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Pavón de Paz I, Rosado Sierra JA, Salguero Ropero AL, Viedma Torres V, Guijarro de Armas G, Cuesta Rodríguez-Torices M, Azcoitia Manrique P, Merino Viveros M, Navea Aguilera C, Iglesias P, Durán Martínez M. [E-consultation as a tool for the relationship between Primary Care and Endocrinology. Impact of COVID-19 epidemic in its use]. J Healthc Qual Res 2022; 37:155-61. [PMID: 34866028 DOI: 10.1016/j.jhqr.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Electronic consultation (eConsultation) can precede, complete, or replace visits to the specialist. OBJECTIVE To describe the profile of eConsultations issued from Primary Care (PC) to the Endocrinology Unit since their implementation in our hospital, to assess the response time and to evaluate changes in trends in relation to the COVID19 pandemic. A secondary objective is to evaluate the degree of satisfaction of PC specialists with this tool. MATERIAL AND METHODS An observational retrospective study of Endocrinology eConsultations conducted from June 2019 to October 2020 analysing 2periods: pre-COVID and post-COVID. The degree of satisfaction of the Family and Community Medicine specialists was assessed by means of a questionnaire. RESULTS 391 eConsultations were answered (69 pre-COVID and 322 post-COVID). The response time was less than 24h in 85% of them. A total of 35.3% were resolved without the need for visits or additional tests. Thyroid pathology was the most consulted. The incidence was significantly higher in the post-COVID period. The proportion of high resolution was significantly higher in the pre-COVID period. There were no differences in the rest of the parameters analysed in both periods. Thirty-nine point 2percent of PC specialists answered the survey. The degree of satisfaction of PC specialists was high. A total of 92.7% considered that the tool met their expectations and 90.5% were satisfied or very satisfied with its use. CONCLUSION The COVID epidemic has driven the use of eConsultation in Endocrinology, which makes it possible to precede, complete or replace visits to the specialist, with a high degree of user satisfaction.
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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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Boom VE, van der Kamp LT, van Zuilen AD, De Ranitz WL, Bos WJ, Jellema WT, Mui KW, Later AF, Prinssen M, Kaasjager K. Ongoing effects of eConsultation in nephrology on hospital referral rates: An observational study. J Telemed Telecare 2020; 28:423-428. [PMID: 32746760 DOI: 10.1177/1357633x20942037] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION eConsultation in nephrology is an innovative way for general practitioners (GPs) to consult a nephrologist. Studies have shown that questions from GPs can be answered and intended referrals can be avoided by eConsultation. However, follow-up data are lacking. The primary aim of this study was therefore to assess whether patients for whom a referral to the outpatient clinic of a medical specialist was avoided in the short term were not then referred for the same problem within one year after the eConsultation. METHODS All eConsultations sent between June 2017 and April 2018 to seven nephrologists in three different hospitals in The Netherlands were included. Exclusion criteria were duplications and missing data on follow-up. Data were obtained from the eConsultation application forms and from GP medical records. RESULTS A total of 173 eConsultations were included. Of the 32 patients for whom a referral was initially prevented, 91% (95% confidence interval 75-98) had not been referred to a specialist for the same problem within one year after the eConsultation. DISCUSSION eConsultation in the field of nephrology can prevent referrals in the long term. It can therefore contribute to a more modern and efficient health-care system in which chronic care is provided by GPs in close proximity to patients, while specialist support is easily available and accessible through eConsultation when necessary.
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Affiliation(s)
- Victor Ea Boom
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Laura T van der Kamp
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Arjan D van Zuilen
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Wendela L De Ranitz
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Willem Jan Bos
- Department of Internal Medicine, St Antonius Ziekenhuis Nieuwegein, The Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, The Netherlands
| | - Wilbert T Jellema
- Department of Internal Medicine, St Antonius Ziekenhuis Nieuwegein, The Netherlands
| | - Kwok Wai Mui
- Department of Internal Medicine, Ziekenhuis St Jansdal, The Netherlands
| | - Alexander F Later
- Department of Internal Medicine, Ziekenhuis St Jansdal, The Netherlands
| | | | - Karin Kaasjager
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
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Kohlert S, Murphy P, Tse D, Liddy C, Afkham A, Keely E. Improving access to otolaryngology-head and neck surgery expert advice through eConsultations. Laryngoscope 2017; 128:350-355. [PMID: 28573644 DOI: 10.1002/lary.26677] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 12/03/2016] [Revised: 04/14/2017] [Accepted: 04/20/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Prolonged wait times have become common. Electronic consultations (eConsults) have been shown in previous studies to reduce unnecessary face-to-face consultations to specialists, but no prior study has investigated the feasibility or efficacy of eConsults in an otolaryngology-head and neck surgery (OTO-HNS) practice. STUDY DESIGN Prospective observational study. METHODS The Champlain BASE eConsult system is a secure web portal allowing primary care physicians (PCPs) to communicate asynchronously with specialists about a patient, without requiring a formal face-to-face consult. The data from all eConsults sent through this portal to OTO-HNS practices between July 2011 and January 2015 were collected and analyzed. RESULTS Response time was rapid; over 40% of eConsults received a response within 24 hours, and nearly all eConsults were answered within 7 calendar days. The median response time was nearly 29 times faster than traditional face-to-face consultation. Unnecessary face-to-face referrals were avoided in 33.4% of all eConsults, and in nearly 50% of cases where the PCP initially planned a formal referral. PCPs reported adopting a new or additional course of action over 50% of the time following an eConsult. Eighty-eight percent of PCPs reported the service to be valuable for their patients, and 92% found it valuable for themselves. eConsults require only a limited time commitment from specialists, with over 75% taking less than 10 minutes to complete. CONCLUSIONS eConsultation is a cost-effective system that can lead to decreased wait times, improved communication between PCPs and otolaryngologists, and help guide the development of targeted continuing professional development modules for PCPs. LEVEL OF EVIDENCE 4. Laryngoscope, 128:350-355, 2018.
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Affiliation(s)
- Scott Kohlert
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick Murphy
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Darren Tse
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, 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
| | - Amir Afkham
- Champlain Local Health Integration Network, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
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Murthy R, Rose G, Liddy C, Afkham A, Keely E. eConsultations to Infectious Disease Specialists: Questions Asked and Impact on Primary Care Providers' Behavior. Open Forum Infect Dis 2017; 4:ofx030. [PMID: 28470015 PMCID: PMC5407213 DOI: 10.1093/ofid/ofx030] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2010, the Champlain BASE (Building Access to Specialist Advice through eConsultation) has allowed primary care providers (PCPs) to submit clinical questions to specialists through a secure web service. The study objectives are to describe questions asked to Infectious Diseases specialists through eConsultation and assess impact on physician behaviors. METHODS eConsults completed through the Champlain BASE service from April 15, 2013 to January 29, 2015 were characterized by the type of question asked and infectious disease content. Usage data and PCP responses to a closeout survey were analyzed to determine eConsult response time, change in referral plans, and change in planned course of action. RESULTS Of the 224 infectious diseases eConsults, the most common question types were as follows: interpretation of a clinical test 18.0% (41), general management 16.5 % (37), and indications/goals of treating a particular condition 16.5% (37). The most frequently consulted infectious diseases were as follows: tuberculosis 14.3% (32), Lyme disease 14.3% (32), and parasitology 12.9% (29). Within 24 hours, 63% of cases responded to the questions, and 82% of cases took under 15 minutes to complete. In 32% of cases, a face-to-face referral was originally planned by the PCP but was no longer needed. In 8% of cases, the PCP referred the patient despite originally not planning to make a referral. In 55% of cases, the PCP either received new information or changed their course of action. CONCLUSIONS An eConsult service provides PCPs with timely access to infectious disease specialists' advice that often results in a change in plans for a face-to-face referral.
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Affiliation(s)
| | | | - Clare Liddy
- Bruyere Research Institute, Department of Family Medicine, University of Ottawa, Canada; and
| | - Amir Afkham
- BEng, Champlain Local Health Integration Network, Ottawa, Canada
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