Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

Abstract

Background In response to lengthy wait times for specialist outpatient appointments, electronic consultation (eConsult) services have developed globally, providing asynchronous, secure and timely communication between general practitioner (GP) and specialist. This study aims to track adoption of a Queensland eConsultant service in two Australian Primary Health Networks (Western Queensland and Brisbane South) to understand key barriers and enablers to adoption and inform modification of the implementation strategy. Methods Our theory-informed mixed-methods evaluation assessed implementation between July 2020 and March 2022. Adoption and implementation activities were prospectively recorded in bespoke tracking spreadsheets with implementation activities coded against the Expert Recommendations for Implementing Change (ERIC) strategies. Semi-structured interviews with GPs and stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) were conducted to understand determinants of implementation. Results Of the 40 practices invited to take part in the eConsultant service, 20 (50%) enrolled. Of the 97 GPs who consented, 38 sent at least one Request for Advice (RFA) to the eConsultant with a total of 112 RFA sent. Implementation was predominantly guided by eight strategies. Qualitative interviews were conducted with 11 GPs and 4 stakeholders (12 from rural/remote regions, 11 females and two sole practitioners). Interviewees felt the eConsultant service supported outpatient appointment avoidance and provided efficient, timely access to specialist support for GPs and their patients. Barriers identified to using eConsultant related to digital infrastructure, competing priorities, and keeping the service ‘front of mind’. Key enablers identified were the relative advantage of eConsultant over other options, patient benefits and COVD-19 facilitating the use of digital technology. Conclusions This evaluation highlighted service enablers as well as user priorities for broader implementation. A focus on a well-integrated digital system and availability of a variety of eConsultant specialties are seen as key strategies to embedding the eConsultant option in GP advice processes in Australia.

Impact of eConsults on Clinical Care in Primary Care: A Cross-Sectional Analysis of Primary Care Provider Behavior

“…4,19 eConsults can help circumvent provider shortages in these settings. 20,21 Comments from the PCPs we interviewed reinforced our chart review findings. PCPs affirmed their appreciation for eConsults and their intent to act on eConsult specialists' recommendations, but noted that their patients' inability to access or afford some types of treatment impacted whether they would incorporate the recommendation into their treatment plan.…”

Understanding inherent influencing factors to digital health adoption in general practices through a mixed-methods analysis

“…Our literature review and expert interviews aimed to identify and synthesize currently postulated adoption barriers and improvement strategies for digital health adoption more broadly and validate their relevance in general practice settings. We initially retrieved 1276 records in the literature search, of which we included 24 articles 13 , 15 , 17 – 19 , 22 , 23 , 28 – 44 .…”

“…The literature review identified technological, social, and organizational adoption barriers. More than 90% of included studies reported organizational adoption barriers 13 , 15 , 17 , 18 , 22 , 23 , 28 – 44 (23/24), with more than half reporting high workload 17 , 22 , 29 , 30 , 34 , 36 – 44 and a lack of time 13 , 15 , 17 , 18 , 23 , 28 , 29 , 31 – 34 , 36 , 40 , 42 (each 14/24; 58%) as predominant barriers. Another 88% of studies identified social adoption barriers 13 , 15 , 17 , 18 , 22 , 23 , 28 – 32 , 35 – 44 (21/24).…”

“…More than 90% of included studies reported organizational adoption barriers 13 , 15 , 17 , 18 , 22 , 23 , 28 – 44 (23/24), with more than half reporting high workload 17 , 22 , 29 , 30 , 34 , 36 – 44 and a lack of time 13 , 15 , 17 , 18 , 23 , 28 , 29 , 31 – 34 , 36 , 40 , 42 (each 14/24; 58%) as predominant barriers. Another 88% of studies identified social adoption barriers 13 , 15 , 17 , 18 , 22 , 23 , 28 – 32 , 35 – 44 (21/24). Of these, physicians’ familiarity with digital health solutions 15 , 17 , 18 , 22 , 23 , 28 , 30 – 32 , 36 , 38 – 44 (17/24; 71%) was the most cited social barrier, followed by overall awareness 15 , 18 , 22 , 23 , 29 , 30 , 32 , 35 , 43 , 44 (10/24; 42%) and patient preferences 15 , 18 , 23 , 29 – 31 …”

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

“…Our eConsultant service was piloted and implemented with a general (internal) medicine physician specialist, able to provide advice across all medical subspecialities bar dermatology. 14 The specialist was employed by an urban tertiary hospital which provided hospital-based general medicine clinics. In 2019, the hospital complemented this with an eConsultant service to two Australian regions (Western Queensland, and Brisbane South), resulting in 87% of requests for advice to the eConsultant replacing a traditional outpatient referral.…”