通过电子会诊建立获得专科护理的途径。

Building access to specialist care through e-consultation.

作者信息

Liddy Clare, Rowan Margo S, Afkham Amir, Maranger Julie, Keely Erin

机构信息

Department of Family Medicine, University of Ottawa, Ontario, Canada.

出版信息

Open Med. 2013 Jan 8;7(1):e1-8. Print 2013.

DOI:

PMID:23687533

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3654501/

Abstract

BACKGROUND

Limited access to specialist care remains a major barrier to health care in Canada, affecting patients and primary care providers alike, in terms of both long wait times and inequitable availability. We developed an electronic consultation system, based on a secure web-based tool, as an alternative to face-to-face consultations, and ran a pilot study to evaluate its effectiveness and acceptability to practitioners.

METHODS

In a pilot program conducted over 15 months starting in January 2010, the e-consultation system was tested with primary care providers and specialists in a large health region in Eastern Ontario, Canada. We collected utilization data from the electronic system itself (including quantitative data from satisfaction surveys) and qualitative information from focus groups and interviews with providers.

RESULTS

Of 18 primary care providers in the pilot program, 13 participated in focus groups and 9 were interviewed; in addition, 10 of the 11 specialists in the program were interviewed. Results of our evaluation showed good uptake, high levels of satisfaction, improvement in the integration of referrals and consultations, and avoidance of unnecessary specialist visits. A total of 77 e-consultation requests were processed from 1 Jan. 2010 to 1 Apr. 2011. Less than 10% of the referrals required face-to-face follow-up. The most frequently noted benefits for patients (as perceived by providers) included improved access to specialist care and reduced wait times. Primary care providers valued the ability to assist with patient assessment and management by having access to a rapid response to clinical questions, clarifying the need for diagnostic tests or treatments, and confirming the need for a formal consultation. Specialists enjoyed the improved interaction with primary care providers, as well as having some control in the decision on which patients should be referred.

INTERPRETATION

This low-cost referral system has potential for broader implementation, once payment models for physicians are adapted to cover e-consultation.

摘要

背景

在加拿大，获得专科护理的机会有限仍然是医疗保健的一个主要障碍，在等待时间长和可及性不公平方面，对患者和初级保健提供者都会产生影响。我们开发了一种基于安全网络工具的电子咨询系统，作为面对面咨询的替代方案，并开展了一项试点研究，以评估其对从业者的有效性和可接受性。

方法

在2010年1月开始的为期15个月的试点项目中，该电子咨询系统在加拿大安大略省东部一个大型健康区域的初级保健提供者和专科医生中进行了测试。我们从电子系统本身收集了使用数据（包括满意度调查的定量数据），并从焦点小组以及对提供者的访谈中收集了定性信息。

结果

在试点项目的18名初级保健提供者中，13人参加了焦点小组，9人接受了访谈；此外，该项目的11名专科医生中有10人接受了访谈。我们的评估结果显示，该系统得到了很好的应用，满意度很高，转诊和咨询的整合得到了改善，避免了不必要的专科就诊。2010年1月1日至2011年4月1日期间，共处理了77项电子咨询请求。不到10%的转诊需要面对面随访。提供者认为，对患者最常提到的好处包括获得专科护理的机会增加和等待时间缩短。初级保健提供者重视通过快速获得临床问题的答复、明确诊断检查或治疗的必要性以及确认正式咨询的必要性来协助患者评估和管理的能力。专科医生喜欢与初级保健提供者改善互动，以及在决定应转诊哪些患者方面有一定的控制权。