Abstract
ABSTRACTBackground: Residents of remote communities face inequities in access to specialists, excessive wait times, and poorly coordinated care. The Champlain BASETM (Building Access to Specialists through eConsultation) service facilitates asynchronous communication between primary care providers (PCP) and specialists. The service was extended to several PCPs in Nunavut in 2014.Objective: To (1) describe the use of eConsult services in Nunavut, and (2) conduct a costing evaluation.Design: A cross-sectional study and cost analysis of all eConsult cases submitted between August 2014 and April 2016.Results: PCPs from Nunavut submitted 165 eConsult cases. The most popular specialties were dermatology (16%), cardiology (8%), endocrinology (7%), otolaryngology (7%), and obstetrics/gynaecology (7%). Specialists provided a response in a median of 0.9 days (IQR=0.3–3.0, range=0.01–15.02). In 35% of cases, PCPs were able to avoid the face-to-face specialist visits they had originally planned for their patients. Total savings associated with eConsult in Nunavut are estimated at $180,552.73 or $1,100.93 per eConsult.Conclusions: The eConsult service provided patients in Nunavut’s remote communities with prompt access to specialist advice. The service’s chief advantage in Canada’s northern communities is its ability to offer electronic access to a breadth of specialties far greater than could be supported locally. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings.
Highlights
Canada’s northern communities face numerous geographic, economic, and cultural barriers to accessing specialist care
Our results will be of interest to other health regions considering implementing an eConsult service. This is a cross-sectional study and cost analysis of all eConsult cases submitted by participating primary care providers (PCP) located in Nunavut between August 2014 and April 2016
The eConsult service began as a small proof of concept in 2009–2010 and has grown into a full service funded by the Ontario Ministry of Health and Long-Term Care and research funding
Summary
Canada’s northern communities face numerous geographic, economic, and cultural barriers to accessing specialist care Residents of these remote communities face inequities in access to service, excessive wait times, and poorly coordinated care. Many communities rely on nurses and nurse practitioners to provide the bulk of primary care services, supplemented by occasional visits from family physicians or a small group of core specialists (e.g. paediatricians), which may occur only a few times a year [1]. Beyond these infrequent visits, access to specialists often requires travel outside of the territory to cities thousands of kilometres away. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings
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