University Health Network, Toronto, Ontario, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Am J Nephrol. 2019;50(4):262-271. doi: 10.1159/000502602. Epub 2019 Aug 30.
Collaborative management of kidney disease relies on coordinated and effective partnerships between multiple provider teams. Siloed care contributes to limited access between physicians, resulting in delays in the diagnosis and treatment of kidney disease and inappropriate use of healthcare resources. These gaps contribute to dissatisfied and disempowered providers and patients. Digital systems such as eConsult can support collaborative management and address these gaps, thereby streamlining the consultation and referral process between primary care physicians (PCPs) and nephrologists. In this study, we evaluated an established eConsult platform integrated with a central triage process for a network of PCPs and nephrologists. The study aimed to assess the acceptability, feasibility, and impact on access to nephrology when using eConsult integrated into the management of kidney disease between PCPs and nephrologists.
We conducted a 1-year pilot study and used mixed methods to measure the acceptability and feasibility of using eConsult for the management of kidney disease. We compared eConsult and traditional referrals with respect to types of consultation, referrals, and times to response to determine impact on access to kidney care. We conducted semi-structured interviews of PCPs and nephrologists to assess physician experience.
From January 8, 2018, to January 11, 2019, 52 PCPs and 23 nephrologists participated in the study, with 250 traditional referrals and 106 eConsults submitted during that period. The median response time for eConsult was 15 (3-64) h, with 25% originating outside the central Toronto region. The median time to first clinic appointment from a traditional referral was 4 months (111 [61-163] days). PCP and nephrologist interviews revealed high user satisfaction, citing efficiency and timely response as key facilitators.
The eConsult platform was acceptable, feasible, and facilitated access to nephrology care compared to traditional referrals. Physicians report improvements in physician care delivery, nephrology care gaps, patient experience, and healthcare utilization.
肾脏疾病的协作管理依赖于多个医疗团队之间的协调和有效的合作关系。孤立的护理导致医生之间的交流机会有限，从而导致肾脏疾病的诊断和治疗延迟，以及医疗资源的不当使用。这些差距导致提供者和患者感到不满和无力。电子咨询等数字系统可以支持协作管理并解决这些差距，从而简化初级保健医生（PCP）和肾病学家之间的咨询和转诊流程。在这项研究中，我们评估了一个为 PCP 和肾病学家网络集成的中央分诊流程的成熟电子咨询平台。该研究旨在评估在 PCP 和肾病学家管理肾脏疾病时使用电子咨询的可接受性、可行性以及对获得肾病学治疗的影响。
我们进行了为期一年的试点研究，并使用混合方法来衡量使用电子咨询管理肾脏疾病的可接受性和可行性。我们比较了电子咨询和传统转诊在咨询类型、转诊和响应时间方面对获得肾脏护理的影响。我们对 PCP 和肾病医生进行了半结构化访谈，以评估医生的经验。
从 2018 年 1 月 8 日至 2019 年 1 月 11 日，52 名 PCP 和 23 名肾病医生参与了该研究，在此期间提交了 250 份传统转诊和 106 份电子咨询。电子咨询的中位数响应时间为 15 小时（3-64 小时），其中 25%来自多伦多市中心以外的地区。传统转诊的首次就诊预约中位数时间为 4 个月（111 [61-163] 天）。PCP 和肾病医生的访谈显示，用户满意度很高，他们表示效率和及时响应是关键的促进因素。
与传统转诊相比，电子咨询平台具有可接受性、可行性，并促进了获得肾病学治疗的机会。医生报告说，他们在提供医生护理、减少肾病学护理差距、改善患者体验和利用医疗保健资源方面都有了改善。
