Evaluation of an Electronic Consultation Service in Obstetrics and Gynecology in Ontario

Shehata, Fady; Posner, Glenn; Afkham, Amir; Liddy, Clare; Keely, Erin

doi:10.1097/aog.0000000000001431

Cited by 27 publications

(39 citation statements)

References 2 publications

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“…Our results our similar to what has been reported in other specialties in Champlain BASE and other eReferral/eConsult studies examining preconsultation exchanges between PCP and specialists. [24][25][26][27] These studies have shown similar numbers of referrals that did not actually need to be seen by specialists. This is important, as it helps to allay some of the fear that patients are being missed by not being physically eConsultations in urology seen, as multiple studies across specialties consistently show eConsult to be an evolving and safe method of triaging patient referrals.…”

Section: Discussionmentioning

confidence: 79%

Improving access to urologists through an electronic consultation service

Witherspoon

Liddy²,

Afkham³

et al. 2017

CUAJ

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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.

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Section: Discussionmentioning

confidence: 79%

Improving access to urologists through an electronic consultation service

Witherspoon

Liddy²,

Afkham³

et al. 2017

CUAJ

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“…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.…”

Section: Patient and Clinician Experiencementioning

confidence: 85%

“…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.…”

Section: Costsmentioning

confidence: 99%

Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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Objective Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.

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“…For example, the utilisation of telemedicine between O&G specialists and general practitioners (GP) prior to the pandemic resulted in a third of referrals being de-escalated back for management in primary care. 15 This suggests a significant proportion of referrals could be managed by the GP providing they have access to specialist input. Moreover, in the context of RAC, data from a single centre identified half of referrals were inappropriate when compared with protocol-driven referral criteria.…”

Section: Referral Pathwaysmentioning

confidence: 99%