JMIR Publications

ABSTRACT

Background:

The Ontario eConsult Service allows a primary care provider (PCP) to access specialist advice through two models: direct-to-specialist (DTS), where PCPs select a specialist from a directory, and BASE™ managed specialty service, where PCPs choose a specialty group and are assigned a specialist from a qualified pool based on availability.

Objective:

To examine patterns of use between the two models of eConsult delivery.

Methods:

We conducted a cross-sectional analysis of utilization data collected from eConsults completed between October 2018 and September 2019. Cases were grouped based on the model used for submission (i.e., BASE™ or DTS). Each model was assessed for the number of cases submitted over time, proportion resulting in new/additional information, impact on PCP’s decision to refer, and billing time.

Results:

PCPs submitted 26,121 eConsults during the study period. Monthly case volume increased 43% over the duration of the study, primarily in the BASE™ model (69% vs 7% for DTS). PCPs were able to confirm a course of action that they originally had in mind in 41% of cases for both models, and received advice for a new or additional course of action in 55% (BASE™) and 56% (DTS) of cases. A referral was originally contemplated but avoided in 51% (BASE™) and 53% (DTS) of cases, originally contemplated and still needed in 20% (BASE™) and 18% (DTS), and neither originally contemplated or not needed in 22% (both models).

Conclusions:

Both eConsult models received strong uptake. Usage patterns varied between models, with the majority of growth occurring under BASE™, but survey responses showed that both models provided similar outcomes in terms of new information offered and impact on decision to refer.