases and 53.3% (4336/8136) of DTS cases, originally contemplated and still needed in 19.4% (2986/15,376) of BASE cases and 17.7% (1438/8136) of DTS cases, and neither originally contemplated nor needed in 21.7% (3334/15,376) of BASE cases and 21.9% (1781/8136) of DTS cases. Conclusions Both eConsult models had strong uptake. Use patterns varied between models, with the majority of growth occurring under BASE, but survey responses showed that both models provided similar outcomes in terms of new information offered and impact on decision to refer.
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Affiliation(s)
- Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Rhea Mitchell
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
| | - Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
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Singh J, Lou A, Green M, Keely E, Greenaway M, Liddy C. Evaluation of an electronic consultation service for transgender care. BMC Fam Pract 2021; 22:55. [PMID: 33743596 PMCID: PMC7980551 DOI: 10.1186/s12875-021-01401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
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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Affiliation(s)
- Jatinderpreet Singh
- Department of Family Medicine, Queen's University, Kingston, ON, Canada. .,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
| | | | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
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Tran C, Archibald D, Humphrey-Murto S, Wood TJ, Dudek N, Liddy C, Keely E. eConsult Specialist Quality of Response (eSQUARE): A novel tool to measure specialist correspondence via electronic consultation. J Telemed Telecare 2021; 28:280-290. [PMID: 33657913 PMCID: PMC9066665 DOI: 10.1177/1357633x21998216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
High-quality correspondence between healthcare providers is critical for effective patient care. We developed an assessment tool to measure the quality of specialist correspondence to primary care providers (PCPs) via electronic consultation (eConsult), where specialists provide advice without specialist-patient interactions. We incorporated fourteen previously described features of high-quality eConsult correspondence into an assessment tool named the eConsult Specialist Quality of Response (eSQUARE). Six PCPs and two specialists applied the 10-item eSQUARE tool to 30 eConsults of varying quality as informed by PCP survey data. Content, response process, and internal structure validity evidence was gathered. Psychometric properties were calculated using descriptive statistics and generalizability analyses. Mean total score for low-quality eConsults (M = 24 ± 5.6) was significantly lower than moderate-quality eConsults (M = 38 ± 4.7; p<0.001) which was significantly lower than high-quality eConsults (M = 46 ± 3.0; p = 0.002). Reliability measures were high, including generalizability coefficient (0.96), inter-item (≥0.55) and item-total correlations (≥0.68). A decision study demonstrated that a single rater was adequate to achieve a reliability measure of ≥0.70. This study demonstrates initial validity evidence including multiple reliability measures for the eSQUARE. A single rater is adequate to achieve reliability measures for formative feedback. Future studies can apply the eSQUARE when planning educational initiatives aiming to improve specialist-to-PCP correspondence via eConsult.
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Affiliation(s)
- Christopher Tran
- Department of Medicine, University of Ottawa, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Canada.,Bruyère Research Institute, Canada
| | - Susan Humphrey-Murto
- Department of Medicine, University of Ottawa, Canada.,Department of Innovation in Medical Education, University of Ottawa, Canada
| | - Timothy J Wood
- Department of Innovation in Medical Education, University of Ottawa, Canada
| | - Nancy Dudek
- Department of Medicine, University of Ottawa, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Canada.,Bruyère Research Institute, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Canada
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Abstract
BACKGROUND In Canada, wait times for access to specialized rheumatology services have increased, leading to new strategies to improve timely care; electronic consultations (eConsults) enable providers to ask specialists a clinical question using a secure platform, often reducing the need for a face-to-face visit. In this study, we sought to compare the types of referrals received through fax versus eConsult and to determine whether faxed referrals could be addressed using eConsult. METHODS We conducted a descriptive study of consecutive faxed referrals sent to a tertiary care centre between Feb. 1 and Mar. 6, 2017, and a convenience sample of eConsults directed to rheumatology between Feb. 1, 2015, and Sept. 30, 2016, through the Champlain BASE eConsult Service, an Ontario-based service. We reviewed all referrals and categorized them by clinical content and question type. A rheumatologist with experience completing eConsult referrals assessed faxed referrals for their suitability to be answered through eConsults. Descriptive statistics were generated. RESULTS We analyzed 300 consecutive faxed referrals and 300 (of 470) eConsult referrals. Faxed questions more often pertained to rheumatoid arthritis (32/300 [10.7%] v. 17/300 [5.7%]), systemic lupus erythematosus (24/300 [8.0%] v. 10/300 [3.3%]), and polyarthritis (30/300 [10.0%] v. 18/300 [6.0%]). eConsults more often addressed abnormal serology without joint symptoms (27/300 [9.0%] v. 8/300 [2.7%]) and gout (15/300 [5.0%] v. 4/300 [1.3%]). Faxed referrals were more likely to have no specific question (116/300 [38.7%]), and eConsults were more likely to have more than 1 question posed (99/300 [33.0%]) and a drug-related question (67/300 [22.3%]). The rheumatologist identified potential benefit from eConsult in 216/300 (72.0%) faxed referrals and 55/59 (93.2%) declined faxed referrals. INTERPRETATION Despite differences in diagnosis between eConsults and faxed referrals, most faxed referrals showed the potential to be addressed through eConsult. Using eConsult may allow primary care providers to obtain answers to questions without requesting a face-to-face specialist referral, or provide support for patients awaiting face-to-face consultation.
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Affiliation(s)
- Erin Keely
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont.
| | - Krista Rostom
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Douglas Smith
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Clare Liddy
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
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Kessler D, Hatch S, Alexander L, Grimes D, Côté D, Liddy C, Mestre T. The Integrated Parkinson's disease Care Network (IPCN): Qualitative evaluation of a new approach to care for Parkinson's disease. Patient Educ Couns 2021; 104:136-142. [PMID: 32660740 DOI: 10.1016/j.pec.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To evaluate the acceptability of the Integrated Parkinson's disease Care Network (IPCN) from the perspectives of persons with Parkinson's disease (PD), their care partners and healthcare providers, including identification of important components and areas for improvement. METHODS We used a descriptive qualitative approach with interviews (n = 15) and focus groups (n = 31) with persons with PD who were newly diagnosed and those with advanced PD, care partners and healthcare providers. Questions were designed to gather feedback on each component of the IPCN. RESULTS Four overarching categories emerged: CCI support, New knowledge, Goal identification and achievement, and Readiness for self-management. These represent important aspects of participants' experiences of the IPCN. CONCLUSION Most participants experienced the IPCN as helpful for managing living with PD and accessing resources. The relationship with the CCI was a critical component; the CCI was perceived to be knowledgeable, accessible, and responsive. PRACTICE IMPLICATIONS The IPCN is a model to promote coordinated care and self-management. This study supports the key components of the IPCN as important for supporting patients in managing their lives with PD. Incorporation of other strategies to support self-management may enhance the model. Availability of and access to community resources was identified as an ongoing challenge.
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Affiliation(s)
- Dorothy Kessler
- School of Rehabilitation Therapy, 31 George Street, Queen's University, Kingston, Ontario, K7L 3N6, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, ON, K1N 5C8, Canada.
| | - Stacey Hatch
- School of Rehabilitation Therapy, 31 George Street, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Libby Alexander
- School of Rehabilitation Therapy, 31 George Street, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - David Grimes
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada; University of Ottawa Brain and Mind Research Institute, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON, K1J 8M5, Canada
| | - Diane Côté
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Cres. Suite 201, Ottawa, ON, K1G 5Z3, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, ON, K1N 5C8, Canada
| | - Tiago Mestre
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada; University of Ottawa Brain and Mind Research Institute, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON, K1J 8M5, Canada
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Abstract
Background: Electronic consultation (eConsult) allows asynchronous virtual communication between primary care providers (PCPs) and specialists regarding patient care. Introduction: The Ontario eConsult Program enables timely and equitable access to specialist advice for Ontarians. This study examines clinicians' perspectives and experiences with the program. Materials and Methods: We conducted an anonymous survey of PCPs registered for the Ontario eConsult Program. The survey ran from June to August 2019 and included questions on PCPs' experiences with the service, opinions on remuneration, and recommendations for enhancement. Results: One thousand two hundred fifty-six PCPs completed the survey (response rate of 16%). Seventy-eight percent had submitted an eConsult, of whom 67% were active users (i.e., had submitted ≥3 eConsults in the past 6 months). The majority of PCPs stated that their user experience was very good (57%) or good (31%), 74% agreed that eConsult improved their referral decision making, and 73% agreed that eConsult increased their ability to manage a broader array of diagnoses. Thirty-seven percent felt adequately compensated for using eConsult, 30% wanted higher rates of remuneration, and 31% were not compensated or were unaware of the fee code. Discussion: The majority of PCPs who use eConsult had positive experiences with the service. Nevertheless, improvements to further streamline the service's use, particularly through electronic medical record integration, were broadly cited as a desirable improvement. Conclusions: PCPs expressed an overall positive experience with the Ontario eConsult Program, citing prompt response times and improved care delivery as chief benefits.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Ariana Mihan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Isabella Moroz
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Canada
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Mestre TA, Kessler D, Côté D, Liddy C, Thavorn K, Taljaard M, Grimes D. Pilot Evaluation of a Pragmatic Network for Integrated Care and Self-Management in Parkinson's Disease. Mov Disord 2020; 36:398-406. [PMID: 33280165 DOI: 10.1002/mds.28332] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic neurodegenerative disorder that challenges care provision. A multidisciplinary care model needs to be impactful, feasible, and viable economically for widespread utilization. Supportive evidence is lacking. OBJECTIVE The objective of this study was to evaluate the implementation and impact of a pragmatic network for PD care, the Integrated Parkinson Care Network (IPCN). METHODS A 6-month, pre-post design, single-center, phase 2 study for complex interventions for patients with newly diagnosed (<1 year) and advanced (diagnosis >8 years) PD was used to assess a patient-centered care model based on integrated care, self-management support, and technology-enabled care. We comprehensively assessed the implementation of care paths, change in selected health and care quality outcomes after the Integrated Parkinson Care Network program, and costs analyses. RESULTS We recruited 100 participants in 6 months. Overall, the top care priorities were speech and communication (33.7%), anxiety and depression (31.6%), and mobility, balance, and falls (29.6%), and the most commonly (>45%) used resources were speech-language pathology, community seniors services, and physiotherapy. Care priorities were met successfully in 90.6% of the cases, and there was a positive change in the Parkinson's Disease Questionnaire-8 (2.7; 95% confidence interval, 0.4-5.0; statistically significant in the advanced group), the perception of support for chronic care (Patient Assessment of Chronic Illness Case score, 1.1; 95% confidence interval, 0.9-1.4), and self-management (5As score, 1.2; 95% confidence interval, 1.0-1.4). The total cost of the Integrated Parkinson Care Network was C$1367 per patient. CONCLUSIONS A pragmatic development of a care delivery network based on integrated care and self-management support is promising for its feasibility, impact, and a sustainable cost. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tiago A Mestre
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Diane Côté
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Method's Center, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Method's Center, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David Grimes
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
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47
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Wooltorton E, Seale E, Lewis D, Noel K, Liddy C, Viner G, Shoppoff L, Archibald D. Rapid, collaborative generation and review of COVID-19 pandemic-specific competencies for family medicine residency training. Can Med Educ J 2020; 11:e50-e55. [PMID: 33062090 PMCID: PMC7522871 DOI: 10.36834/cmej.70254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND In March 2020, the COVID-19 pandemic disrupted competency-based medical education in Family Medicine programs across Canada. Faculty and residents identified a need for clear, relevant, and specific competencies to frame teaching, learning, supervision and feedback during the pandemic. METHODS A rapid, iterative, educational quality improvement process was launched. Phase 1 involved experienced educators defining gaps in our program's existing competency-database, reviewing emerging public health and regulatory guidelines, and drafting competencies. Phase 2 involved translation, member-checking, and anonymous feedback and editing of draft competencies by residents and other educational leaders. Phase 3 involved wider dissemination, collaborative editing and feedback from residents and faculty throughout the department. RESULTS A total of 44 physicians including residents and faculty from multiple contexts provided detailed feedback, review, and editing of an ultimate list of 33 competencies organized by CanMEDS-FM roles. Broad agreement was obtained that the competencies form reasonable learning outcomes during the COVID-19 pandemic. CONCLUSIONS These competencies represent learning objectives reflecting the initial educational mindsets of a wide range of teachers and learners experiencing a global pandemic. The project illustrates a novel collaboration across educational portfolios as a rapid educational response to a public health crisis.
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Affiliation(s)
- Eric Wooltorton
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Edward Seale
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Denice Lewis
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Kendall Noel
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Gary Viner
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Lina Shoppoff
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Ontario, Canada
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Breton M, Ann Smithman M, Lamoureux‐Lamarche C, Dumas Pilon M, Keely E, Farrell G, Singer A, Woods P, Bibeau C, Nabelsi V, Gaboury I, Gagnon M, Steele Gray C, Shaw J, Hudon C, Aubrey‐Bassler K, Bush P, Côté‐Boileau É, Gagnon J, Visca R, Liddy C. DISSEMINATION, IMPLEMENTATION, AND IMPACT. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. Breton
- University of Sherbrooke Longueuil QC Canada
| | | | | | - M. Dumas Pilon
- Collège québécois des médecins de famille Laval QC Canada
| | - E. Keely
- Department of Medicine University of Ottawa Ottawa ON Canada
| | | | - A. Singer
- University of Manitoba Winnipeg MB Canada
| | | | | | - V. Nabelsi
- Université du Québec en Outaouais Gatineau QC Canada
| | - I. Gaboury
- University of Sherbrooke Longueuil QC Canada
| | | | | | - J. Shaw
- Women's College Hospital Toronto ON Canada
| | - C. Hudon
- University of Sherbrooke Sherbrooke QC Canada
| | | | - P. Bush
- McGill University Montréal QC Canada
| | | | - J. Gagnon
- McGill University Montréal QC Canada
| | - R. Visca
- McGill University Montréal QC Canada
| | - C. Liddy
- Family Medicine C.T. Lamont Primary Health Care Research Centre Bruyère Research Institute Ottawa ON Canada
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49
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Helmer-Smith M, Fung C, Afkham A, Crowe L, Gazarin M, Keely E, Moroz I, Liddy C. The Feasibility of Using Electronic Consultation in Long-Term Care Homes. J Am Med Dir Assoc 2020; 21:1166-1170.e2. [DOI: 10.1016/j.jamda.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Staykov E, Qureshi D, Scott M, Talarico R, Hsu AT, Howard M, Costa AP, Fung C, Ip M, Liddy C, Tanuseputro P. Do Patients Retain their Family Physicians after Long-Term Care Entry? A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1951-1957. [PMID: 32586719 DOI: 10.1016/j.jamda.2020.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Older adults value and benefit from the long-standing relationship they have with their family physicians. This dynamic has not been researched in a long-term care (LTC, ie, nursing home) setting. We sought to determine the proportion of LTC residents who retain their community family physician within the first 180 days of LTC, and the resident, physician, and LTC home factors that may influence retention. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Individuals from Ontario, Canada, aged 60 years or older who were newly admitted to a LTC home between April 1, 2014 and March 31, 2017. METHODS Residents were indexed upon LTC admission, and their data was linked across ICES databases. Residents were matched to their rostered family physician, and physician retention was defined as having at least 1 visit by their matched physician within 0 to 90 days and 90 to 180 days of LTC admission. RESULTS Out of 50,089 LTC residents, 12.1% retained their family physicians post-LTC admission. Resident factors associated with reduced odds of retention included physical impairment [odds ratio OR (95% confidence interval, CI) = 0.59 (0.42‒0.83)], cognitive impairment [0.39 (0.33‒0.47)], and a dementia diagnosis [0.80 (0.74‒0.86)]. Physician factors associated with lower retention included a greater distance from the LTC home to the family physician's clinic [30+ kilometers 0.41 (0.35‒0.48)], having a physician who is female [0.90 (0.83‒0.98)], an international medical graduate [0.89 (0.81‒0.97)] or someone who practices in a capitation-based Family Health Organization [0.86 (0.78‒0.95)]. Factors associated with greater odds of retention were residing in a rural LTC home [2.23 (1.78‒2.79)], having a rural family physician [1.70 (1.52‒1.90)], or a family physician who has billed LTC fee codes in the past year [2.64 (2.45‒2.85)]. CONCLUSIONS AND IMPLICATIONS Few LTC residents retained their family physician post-LTC admission, underscoring this healthcare transition as a breakdown point in relational continuity. Factors that influenced retention included resident health, LTC home geography, and family physician demographics and practice patterns.
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Affiliation(s)
- Emiliyan Staykov
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Danial Qureshi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michelle Howard
- ICES McMaster, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada
| | - Michael Ip
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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