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. 2025 Jan-Dec:16:21501319251354830.
doi: 10.1177/21501319251354830. Epub 2025 Jul 16.

Examining Differences in Utilization of the Ontario eConsult Service in Rural Versus Urban Settings: A Retrospective Cross-Sectional Analysis

Clare Liddy  1   2   3 , Sheena Guglani  1 , Nikhat Nawar  4 , Erin Keely  3   4   5
Affiliations

Examining Differences in Utilization of the Ontario eConsult Service in Rural Versus Urban Settings: A Retrospective Cross-Sectional Analysis

Clare Liddy et al. J Prim Care Community Health. 2025 Jan-Dec.

Abstract

Introduction: We conducted a retrospective, cross-sectional analysis exploring patterns of usage and outcomes from urban vs. rural eConsults to examine eConsult's impact on equity of access in rural Ontario, Canada. Patients living in rural regions face many barriers in accessing specialist care. The Ontario eConsult Service connects primary care providers (PCP) with specialists regardless of geographical location, improving equity of access.

Methods: We included all Ontario eConsult cases submitted between January 1 and December 31, 2021. Usage data collected automatically by the service and responses to a mandatory closeout survey were analyzed using descriptive statistics. Cases were identified as rural using the forward sorting area of the PCP's primary practice.

Results: Of the 72,948 cases submitted during the study period, 7550 were coded rural. Usage among rural PCPs was most frequent in Ontario Health North East (1.78 eConsult cases/1000 residents) and Ontario Health North West (1.64). Rural and urban eConsult cases had the same top 5 most frequently requested specialties. Both groups had median response times of 1.0 days, reported time billed of 15 min, and cost per case of $50.

Conclusions: PCPs in rural and urban regions use eConsult with equal frequency and had similar usage patterns and outcomes.

Keywords: eConsult; electronic consultation; equity of access; primary care; rural; specialist; urban.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Liddy and Dr. Keely are the co-founders of the eConsultBASE™ service but have no commercial interest in the service. Dr. Keely is the Executive Director of the Ontario eConsult Centre of Excellence and receives salary support from Ontario Health. Dr. Keely completes occasional eConsults as a specialist through the service for which she is reimbursed. Dr. Liddy is the Director of Evaluation for the Ontario eConsult Centre and receives salary support from Ontario Health. They have no other conflicts of interest to declare.

Figures

Map of Ontario Health Regions and number of eConsult cases per 1000 rural and urban residents
Figure 1.
(A) Map of the Ontario Health Regions with local health units numbered 1 to 35. Reproduced with permission from BMC Public Health. (B) Urban and rural eConsult cases per 1000 residents in each health region.
Using this as context information this is what my response would be "This chart presents the percentage of survey responses based on rural versus urban settings to assess if eConsult confirmed an existing course of action or provided a new one. It covers four response categories: 1) ability to confirm a course of action students originally had, 2) gaining new or additional advice for a course of action, 3) usefulness of response, and 4) other unspecified options.
Figure 2.
Responses to survey question assessing whether eConsult confirmed an existing course of action or provided a new or additional course of action, divided by rurality.
""Bar chart showing survey results on eConsult’s influence on referral decisions, split by rural vs urban for categories: referral originally contemplated, referral not originally contemplated, no referral but completed, and other, with varying percentages.
Figure 3.
Responses to survey question assessing eConsult’s impact on decision to refer, divided by rurality.
See this image and copyright information in PMC

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