Improving access to otolaryngology–head and neck surgery expert advice through eConsultations

Abstract

4. Laryngoscope, 128:350-355, 2018.

Electronic consultations (E-consults) and their outcomes: a systematic review

“…At the time of our 2015 review, most studies reported high PCP satisfaction with e-consults, including perceived value, improved timeliness of specialty input, and enhanced communication with specialist. Newer studies using PCP surveys support these findings, 11,13,14,[18][19][20][21][22]24,26,[29][30][31][33][34][35][36]41,54,57,60,[62][63][64][65][67][68][69][70][71] and 2 qualitative studies also report generally high PCP satisfaction. 7,39 More recent studies have also described a strong educational benefit to less-experienced PCPs.…”

“…Sleep medicine e-consultation followed by the specialists' order of a sleep study and positive airway pressure therapy, if indicated, resulted in a decrease over 4 years in the interval between sleep consult and positive airway pressure prescription from 60 days to 7 days. 38 More than a dozen studies report a response time (i.e., the time between when the e-consult is requested and when the responding specialist provides the response) of a few days or less, 11,13,14,16,20,21,28,32,34,35,40,46,47,51,56,61,62,67,69 whereas face-toface visits generally require days to weeks to be completed.…”

“…62 Several publications from the Champlain BASE program report on a PCP survey question at the end of each e-consult request about whether a face-to-face consult would have been sent in the absence of the e-consult option. Depending on specialty of the consultation being requested, 32%-80% of PCPs report that a face-to-face visit would have been required absent the e-consult, [12][13][14]16,[18][19][20][21]24,26,[28][29][30][31][32][33][34][35][36]41,47,51,58,62,65 suggesting that up to as many as 4 out of 5 e-consults are perceived to obviate a face-to-face visit. Using these data on face-to-face referrals avoided, the Champlain BASE group calculated payer costs decreasing from $131.05 to $6.45 (CAD) per econsult from year 1 to year 3 of the program.…”

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

“…Most identified studies were published in the last 10 years (online supplementary eFigure 1) and included eConsult programme from eight countries: Finland, Ireland, Canada, Spain, Brazil, the UK, The Netherlands and USA (online supplementary eFigure 1). Observational designs were commonly used to report eConsult programme, and these included surveys,11 38–50 focus groups/interviews16 17 48 51–56 and mixed methods 57–59. We also identified three RCTs,60–62 three systematic reviews15 63 64 and four narrative reviews 65–68.…”

“…In one study,89 it was reported that over 90% of patients surveyed were highly satisfied with their eConsult experiences, and in another study the majority of patients (86.6%) stated that eConsult was “useful in their situation.”52 In other studies, PCPs’ perceptions were used as a proxy to evaluate patient satisfaction. In several studies, the majority of providers rated eConsult as ‘very good’ to ‘excellent’ service for their patients 11 39 41 43 76 92 93. The perspective of PCPs is also important, as one study of patient engagement in eConsult found that most patients expressed minimal desire to directly engage with eConsult and preferred their PCPs to take on that role 48…”