Luke Witherspoon1, Clare Liddy2, Amir Afkham3, Erin Keely4, John Mahoney1. 1. Department of Urology, University of Ottawa; Ottawa, ON, Canada. 2. Department of Family Medicine, University of Ottawa and C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute; Ottawa, ON, Canada. 3. Champlain LHIN; Ottawa, ON, Canada. 4. Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute; Ottawa, ON, Canada.
Abstract
INTRODUCTION: Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. METHODS: Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. RESULTS: Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. CONCLUSIONS: Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists.
INTRODUCTION: Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. METHODS: Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. RESULTS: Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. CONCLUSIONS: Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists.
Authors: Varsha G Vimalananda; Jay D Orlander; Melissa K Afable; B Graeme Fincke; Amanda K Solch; Seppo T Rinne; Eun Ji Kim; Sarah L Cutrona; Dylan D Thomas; Judith L Strymish; Steven R Simon Journal: J Am Med Inform Assoc Date: 2020-03-01 Impact factor: 4.497
Authors: Milan Patel; Adam J Gadzinski; Alexander M Bell; Kara Watts; Emma Steppe; Anobel Y Odisho; Claire C Yang; Chad Ellimoottil Journal: Urol Pract Date: 2020-12-02
Authors: Christopher J D Wallis; James W F Catto; Antonio Finelli; Adam W Glaser; John L Gore; Stacy Loeb; Todd M Morgan; Alicia K Morgans; Nicolas Mottet; Richard Neal; Tim O'Brien; Anobel Y Odisho; Thomas Powles; Ted A Skolarus; Angela B Smith; Bernadett Szabados; Zachary Klaassen; Daniel E Spratt Journal: Eur Urol Date: 2020-09-04 Impact factor: 20.096