Understanding Patient Referral Wait Times for Specialty Care in Ontario: A Retrospective Chart Audit.

CONTEXT: When examining wait times for specialist care, the duration between a patient's referral and specialist visit (wait time one) is poorly understood. OBJECTIVES: To calculate wait time one in primary care clinics across Ontario using chart audit. METHODS: We conducted a retrospective chart audit at five Ontario-based primary care clinics in 2014-2015. RESULTS: We analyzed 461 referrals. Median wait time one for non-urgent and urgent referrals was 79 and 49 days, respectively. Gastroenterology, obstetrics/gynecology, and ear, nose and throat received the most referrals. Wait times were longest for dermatology (112 days) and shortest for general surgery (32 days). CONCLUSION: Wait times vary substantially by referral urgency and specialty type in Ontario. Calculating wait time from primary care clinics directly offers new perspectives on wait time one and enables clinics to target improvement efforts to best meet patient needs. Our findings will be relevant to providers and policy makers interested in implementing strategies to reduce wait times.

Improving access to allied health professionals through the Champlain BASE™ eConsult service: a cross-sectional study in Canada.

BACKGROUND: Allied health services are an important part of providing effective team-based care. The Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service facilitates quick and secure communication between primary care providers (PCPs) and allied health professionals (AHPs). AIM: To assess the eConsult service's ability to improve access to advice from AHPs. DESIGN AND SETTING: A cross-sectional study was carried out on all cases submitted to AHPs through the eConsult service between April 2011 and May 2016. The service covers Ottawa, Canada, and its surrounding rural communities. METHOD: A descriptive overview of all cases submitted to allied health services was conducted. Utilisation and survey metrics for AHP eConsults were compared with those sent to medical specialties, in order to understand the potential differences and generalisability of eConsult access beyond the traditional medical specialty referral. RESULTS: PCPs submitted 127 cases to nine allied health specialties during the study period. The most popular specialty was clinical pharmacist, which received an average of 1.5 cases per month. The median specialist response time was 2.1 days (interquartile range [IQR] 0.7-5.3 days, range 0.01-14.2 days) versus 0.9 days (IQR 0.2-3.4 days, range 0-49.5 days) for medical specialties. PCPs received advice for a new or additional course of action in 70% (versus 58% for medical specialties) of cases. They rated the service as being of high or very high value for their patients in 88% of cases (versus 93% for medical specialties), and for themselves in 89% (94% for medical specialties) of cases. CONCLUSION: The eConsult service has demonstrated the ability to support prompt communication between PCPs and AHPs, improving patients' access to AHP care. Given the importance of AHPs in providing primary care, allied health services should be offered in the menu of specialties available through electronic consultation services.

Improving access to specialists in remote communities: a cross-sectional study and cost analysis of the use of eConsult in Nunavut.

BACKGROUND: 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.

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation.

OBJECTIVE: This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. DESIGN: Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. SETTING: Champlain health region in Eastern Ontario, Canada. POPULATION: Primary care providers and specialists registered to use the eConsult service. MAIN OUTCOME MEASURES: Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. RESULTS: A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. CONCLUSIONS: Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner.

A comparison of referral patterns to a multispecialty eConsultation service between nurse practitioners and family physicians: The case for eConsult.

PURPOSE: To explore referral patterns of nurse practitioners (NPs) and family physicians (FPs) using an electronic consultation (eConsult) service, and assess their perspectives on the service's value to their patients and themselves. DATA SOURCES: A mixed methods study including a cross-sectional analysis of utilization data drawn from all eConsults completed from April 15, 2011 to September 30, 2014, and a content analysis of NP survey responses completed from January 1 to September 30, 2014. CONCLUSIONS: A total of 4260 eConsults were included in the cross-sectional analysis (3686 from FPs and 574 from NPs). In our sample, NPs directed more cases to dermatology and fewer cases to cardiology and neurology (p < .0001) than did FPs, and were more likely to report that an eConsult led to new advice for a new or additional course of action (62.8% vs. 57.5%) and less likely to report it resulted in an avoided referral (35.5% vs. 41.8%, p = .005). NPs reported slightly higher levels of perceived value of eConsults for their patients and themselves. IMPLICATIONS FOR PRACTICE: Differences in use and impact of eConsult exist between NPs and FPs. NPs value the service highly for their patients and themselves. The service reduces potential inequities related to outdated payment and scope of practice policies.