Primary Care Clinician Adherence to Specialist Advice in Electronic Consultation

Abstract

PURPOSE Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. METHODS This is a descriptive analysis based on a retrospective chart audit of 291 eConsults done between January 20, 2017 and August 31, 2017 at the Bruyère Family Health Team, located in Ottawa, Canada. Patients' charts were reviewed until 6 months after specialist response for the following main outcomes: implementation of specialist advice by primary care clinicians, communication of the results to the patients, method, and time frame of communication. RESULTS Primary care clinicians adhered to specialist advice in 82% of cases. Adherence ranged from 62% to 93% across recommendation categories. Questions asked by primary care clinicians related to diagnosis (63%), management (27%), drug treatment (10%), and procedures (1%). Recommendations of the eConsult were communicated to patients in 79% of cases, most often by face-toface visit (38%), telephone call (32%), or use of the patient portal (9%). Communication occurred in a median of 5 days. CONCLUSIONS We found little evidence of barriers to implementing specialist advice with use of eConsult, which suggests recommendations given through service were actionable. With a high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, we conclude that eConsult delivers good-quality care and improves patient management.

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

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Improving Equity of Access Through Electronic Consultation: A Case Study of an eConsult Service

“…As such, we could not determine whether and to what extent PCPs followed specialists' advice, nor examine any follow-up conversations between the PCP and the patient. Though a recent study by our team found that PCPs adhered to specialist advice in 82% of cases (39), the nature of the data nevertheless limits our ability to interpret outcomes. Additional case studies that include patient and PCP follow-up through interviews and access to health administrative data would be illuminating.…”

Abordaje compartido de patología digestiva en Ourense: motivación y utilidad de la e-consulta

“…Tras una sola consulta no presencial del especialista de Aparato Digestivo sería posible hacer el diagnóstico, pautar un tratamiento e, incluso, fijar una revisión para la misma. Analizadas las e-consultas realizadas en nuestro medio, podemos afirmar que los resultados obtenidos son similares a los descritos en estudios realizados en otros países [19][20][21] . La e-consulta lleva años aplicándose en gran parte del territorio nacional, aunque en cada AS tiene sus particularidades.…”

“…Diversos estudios norteamericanos relativos a la utilidad y satisfacción de la e-consulta objetivan que la mayoría se realizaron al Servicio de Gastroenterología, y entre ellas las relativas a endoscopias 19 . Además, estos estudios analizan los motivos por los que son llevadas a cabo: la mayor parte de las preguntas de los MF son relativas a cuestiones diagnósticas 20,21 . No obstante, carecemos de estudios que analicen la e-consulta en nuestro medio en relación con la utilidad, satisfacción o consumo de recursos.…”