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Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and
Lillian Lai1, Sophia Roubos2, Dhenuka Radhakrishnan3,4
1Division of Cardiology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.
Insights
The Champlain BASE™ eConsult service (eConsult) averts specialist referrals, with less than 5% of patients needing follow-up visits. This eConsult approach is safe, cost-effective, and improves healthcare system efficiency.
Area of Science:
- Health Services Research
- Digital Health
- Pediatric Care
Background:
- Primary care practitioners (PCPs) utilize eConsult services to reduce face-to-face (FTF) specialist referrals.
- Concerns exist regarding potential duplication of services and adverse patient outcomes with eConsult.
- The Champlain BASE™ eConsult (eConsult) service is a key tool for primary care physicians.
Purpose of the Study:
- To evaluate patient healthcare utilization and associated treatment costs following an eConsult that averted a FTF specialist referral.
- To compare healthcare utilization and costs between eConsult and matched FTF visits.
- To assess primary care practitioner satisfaction with the eConsult service.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) from 2014-2018 where eConsult averted a FTF referral.
- Linking patient data to provincial health administrative databases and electronic medical records for 18-month post-eConsult utilization analysis.
- Retrospective case-control study comparing utilization and costs of eConsult versus matched FTF visits for identical diagnoses.
Main Results:
- Less than 5% of eConsult patients required subsequent healthcare system access for the same diagnosis and specialty.
- Face-to-face (FTF) visits resulted in significantly more outpatient visits (12.6 times higher) and increased costs compared to eConsult.
- No hospital admissions or deaths were observed in the eConsult cohort; 98% of PCPs rated the service as excellent.
Conclusions:
- eConsult is associated with minimal subsequent FTF visits for the same condition, indicating high initial effectiveness.
- eConsult leads to lower healthcare utilization and costs compared to traditional FTF specialist visits.
- The eConsult service in pediatrics is safe, efficient, and cost-effective, enhancing healthcare system capacity and potentially reducing elective specialist referrals.
Objectives:
Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs.
Methods:
Retrospective cohort study (2014 to 2018) of patients (<18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case-control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction.
Results:
In follow-up, <5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service.
Conclusions:
Using eConsult is associated with <5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.
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