Use of eConsult to enhance genetics service delivery in primary care: A multimethod study

June C Carroll; Clare Liddy; Amir Afkham; Erin Keely; Elaine S Goh; Gail E Graham; Joanne A Permaul; Judith Allanson; Ruth Heisey; Tutsirai Makuwaza; Donna P Manca; Mary Ann O'Brien; Eva Grunfeld; CanIMPACT

doi:10.1016/j.gim.2022.07.003

Use of eConsult to enhance genetics service delivery in primary care: A multimethod study

Genet Med. 2022 Oct;24(10):2034-2041. doi: 10.1016/j.gim.2022.07.003. Epub 2022 Aug 10.

Authors

June C Carroll¹, Clare Liddy², Amir Afkham³, Erin Keely⁴, Elaine S Goh⁵, Gail E Graham⁶, Joanne A Permaul⁷, Judith Allanson⁶, Ruth Heisey⁸, Tutsirai Makuwaza⁷, Donna P Manca⁹, Mary Ann O'Brien¹⁰, Eva Grunfeld¹¹; CanIMPACT

Affiliations

¹ Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Ontario, Canada. Electronic address: June.Carroll@sinaihealth.ca.
² C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.
³ Ontario Health East, Ottawa, Ontario, Canada.
⁴ Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Endocrinology & Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada.
⁵ Laboratory Medicine and Genetics and Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada.
⁶ Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
⁷ Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada.
⁸ Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada.
⁹ Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁰ Department of Family & Community Medicine, University of Toronto, Ontario, Canada.
¹¹ Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada.

PMID: 35947109
DOI: 10.1016/j.gim.2022.07.003

Abstract

Purpose: Electronic consultation (eConsult) is a freely-available secure online platform connecting primary care providers (PCPs) to geneticists. Our purpose was to determine whether eConsult is effective in improving genetics service delivery in primary care.

Methods: PCP questionnaires regarding eConsult's utility, geneticists' tracking form assessments of eConsult type and appropriateness, and geneticists' interviews on implementing eConsult were carried out.

Results: In 2 regions of Ontario, Canada, from January 2019 to June 2020, there were 305 genetics eConsults. For 169 (55%), PCPs indicated receiving good advice for a new course of action; for 110 (36%), referral was now avoided; and for 261 (86%), eConsult was perceived valuable for patient management. Of the 131 geneticist-completed tracking forms, cancer questions were most common (68, 52%). For 63 (48%), geneticists disagreed/strongly disagreed PCPs should know the answer to the referral question. From the interview data, it was observed that geneticists described eConsult positively and suggested how it might improve access and efficiencies if integrated into genetic service delivery. Dealing with eConsults virtually could reduce waitlists, and suggesting appropriate investigations for PCPs could improve efficiencies.

Conclusion: eConsult offers a potential solution for receiving timely genetics advice and avoiding unnecessary patient referrals, however, greater effect on access and wait times will need systematic integration into PCP and geneticist practice.

Keywords: Electronic consultations; Genetics; Primary care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Genetic Services
Health Services Accessibility
Humans
Ontario
Primary Health Care* / methods
Referral and Consultation
Telemedicine* / methods

Grants and funding

TT7-128272/CIHR/Canada