Gwen de Man1,2,3, Isabella Moroz1, Jay Mercer2,4, Erin Keely5,6, Clare Liddy7,2. 1. CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada. 2. Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada. 3. Radboud University, Nijmegen, The Netherlands. 4. Bruyère Academic Family Health Team, Bruyère Continuing Care, Ottawa, Ontario, Canada. 5. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 6. Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada. 7. CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada cliddy@bruyere.org.
Abstract
PURPOSE: Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. METHODS: This is a descriptive analysis based on a retrospective chart audit of 291 eConsults done between January 20, 2017 and August 31, 2017 at the Bruyère Family Health Team, located in Ottawa, Canada. Patients' charts were reviewed until 6 months after specialist response for the following main outcomes: implementation of specialist advice by primary care clinicians, communication of the results to the patients, method, and time frame of communication. RESULTS: Primary care clinicians adhered to specialist advice in 82% of cases. Adherence ranged from 62% to 93% across recommendation categories. Questions asked by primary care clinicians related to diagnosis (63%), management (27%), drug treatment (10%), and procedures (1%). Recommendations of the eConsult were communicated to patients in 79% of cases, most often by face-to-face visit (38%), telephone call (32%), or use of the patient portal (9%). Communication occurred in a median of 5 days. CONCLUSIONS: We found little evidence of barriers to implementing specialist advice with use of eConsult, which suggests recommendations given through service were actionable. With a high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, we conclude that eConsult delivers good-quality care and improves patient management.
PURPOSE: Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. METHODS: This is a descriptive analysis based on a retrospective chart audit of 291 eConsults done between January 20, 2017 and August 31, 2017 at the Bruyère Family Health Team, located in Ottawa, Canada. Patients' charts were reviewed until 6 months after specialist response for the following main outcomes: implementation of specialist advice by primary care clinicians, communication of the results to the patients, method, and time frame of communication. RESULTS: Primary care clinicians adhered to specialist advice in 82% of cases. Adherence ranged from 62% to 93% across recommendation categories. Questions asked by primary care clinicians related to diagnosis (63%), management (27%), drug treatment (10%), and procedures (1%). Recommendations of the eConsult were communicated to patients in 79% of cases, most often by face-to-face visit (38%), telephone call (32%), or use of the patient portal (9%). Communication occurred in a median of 5 days. CONCLUSIONS: We found little evidence of barriers to implementing specialist advice with use of eConsult, which suggests recommendations given through service were actionable. With a high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, we conclude that eConsult delivers good-quality care and improves patient management.
Keywords:
access to care; communication; coordination of care; decision making; delivery of health care; eConsult; health informatics; integrated; practice-based research; primary care clinician adherence; professional practice
Authors: Christopher J Stille; Thomas J McLaughlin; William A Primack; Kathleen M Mazor; Richard C Wasserman Journal: Pediatrics Date: 2006-10 Impact factor: 7.124
Authors: Varsha G Vimalananda; Gouri Gupte; Siamak M Seraj; Jay Orlander; Dan Berlowitz; Benjamin G Fincke; Steven R Simon Journal: J Telemed Telecare Date: 2015-05-20 Impact factor: 6.184