Utilization, Benefits, and Impact of an e-Consultation Service Across Diverse Specialties and Primary Care Providers

Abstract

Background: Access to specialist advice remains a barrier for primary care providers (PCPs) and their patients. Virtual consultations have been used to expedite access. There are few studies demonstrating the utilization and impact of such services. We established a regional e-consultation service that was used across a wide range of specialty services and PCPs. Materials and Methods: We prospectively collected all e-consultations submitted from April 1, 2011 to June 30, 2012. Utilization data collected included number of econsultations submitted, specialist response, and time required for the specialist to complete the e-consultation. Perceived benefit to the PCPs and their patients and the impact on care delivery were determined from a close-out survey. Results: Fifty-nine PCPs submitted 406 e-consultations to 16 specialty services. The specialist provided an answer without requesting further information in 89% of cases, with > 90% of cases taking < 15 min for the specialist to complete. Seventy-five percent of cases were answered in < 3 days. The service was perceived as highly beneficial to providers and patients in > 90% of cases. In 43% of submitted cases a traditional referral was originally contemplated but was now avoided. Conclusions: We successfully implemented an e-consultation service across diverse PCPs and specialty services that was highly valued. Almost half of referrals submitted would have required a face-to-face consultation if the service had not been available. Thus e-consultation has tremendous potential for improving access to specialist advice in a much more timely manner than the traditional referral-consultation process.

Improving access to urologists through an electronic consultation service

“…22 The Champlain BASE system is a secure, web-based service that interfaces between a PCP (general practitioner or nurse practitioner) and a specialist. The PCP is able to submit questions using a standardized, patient-specific form.…”

Ten Steps to Establishing an e-Consultation Service to Improve Access to Specialist Care

“…As of June 30, 2013, over 1,257 consults have been processed through the system. 23 User satisfaction is high, with satisfaction ratings of 4.63 out of 5. We have 26 different specialists services available for consultation, including the recent addition of a clinical pharmacist.…”

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ™ eConsult Service

“…16,17 These findings correspond with those for the Champlain BASE ™ eConsult service, both overall and specifically with regard to chronic pain cases. 14,19,32 Notably, PCPs have expressed high levels of satisfaction with cases submitted to chronic pain specialists. In a closeout survey completed at the end of each case, PCPs ranked the service as having high or very high value for their patients and themselves in 90% and 92% of cases, respectively.…”

“…18,19 Given the complexity of treating people with chronic pain, we were interested in further understanding the types of questions asked and the nature of the response from the specialists. Therefore, the purpose of this article is to identify the major themes emerging from exchanges between PCPs and specialists regarding patients with chronic pain.…”