Feasibility of an asynchronous general practitioner–to–general physician eConsultant outpatient substitution program: A Queensland pilot study

Job, Jennifer; Donald, Maria; Borg, Samantha J.; Nicholson, Caroline; Chaffey, Jan; O'Hara, Kathleen; Fagermo, Narelle; Jackson, Claire

doi:10.31128/ajgp-11-20-5707

Cited by 6 publications

(6 citation statements)

References 20 publications

(33 reference statements)

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“…Using the IRLM to integrate theory underpinning our implementation has allowed us to examine and modify our strategy bundle for ongoing implementation. Continuing quality and safety monitoring informs our service and fidelity outcomes which have been previously reported [ 22 ]. The next step in our research as implementation expands is to evaluate sustainability and service outcomes including a costing analysis to inform the benefits from both the patient and health system perspective.…”

Section: Discussionmentioning

confidence: 95%

“…Our eConsultant service [ 22 ] is based on a Canadian model [ 4 ]. Currently, the service provides general medicine physician support to GPs, for patients requiring specialist input who would have otherwise been referred for an outpatient department (OPD) appointment.…”

Section: Methodsmentioning

confidence: 99%

“…In 2018 we introduced an eConsult (eConsultant service) proof-of-concept in one urban general practice in Queensland, Australia. Subsequently the service was introduced to four rural practices as part of a pilot study in 2019 [ 22 ], with staged implementation to additional practices across Queensland since 2020. Our eConsultant service provides general medicine specialist support from the Mater Hospital Brisbane to participating practices state-wide.…”

Section: Introductionmentioning

confidence: 99%

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Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

Job

Nicholson

Calleja

et al. 2022

BMC Health Serv Res

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Background In response to lengthy wait times for specialist outpatient appointments, electronic consultation (eConsult) services have developed globally, providing asynchronous, secure and timely communication between general practitioner (GP) and specialist. This study aims to track adoption of a Queensland eConsultant service in two Australian Primary Health Networks (Western Queensland and Brisbane South) to understand key barriers and enablers to adoption and inform modification of the implementation strategy. Methods Our theory-informed mixed-methods evaluation assessed implementation between July 2020 and March 2022. Adoption and implementation activities were prospectively recorded in bespoke tracking spreadsheets with implementation activities coded against the Expert Recommendations for Implementing Change (ERIC) strategies. Semi-structured interviews with GPs and stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) were conducted to understand determinants of implementation. Results Of the 40 practices invited to take part in the eConsultant service, 20 (50%) enrolled. Of the 97 GPs who consented, 38 sent at least one Request for Advice (RFA) to the eConsultant with a total of 112 RFA sent. Implementation was predominantly guided by eight strategies. Qualitative interviews were conducted with 11 GPs and 4 stakeholders (12 from rural/remote regions, 11 females and two sole practitioners). Interviewees felt the eConsultant service supported outpatient appointment avoidance and provided efficient, timely access to specialist support for GPs and their patients. Barriers identified to using eConsultant related to digital infrastructure, competing priorities, and keeping the service ‘front of mind’. Key enablers identified were the relative advantage of eConsultant over other options, patient benefits and COVD-19 facilitating the use of digital technology. Conclusions This evaluation highlighted service enablers as well as user priorities for broader implementation. A focus on a well-integrated digital system and availability of a variety of eConsultant specialties are seen as key strategies to embedding the eConsultant option in GP advice processes in Australia.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

Job

Nicholson

Calleja

et al. 2022

BMC Health Serv Res

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“…Remote access to specialist advice where GPs can discuss their patients without referring them for a specialist consultation is one possible solution to bridge this gap. 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).…”

Section: Discussionmentioning

confidence: 99%

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

Sunjaya

Martin

Arnott

et al. 2023

Aust. J. Prim. Health

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Background. To explore the perspectives of GPs, non-GP specialists, and allied health professionals on the role of primary care in diagnosing and managing chronic breathlessness, the barriers faced, and the resources needed to optimise care of patients with chronic breathlessness. Methods. This was a qualitative study involving focus group discussions that included 35 GPs, non-GP specialists, and allied health professionals. Topics explored included:(1) views on the role of primary care in diagnosing and managing chronic breathlessness;(2) barriers to optimal assessment in primary care; and (3) facilitators to further optimise the care of patients with chronic breathlessness. Results. All participants considered that primary care has a central role to play in the assessment and management of chronic breathlessness, but greater access to referral services, suitable funding structures, and upskilling on the use of diagnostic tests such as spirometry and electrocardiography are required for this to be realised. Both GPs and non-GP specialists described great potential for developing better linkages, including new ways of referral and online consultations, greater ease of referral to allied health services, even if conducted virtually, for patients with functional causes of breathlessness. Participants identified a need to develop integrated breathlessness clinics for patients referred by GPs, which would ensure patients receive optimal care in the shortest possible time frame. Conclusions. GPs are crucial to achieving optimal care for breathless patients, especially given the multifactorial and multimorbid nature of breathlessness; however, there are significant gaps in services and resources at present that limit their ability to perform this role.

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“…8 Findings from initial evaluations of Australian eConsultant services support international evidence of reduced wait times and improved access to specialist input, signi cant avoidance of face-to-face hospital outpatient visits and better integrated care. 12,13 Additionally, eConsultant offers workplace exibility for the specialist, with the ability to deliver advice at the most suitable time and place. Our eConsultant service was piloted and implemented with a general (internal) medicine physician specialist, able to provide advice across all medical subspecialities bar dermatology.…”

Section: Introductionmentioning

confidence: 99%

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

Job¹,

Nicholson²,

Donald³

et al. 2023

Preprint

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Background The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. Methods A cost analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a health system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. Results The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. Conclusions The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.

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Feasibility of an asynchronous general practitioner–to–general physician eConsultant outpatient substitution program: A Queensland pilot study

Cited by 6 publications

References 20 publications

Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

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

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

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