Keely Erin, Li Jennifer, Magner Peter, Afkham Amir, Liddy Clare
Department of Medicine, University of Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ontario, Canada.
Can J Kidney Health Dis. 2018 Jan 23;5:2054358117753619. doi: 10.1177/2054358117753619. eCollection 2018.
The Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service allows primary care providers (PCPs) to submit patient-specific clinical questions to specialists via a secure web service.
Our objective was to describe the types of nephrology questions asked through an eConsult service based in eastern Ontario and assess the service's impact on the need for face-to-face consultations.
Cross-sectional study using descriptive statistics was conducted using nephrology cases submitted between May 2011 and January 2015. Specialist response times and referral avoidance were collected. Validated taxonomies were used to categorize cases based on question type and content.
Patient cases were collected from PCPs in Ottawa, Ontario, and its surrounding communities and submitted to nephrologists at the Ottawa Hospital.
During the study period, 155 eConsults were submitted to nephrology.
Utilization and survey data were collected for all eConsults. Questions were categorized by subject matter and question type.
A traditional consult visit was avoided in 45% of cases based on the specialist's advice; 21% cases required referral. Thirty-two percent of eConsults took specialists less than 10 minutes to complete, 55% took 10 to 15 minutes, 11% took 15 to 20 minutes, and only 2% took more than 20 minutes. Twenty-five percent of cases were related to proteinuria, 18% to chronic kidney disease (CKD), 17% to imaging, and 12% to drug use in CKD. Common question types included general management (37%), interpretation of laboratory test (17%), interpretation of an image report (13%), and need for nephrology referral (11%).
Some consults contained multiple categories and question types. Our analyses required a single classification, which may underestimate the number of questions in each category. Our study had a small sample size using cases completed in a single health jurisdiction, limiting generalizability.
The Champlain BASE™ eConsult service provided guidance to PCPs and reduced the number of face-to-face nephrology consultations.
尚普兰基础™（通过电子会诊让基层医疗服务提供者接触专科医生）电子会诊服务允许基层医疗服务提供者（PCP）通过安全的网络服务向专科医生提交针对特定患者的临床问题。
我们的目的是描述通过安大略省东部的一项电子会诊服务提出的肾脏病问题的类型，并评估该服务对面对面会诊需求的影响。
采用描述性统计的横断面研究，对2011年5月至2015年1月期间提交的肾脏病病例进行分析。收集专科医生的回复时间和避免转诊的情况。使用经过验证的分类法根据问题类型和内容对病例进行分类。
患者病例从安大略省渥太华及其周边社区的基层医疗服务提供者处收集，并提交给渥太华医院的肾脏病专家。
在研究期间，共向肾脏病学提交了155份电子会诊申请。
收集所有电子会诊的使用情况和调查数据。问题按主题和问题类型进行分类。
根据专科医生的建议，45%的病例避免了传统的会诊就诊；21%的病例需要转诊。32%的电子会诊专科医生完成时间不到10分钟，55%需要10至15分钟，11%需要15至20分钟，只有2%需要超过20分钟。25%的病例与蛋白尿有关，18%与慢性肾脏病（CKD）有关，17%与影像学有关，12%与CKD中的药物使用有关。常见的问题类型包括一般管理（37%）、实验室检查结果解读（17%）、影像报告解读（13%）以及肾脏病转诊需求（11%）。
一些会诊包含多个类别和问题类型。我们的分析需要单一分类，这可能低估了每个类别中的问题数量。我们的研究样本量较小，使用的是在单一卫生辖区完成的病例，限制了普遍性。
尚普兰基础™电子会诊服务为基层医疗服务提供者提供了指导，并减少了面对面肾脏病会诊的数量。
