The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years

Liddy, Clare; Mitchell, Rhea; Guglani, Sheena; Mihan, Ariana; Sethuram, Claire; Miville, Andrea; Keely, Erin

doi:10.1370/afm.2812

Cited by 6 publications

(17 citation statements)

References 8 publications

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“…We screened 181 full-text articles, of which we excluded 108 records after applying exclusion criteria. A total of 72 studies were eligible for data extraction (Figure).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 72 studies, 34 (47%) were conducted in the US, 31 (43%) in Canada,and 7 (10%) in the rest of the world (Table 2). Of the 72 studies, 31 (43%) focused on multispecialty services, and 14 (19%) focused on internal medicine or a subspecialty of internal medicine . The number of included e-consultations per study ranged from 54 to 3 177 998.…”

Section: Resultsmentioning

confidence: 99%

“…The number of included e-consultations per study ranged from 54 to 3 177 998. Of all 72 studies, 2 (3%) were RCTs, 4 (5%) were nonrandomized trials, and 66 (92%) were observational . The most frequently mentioned reasons for implementing the e-consultation were improving access to hospital care (63 of 72 studies [88%]), avoiding hospital referrals (28 of 72 studies [38%]), and enhancing clinician communication (9 of 72 studies [13%]).…”

Section: Resultsmentioning

confidence: 99%

“…Of all 72 studies, 2 (3%) were RCTs, 4 (5%) were nonrandomized trials, and 66 (92%) were observational . The most frequently mentioned reasons for implementing the e-consultation were improving access to hospital care (63 of 72 studies [88%]), avoiding hospital referrals (28 of 72 studies [38%]), and enhancing clinician communication (9 of 72 studies [13%]). Reasons for avoiding hospital referrals included (1) reducing unnecessary referrals (28 of 72 studies [38%]), for example, during the COVID-19 pandemic or for patients unable to travel to the hospital, and (2) controlling health care costs (7 of 72 studies [10%]).…”

Section: Resultsmentioning

confidence: 99%

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

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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“…We screened 181 full-text articles, of which we excluded 108 records after applying exclusion criteria. A total of 72 studies were eligible for data extraction (Figure).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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“…7 The eConsult model of care is an outpatient substitution approach which has been evaluated, and implemented extensively internationally. [8][9][10][11] It provides an asynchronous, digital, clinician-to-clinician advice service, giving GPs remote access to specialist support for patient care within 3 business days. 8 Findings from initial evaluations of Australian eConsultant services support international evidence of reduced wait times and improved access to specialist input, signi cant avoidance of face-to-face hospital outpatient visits and better integrated care.…”

Section: Introductionmentioning

confidence: 99%

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

Job¹,

Nicholson²,

Donald³

et al. 2023

Preprint

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Background The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. Methods A cost analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a health system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. Results The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. Conclusions The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.

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Supporting complex care in general practice via an eConsultant model of care: the Australian specialist perspective

Petre,

Donald,

Jackson

2023

Aust. J. Prim. Health

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Background Accessing timely specialist physician advice and guidance is of critical importance to both Australian GP specialists (GPs) and their patients. The traditional method of referral, triage and subsequent face-to-face (FTF) consultation is facing challenges from an ever increasing volume of referrals and the needs of underserved populations. In response to such issues, electronic consults (eConsults) have been successfully used internationally to provide GPs with a means of asynchronously accessing specialist physician advice and guidance within 72 h. Few studies have addressed the potential impact of eConsults from the view of the non-GP specialist receiving the request, and none specifically related to specialist adult medicine physicians. The aim of this study was to determine the perceptions of current Royal Australasian College of Physicians (RACP) adult medicine Fellows towards establishing an eConsult model of care within their own clinical practice. Methods Semi-structured interviews were conducted with 14 RACP adult medicine Fellows between December 2019 and February 2020. Purposive and snowball sampling strategies were used to recruit physicians of differing ages and gender from diverse specialties and healthcare settings. The data were subjected to a descriptive thematic analysis. Results We describe five key themes of relevance to study participants: (1) improved access to non-GP specialist care; (2) the business model in relation to remuneration and time; (3) enhanced GP–Physician relationships; (4) impact on physician work–life balance; and (5) the need for a structured model of care. There was broad consensus that a significant number of outpatient referrals to adult medicine physicians would be more appropriately addressed in primary care with support via an asynchronous eConsult arrangement. RACP Fellows agreed this could improve access to timely specialist advice, place downward pressure on outpatient FTF clinic waiting times and reduce unnecessary patient travel. Conclusion These findings identify the drivers and barriers to the establishment of an Australian eConsultant model of care from the adult medicine physician’s perspective.

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The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years

Cited by 6 publications

References 8 publications

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

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

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

Supporting complex care in general practice via an eConsultant model of care: the Australian specialist perspective

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