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.

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 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.