Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool.

BACKGROUND: Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings. METHODS: The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility. RESULTS: Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%). INTERPRETATION: Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study's findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.

Specialists accessing specialty advice: Evaluating utilization, benefits, and impact of care of an e-consultation service.

INTRODUCTION: The usual referral pathway is from a primary care provider (PCP) to a specialist; however, specialists also refer to and consult with other specialists. Electronic consultation (eConsult) allows clinicians to submit questions on behalf of patients to specialists to receive timely advice. Most eConsult studies in the past have examined questions asked from PCPs to specialists. This study investigates the utilization of specialists submitting clinical questions to other specialists through the Ontario eConsult Service and identifies use-case scenarios where specialist-to-specialist eConsult may be beneficial. METHODS: A retrospective, descriptive, cross-sectional analysis of eConsults submitted by specialists through the Ontario eConsult Service for 24 months (March 2019 to February 2021). Utilization data is collected automatically by the service, including specialty referred to, time billed, region, and results from a closeout survey which includes the referral outcome of the eConsult and the utility to the submitting clinician. RESULTS: 4% (n = 3285) of all eConsults sent within the study period were specialist-to-specialist, with the others being sent by a PCP. The number of specialist-to-specialist eConsults grew 120% following the onset of the COVID-19 pandemic. The top three specialties that submitted eConsults were pediatrics, internal medicine, and endocrinology. The top three specialties that specialists submitted to were dermatology, neurology, and hematology. A face-to-face referral was avoided in 69% of referrals. CONCLUSION: Evaluating the utilization patterns of specialist-to-specialist eConsults allows us to better understand and expand the scope of eConsult services, which have traditionally been thought of as a workflow between a PCP and a specialist.

Utility of eConsults for COVID-19 vaccine-related concerns in Ontario: a cross-sectional analysis.

BACKGROUND: The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored. METHODS: We performed a cross-sectional descriptive analysis of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly sample of 499 total cases. Data regarding whether external resources were required to answer each eConsult, impact on primary care provider referral decisions, and allergy consultant response times were collected. A 2-question survey was completed by primary care providers following eConsultation and results were collected. RESULTS: 41.08% of eConsults received involved safety concerns regarding COVID-19 vaccine administration in the setting of prior allergic disease and another 36.1% involved a potential reaction the first dose of a COVID-19 vaccine. 72.1% of eConsults were answered by specialist without needing external resources, and only 9.8% of all eConsults received resulted in a recommendation for formal in-person referral to Clinical Immunology & Allergy specialist or another subspecialty. Average time to complete eConsult was 16.4 min, and 79.7% of PCP eConsult queries which would have traditionally resulted in formal consultation were resolved based on advice provided in the eConsult without need for in-person assessment. CONCLUSIONS: Our study demonstrates the utility of the eConsult service as it pertains to COVID-19 vaccine-related concerns. The eConsult platform proved an effective tool in diverting the need for in-person assessment by an Allergist or other medical specialty. This is significant given the large volume of eConsults completed by Allergists, and demonstrates the impact of an effective electronic delivery of care model during a time of strained resources and public health efforts directed at mass vaccination.

Development of eConsult reflective learning tools for healthcare providers: a pragmatic mixed methods approach.

BACKGROUND: Electronic consultation (eConsult) programs are crucial components of modern healthcare that facilitate communication between primary care providers (PCPs) and specialists. eConsults between PCPs and specialists. They also provide a unique opportunity to use real-world patient scenarios for reflective learning as part of professional development. However, tools that guide and document learning from eConsults are limited. The purpose of this study was to develop and pilot two eConsult reflective learning tools (RLTs), one for PCPs and one for specialists, for those participating in eConsults. METHODS: We performed a four-phase pragmatic mixed methods study recruiting PCPs and specialists from two public health systems located in two countries: eConsult BASE in Canada and San Francisco Health Network eConsult in the United States. In phase 1, subject matter experts developed preliminary RLTs for PCPs and specialists. During phase 2, a Delphi survey among 20 PCPs and 16 specialists led to consensus on items for each RLT. In phase 3, we conducted cognitive interviews with three PCPs and five specialists as they applied the RLTs on previously completed consults. In phase 4, we piloted the RLTs with eConsult users. RESULTS: The RLTs were perceived to elicit critical reflection among participants regarding their knowledge and practice habits and could be used for quality improvement and continuing professional development. CONCLUSION: PCPs and specialists alike perceived that eConsult systems provided opportunities for self-directed learning wherein they were motivated to investigate topics further through the course of eConsult exchanges. We recommend the RLTs be subject to further evaluation through implementation studies at other sites.

Electronic consultation use by advanced practice nurses in older adult care-A descriptive study of service utilization data.

AIMS AND OBJECTIVES: To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults. BACKGROUND: Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns. METHODS: This is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data. RESULTS: Of 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational. CONCLUSIONS: Through eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system. RELEVANCE TO CLINICAL PRACTICE: There is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce. PATIENT OR PUBLIC CONTRIBUTION: Current APN eConsult users were involved in the study design and interpretation of results.

Expanding the scope of an eConsult service: acceptability and feasibility of an optometry-ophthalmology pilot project.

OBJECTIVE: To determine the feasibility and acceptability of connecting optometrists to ophthalmologists on an eConsult service. DESIGN: Descriptive analysis of utilization data and an anonymous survey. PARTICIPANTS: All eConsult cases sent by optometrists between March 2019 and February 2020 (utilization data); optometrists and ophthalmologists participating in the eConsult Vision Pilot Project (survey). METHODS: Utilization data for the study period were collected automatically and underwent descriptive analysis. Participating optometrists and ophthalmologists received an email invitation to a survey assessing the project. RESULTS: Thirteen optometrists from 5 clinics in the southeast region and 7 ophthalmologists were recruited to participate in the pilot project. Optometrists sent 109 eConsults in a 13-month period, representing 33% of all cases submitted to ophthalmology through the eConsult service provincially (March 2019-March 2020). Sixty-eight percent of respondents to an anonymous online survey valued the recruitment and engagement of eye care professionals from the same health region. The influence of the eConsult service was reported to have a "somewhat positive" (27%) to "very positive" (50%) influence on the relationship between the two professional groups. CONCLUSION: The eConsult Vision Pilot Project fills a gap in service and provides an opportunity for patients to get access to specialty advice. We demonstrated that allowing optometrists to solicit specialist advice from ophthalmologists was acceptable and feasible.

The effect of eConsult on the provision of orthopaedic services in Nunavut.

To assess the effect of eConsultation in providing Orthopaedic Surgery specialist service to patients in Nunavut. A cross-sectional study of 161 Orthopaedic Surgery consultations received from primary care providers (PCPs) in Nunavut via the Champlain Building Access to Specialist service through eConsult (BASETM) service over the 2-year period from January 2017 to December 2018. Data captured were: reason for consultation, impact of advice on referral, perceived value to the PCPs and time spent. eConsult avoided unnecessary in-person consultation 62% of the time while catching 5% of the referrals that would have otherwise been missed. PCP referral behaviour was modified 48% of the time. 94% of eConsults were rated as valuable to PCPs in their practice and 100% of eConsults resulted in actionable advice. Further, eConsults took an average of 15.4 minutes of specialist time to complete, and the mean time from referral to response was 1.4 days. eConsultation spares unnecessary consultation to Orthopaedic Surgery, catches important referrals that would have otherwise been missed, decreases wait time, and may reduce cost in remote healthcare systems such as Nunavut.

Benefits of Providing Feedback and Utilisation Metrics to Specialists on Their Participation in eConsult.

Our study evaluates the impact of feedback sent to specialists participating in eConsult services. eConsult Specialists from two eConsult services in Ontario, Canada, received feedback on their use of eConsult via bi-annual specialist reports. An 11-item survey was developed to evaluate the impact, content, and distribution process of these specialist reports. We distributed 742 specialist reports in March 2021 and surveyed the specialists in July 2021. Our findings show that specialists largely felt that the feedback received validated their efforts (83%) and that receiving the report made them more likely to continue to participate in the eConsult service (59%). Most did not feel judged (74%) or distressed (79%) by the reports, and 72% said that reporting the median self-reported billing time did not impact their own billing times. Overall, eConsult services can capture, report and aggregate data valuable to specialists and is useful for Continuing Professional Development. Benefits and lack of risk implementing this type of feedback should encourage other services to consider similar processes.

Access to orthopedic specialist service in Ontario via eConsult.

BACKGROUND: Increasing strain on public health resources in Canada, in particular with respect to accessing specialist care, necessitates the exploration of alternative models of care. The aim of this study was to assess the efficacy of electronic consultation (eConsult) in providing orthopedic surgery specialist service to patients in the Champlain Local Health Integration Network (LHIN) of Ontario. METHODS: This was a cross-sectional review of all 564 Champlain LHIN orthopedic surgery referral requests received via the Champlain Building Access to Specialist service through the eConsult (BASE) system in 2017. Primary outcome measures were impact on primary care provider (PCP) referral pattern and time to receive orthopedic consultation. RESULTS: eConsult prevented unnecessary in-person consultation 64% of the time, while PCP referral decisions were modified 51% of the time. Of all eConsults, 94% were rated as valuable to PCPs in their practice and 97% of eConsults resulted in actionable advice. eConsults took an average of 14.5 minutes of specialist time to complete, and the mean time from referral to response was 3.7 days. CONCLUSION: The eConsult system spares unnecessary consultation to orthopedic surgery; catches important referrals that would have otherwise been missed; saves time for patients, PCPs and orthopedic surgeons; and improves efficiency in a socialized health care system.

Evaluation of an Electronic Consultation Service for COVID-19 Care.

PURPOSE: COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS: This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS: A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS: This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input.

The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years.

This paper reports on a multimethod cross-sectional study of the Ontario electronic consultation (eConsult) service. Utilization and closeout survey data from July 2018 through June 2020 were analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Requesting clinicians submitted 60,474 eConsults, and monthly cases increased from 1,487 in July 2018 to 4,179 in June 2020. The median specialist response time was 1 day. An originally contemplated referral was avoided in 51% of cases. Ontario eConsult showed successful uptake across Ontario, demonstrating continued spread and scale, and offering a template for trailblazers looking to implement digital health innovations in their own jurisdictions.

How One eConsult Service Is Addressing Emerging COVID-19 Questions.

INTRODUCTION: The COVID-19 pandemic has made innovative solutions to providing safe, effective care paramount. eConsult allows primary care providers to access specialist advice for their patients without necessitating an in-person visit. This study aims to explain how an eConsult service adapted to providing care for COVID-19 patients and examine its impact on patient care. METHODS: We conducted a cross-sectional analysis of cases submitted to COVID-19 specialties through the Ontario eConsult service between October 2020 and April 2021. Utilization data were extracted from all eligible cases to assess number of cases submitted, patterns of use, response times, and case outcomes (ie, whether eConsult resulted in new or additional information, whether or not a referral was needed). RESULTS: 2783 eConsults were submitted to 5 COVID-19 specialty groups during the study period. 71% of the cases were for vaccine-related questions. The median response interval was 12 hours. Providers received advice for a new or additional course of action in 36% of cases. 84% of the cases did not require a referral. CONCLUSIONS: Our study demonstrated the effectiveness of rapidly adapting eConsult for COVID-19 care and supports similar action for other services.

The Ontario Electronic Consultation (eConsult) Service: Cross-sectional Analysis of Utilization Data for 2 Models.

BACKGROUND: The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)-managed specialty service, where PCPs choose a specialty group and are assigned a specialist from a qualified pool based on availability. OBJECTIVE: The aim of this study is to examine patterns of use between the 2 models of eConsult delivery. METHODS: We conducted a cross-sectional analysis of utilization data collected from eConsults completed between October 2018 and September 2019. Cases were grouped based on the model used for submission (ie, BASE or DTS). Each model was assessed for the number of cases over time, specialty distribution, proportion resulting in new or additional information, impact on PCPs' decisions to refer, and billing time. RESULTS: PCPs submitted 26,121 eConsults during the study period. The monthly case volume increased by 43% over the duration of the study, primarily in the BASE model (66% compared to 6% for DTS). PCPs were able to confirm a course of action that they originally had in mind in 41.4% (6373/15,376) of BASE cases and 41.3% (3363/8136) of DTS cases and received advice for a new or additional course of action in 54.7% (8418/15,376) of BASE cases and 56.3% (4582/8136) of DTS cases. A referral was originally contemplated but avoided in 51.3% (7887/15,376) of BASE cases and 53.3% (4336/8136) of DTS cases, originally contemplated and still needed in 19.4% (2986/15,376) of BASE cases and 17.7% (1438/8136) of DTS cases, and neither originally contemplated nor needed in 21.7% (3334/15,376) of BASE cases and 21.9% (1781/8136) of DTS cases. CONCLUSIONS: Both eConsult models had strong uptake. Use patterns varied between models, with the majority of growth occurring under BASE, but survey responses showed that both models provided similar outcomes in terms of new information offered and impact on decision to refer.

Electronic Consultation by Advanced Practice Nurses to Improve Access to Specialist Care for Older Adults.

Older adults face several challenges when accessing specialist care. Advanced practice nurses (APNs) can perform an important role in primary care for older adults, particularly when bolstered with digital tools. In the current study, we conducted a multiple case study of electronic consultations (eConsults) involving APNs to assess how these practitioners use the service to improve access to care. All eConsults submitted by or to an APN in 2019 on behalf of patients aged ≥65 years were reviewed to identify examples from six settings representative of the range of advanced nursing practices. For each setting, a final case was chosen using an iterative process and stratified by specialty and type of advice. Included cases were assessed using a conceptual framework for health care access. Selected cases illustrate how APNs can be effective users of eConsults in a diversity of health care settings. The framework allowed for an in-depth study of access over the range of interactions that take place among patients, caregivers, providers, and the health care system. [Journal of Gerontological Nursing, 48(4), 33-40.].

Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic.

BACKGROUND: During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. OBJECTIVES: (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. METHODS: We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. RESULTS: The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. CONCLUSIONS: Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.

The Utilization of an Electronic Consultation Service During the Coronavirus Disease 2019 Pandemic.

Objective: The coronavirus disease 2019 (COVID-19) pandemic forced many clinicians to rapidly adopt changes in their practice. In this study, we compared patterns of utilization of Ontario eConsult before and after the onset of the COVID-19 pandemic, to assess COVID 19's impact on how eConsult is used. Materials and Methods: We conducted a longitudinal analysis of registration and utilization data for Ontario eConsult. All primary care providers (PCPs) and specialists who joined the service between March 2019 and November 2020, and all eConsult cases closed during the same period were included. The data were divided into two timeframes for comparison: prepandemic (March 2019-February 2020) and pandemic (March 2020-November 2020). Results: In total, 5,925 PCPs joined during the study period, more than doubling total enrollment to 11,397. The average monthly number of eConsults increased from 2,405 (standard deviation [SD] = 260) prepandemic to 3,906 (SD = 420) pandemic. Case volume jumped to 24.3% in the first month of the pandemic, and increased by 71% during the COVID-19 pandemic timeframe. The median response time was similar in both timeframes (prepandemic: 1.0 days; pandemic: 0.9 days). The proportion of cases resulting in new/additional information (prepandemic: 55%, pandemic: 57%) or avoidance of a contemplated referral (prepandemic: 52%, pandemic: 51%) remained consistent between timeframes. Conclusions: Registration to and usage of eConsult increased during the pandemic. Metrics of the service's impact, including response time, percentage of cases resulting in new or additional information, and avoidance of originally contemplated referrals were all consistent between the prepandemic and COVID-19 pandemic timeframes, suggesting scalability.

Improving primary care access to respirologists using eConsult.

BACKGROUND: Patients and primary care providers (PCPs) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. METHODS: This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of questions asked by the referring provider and by the clinical content of the referral. Specialists' response time and time spent answering the clinical question were analyzed. Referring providers' close-out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. RESULTS: Of the 26 679 cases submitted to the Champlain BASE TM eConsult service, 268 were respirology cases (1%). 91% were sent by family physicians and 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 min. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), chronic obstructive pulmonary disease (8.6%) and dyspnea Not Yet Diagnosed (NYD) (7.8%). The most common types of questions asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%) and drug of choice (6.3%). In 23% of cases, the PCP indicated they were planning to refer the patient for an in-person consultation but no longer needed to after receiving the eConsult advice (avoided referrals). On the other hand, in 13% of cases, the PCP was not going to refer but did after the eConsult (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases, the PCP suggested the clinical topic would be well suited to a CME event. CONCLUSIONS: Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visits and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of questions for CME planning should be considered. Future research may include a cost analysis and provider perspectives on the role of eConsult in respirology care.

Improving Equity of Access Through Electronic Consultation: A Case Study of an eConsult Service.

Background: Patients with complex circumstances pertaining to geography, socioeconomic status, or functional health often face inequities in accessing care. Electronic consultation (eConsult) is a secure online application that allows primary care providers (PCPs) and specialists to communicate regarding a patient's care. eConsult has demonstrated an ability to improve access to specialist care, and may be of particular use in cases of inequitable access. Methods: We examined how eConsult is used to improve equity of access for patients in complex circumstances by conducting a multiple case study of eConsults from seven patient groups: addiction, frail elderly, homeless, long-term care, rural, special needs, and transgender. Cases from these groups were selected from all eConsult cases completed between January 1 and December 31, 2017 using a data collection strategy tailored to each group. An access framework by Levesque et al. was applied to the data to examine five dimensions of access, arranged in chronological order, that reflect the process of a patient seeking care: approachability, acceptability; availability, affordability, and appropriateness. Two reviewers analyzed the cases using an iterative approach, regularly presenting findings to the research team for discussion and interpretation. Results: Eight hundred and twenty-five cases emerged across the seven target groups. The selected cases highlighted a number of key factors, including the value of the patient-PCP relationship, the importance of considering patient perspectives when providing care, and efforts to accommodate patients facing particular challenges to accessing care. Examples emerged among all five dimensions of the Levesque et al. access framework, with the final dimension, appropriateness, emerging across all cases. Conclusions: By leveraging the eConsult platform, PCPs can help improve equitable access to specialist care. More research is needed to understand why patients with complex circumstances face a longer wait time compared to the general population, and the impact that eConsults can have in improving health outcomes and wait times for this population.