eConsults and Learning Between Primary Care Providers and Specialists

Liddy, Clare; Abu-Hijleh, Tala; Joschko, Justin; Archibald, Douglas; Keely, Erin

doi:10.22454/fammed.2019.407574

Cited by 26 publications

(20 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have highlighted the potential educational value of eConsults for primary care providers. For example, a qualitative analysis conducted by Liddy et al, found that many providers using the system have commented on the educational value of specialist responses, which often times extends beyond the specific case-related question [20]. Amongst the eConsults assessed, there were a number of recurring themes with questions across different providers, potentially representing common gaps in knowledge amongst primary care providers.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have also demonstrated that eConsult is both safe and results in overall cost savings [11][12][13][14][15][16][17][18]. Furthermore, several studies have pointed to the unique learning opportunities that users have noted through using the system and several researchers have highlighted the potentially rich learning opportunities that could be gained from continuing education sessions focussed on the questions and content of eConsults [19,20].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of an electronic consultation service for transgender care

Singh

Lou²,

Green

et al. 2021

BMC Fam Pract

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of an electronic consultation service for transgender care

Singh

Lou²,

Green

et al. 2021

BMC Fam Pract

Self Cite

View full text Add to dashboard Cite

show abstract

“…The immediate discourse opened through e-consultations was seen as enhancing care by avoiding unnecessary visits to adolescent medicine specialists, identifying when alternative visit types (eg, telemedicine visits) might be appropriate, and triaging the immediacy with which patients should be seen. The ongoing communication facilitated by e-consultations was perceived to both enhance coordination of care and provide valuable opportunities for PCPs to enhance their adolescent health skills, a finding suggested in prior qualitative work and hinted at through a study of referral patterns throughout time [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design

Rankine¹,

Yeramosu²,

Matheo³

et al. 2021

JMIR Hum Factors

View full text Add to dashboard Cite

Background e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. Objective This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. Methods We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. Results Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. Conclusions Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.

show abstract

“…4 The literature shows that benefits of eConsults outside of patient care included increasing PCP confidence/reassurance, gaining information on guidelines/literature/ resources, and acquisition of new knowledge. 11 Neurology-specific eConsults offering has been explored by other countries successfully. The results highlight the benefits such as allowing prompt response to PCP inquires, early initiation of treatment, and reduced need for traditional visits to the clinics.…”

Section: Why Use Econsults?mentioning

confidence: 99%