Who Uses eConsult? Investigating Physician Characteristics Associated with Usage (and Nonusage).

Abstract

The Champlain BASE™ eConsult Service was developed in a Local Health Integration Network (LHIN) in Ontario, Canada in 2010 to reduce wait times and improve access to specialist care. The service allows primary care providers to receive advice from specialists via a secure electronic platform without necessarily requiring a face-to-face consultation. As of 2015, over half of the LHIN's family physicians were registered and trained to use the service. However, 24% of registrants never went on to submit a case. The purpose of this study is to examine the demographic characteristics associated with usage. Usage data for the pool of physicians registered between January 1, 2011 and September 30, 2015 were linked to physician characteristics retrieved from the College of Physicians and Surgeons of Ontario database. Probit regressions were estimated to determine characteristics associated with usage. Neither sex, being an international medical school graduate-documented predictors of electronic medical records adoption-nor proximity to specialists were found to explain usage. Only length of time in practice was found to be predictive. Being out of medical school an additional 10 years was estimated to decrease the probability of ever using eConsult by five percentage points (p < 0.01). Lower use by veteran physicians may reflect their lower need for services like eConsult given their well-established specialist networks, or their greater confidence in practicing medicine. Future work should explore the reasons and barriers for not registering, or not using eConsult, with an aim toward increasing the appropriate use of this cost-effective and innovative service.