Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

Abstract

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

Management of HIV Care in Primary Care Settings

“…In Ontario, the Champlain Local Health Integration Network used the BASE eConsult service to connect primary care providers with HIV specialist physicians, HIV pharmacists, and social workers via a secure, web-based system. 16 During the study period of 2015 to 2017, the health network provides cared for around 2,000 PLWH and includes approximately 1,400 primary care physicians. The demographic profiles in this region are similar to the rest of Ontario.…”

“…The demographic profiles in this region are similar to the rest of Ontario. 16 A mixed methods study was undertaken to assess the usefulness and acceptability of the eConsult service. Primary care physicians can use the service to submit questions to the specialists and can attach any relevant files for review.…”

“…At that time, the physician is required to complete a survey regarding the outcomes and value of the service. 16 Forty-six consults were submitted by 21 primary care physicians during the study period. 16 The median response time for specialists was 1 day and 18 hours and 65.2% of cases were responded to in 3 days or less.…”

“…16 Forty-six consults were submitted by 21 primary care physicians during the study period. 16 The median response time for specialists was 1 day and 18 hours and 65.2% of cases were responded to in 3 days or less. Questions were most often related to drug treatment (how to prescribe, interactions, drug of choice), disease management, or diagnosis (interpretation of a lab test or clinical finding).…”

“…Questions about counseling patients regarding drug affordability issues were also common and were most often answered by an HIV pharmacist. 16 The HIV pharmacists tended to suggest engagement in multidisciplinary coordinated patient care with the primary care physician, while HIV specialist physicians seemed more likely to attempt to reassume the care coordination role from the primary care physician. Overall, the authors concluded that the eConsult service was a beneficial added support for primary care physicians caring for PLWH.…”