(CSEMP073) EXPERIENCES OF SPECIALIST PHYSICIANS WITH E-CONSULTATIONS IN A SMALL ACADEMIC CENTRE

Abstract:

Background: E-consultation (e-consult) is an electronic service which allows primary care providers to interact with specialist physicians over a secure web-based platform. The purpose is to reduce specialist wait times and enhance access to expert care. Endocrinology is well suited to the use of e-consults, which have been implemented successfully in larger Canadian centres. The experiences of specialist physicians with e-consults are generally positive, although most studies are from large academic centres. The perspectives of specialist physicians regarding e-consults in small academic centres are unknown.

Objectives: To explore the experiences of specialists with e-consults in a small academic centre.

Methods: An electronic questionnaire was emailed to specialists who participated in the local e-consult service between 2018 and 2022. The questionnaire assessed time, technology, consult quality and future improvements. Data was analyzed for descriptive results and themes (Qualtrics XM software).

Results: A total of 36 physicians completed the questionnaire (response rate 55%). Respondents were predominantly Internal Medicine specialists (53%), including Endocrinologists (8%). The majority work in departments of 5-10 people (92%) and have no protected time (89%) or dedicated financial compensation (56%) to complete e-consults. Most specialists complete e-consults outside of working hours (92%). Three quarters (75%) of respondents need to do a chart review at least occasionally, and report this takes on average 5-15 minutes to complete. In addition, 44% reported the current electronic platform is a barrier to participation. Participants reported that financial remuneration (81%) and addition of electronic templates (56%) would improve long-term participation by specialists.

Discussion: While e-consults have the potential to increase timely access to care, specialists who complete these e-consults require sufficient time to participate in the service. Specialists in small academic centres have limited resources and e-consults may contribute to increased workload and potential for burnout. Indeed, the majority of participants required time outside of working hours to complete these e-consults, which is not feasible over the long term. Study limitations include a small sample size and the potential selection bias, as participants with negative experiences with e-consults may have been more likely to respond. Furthermore, the responses of participants who had stopped using the system may not reflect the most recent platform upgrades.

Conclusion: Specialists in this small academic centre identified a need for protected clinical time, adequate financial remuneration, electronic platform improvements, and use of templates to ensure ongoing provision of e-consults.