An Integrated Kidney Care eConsult Practice Model: Results from the iKinect Project

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Chronic kidney disease; Comanagement and referral; Health informatics; Primary care; eConsult.