Electronic consultations (e-consultations) between family physicians (FPs), or primary care physicians, and hospital specialists represent an emerging health innovation, employing asynchronous digital communication. An e-consultation is initiated by an FP through a secure digital platform, where the FP presents a specific clinical question or seeks advice from a hospital specialist regarding a patient’s care. This interaction concludes with the specialist providing a response to the FP.
Globally, healthcare systems grapple with challenges in managing costs, maintaining access to hospital care, ensuring quality, and promoting a healthy work-life balance for caregivers. E-consultations offer potential advantages in addressing these challenges. They present fewer disruptions in clinical work compared to telephone consultations, enabling physicians to engage in e-consultations when convenient. Additionally, e-consultations facilitate the digital sharing of patient information, including recent diagnostics and medical history, with documentation in the patient record.
While previous systematic reviews primarily conducted in the US and Canada have employed narrative synthesis to analyze e-consultation studies between FPs and hospital specialists, the focus of this review is on addressing pertinent questions from the perspectives of both the FP and the patient in the consultation room. Specifically, it aims to determine if e-consultations provide timely access to hospital care for patients and enable FPs to deliver appropriate and well-informed care without necessitating a visit to the hospital outpatient department.
This review centers on a quantitative synthesis of outcomes related to access to hospital care and the avoidance of hospital referrals. It seeks to answer two key questions: (1) What is the association between FP–to–hospital specialist e-consultations and access to care, as well as the avoidance of hospital referrals? and (2) What is the quality of the evidence concerning these outcome measures?
The process of Family Physician (FP)–to–Hospital Specialist Electronic Consultation and Access to Hospital Care involves various key methods and steps.
Here is a detailed breakdown of these fundamental components:
Initiation of Electronic Consultation:
Family physicians commence consultations through secure digital platforms.
Utilization of electronic health record systems or dedicated communication tools.
Clinical Inquiry:
FPs present specific clinical questions or seek advice on patient care.
Formulating clear and concise queries directed towards hospital specialists.
Asynchronous Communication:
Communication between FPs and specialists occurs asynchronously.
This approach offers flexibility in responses, minimizing disruptions.
Secure Digital Platforms:
Adoption of secure online platforms ensures confidential communication.
Adherence to privacy regulations and cybersecurity standards.
Patient Information Sharing:
FPs share relevant patient information, including medical history and diagnostic results.
Facilitation of informed decision-making by specialists.
Expert Recommendations:
Specialists provide expert recommendations, guidance, or clarifications.
Assisting FPs in managing patient cases effectively.
Documentation of Consultations:
Detailed recording of electronic consultations in the patient’s health record.
Maintenance of a comprehensive and accurate history for continuity of care.
Timely Responses:
Specialists respond to consultations promptly.
Enhancing efficiency in the delivery of patient care.
Efficient Workflow:
Minimization of disruptions in the workflow for both FPs and hospital specialists.
Allowance for healthcare professionals to manage consultations at convenient times.
Access to Specialized Care:
FPs gain access to expert opinions and specialized care advice.
Reduction in the immediate need for physical referrals.
Avoidance of Hospital Referrals:
Evaluation of the contribution of electronic consultations to avoiding unnecessary hospital referrals.
Assessment of the impact on patient outcomes and healthcare costs.
Quality Assessment:
Evaluation of the quality of evidence concerning the outcomes of electronic consultations.
Utilization of frameworks such as Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
Quantitative Synthesis:
Conducting a quantitative synthesis of outcomes related to access to hospital care.
Analysis of data to comprehend the effectiveness of electronic consultations.
This method involves harnessing technology to facilitate efficient communication between FPs and hospital specialists, ultimately enhancing access to specialized care while minimizing the immediate need for hospital referrals.
