The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Abstract

Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated. We completed a thematic analysis of 4 focus groups with PCPs, senior leadership, and a nurse champion working in LTC homes where eConsult is used. Sixty-four cases were submitted to 23 specialty and subspecialty groups by LTC PCPs, most frequently dermatology (19%), geriatric medicine (11%), and infectious disease (9%). Specialists responded in a median of 0.6 days, and 70% of cases were resolved without the resident needing a face-to-face specialist visit. In 60% of cases, PCPs received advice for a new or additional course of action. Participants described complexities in the LTC context, the value of eConsult in LTC, and considerations for implementation. PCPs with experience using the service described increased access to specialist advice, ease of use, and benefits to themselves, residents, and families. eConsult is feasible in LTC and should continue to be used in this region and beyond to improve equity of access to specialist advice. Resolving the identified limitations in LTC, which hinder access to specialists and adoption of eConsult and similar innovations, should be of high priority to researchers and policy makers.

Innovation Through Regulation: COVID-19 and the Evolving Utility of Telemedicine

“…The integrated health network of Eastern Ontario has demonstrated the feasibility of using e-consultation for specialty care such as dermatology and infectious disease and identified perceived value with respect to timeliness, quality of care, and cost. 10 Similarly, investigators in the AMDA Telemedicine workgroup conducted a study of the perceived value of subspecialty telemedicine that showed that dermatology, geriatric psychiatry, and infectious disease were the specialties that PALTC practitioners would consult the most if available. 11 Similarly, many have called for reimbursement models to further expand reimbursement for telemonitoring and other telephonic-based care modalities.…”

Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study

“…91% of PCPs rate the response as helpful and 60% of PCPs agree the case would be educational for their peers (Champlain BASE™ eConsult Service, 2017–2018). Further, previous work found that eConsult provided LTC PCPs with a new or additional course of action in 60% of cases ( Helmer-Smith et al, 2020 ).…”

“…Given the limited access to specialist advice within LTC homes, challenges associated with external transfer, restrictions related to COVID-19 and infection control, and eConsult’s proven ability to facilitate high-quality, specific and helpful PCP-specialist communication about a residents’ care, eConsult is highly applicable to the LTC setting. Through eConsult, residents and their PCPs are able to obtain specialist advice to treat/manage the residents’ condition(s) and inform care planning, often without the need for a face-to-face specialist visit (70%) ( Helmer-Smith et al, 2020 ). In this way, eConsult is improving equitable access to specialist advice, supporting clinical decision-making, helping to address traditionally unmet needs, and improving residents’ quality of life.…”

“…These appointments are challenging for most residents due to the barriers associated with mobility and transfers, transportation, and coordinating caregiver escorts. Thus, referrals may not be initiated ( Helmer-Smith et al, 2020 ) and conditions may go untreated or managed without the advice of specialists. In the case of a persistent skin condition, for example, this can have a significant impact on the resident’s quality of life ( Shah & Coates, 2006 ).…”

“…In community settings, eConsult services improve timely access to specialist advice, are effective clinical-decision support tools, improve patient experience, have high provider satisfaction, build PCP-specialist relationships, are sustainable, and are cost-effective ( Barnett et al, 2017 ; Lee et al, 2018 ; Liddy et al, 2016 , 2019 ; Liddy & Keely, 2018 ; Vimalananda et al, 2015 ). Though the feasibility of using eConsult in LTC was recently demonstrated ( Helmer-Smith et al, 2020 ), little is known about how PCPs are using it in this setting or the type of advice they are seeking.…”