ISQUA18-1492Better Communication, Better Quality Person-Centred Care: Supporting Primary Care in the Community with eConsult

Abstract

Objectives: Poor access to specialist care is a serious issue in Canada. A 2016 survey by the Commonwealth Fund ranked it last among 11 countries surveyed on wait times for specialist treatment. (1) To address this issue, we launched the Champlain BASETM (Building Access to Specialists through eConsultation) eConsult service, a secure online application that allows primary care providers (PCP) and specialists to communicate electronically regarding a patient's care. PCPs log into the service using a web browser, enter their question, attach any supplementary files (e.g. photographs, test results), and select a specialty group such as dermatology, endocrinology, etc. The case is assigned to an available specialist, who responds within one week with advice for treatment, in-person referral, or further investigation. We evaluated the service's impact on supporting PCPs in the community by providing timely access to high quality specialist advice, enhancing care around the needs of the patient rather than availability of specialists. Method(s): We conducted a cross-sectional analysis of eConsult cases completed between April 2011 and December 2017. Utilization data was collected automatically by the service, along with the results of a survey completed by PCPs at the close of each case. The survey consists of four multiple choice/Likert scale questions assessing 1) the outcome of the case, 2) the case's impact on the PCP's decision to refer the patient, 3) value to the patient, and 4) value to the provider. Questions 3 and 4 were changed in October 2016 to assess the case's educational value for inclusion in continuing medical education (CME) curricula. An optional fifth question allows PCPs to leave free-text comments. Result(s): 33,327 cases were completed during the study period. Monthly case volume grew steadily from 4 cases in April 2011 to 1,034 in December 2017. The service enrolled 1,160 family physicians and 195 nurse practitioners from 484 clinics in 112 communities, and offered access to 109 specialty groups. Specialists responded to cases in a median of 0.9 days. Top 4 specialties consulted were dermatology (16%), obstetrics/gynecology (7%), hematology (6%) and endocrinology (6%). PCP received advice for a new or additional course of action in 57% of cases, and in 68% of cases a face-to-face specialist referral was not needed. PCPs ranked eConsult as high value in 93% of cases, and as high educational value in 92%. In 57% of cases, PCPs agreed/strongly agreed that the case content should be used in upcoming CME events. Conclusion(s): The eConsult service has empowered PCPs to provide more timely and better quality person-centered care in their communities. Through eConsult, thousands of patients have received the treatment they need from their PCP, allowing them to avoid specialist visits, which often entail delays of months or years, delays in assessment and treatment, and travel hardship for patients in remote regions. Building on its success, eConsult is being implemented provincially across Ontario and expanding across Canada. Other countries would benefit from considering a similar program.