By AJ Adams

Poor access to specialist care remains a serious issue in Canada, causing frustration for patients and providers alike. Too often, patients wait months or even years for a specialist appointment, only to learn that all they needed was a new prescription or another test. In the meantime, they likely faced the frustration and anxiety of waiting, coupled in some cases with worsening health outcomes.

Delays in care become even more concerning as patients age. A recent report from the Canadian Institute for Health Information noted that 25 per cent of elderly Canadian patients waited over two months for specialist care, and 37 per cent went to hospital emergency departments for treatments their primary care provider could have provided. These figures place Canada last among the 11 countries surveyed.  Residents of long-term care facilities—many of whom are elderly—face additional barriers to accessing care, as a growing number suffer from Alzheimer’s disease or other dementias, complex health issues, behavioral challenges, and physical frailty. These conditions increase the need for specialist care and, at the same time, reduce residents’ ability to travel to a specialist appointment.

An integrated solution

The Ontario eConsult service is a secure web-based tool that lets primary care providers across Ontario send questions to specialists concerning a patient’s care. No matter where in Ontario they practice, providers can use eConsult to connect with specialists from over 80 specialties and receive a response in a timely manner—two days on average. In two-thirds of cases, the provider can go on to treat the patient themselves, without the patient needing an in-person specialist visit. Neither the provider nor the patient has to pay for this service.

Since 2018, the Ontario eConsult Program has collaborated with the Ontario Centre for Learning, Research and Innovation in Long-Term Care (CLRI) at Bruyère to offer eConsult to providers working in long-term care homes. Guided by a multi-institutional advisory committee with strong representation from caregiver partners, this collaboration strives to improve integration of care, patient safety, and quality of life for long-term care residents.

In the first year of this exciting collaboration, providers working in 26 long-term care homes have joined the eConsult service.  Data from the first 99 cases submitted by providers working in LTC in the Champlain region showed:

• 60 per cent of eConsults provided LTC providers with advice for a new or additional course of action
• 73 per cent of cases were resolved without the need for a face-to-face specialist visit
• Providers accessed a wide range of specialty groups, with the most common being dermatology, infectious diseases and cardiology

Feedback from users has been very positive. Some providers noted that using the advice received through eConsult, they were “able to avoid an ER visit and instead connect [their] patient directly to proper specialist care.” Others valued the “extraordinary attention to detail” and not having to “[make] important decisions in isolation.” In turn, caregivers recognized that “eConsult would provide an extremely valuable service [to their loved ones living in a long-term care home] by helping to connect their primary care providers with specialists.”

In its 2017 assessment of eConsult, the Canadian Medical Protective Association indicated that “[eConsult] provides an opportunity to improve efficiency, enhance patient care, expand access to specialists and provides a clear audit trail of the specialist’s advice given to the provider for the suggested care of the patient.” As such, the Ontario eConsult Program is a valuable part of our increasingly integrated Ontario healthcare system.

For residents of long-term care homes, eConsult offers a way to transcend the typical barriers in accessing specialist advice and ensure these patients get the care they need in a prompt and safe manner.

The program is led by the Ontario eConsult Centre of Excellence (eConsult COE), housed at The Ottawa Hospital in partnership with the Bruyère Research Institute. Regional partners include Champlain BASE™ (Building Access to Specialists through eConsultation) and the South East Academic Medical Organization (SEAMO). Delivery partners are the Ontario Telemedicine Network (OTN), OntarioMD, and eHealth Ontario, with the support of the Ministry of Health and Long-Term Care. The work in expanding eConsult to the long-term care sector is supported in part with funding from the Government of Ontario through the Ontario Centre for Learning, Research and Innovation in Long-Term Care hosted at Bruyère. The views expressed herein do not necessarily reflect the views of the Province.

For more information about eConsult visit www.champlainbaseeconsult.com and about the Ontario CLRI visit www.clri-ltc.ca

AJ Adams is the  Communications & Events Coordinator at the Ontario Centre for Learning, Research and Innovation in Long-Term Care at Bruyère.