The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study

Abstract

BackgroundChamplain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit “elective” clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction.ObjectiveTo determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults.DesignProspective observational cohort study.SettingSingle Canadian tertiary-care academic pediatric hospital (June 2014–16) servicing 1.2 million people.Participants1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions.Main outcomes and measuresSpecialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected.Results1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9–1.2) compared with a face-to-face referral (132 days; 95%CI:127–136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service.Conclusions and relevanceSimilar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes.

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.…”

Seeking Normalcy as the Curve Flattens: Ethical Considerations for Pediatricians Managing Collateral Damage of Coronavirus Disease-2019

“…Primary care pediatricians, pediatric subspecialists, and pediatric surgeons must collaborate and carefully monitor all patients whose treatment was postponed to ensure that they are not getting worse. 13,14 Communicating with patients on processes to make clinic visits safe may reassure anxious parents. All pediatricians should notify families about the options to connect with their care providers whether in person or via telephone, email, or telemedicine.…”

A pilot eConsultation service in Eastern Ontario: bridging clinical genetics and primary care

“…To date, there have been no reports describing experience with a genetics eConsult service. Within the Champlain Local Health Integration Network (LHIN), one of 14 regional health regions in the province of Ontario, Canada, that serves a population of 1.4 million, the Champlain Building Access to Specialists through eConsultation (BASE) TM service has demonstrated improved access to many sub-specialties to date [13][14][15][16][17][18]. The success of this and other programs has led to the planned development of a provincial eConsult program [19].…”