Building Capacity for Specialized Services Through eConsultation

Summary

The consultation-referral process is complex, involving several steps including 1) the PCP recognizing the need for specialist advice/intervention, 2) patient agreement on seeing the specialist, 3) referral letter and information sent to specialist, 4) appointment booked and communicated, 5) patient visit(s) with the specialist and 6) communication back to the PCP.

There are many factors during this process which limit the effectiveness and efficiency of patient care. These include inequitable access for patients and providers, long wait times before specialist advice received/implemented, delayed communication and mismatched consult expectations. These gaps result in significant breakdowns in transitions of care, inappropriate treatment, patient dissatisfaction and potential harm. Moreover, not all individuals are willing or able to travel to see specialists in a large academic medical centre even when recommended by the PCP.

Electronic consultation (eConsult) service is a form of asynchronous communication whereby primary care providers (PCP) and specialists can communicate directly about a patient through a secure web-based application. eConsult has the potential for improving transitions in care through improved communication ensuring that patients are seen by the right specialist, when necessary, with the right information and in a timely manner. The goal of this project is to evaluate the impact of eConsult on specialist referral rates using health administrative data.

Conditions

• Health Services Research

Interventions

OTHER

Champlain BASE eConsult Service

After undergoing registration, which includes orientation and brief training on the use of the service, physicians randomized to intervention arm will be able to submit patient-specific clinical questions to specialists through a secure, web-based application. Specialists are asked to respond within 7 days and, for each eConsult, are able to: (1) provide a recommendation, (2) request more information, or (3) recommend a face-to-face referral. The communication between PCPs and specialists is iterative and the discussion can occur back and forth until, ultimately, the PCP closes the case.

Sponsors & Collaborators

• Ontario Ministry of Health and Long Term Care

  collaborator OTHER_GOV

• The Ottawa Hospital

  collaborator OTHER

• Ontario Medical Association

  collaborator OTHER

• Champlain Local Health Integration Network

  collaborator UNKNOWN

• Bruyère Health Research Institute.

  lead OTHER

Principal Investigators

• Clare Liddy, MD · Bruyere Research Institute, C. T. Lamont Primary Health Care Research Centre

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2014-01-01

Primary Completion

2016-12-31

Completion

2017-12-31

Countries

• Canada

Study Locations