Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians’ and Specialists’ Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study (Preprint)

Abstract

BACKGROUND Electronic Consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients’ medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care, prevent unnecessary referrals, improve PCPs’, specialists’ and patients’ satisfaction, and therefore have a large impact on costs. However, no studies have evaluated PCPs’ and specialists’ acceptance of eConsult services in Canada, and worldwide. OBJECTIVE This exploratory study aimed to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across three regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Usage of Technology (UTAUT) and Task-Technology Fit (TTF) models, and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. METHODS A cross-sectional web-based survey was sent to all PCPs (N=263) and specialists (N=62) who used the eConsult Quebec Service between July 2017 to May 2021. We proposed a unified model integrating the UTAUT model and TTF model, and user satisfaction by endorsing eleven hypotheses. The partial least squares (PLS) was used to investigate factors influencing the acceptance of the eConsult Quebec Service. RESULTS Of the 325 end users, 41.8% (N=101 or 38% PCPs and N=35 or 56% specialists) responded. The results of the analysis with PLS indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. Results suggest that satisfaction (SAT) is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (PE) (P<.001) and effort expectancy (EE) (P<.05) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact on adoption (ATT). TTF has an influence on PE (P<.001), ATT (P<.05) and SAT (P<.001). However, results show that there is no direct effect between social influence (SI) (P=.064) and BI or between facilitating conditions (FC) (P=.114) and ATT. CONCLUSIONS This study provides a better understanding of the factors influencing PCPs’ and specialists’ intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that has never been explored in Quebec until now. Based on the results, the service is a good fit to meet the users’ need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy-makers in order to maximize acceptance, use, adoption and success across the province of Quebec. In fact, after four successful years, the eConsult Quebec pilot project is now the Conseil Numérique (CN) digital consultation service. CLINICALTRIAL None.