Evaluation of an Electronic Consultation Service for COVID-19 Care

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. RESULTSA 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. CONCLUSIONSThis 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.

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

“…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).…”

“…Of the 72 studies, 34 (47%) were conducted in the US, 31 (43%) in Canada,and 7 (10%) in the rest of the world (Table 2). Of the 72 studies, 31 (43%) focused on multispecialty services, and 14 (19%) focused on internal medicine or a subspecialty of internal medicine .…”

“…The number of included e-consultations per study ranged from 54 to 3 177 998. Of all 72 studies, 2 (3%) were RCTs, 4 (5%) were nonrandomized trials, and 66 (92%) were observational . The most frequently mentioned reasons for implementing the e-consultation were improving access to hospital care (63 of 72 studies [88%]), avoiding hospital referrals (28 of 72 studies [38%]), and enhancing clinician communication (9 of 72 studies [13%]).…”

“…Of all 72 studies, 2 (3%) were RCTs, 4 (5%) were nonrandomized trials, and 66 (92%) were observational . The most frequently mentioned reasons for implementing the e-consultation were improving access to hospital care (63 of 72 studies [88%]), avoiding hospital referrals (28 of 72 studies [38%]), and enhancing clinician communication (9 of 72 studies [13%]). Reasons for avoiding hospital referrals included (1) reducing unnecessary referrals (28 of 72 studies [38%]), for example, during the COVID-19 pandemic or for patients unable to travel to the hospital, and (2) controlling health care costs (7 of 72 studies [10%]).…”

Management of chronic breathlessness in primary care: what do GPs, non-GP specialists, and allied health professionals think?

“…A 2021 pilot study on the use of remote access to specialists in Queensland showed that it is feasible in Australia and reduced the need for a face-to-face referral by about 85% (Job et al 2021). A similar study in Ontario, Canada, during the COVID-19 pandemic suggested that telemedicine consults can prevent about 25% of what would otherwise be in-person specialist visits, thus freeing up space in the health system (Singh et al 2022).…”