The Utilization of an Electronic Consultation Service During the Coronavirus Disease 2019 Pandemic

Singh, Jatinderpreet; Keely, Erin; Guglani, Sheena; Garber, Gary; Liddy, Clare

doi:10.1089/tmj.2021.0497

Cited by 13 publications

(18 citation statements)

References 14 publications

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“…We screened 181 full-text articles, of which we excluded 108 records after applying exclusion criteria. A total of 72 studies were eligible for data extraction (Figure).…”

Section: Resultsmentioning

confidence: 99%

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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“…We screened 181 full-text articles, of which we excluded 108 records after applying exclusion criteria. A total of 72 studies were eligible for data extraction (Figure).…”

Section: Resultsmentioning

confidence: 99%

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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“…Across several specialties, eConsults have been found to be effective, 1,2 cost‐saving 3 and acceptable to patients, who are saved the inconvenience and expense of unnecessary in‐person visits to specialists 4 . The use of eConsults has increased in recent years, with a particularly marked uptick associated with the coronavirus disease 2019 (COVID‐19) pandemic 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…4 The use of eConsults has increased in recent years, with a particularly marked uptick associated with the coronavirus disease 2019 (COVID-19) pandemic. 5,6 The ChamplainBASE eConsult service 7,8 offers access to general internists and other specialists as electronic consultants. In Canada, general internists rarely function as PCPs, more often functioning as hospital-based physicians and consultants for outpatient services.…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the use of electronic consultation in general internal medicine

Lai

Keely

McCutcheon

et al. 2022

Internal Medicine Journal

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BackgroundGeneral internists in Canada are subspecialty providers in the inpatient and outpatient settings. Electronic consultations (eConsult) allow primary care providers (PCPs) to virtually consult specialists to address clinical questions. There is a paucity of literature examining the utility and benefits of eConsults by general internists.AimsTo determine how an eConsult service is used to access general internists.MethodsA retrospective cross‐sectional analysis of internal medicine cases was completed between 1 January 2016 and 31 December 2019 via the ChamplainBASE eConsult service. Two authors derived and validated a general internal medicine (GIM)–specific taxonomy using the validated: (i) Taxonomy of Generic Clinical Questions; and (ii) Internal Classification for Primary Care. Two hundred seventy‐six cases were coded following taxonomy validation. ChamplainBASE utilisation summary and closeout survey data were also analysed.ResultseConsults were responded to in a median of 3.1 days and took 15 min to complete. The eConsult's helpfulness and educational value were rated as 4 to 5/5 and often provided advice for a new or additional course of action. In‐person referral was avoided in 40% of cases. The majority of eConsults consisted of a single question (88%) related to diagnostic clarification. The median remuneration per eConsult was $50.ConclusionsThe majority of eConsults to general internists sought diagnostic clarification and confirmed the view of general internists as expert diagnosticians. eConsults cost less than an in‐person consultation and were viewed favourably by PCPs. Further research can consider the eConsult provider experience and whether eConsults should become a required part of GIM ambulatory practice.

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“…The COVID-19 pandemic has also irrevocably changed public perception regarding virtual delivery of medical care, requiring many clinicians to pivot their practice to facilitate fewer in-person visits (4). We have seen virtual care models enable allergists to supervise introduction of commonly allergenic foods at home (5), with other data showing 1-4 hours of patient time saved by attending virtual allergist care where appropriate (6).…”

mentioning

confidence: 99%

“…Effectiveness in the elds of nephrology (12), rheumatology (13), hematology (14), and other medical specialties has been well studied. The utility of eConsults the setting of the COVID-19 pandemic has been reviewed previously (4), but use of these platforms as it pertains to potential COVID-19 vaccine-related concerns has yet to be delineated. We sought to determine the utility of this platform as it pertains to COVID vaccinerelated concerns posed to allergy specialists by PCPs in Ontario, particularly given the limited availability of inperson consultation and low utility of many of the traditional diagnostic tools of CIA specialists in this domain (15).…”

mentioning

confidence: 99%

Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

Walter

Jeimy

Liddy

et al. 2022

Preprint

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Background The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored. Methods We performed a cross-sectional review of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly sample of 499 total cases. Data regarding whether external resources were required to answer each eConsult, impact on primary care provider referral decisions, and allergy consultant response times were collected. A 2-question survey was completed by primary care providers following eConsultation and results were collected. Results 41.08% of eConsults received involved safety concerns regarding COVID-19 vaccine administration in the setting of prior allergic disease and another 36.1% involved a potential reaction the first dose of a COVID-19 vaccine. 72.1% of eConsults were answered by specialist without needing external resources, and only 9.8% of all eConsults received resulted in a recommendation for formal in-person referral to Clinical Immunology & Allergy specialist or another subspecialty. Average time to complete eConsult was 16.4 minutes, and 79.7% of PCP eConsult queries which would have traditionally resulted in formal consultation were resolved based on advice provided in the eConsult without need for in-person assessment. Conclusions Our review demonstrates the utility of the eConsult service as it pertains to COVID-19 vaccine-related concerns. The eConsult platform proved an effective tool in diverting the need for in person assessment by an Allergist or other medical specialty. This is significant given the large volume of eConsults completed by Allergists, and demonstrates the impact of an effective electronic delivery of care model during a time of strained resources and public health efforts directed at mass vaccination.

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The Utilization of an Electronic Consultation Service During the Coronavirus Disease 2019 Pandemic

Cited by 13 publications

References 14 publications

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

A retrospective analysis of the use of electronic consultation in general internal medicine

Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

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