Scaling up eConsult for access to specialists in primary healthcare across four Canadian provinces: study protocol of a multiple case study

Abstract

Background Canada has been referred to as the land of ‘perpetual pilot projects’. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times – one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communication that allows primary care providers to electronically consult with specialists regarding their patients’ medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador. Our aim is to understand and support the scale-up process of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-up process in each province; (2) understand the eConsult scale-up process in each province and compare across provinces; (3) identify policy issues and strategies to scaling up eConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling up eConsult. Methods We will conduct a qualitative multiple case study to investigate the scaling up of eConsult in four Canadian provinces using a grey literature review, key stakeholder interviews (10 interviews/province), non-participant observations, focus groups and deliberative dialogues. We will identify the main components of eConsult to be scaled up using logic models (obj. 1). Scaling up processes will be analysed using strategies adapted from process research (obj. 2). Policy issues and strategies to scale-up eConsult will be analysed thematically (obj. 3). Finally, a symposium will foster pan-Canadian learning on the process of scaling up eConsult (obj. 4). Discussion This study will likely increase learning and support evidence-based policy-making across participating provinces and may improve the capacity for a pan-Canadian scale-up of eConsult, including in provinces where eConsult has not yet been implemented. This work is essential to inform how similar innovations can reshape our health systems in the evolving information age.

Use of Electronic Medical Record Data to Create a Dashboard on Access to Primary Care

“…Such a process was instrumental and essential to access nominal data to develop a dashboard. Creating a dashboard within a research project under the jurisdiction of a research ethics committee temporarily allowed us to circumvent regulatory requirements, a strategy that has been shown to be efficient for other innovation scale-up projects in PHC, such as eConsultation ( Breton et al 2019 ; Moroz et al 2020 ). This facilitated the consent process, from the clinics' perspective, to provide access to confidential and sensitive data.…”

Scaling-Up eConsult: Promising Strategies to Address Enabling Factors in Four Jurisdictions in Canada

“…The researchers and knowledge users on our team helped us identify key actors to approach for participation. We adapted the interview guide from a previously published guide 25 and tailored it according to each participant’s role and province. Two researchers with expertise in qualitative interviewing (MAS and CLL) who had not played a role in the scale-up of eConsult conducted the interviews to ensure confidentiality and minimize the influence of the interviewers on the answers provided.…”

“…The fact that the four provinces are at different stages of the scale-up process offers a unique learning opportunity. 25 …”

Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory (Preprint)

“…Among the 3944 records, we found 5 records concerning the early adoption of telehealth interventions in general practice. We identified 1 conceptual article [29], 1 study protocol [30], 1 case study of an early adopter site [31], and 2 qualitative studies [32,33]. The case study describes the impact of a web-based consultation system on working practices in an inner-city general practice.…”