Building Capacity for Specialized Services Through eConsultation

NCT02053467 | Completed

• 1 other identifier: 20130674-01H
• Study Type: interventional
• Target: 113
• Locations: 1 country
• Sites: 1

Brief Summary

The consultation-referral process is complex, involving several steps including 1) the PCP recognizing the need for specialist advice/intervention, 2) patient agreement on seeing the specialist, 3) referral letter and information sent to specialist, 4) appointment booked and communicated, 5) patient visit(s) with the specialist and 6) communication back to the PCP. There are many factors during this process which limit the effectiveness and efficiency of patient care. These include inequitable access for patients and providers, long wait times before specialist advice received/implemented, delayed communication and mismatched consult expectations. These gaps result in significant breakdowns in transitions of care, inappropriate treatment, patient dissatisfaction and potential harm. Moreover, not all individuals are willing or able to travel to see specialists in a large academic medical centre even when recommended by the PCP. Electronic consultation (eConsult) service is a form of asynchronous communication whereby primary care providers (PCP) and specialists can communicate directly about a patient through a secure web-based application. eConsult has the potential for improving transitions in care through improved communication ensuring that patients are seen by the right specialist, when necessary, with the right information and in a timely manner. The goal of this project is to evaluate the impact of eConsult on specialist referral rates using health administrative data.

Conditions

Health Services Research

Keywords

eConsultation; Specialist care; Primary health care; Reducing wait times for specialist care; Reducing referral rates

Outcome Measures

Primary Outcomes (1)

• Specialist referral rate per 100 patients seen (to medical specialties available through eConsult)

  Specialist referral rate defined as the total number of referrals to all medical specialties available through eConsult service during the study period per 100 unique patients (not encounters) seen. The denominator "patients seen" included patients who were seen at least once during the assessment period (baseline or post-intervention).

  24 months

Secondary Outcomes (1)

• Specialist referral rates per 100 patients seen (to all medical specialties)

  24 months

Study Arms (2)

eConsult

EXPERIMENTAL

Physicians randomized to the intervention will have access to the Champlain BASE eConsult service right away (pending completion of an orientation session)

Other: Champlain BASE eConsult Service

Control

NO INTERVENTION

Physicians randomized to the control group will use their standard referral practices for one year after randomization and only then will be given the option to use eConsult.

Interventions

Champlain BASE eConsult Service OTHER

After undergoing registration, which includes orientation and brief training on the use of the service, physicians randomized to intervention arm will be able to submit patient-specific clinical questions to specialists through a secure, web-based application. Specialists are asked to respond within 7 days and, for each eConsult, are able to: (1) provide a recommendation, (2) request more information, or (3) recommend a face-to-face referral. The communication between PCPs and specialists is iterative and the discussion can occur back and forth until, ultimately, the PCP closes the case.

Also known as: A secure Microsoft SharePoint network

eConsult

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Any practicing primary care provider (PCP) in Ontario who is not currently registered to use the Champlain BASE eConsult service may be recruited to participate in the research study, beginning with the Champlain and South East Local Health Integration Networks.

Sponsors & Collaborators

• Bruyère Health Research Institute.: lead
• Ontario Ministry of Health and Long Term Care: collaborator
• The Ottawa Hospital: collaborator
• Ontario Medical Association: collaborator
• Champlain Local Health Integration Network: collaborator

Study Sites (1)

Bruyere Research Institute, C. T. Lamont Primary Health Care Research Centre

Ottawa, Ontario, Canada

Location

Related Publications (4)

• Liddy C, Maranger J, Afkham A, Keely E. Ten steps to establishing an e-consultation service to improve access to specialist care. Telemed J E Health. 2013 Dec;19(12):982-90. doi: 10.1089/tmj.2013.0056. Epub 2013 Sep 27.

  PMID: 24073898 BACKGROUND

• Keely E, Liddy C, Afkham A. Utilization, benefits, and impact of an e-consultation service across diverse specialties and primary care providers. Telemed J E Health. 2013 Oct;19(10):733-8. doi: 10.1089/tmj.2013.0007. Epub 2013 Aug 27.

  PMID: 23980939 BACKGROUND

• Liddy C, Rowan MS, Afkham A, Maranger J, Keely E. Building access to specialist care through e-consultation. Open Med. 2013 Jan 8;7(1):e1-8. Print 2013.

  PMID: 23687533 BACKGROUND

• Liddy C, Moroz I, Keely E, Taljaard M, Deri Armstrong C, Afkham A, Kendall CE. Understanding the impact of a multispecialty electronic consultation service on family physician referral rates to specialists: a randomized controlled trial using health administrative data. Trials. 2019 Jun 10;20(1):348. doi: 10.1186/s13063-019-3393-5.

  PMID: 31182123 DERIVED

Study Officials

• Clare Liddy, MD

  Bruyere Research Institute, C. T. Lamont Primary Health Care Research Centre

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 30, 2014
• First Posted: February 3, 2014
• Study Start: January 1, 2014
• Primary Completion: December 31, 2016
• Study Completion: December 31, 2017
• Last Updated: February 5, 2019

Record last verified: 2017-02

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)