Evaluation of an electronic consultation service for transgender care

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.

Pediatric Primary Care Providers’ Perspectives on Telehealth Platforms to Support Care for Transgender and Gender-Diverse Youths: Exploratory Qualitative Study

“…Electronic consultation uses store-and-forward electronic dialogue to provide patient-specific, specialist-to-PCP consultation. This modality, which has also shown great promise in facilitating gender-affirming care provision in primary care for TGD adults [19][20][21][22], has led to increased provider knowledge along with decreased barriers to accessing specialty care [23][24][25]. Finally, telephonic consultation, which is the most common of these consultation models, typically involves PCPs calling an on-call specialist to discuss a specific case over the telephone [26].…”

Information and communication technology-based health interventions for transgender people: A scoping review

“…e-Consultation platforms. Two projects [64,65] described the use of e-consultation platforms to link primary health providers with transgender health specialists. Using these platforms, clinicians who were not familiar with gender-affirming care were able to seek support from a wider network of specialists, thereby increasing the access and linkage of transgender people to appropriate care, especially for those who lived in rural areas.…”

“…Moreover, analysing the questions that providers asked could also help researchers in identifying potential gaps in knowledge among primary care providers. However, some challenges included delayed response from specialists, and specialists may provide impractical recommendations because they did not understand the context and difficulties of under-resourced settings [64].…”

Transgender Individuals and Digital Health

“…An exciting new development in telehealth is the ability for transgender medicine content experts to mentor clinicians through electronic consultations (eConsults). eConsults are typically provided promptly and securely through the electronic medical record software [ 44 ]. The use of eConsults minimizes the need for specialty referrals and has been shown to be both efficient and cost-effective [ 45 ].…”

“…The use of eConsults minimizes the need for specialty referrals and has been shown to be both efficient and cost-effective [ 45 ]. eConsults in transgender health have been used to assist with hormonal therapy management, management of bloodwork, and behavioral health–related care [ 44 , 46 , 47 ]. Studies have also pointed to the educational value of eConsults in the training of PCPs in transgender care, with most PCPs reporting increased knowledge, improved comfort caring for transgender clients, and improved patient care plans [ 47 , 48 ].…”