SIIReN - System Integration & Innovation Research Network

Primary Health Care System


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“Linking Primary Care Physicians with Specialists Through

Presenters: Clare Liddy, University of Ottawa
September 15, 2011



Availability of effective means of communication between primary care physicians and specialists will ultimately result in an improved quality of patient’s care and a better functioning healthcare system. Started in 2010, the Champlain BASE Project: Building Access to Specialists through eConsultation is a web-based service that allows primary care practitioners to submit a patient specific clinical question to a specialist with relevant expertise, by using a standardized electronic form through a secure online system in which confidentiality and privacy of patient information is ensured. Supplementary patient information such as laboratory results, digital images and health history can be added by the primary care physician to assist the specialist in making an informed recommendation. Based on the received information, the specialist may:

  1. Provide the primary care physician with answers to questions (so that the primary care physician can make further actions without sending the patient for a formal referral to the specialist)

  2. Ask for additional information before being able to provide his/her recommendations, or

  3. Recommend a formal referral (in this case, additional diagnostic tests might be requested and courses of treatment might be started by the primary care physician before patient's appointment with the specialist)

Descriptive analysis of quantitative data was performed such as number of eConsults done, specialties used, average time it took for specialists to respond, type of questions, etc. In addition, we ran in-person interviews and focus groups with primary care physicians and specialists to gain an in-depth understanding of their experience and to find ways to improve the system. The transcribed interviews and focus groups were analyzed using immersion-crystallization approach.

The project currently involves 40 primary care physicians and 28 specialists from across the Champlain region in Ontario. By May 2011, a total of 74 consultation requests were completed. The content of the questions ranged from questions about potential diagnosis to possible treatments, concerning high-risk to low-risk patients in different age-groups. The most commonly used speciality services included dermatology, endocrinology and cardiology. The qualitative approach explored several aspects on barriers and facilitators of implementation, perceived benefits and impacts of eConsultation, and issues around physician’s remuneration and patient’s privacy.

We expect that e-consultation will improve access to clinics, reduce the number of visits for patients and waiting times, and lead to individualized specialist advice in the region. This service can easily be adapted for use in other health regions across Canada.

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