Accepted for/Published in: JMIR Human Factors
Date Submitted: Mar 21, 2024
Date Accepted: Jan 15, 2025
The utilization of eConsults to address emerging questions related to long Covid-19 in Ontario, Canada: a mixed-methods analysis
ABSTRACT
Background:
Long COVID is an often-debilitating condition affecting millions of people. Its diverse clinical presentations make effective diagnosis and management at the primary care level difficult, while specialist services for long-COVID face extensive wait times. An electronic consultation (eConsult) program in Ontario developed a long COVID specialist group to allow primary care providers (PCPs) prompt access to specialist advice for patients with long COVID.
Objective:
To assess patterns of service use, response times, impact, and clinical content of eConsult cases submitted to an eConsult long COVID specialist group in Ontario.
Methods:
This study is a mixed-methods analysis of eConsults submitted by PCPs to the long COVID specialist group of two eConsult services (Champlain eConsult BASE™ and Ontario eConsult) between June 1st, 2021 and July 31st, 2022. Data sources included usage data collected automatically by the services, responses to a mandatory closeout survey, and the content of PCP questions and specialist responses (Champlain eConsult BASE™ service only). Clinical questions/responses were analyzed using two validated taxonomies. Descriptive statistics were used for survey responses and usage data.
Results:
Forty PCPs submitted 47 eConsults through Champlain eConsult BASE™ and 197 PCPs submitted 228 cases through Ontario eConsult. Median specialist response time was 0.6 days (range = 0.003-14.31). The five most common symptoms of long COVID were fatigue (n = 14, 29.8%), dyspnea (n = 7, 14.9%), cough (n = 6, 12.8%), altered sense of smell (i.e., anosmia, parosmia) (n = 6, 12.8%), and cognitive changes (n = 6, 12.8%). The five main question categories asked by PCPs were: (1) management of chronic symptoms of COVID-19, (2) need for additional work-up or follow-up testing, (3) community resources to support/manage patients with long COVID, (4) diagnostic clarification, and (5) guidance regarding COVID-19 vaccination.
Conclusions:
The long COVID groups provided rapid access to a multi-specialty service that facilitated the avoidance of unnecessary face-to-face referrals. An assessment of eConsults highlighted five common question types, providing insight into potential gaps in knowledge among PCPs that could help guide medical education and policy. Clinical Trial: n/a
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