Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial

Gelder, Vincent A van; Haan, Nynke Scherpbier-de; Berkel, Saskia van; Akkermans, Reinier; Grauw, Inge S de; Adang, Eddy; Assendelft, W.J.J.; Grauw, Wim J C de; Biermans, Marion C J; Wetzels, Jack F.M.

doi:10.1093/fampra/cmw131

Cited by 23 publications

(42 citation statements)

References 13 publications

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“…Our results are remarkably comparable to the other 3 international reports. 8 - 10 In all studies, there was high provider satisfaction, quick turnaround, similar requirement of specialist time (15 minutes on average), and reduction in need for face-to-face visits. There are some significant differences between our service and the others reported.…”

Section: Discussionmentioning

confidence: 90%

“… 6 , 7 Three other groups have looked at eConsults in nephrology clinics. 8 - 10 A quality improvement initiative undertaken in 17 volunteer practices in one region in the United Kingdom to improve communication between PCPs and nephrologists launched a nephrology specific eConsultation service through a shared electronic medical record. Overall, 68 eConsults were completed with a mean response time of 7 days, and specialist time to complete of 15.5 minutes.…”

Section: Introductionmentioning

confidence: 99%

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Nephrology eConsults for Primary Care Providers: Original Investigation

Keely

Magner

et al. 2018

Can J Kidney Health Dis

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Background:The Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service allows primary care providers (PCPs) to submit patient-specific clinical questions to specialists via a secure web service.Objective:Our objective was to describe the types of nephrology questions asked through an eConsult service based in eastern Ontario and assess the service’s impact on the need for face-to-face consultations.Design:Cross-sectional study using descriptive statistics was conducted using nephrology cases submitted between May 2011 and January 2015. Specialist response times and referral avoidance were collected. Validated taxonomies were used to categorize cases based on question type and content.Setting:Patient cases were collected from PCPs in Ottawa, Ontario, and its surrounding communities and submitted to nephrologists at the Ottawa Hospital.Patients:During the study period, 155 eConsults were submitted to nephrology.Measurement:Utilization and survey data were collected for all eConsults. Questions were categorized by subject matter and question type.Results:A traditional consult visit was avoided in 45% of cases based on the specialist’s advice; 21% cases required referral. Thirty-two percent of eConsults took specialists less than 10 minutes to complete, 55% took 10 to 15 minutes, 11% took 15 to 20 minutes, and only 2% took more than 20 minutes. Twenty-five percent of cases were related to proteinuria, 18% to chronic kidney disease (CKD), 17% to imaging, and 12% to drug use in CKD. Common question types included general management (37%), interpretation of laboratory test (17%), interpretation of an image report (13%), and need for nephrology referral (11%).Limitations:Some consults contained multiple categories and question types. Our analyses required a single classification, which may underestimate the number of questions in each category. Our study had a small sample size using cases completed in a single health jurisdiction, limiting generalizability.Conclusions:The Champlain BASE™ eConsult service provided guidance to PCPs and reduced the number of face-to-face nephrology consultations.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Nephrology eConsults for Primary Care Providers: Original Investigation

Keely

Magner

et al. 2018

Can J Kidney Health Dis

View full text Add to dashboard Cite

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“…Observational designs were commonly used to report eConsult programme, and these included surveys,11 38–50 focus groups/interviews16 17 48 51–56 and mixed methods 57–59. We also identified three RCTs,60–62 three systematic reviews15 63 64 and four narrative reviews 65–68. Characteristics of the included studies summarised in online supplementary eTable 1.…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

et al. 2019

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IntroductionElectronic consultation (eConsult)—provider-to-provider electronic asynchronous exchanges of patient health information at a distance—is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services.MethodsWe applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of eConsult (asynchronous (store-and-forward) use of telemedicine to exchange patient health information between two providers (primary and secondary) at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied.ResultsAmong the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were increased workload for providers, privacy concerns and insufficient reimbursement for providers. Main facilitators were remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult.ConclusionThere are multiple barriers to and facilitators of eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.

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“…We have seen that extra education for the GPs in our previous study did not meet their needs in interpreting and managing CKD [ 20 ]. We hypothesise that educational interventions should be even more intense, as Pang found in a study in which GPs perceived an increase in knowledge after interventions during which they were personally mentored by nephrologists [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Four focus group interviews were conducted with 27 Dutch GPs. We recruited (by phone and e-mail) from practices that had participated in the CONTACT study (Consultation Of Nephrology by Telenephrology Allows optimal Chronic kidney disease Treatment in primary care) [ 20 ]. These GPs were definitely informed about the guideline.…”

Section: Methodsmentioning

confidence: 99%

General practitioners’ perspectives on management of early-stage chronic kidney disease: a focus group study

et al. 2018

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BackgroundGuideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners’ (GPs’) perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care.MethodQualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data. Mind-mapping sessions were performed after data-saturation.ResultsFive themes emerged: defining CKD, knowledge and awareness, patient-physician interaction, organisation of CKD care and value of the guideline. A key finding was the abstractness of the CKD concept. The GPs expressed various perspectives about defining CKD and interpreting estimated glomerular filtration rates. Views about clinical relevance influenced the decision-making, although factual knowledge seems lacking. Striving to inform well enough without creating anxiety and to explain suitably for the intellectual ability of the patient caused tension in the patient-physician interaction. Integration with cardiovascular disease-management programmes was mentioned as a way of implementing CKD care in the future. The guideline was perceived as a rough guide rather than a leading document.ConclusionCKD is perceived as an abstract rather than a clinical concept. Abstractness plays a role in all formulated themes. Management of CKD patients in primary care is complex and is influenced by physician-bound considerations related to individual knowledge and perception of the importance of CKD. Strategies are needed to improve GPs’ understanding of the concept of CKD by education, a holistic approach to guidelines, and integration of CKD care into cardiovascular programmes.Trial registrationNot applicable.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0736-3) contains supplementary material, which is available to authorized users.

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Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial

Abstract: The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.

Cited by 23 publications

References 13 publications

Nephrology eConsults for Primary Care Providers: Original Investigation

Nephrology eConsults for Primary Care Providers: Original Investigation

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

General practitioners’ perspectives on management of early-stage chronic kidney disease: a focus group study

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