Abstract
IntroductioneConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs.MethodsA descriptive, retrospective study of eConsults submitted through the Champlain BASE™ eConsult Service between January 1, 2017, and December 31, 2018, by LTC PCPs was conducted. Cases were classified using validated taxonomies. Descriptive statistics were generated for content and question type classifications, service utilization data, and close-out survey responses.Results22 LTC PCPs submitted 113 eConsults. They sought advice about drug treatment (58%), diagnosis (44%), and management (38%) in a breadth of clinical areas, often skin-related (39%). Long-term care PCPs frequently asked more than one question type (42%). They received advice within 1 week (91%) and rated eConsult as very helpful and educational. Three case examples are presented.ConclusionThis study demonstrates the type of advice LTC PCPs are seeking through eConsult and its usefulness in this setting. Long-term care stakeholders are encouraged to consider implementing eConsult in other regions, as a means to improve access to timely specialist advice, support clinical decision-making, and improve residents’ quality of life.
Highlights
EConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care
Results eConsult cases were submitted between January 1, 2017, and December 31, 2018, by 22 PCPs working in long-term care (LTC) and included for classification. 49% of cases were submitted by nurse practitioners. 91% of cases received a response from a specialist in 1 week or less
In 42% of cases, LTC PCPs asked more than one question type
Summary
EConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. In Ontario, the rate of specialist visits outside of the LTC home is much higher than within the home, as residents are most often required to attend external appointments to receive specialist advice (Shaver et al, 2020). These appointments are challenging for most residents due to the barriers associated with mobility and transfers, transportation, and coordinating caregiver escorts. During the COVID-19 pandemic, there has been particular attention focused on avoiding external transfers and minimizing interactions with medical personnel to reduce the risk of exposure and the potential for institutional outbreaks These measures, necessary, likely further reduce access to specialists
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