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Multicenter Study
. 2018 Mar;16(2):120-126.
doi: 10.1370/afm.2177.

Sustainability of a Primary Care-Driven eConsult Service

Clare Liddy  1   2 , Isabella Moroz  3 , Amir Afkham  4 , Erin Keely  5   6
Affiliations
Multicenter Study

Sustainability of a Primary Care-Driven eConsult Service

Clare Liddy et al. Ann Fam Med. 2018 Mar.

Abstract

Purpose: Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability.

Methods: We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician's course of action, and rate of avoidance of face-to-face visits.

Results: A total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month.

Conclusions: This study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems.

Keywords: access to care; eConsult; electronic consultation; health equity; primary care; referral; telemedicine; wait times.

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Conflict of interest statement

Conflicts of interest: authors report none.

Figures

Figure 1a
Figure 1a
Average number of eConsults completed per primary care clinician for users of the Champlain BASE eConsult service as function of their registration year. BASE = Building Access to Specialists through eConsultation. Note: User denotes an individual who used the service at least once in the year indicated.
Figure 1b
Figure 1b
Number of primary care clinician users of the Champlain BASE eConsult service in relation to all primary care clinicians who registered for the service each year. BASE = Building Access to Specialists through eConsultation. Note: User denotes an individual who used the service at least once in the year indicated.
Figure 2a
Figure 2a
Impact of the Champlain BASE eConsult service on primary care clinician’s course of action by specialty service for the 10 specialites most frequently referred to. BASE = Building Access to Specialists through eConsultation; OB/GYN = obstetrics and gynecology.
Figure 2b
Figure 2b
Impact of the Champlain BASE eConsult service on the need for a face-to-face referral by specialty service for the 10 specialties most frequently referred to. BASE = Building Access to Specialists through eConsultation; OB/GYN = obstetrics and gynecology.
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