Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis

Abstract

ObjectiveTo examine the process of implementing an electronic consultation (eConsult) service and evaluate its impact along key metrics outlined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.DesignCross-sectional study.SettingClinics using eConsult in four provinces across Canada: Alberta, Manitoba, Quebec and Newfoundland and Labrador.ParticipantsAll eConsult cases submitted in four participating provinces were included.InterventionThe eConsult service is a secure online application that allows primary care providers and specialists to communicate regarding a patient’s care. We measured the impact using system utilisation data and mandatory close-out surveys completed at the end of each eConsult.Main outcome measuresImplementation progress and impact were examined using the five categories outlined by the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance.ResultsFour provinces provided data from different periods, ranging from 4 years (Alberta) to 10 months (Manitoba). Total cases completed ranged from 96 (Manitoba) to 6885 (Alberta). Newfoundland had the largest menu of available specialties (n=35), while Alberta and Quebec had the smallest (n=22). The most frequently requested groups varied across provinces, with only endocrinology appearing in the top five for all provinces. The average specialist response time ranged from 3 days (Manitoba) to 16.7 days (Alberta). Between 54% (Newfoundland) and 66% (Manitoba) of cases resulted in new or additional information. Primary care providers avoided completing referrals they had originally considered in 36% (Newfoundland) to 53% of cases (Manitoba), while only between 27 % (Quebec) and 29% (Newfoundland) of cases resulted in a referral. In every province, services demonstrated higher rates of usage in their last quarter of data than their first.ConclusionseConsult was successfully implemented in four new provinces across Canada. Implementation strategies and scope varied, but services demonstrated substantial consistency on several key metrics, most notably on whether new information was learnt and impact on decision to refer.

Teleclinics in rheumatology introduced during the first lockdown phase of the COVID-19 pandemic of 2020

“…5 The General Medical Council (GMC) has recently published guidance for the COVID-19 pandemic entitled Remote Consultations. 6 Electronic consultation and telemedicine have long been used in sparsely populated large countries including Canada 7 and Australia, 8 while teleconsulting has been employed by general practitioners and has been in longer existence. However, many lessons from general practice are not fully generalisable to hospital outpatient services, where consultations are often not patient-initiated and involve detailed review and planning of the management of complex conditions with many relevant comorbidities.…”

Impactos de sistemas eletrônicos de comunicação entre a atenção primária e a especializada: uma revisão integrativa

“…Os estudos incluídos nesta revisão foram publicados no intervalo entre os anos de 2000 e 2020. Com relação ao país de origem, verificou-se que a maior parte dos estudos foram do Canadá, com sete publicações (Archibald et al, 2018;Fogel, Khamisa, Afkham, Liddy, & Keely, 2016;Johnston et al, 2017;Kohlert et al, 2018;Liddy et al, 2019b;Liddy, Moroz, Mihan, & Keely, 2019c;Liddy et al, 2016b); seguidos pela Holanda (van den Akker et al, 2001; Schettini et al, 2019), com quatro e três publicações respectivamente; Reino Unido (Mehrtens, Shall, & Halpern, 2019;Stoves et al, 2010), Finlândia (Harno, Paavola, Carlson, & Viikinkoski, 2000;Jaatinen, Aarnio, Remes, Hannukainen, & Köymäri-Seilonen, 2002), Itália (Scalvini, Rivadossi, Comini, Muiesan, & Glisenti, 2011;Scalvini et al, 2009), Brasil (Carrard et al, 2018;Katz et al, 2020) e Espanha (Lacasta Tintorer et al, 2020;Vidal-Alaball et al, 2018) sediando duas publicações; e finalmente, Portugal (Paiva et al, 2001), França (Piette, Nougairède, Vuong, Crickx, & Tran, 2017) e Nova Zelândia (Mann & van de Weijer, 2018) foram os países de origem de uma publicação cada um.…”

“…Quanto às áreas da saúde nas quais os sistemas eletrônicos de comunicação foram utilizados, cinco estudos se concentraram na especialidade de Dermatologia (Mehrtens et al, 2019;Piette et al, 2017;van den Akker et al, 2001;van der Heijden et al, 2011;Vidal-Alaball et al, 2018), três na área de Nefrologia ( van Gelder et al, 2017;Schettini et al, 2019;Stoves et al, 2010), e dois nas áreas de Hematologia (Fogel et al, 2016;Johnston et al, 2017) e Otorrinolaringologia (Gilani et al, 2020;Kohlert et al, 2018); um estudo nas áreas de Neurologia (Paiva et al, 2001), Dor Crônica (Liddy et al, 2016), Estomatologia (Carrard et al, 2018), Psiquiatria (Archibald et al, 2018), Cardiologia (Scalvini et al, 2011), Angiologia (Chittle et al, 2015) e Ginecologia (Mann et al, 2018). Estudos reportando sistemas para múltiplas especialidades foram em número de oito (Harno et al, 2000;Jaatinen et al, 2002;Katz et al, 2020;Lacasta Tintorer et al, 2020;Liddy et al, 2019b;Liddy et al, 2019c;Scalvini et al, 2009;van der Velden et al, 2019).…”

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

“…Complex or chronic disease management is within the purview of the adult general physician specialty and is well suited to the eConsultant model. 17,18 Generally well accepted by both primary care and specialist providers, the eConsultant model of care facilitates decision support for GPs, an element of care of particular importance in the management of patients with complex or chronic disease. 7 Asynchronous electronic GP-to-specialist consultation services have been researched and successfully…”