Improving Access to Specialists through the Champlain BASE eConsult Service Presentation to ARRNL NP 2017 Susan MacDonald Jean Cook
Disclosure of Commercial Support This program has not received financial support from commercial interests. Potential for conflict(s) of interest: none
Objectives • Overview of the NL BASE eConsultation service • Impact of eConsult access to care • Ongoing research and collaboration
The NL eConsult Team A Collaboration Between: • The Newfoundland & Labrador Medical Association (NLMA) • Department of Health and Community Services • eHealth Research Unit, Memorial University • Champlain BASE* eConsult Service • Eastern Health Current Research Funding • Clinical Stabilization Fund (CSF) • Canadian Foundation for Healthcare Improvement (CFHI) Christopher Kovacs Susan MacDonald Jackie Elliott Specialist Physician Specialist Physician Lead Family Physician Lead Jean Cook Ann Hollett Don Sturge Engagement & Research Coordinator Patient Representative Implementation Lead Gerard Farrell Technology Lead 4
Wait Times for Specialty Care in NL • Median wait time from PCP referral to specialist visit in NL: 14.5 weeks • Specialties with the longest wait: • Neurosurgery (48 weeks) • Internal Medicine (22 weeks) • Specialties with the shortest wait: • Radiation Oncology (1 week) • Medical Oncology (1 week) Barua B. Feixue R. Waiting Your Turn: Wait Times for Health Care in Canada. Fraser Institute, 2016
Access to Care for Rural Populations • Rural communities face greater inequities in care delivery as compared to urban communities • Some of the barriers to accessing care include: • Access to transportation • High costs of travel
A possible solution to improve access to specialists: eConsultation • A secure web-based service for primary care providers to access specialist care for their patients “eConsult allowed me to access advice for my patient without having to go through the referral process. A referral would have taken several years! ” 13
How Does eConsult Work? PCP logs onto secure webpage Completes simple form to submit to a “specialty” Assigned to an appropriate specialist (availability/rotation)) Response received within 7 days; back and forth communication can occur between PCP and specialist PCP closes eConsult and completes survey
How eConsult Works Specialist replies within 1 week with: 1) A reply to the question 2) A request for additional information 3) A recommendation for referral (along with any tests etc. to be completed beforehand) 15
How eConsult Works • PCPs can ask additional questions of specialists or close the case • PCPs complete a brief closeout survey at the conclusion of each case • Service generates a PDF transcript available to PCPs and specialists 16
NL BASE eConsult Service ▪ Funding provided through the Clinical Stabilization Fund for the demonstration phase ▪ Soft launch July 2016 ▪ Hard launch October 2016 ▪ Recruitment is ongoing
Participating Specialties ✓ Addictions Medicine ✓ Hepatology ✓ Pediatrics ✓ Cardiology ✓ Internal Medicine ✓ Public Health & Preventative Medicine ✓ Chronic Pain ✓ Nephrology ✓ Respirology ✓ Dermatology ✓ Neurology ✓ Surgery ✓ Endocrinology & ✓ Opioid Dependency ✓ Urology Metabolism ✓ Gastroenterology ✓ Orthopedics ✓ Wound Care ✓ Hematology ✓ Palliative Care ✓ HIV Provincial Program ✓ Psychiatry
PCP Engagement 125 97 100 89 83 66 75 54 41 50 34 18 17 15 25 10 0 Jul/16 Aug/16 Sept/16 Oct/16 Nov/16 Dec/16 Jan/17 Feb/17 Mar/17 Apr/17 May/17 cumulative
Monthly Volumes (cases completed) Cases Completed per Month * As of May 4th, 2017
Specialty Distribution (188 cases)
Specialist response interval from receipt of request ❖ Median ( ie, half the case were responded to in less than ): 2 days ❖ Average: ~ 4.5 days ❖ 90 th Percentile ( ie, 90% were responded to in less than ): ~ 11 days ❖ Fastest response: 24 minutes! (Endocrinology) * Based on data from 188 cases processed to May 4 th , 2017
Open to Nurse Practitioners - In the role of primary clinician - In the role of specialist (various clinics have NPs with highly specialized knowledge)
Survey Results
Cases Completed – By Patient Age Group [ % of total ] * As of May 4 th , 2017
Impact of eConsultation on Referral [ from PCP survey responses completed for each case ] 72% did not require a face-to-face visit with the specialist N=187 cases *As of May 4 th , 2017 36% unnecessary referral was avoided (Arguably 56%)
Patient Value [ from PCP survey responses completed for each case ] Eliminate travel to specialist Dramatically reduce wait time Appropriate treatment starts quickly, avoids deterioration Reduced anxiety 93% as high or very high value Overall value of the eConsult service in this case for patient (187 Completed Cases) AVG.: 4.75/5 *As of May 4 th , 2017
Clinical Value * from PCP survey responses completed for each case Overall Value of the eConsult Service (AVG.: 4.77/5) 1+2 = 98% 4+5 = 95% *As of May 4 th , 2017
Latest data As of Sept 16th, -538 eConsults. -22 NPs, -129 family physicians -44 specialists
Clinician Comments “I received 3 communications from a specialist within 24 hours! This is amazing…” “This was a frustrating case and “Excellent information from the information provided allowed urology re: helping with this and future cases” me to help reassure the patient regarding the course of action” “Very prompt and useful response’’ 32
Clinician Comments “Most important, the patient will be reassured knowing I spoke with a specialist” “Very helpful advice from Dr. “The feedback is very beneficial Goodridge, avoided long wait for as if I had sent a consult I would a formal consult” still be unsure as to whether or not it was necessary” “Great to be able to do the necessary bloodwork before she sees the specialist’’ 33
Clinicians Comments “ It has already dramatically changed the way I practice and I am convinced it is leading to better outcomes. I have received responses to all eConsults in a timely manner <1week, and the comments and suggestions were excellent. Please keep doing what you are doing and I look forward to continuing this in the future. ”
Conclusion eConsult is quickly being adopted here in NL Preliminary analysis indicates savings are already generated Overall consensus is positive
Want to Know More? • For more information about the NL BASE eConsult service, please contact: Susan MacDonald Chris Kovacs Jackie Elliott Gerard Farrell Jean Cook
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