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Electronic consultation questions asked to addiction medicine specialists by primary care providers: Retrospective
Cynthia Chan1, Grace Zhu2, Clare Liddy3
1Family physician practising in Ontario.
Objective:
To determine the major themes among clinical questions asked to addiction medicine specialists sent by primary care providers (PCPs) via the Champlain Building Access to Specialists through the eConsultation (BASE™) electronic consultation (eConsult) service and the PCP-perceived benefits of this service.
Design:
A descriptive, retrospective study of the eConsult cases submitted to addiction medicine specialists between January 1, 2020, and December 31, 2021.
Setting:
Champlain region of eastern Ontario.
Participants:
Primary care providers who sent an eConsult to addiction medicine.
Interventions:
The BASE™ eConsult service was used to facilitate communication between PCPs and addiction medicine specialists.
Main Outcome Measures:
The classification of question types and clinical topics asked in eConsult cases sent to addiction medicine specialists by PCPs, and the answers in the close-out surveys completed by PCPs after eConsult was completed.
Results:
Primary care providers sought advice regarding opioids (38.0%) and alcohol (34.9%). The most common question types involved pharmacologic (77.5%) and nonpharmacologic (65.1%) management of patients with substance use. Electronic consultations were most frequently related to the clinical topic of chronic pain (28.7%). Over 95% of eConsults were answered by a specialist within 7 calendar days. Providers reported finding the eConsult responses helpful, with nearly one-third of PCPs reporting a potential referral was avoided following an eConsult from specialists.
Conclusion:
This study demonstrates that PCPs sought advice on management regarding opioids and alcohol, reflecting the challenges in controlled substance prescribing during an opioid crisis, with alcohol use disorder being the most prevalent substance use disorder in Canada. The eConsult service provided an accessible, timely, and beneficial process for PCPs to obtain addiction medicine specialist advice. Given the overlap with the COVID-19 pandemic and the study timeframe, further studies to examine postpandemic eConsults will allow for better generalizability of the findings.
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