Effective Integration of an eConsult Service into an Existing Referral Workflow Within a Primary Care Clinic

Liddy, Clare; Man, Gwen de; Moroz, Isabella; Afkham, Amir; Mercer, Jay; Keely, Erin

doi:10.1089/tmj.2019.0014

Cited by 7 publications

(13 citation statements)

References 15 publications

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“…Intervention agents hosted clinical days for case review and 1hour lunch-and-learn sessions at homes where there was interest in tailoring workflows or setting up a delegate(s), a central bodydoften a nurse, ward clerk, or administrative staff memberdwho submits eConsults on behalf of the home's PCPs. 14 This was generally consistent across the region; however, some LTC PCPs created their eConsult accounts without direct or targeted engagement from the intervention agents.…”

Section: Methodsmentioning

confidence: 76%

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Helmer-Smith

Fung

Afkham³

et al. 2020

Journal of the American Medical Directors Association

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Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated. We completed a thematic analysis of 4 focus groups with PCPs, senior leadership, and a nurse champion working in LTC homes where eConsult is used. Sixty-four cases were submitted to 23 specialty and subspecialty groups by LTC PCPs, most frequently dermatology (19%), geriatric medicine (11%), and infectious disease (9%). Specialists responded in a median of 0.6 days, and 70% of cases were resolved without the resident needing a face-to-face specialist visit. In 60% of cases, PCPs received advice for a new or additional course of action. Participants described complexities in the LTC context, the value of eConsult in LTC, and considerations for implementation. PCPs with experience using the service described increased access to specialist advice, ease of use, and benefits to themselves, residents, and families. eConsult is feasible in LTC and should continue to be used in this region and beyond to improve equity of access to specialist advice. Resolving the identified limitations in LTC, which hinder access to specialists and adoption of eConsult and similar innovations, should be of high priority to researchers and policy makers.

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Section: Methodsmentioning

confidence: 76%

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Helmer-Smith

Fung

Afkham³

et al. 2020

Journal of the American Medical Directors Association

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“…This and our overall findings should be reassuring to health services looking to implement surgical eConsults into their workflow. The most common barriers to eConsult implementation that we identified-namely, medicolegal, workload, and reimbursement concerns-are very similar to recent articles dedicated to this topic [81,[85][86][87][88] and, therefore, were not discussed in this paper.…”

Section: Comparison With Prior Workmentioning

confidence: 75%

The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review

Payne¹,

Kevric²,

Stelmach³

et al. 2022

JMIR Perioper Med

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Background Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research.

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“…We screened 181 full-text articles, of which we excluded 108 records after applying exclusion criteria. A total of 72 studies were eligible for data extraction (Figure).…”

Section: Resultsmentioning

confidence: 99%

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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Effective Integration of an eConsult Service into an Existing Referral Workflow Within a Primary Care Clinic

Cited by 7 publications

References 15 publications

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

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