Clare Liddy's research while affiliated with University of Ottawa and other places
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Publications (262)
Background
Wait times at Canadian multidisciplinary pain clinics have been reported as excessive for nearly 2 decades.
Aims
The aim of this study was to gain insight into the patient experience of waiting for chronic pain specialty care.
Methods
A cross-sectional survey of new patients waiting for an appointment was conducted in six multidiscipli...
Background
Frailty is a complex condition that primary care providers (PCPs) are managing in increasing numbers, yet there is no clear guidance or training for frailty care.
Objectives
The present study examined eConsult questions PCPs asked specialists about patients with frailty, the specialists’ responses, and the impact of eConsult on the care...
Introduction
Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to suppor...
Introduction
The usual referral pathway is from a primary care provider (PCP) to a specialist; however, specialists also refer to and consult with other specialists. Electronic consultation (eConsult) allows clinicians to submit questions on behalf of patients to specialists to receive timely advice. Most eConsult studies in the past have examined...
Disclosure: C. Sethuram: None. W. Brown: None. G. Gill: None. C. Liddy: None. A. Afkham: None. E. Keely: None.
Background: Timely access to osteoporosis specialists remains a challenge in Canada, where patients face long wait times for specialist care. Electronic consultations (eConsults) help address this issue by allowing primary care providers (...
Background: Effective healthcare innovations are often not scaled up beyond their initial local context. Lack of practical knowledge on how to move from local innovations to large-system improvement hinders innovation and learning capacity in health systems. Studying scale-up processes can lead to a better understanding of how to facilitate the sca...
Objective:
To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs.
Methods:
A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two revi...
Access to specialty healthcare care remains a major issue for many Canadians. Not only are wait times long, but other barriers contribute to inequitable access. These include the patient’s ability to attend appointments (e.g. related to transportation difficulties and/or cost), and the ability of some patients to participate in an appointment (e.g....
Background:
eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada.
Methods:
We conducted a multiple case study with four cases (ON, QC, MB,...
Background
The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms,...
Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to...
Introduction:
Lack of access to primary care providers (PCPs) is a significant hurdle to receiving high-quality comprehensive health care and creates greater reliance on emergency departments and walk-in clinics.
Methods:
We conducted a rapid review and analysis of the literature that discusses approaches to increasing access to continuous care...
Abstract Background Frailty is a complex age-related clinical condition that increases vulnerability to stressors. Early recognition of frailty is challenging. While primary care providers (PCPs) serve as the first point of contact for most older adults, convenient tools for identifying frailty in primary care are lacking. Electronic consultation (...
Background
Ontario Health Teams (OHTs) are an integrated care system introduced in Ontario, Canada in 2019 after the 14 Local Health Integrated Networks (LHINs) were dissolved. The objective of this study is to give an overview of the current state of the OHT model’s implementation, and what priority populations and transitions of care models were...
Introduction
The number of Canadians 75 years and older is expected to double over the next 20 years, putting continuing care systems such as long-term care (LTC) homes under increasing pressure. Health information technology (IT) has been found to improve the quality, safety and efficiency of care in numerous clinical settings and could help optim...
Background:
The burden of waiting to access specialist expertise may contribute to poorer health outcomes and causes distress for patients and providers. One solution to improve access to specialist care is to use innovative tools such as remote asynchronous electronic consultation (eConsult). Modeled after the Champlain BASE™ (Building Access to...
Background
Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care provid...
Background
Electronic consultation (eConsult) programs are crucial components of modern healthcare that facilitate communication between primary care providers (PCPs) and specialists. eConsults between PCPs and specialists. They also provide a unique opportunity to use real-world patient scenarios for reflective learning as part of professional dev...
Dr. Liddy will present an overview of the Champlain BASE™ eConsult service, with a focus on its implementation in long-term care (LTC). eConsult is a secure web-based tool that enables providers to communicate electronically with specialists concerning a patient’s care. Evaluation of over 100,000 cases has consistently demonstrated positive impacts...
To assess the effect of eConsultation in providing Orthopaedic Surgery specialist service to patients in Nunavut. A cross-sectional study of 161 Orthopaedic Surgery consultations received from primary care providers (PCPs) in Nunavut via the Champlain Building Access to Specialist service through eConsult (BASETM) service over the 2-year period fro...
Aims and objectives:
To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults.
Background:
Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialis...
Previous research has identified communication and care coordination problems for patients with cancer. Healthcare providers (HCPs) have reported communication issues due to the incompatibility of electronic medical records (EMR) software and not being consistently copied on patient reports. We evaluated an asynchronous web-based communication syst...
Background:
General internists in Canada are subspecialty providers in the inpatient and outpatient settings. Electronic consultations (eConsult) allow primary care providers (PCPs) to virtually consult specialists to address clinical questions. There is a paucity of literature examining the utility and benefits of eConsults by general internists....
Background:
Increasing strain on public health resources in Canada, in particular with respect to accessing specialist care, necessitates the exploration of alternative models of care. The aim of this study was to assess the efficacy of electronic consultation (eConsult) in providing orthopedic surgery specialist service to patients in the Champla...
Our study evaluates the impact of feedback sent to specialists participating in eConsult services. eConsult Specialists from two eConsult services in Ontario, Canada, received feedback on their use of eConsult via bi-annual specialist reports. An 11-item survey was developed to evaluate the impact, content, and distribution process of these special...
Objective
To provide an overview of the use of and evidence for eConsult in correctional facilities worldwide.
Design
Scoping review.
Data sources
Three academic databases (MEDLINE, Embase and CINAHL) were searched to identify papers published between 1990 and 2020 that presented data on eConsult use in correctional facilities. The grey literatur...
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 asses...
[This corrects the article DOI: 10.2196/34575.].
Background
The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms,...
UNSTRUCTURED
This is a corrigendum related to MS 34575.
Purpose
Self-management is recommended for addressing chronic conditions, and self-management programmes improve health behaviours and outcomes. However, social and economic factors have been neglected in self-management research, despite their relevance for marginalized groups. Thus, we aimed to explore barriers and facilitators that influence sel...
Background:
The COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learn...
Purpose:
COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on re...
This paper reports on a multimethod cross-sectional study of the Ontario electronic consultation (eConsult) service. Utilization and closeout survey data from July 2018 through June 2020 were analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Requesting clinicians submitted 60,474 eConsults, and monthly c...
Introduction:
The COVID-19 pandemic has made innovative solutions to providing safe, effective care paramount. eConsult allows primary care providers to access specialist advice for their patients without necessitating an in-person visit. This study aims to explain how an eConsult service adapted to providing care for COVID-19 patients and examine...
Older adults face several challenges when accessing specialist care. Advanced practice nurses (APNs) can perform an important role in primary care for older adults, particularly when bolstered with digital tools. In the current study, we conducted a multiple case study of electronic consultations (eConsults) involving APNs to assess how these pract...
Self-management programs improve health outcomes and self-management is recommended for chronic conditions. Yet chronic disease self-management supports have rarely been applied to people who use drugs (PWUD). Thus, our objective was to explore self-management experiences among marginalized PWUD. We used community-based participatory methods and co...
Context: The Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) is a group of researchers, primary care providers (PCPs), cancer specialists, patients and caregivers working to improve cancer care coordination between PCPs and cancer specialists. Previous research by CanIMPACT and others has identified problems rel...
Objective
To determine the feasibility and acceptability of connecting optometrists to ophthalmologists on an eConsult service.
Design
Descriptive analysis of utilization data and an anonymous survey.
Participants
All eConsult cases sent by optometrists between March 2019 and February 2020 (utilization data); optometrists and ophthalmologists par...
Ageing populations have resulted in more patients living in long-term care or nursing homes, where they face challenges to accessing prompt specialist care exacerbated in many cases by physical or cognitive decline. Electronic consultation has demonstrated an ability to improve access to specialist care for vulnerable groups and offers a potential...
Dementia is a growing concern in Canada, affecting peoples’ health and raising the cost of care. Between June and October 2019, we conducted an environmental scan to identify primary care models, strategies, and resources for dementia care from 11 pre-selected countries and assess their impact on quality-of-life measures. Search strategies included...
Objective: The coronavirus disease 2019 (COVID-19) pandemic forced many clinicians to rapidly adopt changes in their practice. In this study, we compared patterns of utilization of Ontario eConsult before and after the onset of the COVID-19 pandemic, to assess COVID 19's impact on how eConsult is used. Materials and Methods: We conducted a longitud...
BACKGROUND
The COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learnin...
Background:
In 2017, the Canadian Foundation for Healthcare Improvement launched the Connected Medicine collaborative to support the implementation, spread and adaptation of 2 innovative remote consult solutions - the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service and the Rapid Access to Consultative Experti...
BACKGROUND
Background: The use of digital surveys for research in clinical settings is increasing, particularly during the COVID-19 pandemic when much data collection planned to be done in-person is now occurring digitally. Successfully preparing and conducting a digital survey can be challenging for even the most experienced researcher, given the...
Introduction
eConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs.
Methods
A descriptive, retrospective study of eConsults submitted through the Champlai...
Background:
Patients and primary care providers (PCP) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7...
Background
The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)–managed specialty service, where PCPs choose a...
BACKGROUND
The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)–managed specialty service, where PCPs choose a...
Objective
To compare the content of traditional faxed referrals and electronic consultations (eConsults) and determine how many questions sent by traditional referral could be successfully addressed using eConsult.
Methods
We conducted a cross-sectional, qualitative study of eConsults and faxed referrals sent to a tertiary diabetes and endocrinolo...
Background
Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to car...
High-quality correspondence between healthcare providers is critical for effective patient care. We developed an assessment tool to measure the quality of specialist correspondence to primary care providers (PCPs) via electronic consultation (eConsult), where specialists provide advice without specialist-patient interactions. We incorporated fourte...
Background:
In Canada, wait times for access to specialized rheumatology services have increased, leading to new strategies to improve timely care; electronic consultations (eConsults) enable providers to ask specialists a clinical question using a secure platform, often reducing the need for a face-to-face visit. In this study, we sought to compa...
Background:
Electronic consultation (eConsult) allows asynchronous virtual communication between primary care providers (PCPs) and specialists regarding patient care.
Introduction:
The Ontario eConsult Program enables timely and equitable access to specialist advice for Ontarians. This study examines clinicians' perspectives and experiences with t...
Objectives
To determine the time to CD4 : CD8 ratio normalization among Canadian adults living with HIV in the modern ART era. To identify characteristics associated with ratio normalization.
Patients and methods
Retrospective analysis of the Canadian Observational Cohort (CANOC), an interprovincial cohort of ART-naive adults living with HIV, recr...
Background
Parkinson's disease (PD) is a chronic neurodegenerative disorder that challenges care provision. A multidisciplinary care model needs to be impactful, feasible, and viable economically for widespread utilization. Supportive evidence is lacking.
Objective
The objective of this study was to evaluate the implementation and impact of a prag...
OBJECTIVE. The purpose of this study was to assess the use of an electronic consultation platform to connect primary care providers and radiologists and provide opportunities for valuable consultation regarding diagnostic imaging in patients, as well as to identify opportunities for targeted education surrounding high-yield radiology topics. MATERI...
Background:
In March 2020, the COVID-19 pandemic disrupted competency-based medical education in Family Medicine programs across Canada. Faculty and residents identified a need for clear, relevant, and specific competencies to frame teaching, learning, supervision and feedback during the pandemic.
Methods:
A rapid, iterative, educational quality...
Objectives
To evaluate the acceptability of the Integrated Parkinson’s disease Care Network (IPCN) from the perspectives of persons with Parkinson’s disease (PD), their care partners and healthcare providers, including identification of important components and areas for improvement
Methods
We used a descriptive qualitative approach with interview...
Background:
The demand for pediatric orthopaedic surgery consultation has grown rapidly, leading to longer wait times for elective consultation in some regions. Some specialties are addressing this increased demand through electronic consultation services. We wanted to examine the impact of pediatric orthopaedic e-consultations in Canada's Eastern...
Background:
Expanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Cana...
Introduction
To support the expansion of a successful regional electronic consultation (eConsult) service, we hosted a full-day national eConsult Policy Think Tank, connecting health-services researchers, clinicians, patients and policymakers to discuss policy considerations related to eConsult. In this paper, we assess the discussion arising from...
Objective
Older adults value and benefit from the long-standing relationship they have with their family physicians. This dynamic has not been researched in a long-term care (LTC, ie, nursing home) setting. We sought to determine the proportion of LTC residents who retain their community family physician within the first 180 days of LTC, and the re...
Objective:
To calculate patient wait times for specialist care using data from primary care clinics across Canada.
Design:
Retrospective chart audit.
Setting:
Primary care clinics.
Participants:
A total of 22 primary care clinics across 7 provinces and 1 territory.
Main outcome measures:
Wait time 1, defined as the period between a patient...
Electronic consultations (eConsults) and referrals (eReferrals) are being implemented to improve access to specialist care. As eConsult and eReferral services rely on a roster of engaged specialists for their success, careful attention must be paid to how the term "specialist" is defined, what criteria inform specialists recruitment, and how qualit...
Adherence to antiretroviral therapy (ART) is essential to reduce morbidity and mortality among people living with HIV (PLWH). However, adherence remains suboptimal, and PLWH may benefit from more self-management support to address the complexities of chronic illness. Our objective was to identify the impact of peer-led self-management interventions...
Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study...
This retrospective cohort study describes the rates, location, and determinants of specialist physician visits among 257,216 long-term care (LTC) residents across 648 LTC homes in Ontario, Canada, between 2007 and 2016. Visit rates in the last year of life were calculated for a sub-cohort of residents who died in LTC between 2013 and 2016. Visits w...
Context: Effective innovations in primary healthcare often remain unscaled and therefore have limited potential to improve our health systems. Yet, few studies have explored strategies that can be used to support scale-up of innovations beyond pilot projects. EConsult – an asynchronous online platform connecting primary care providers to specialist...
Background: Effective communication between primary care providers (PCPs) and specialists plays a key role in providing high-quality patient care. A high-quality referral process should involve referral letters containing all information that is necessary to support shared care between primary and specialty care.
Introduction: There is no consensus...
Background: Patients with complex circumstances pertaining to geography, socioeconomic status, or functional health often face inequities in accessing care. Electronic consultation (eConsult) is a secure online application that allows primary care providers (PCPs) and specialists to communicate regarding a patient's care. eConsult has demonstrated...
![Phases in the scaling-up process (adapted from Milat et al. [12])](publication/335758694/figure/fig1/AS:963514873171976@1606731255827/Phases-in-the-scaling-up-process-adapted-from-Milat-et-al-12_Q320.jpg)
Background:
Canada has been referred to as the land of 'perpetual pilot projects'. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times - one of the most promising innovation...
Introduction
Electronic consultation (eConsult)—provider-to-provider electronic asynchronous exchanges of patient health information at a distance—is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investi...
In 2013, the Living with HIV (LHIV) Innovation team established clinical cohorts of people living with HIV in Manitoba and Newfoundland and Labrador, and they linked the data to provincial health administrative databases. Access to these data enabled researchers to conduct studies across provincial borders; contribute to a national dialogue on HIV...
Background:
When implementing e-health solutions, effective integration into a clinic's existing processes is essential to facilitate adoption and sustained usage.
Introduction:
This article examines the effectiveness of adoption/utilization of an electronic consultation (eConsult) service by primary care providers (PCPs) using a "delegate model...
Background:
Participants in voluntary research present a different demographic profile than those who choose not to participate, affecting the generalizability of many studies. Efforts to evaluate these differences have faced challenges, as little information is available from non-participants. Leveraging data from a recent randomized controlled t...
Introduction:
The electronic consultation service, eConsult, is an asynchronous web-based platform for provider-to-provider consultation with specialists. This study described the utilization of eConsult by primary care providers to obtain specialist opinion in gynaecologic malignancy screening, with a specific focus on pathology-related inquiries...
With the advent of continuous antiretroviral therapy, HIV has become a complex chronic, rather than acute, condition. The Chronic Care Model (CCM) provides an integrated approach to the delivery of care for people with chronic conditions that could therefore be applied to the delivery of care for people living with HIV. Our objective was to assess...
Background:
Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an el...
Background and objectives:
Patients in many countries face poor access to specialist care. Electronic consultation (eConsult) improves access by allowing primary care providers (PCPs) and specialists to communicate electronically. As more countries adopt eConsult services, there has been growing interest in leveraging them as educational tools. Ou...
Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include H...
The objectives of this paper are to: (1) identify contextual factors such as policy that impacted the implementation of community-based primary health care (CBPHC) innovations among 12 Canadian research teams and (2) describe strategies used by the teams to address contextual factors influencing implementation of CBPHC innovations. In primary care...
Background:
Electronic consultation (eConsult) services are secure online applications facilitating provider-to-provider communication. They have been found to improve access to specialist care. However, little is known about eConsult's impact on family physicians' referral rates to specialty care. The objective of this study was to assess the imp...
Background:
Electronic consultation (eConsult) services have been shown to reduce the need for face-to-face consultations. The largest expense is remunerating the specialist.
Introduction:
The Champlain BASE™ eConsult service remunerates specialists based on their self-reported billing time. It is important for funders of eConsult systems to und...
Objective
To examine the process of implementing an electronic consultation (eConsult) service and evaluate its impact along key metrics outlined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.
Design
Cross-sectional study.
Setting
Clinics using eConsult in four provinces across Canada: Alberta, Manitoba,...
Background
Parkinson’s disease (PD) is a progressive neurological illness that impacts various aspects of life. Integration of medical and self-management in a collaborative approach to care is needed to enhance functioning and the quality of life of PD patients. In developing an integrated care program at a tertiary PD clinic, we used a co-design...
Introduction:
Excessive wait times for specialist care are a significant issue in many countries. Electronic consultation (eConsult) services have demonstrated the ability to improve access to specialist care. In this article, we evaluated the implementation of a successful eConsult service in a new jurisdiction to test its generalizability.
Meth...
Purpose:
Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists th...
Purpose:
For people living with HIV (PLWH) using continuous antiretroviral therapy, HIV is now a complex chronic condition often managed in primary care settings. The patient-centered medical home (PCMH) is a model to deliver comprehensive, coordinated, and integrated primary care that promotes collaboration between primary and specialist care and...
Introduction:
Poor communication between health professionals can compromise patient safety, yet specialists rarely receive feedback on their written communication. Although worldwide implementation of electronic consultation (eConsult) services is rising rapidly, little is known about the features of effective communication when specialists provi...
Citations
... The Champlain BASE® eConsult service has been available in the region of Ottawa, Ontario since 2010 and offers over 150 specialties, including GeriMedRisk: three interdisciplinary services composed of physicians, nurses, and pharmacists for geriatric consults pertaining to medicine, psychiatry, and clinical pharmacology [4,8,9]. A recent analysis of eConsult cases for patients with frailty found 41% of questions pertained to drug treatments [10]. ...
... Moreover, numerous studies underscore the significant repercussions of even a few months' delay in diagnosis, manifesting in heightened costs and diminished survival rates [2,3]. Primary care providers encounter different barriers to accessing specialist care, often struggling to convey their clinical impressions or the urgency of early intervention [4]. The Spanish guidelines strongly advocate for swift and efficient communication channels between general practitioners (GPs) and endoscopic units to expedite the early diagnosis of colorectal cancer [5]. ...
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... Three studies reported high attendance rates [53,56,58]. Factors like scheduling conflicts could be potential barriers to programming the implementation [67]. Only the study by Hartung et al. [58] reported this barrier and tailored its intervention to the participants' needs. ...
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... 1,4,[17][18][19] Secondly, there is a notable dearth of evidence on the operationalization of scale-up and strategies that key actors can adopt to address enabling factors. 20 Thus, there is a need to study empirical scale-up processes and strategies within the context of high-income countries. Such evidence may provide much-needed guidance on expanding proven healthcare innovations to improve equitable health outcomes in universal health systems. ...
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... The low hospitalization rate of patients who did not seek prOC up to 3 days before attending the ED (35.2%) may indicate that patients with low urgency experienced barriers to accessing prOC before coming to the ED [20]. In a sectoralized health care system such as Germany, the OC provider is meant to serve as a gate-keeper to primary and secondary care as well as to secure continuity and coordination of care [21]. Due to insu cient capacity of primary and secondary OC providers, patients may opt to visit an ED for a specialist opinion or diagnostic imaging. ...
... 4,19 eConsults can help circumvent provider shortages in these settings. 20,21 Comments from the PCPs we interviewed reinforced our chart review findings. PCPs affirmed their appreciation for eConsults and their intent to act on eConsult specialists' recommendations, but noted that their patients' inability to access or afford some types of treatment impacted whether they would incorporate the recommendation into their treatment plan. ...
... The implementation aim was addressed through qualitative interviews, analysis of eOncoNote system usage metrics, and data abstracted from the hospital EMR. Results from the pRCT [17] and qualitative interviews [18] have been reported separately. This paper focuses on the findings from the PCP survey and eOncoNote system usage data. ...
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... 9 Previous work has demonstrated that eConsults play an important role in improving access to specialty care for uninsured patients in Texas. 7 Although limited prior research indicates that primary care providers (PCPs) intend to apply guidance received from eConsults in practice, [10][11][12] less is known about how this intention translates into actual changes in clinical practice. 13 To address this question we conducted a retrospective evaluation of an eConsult program for uninsured patients in central Texas cared for at a large, multi-site FQHC. ...
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... Future analyses should therefore take into consideration the specific terms in addition to the count to improve the specificity of the proposed methods. Application of a Receiver Operating Characteristic (ROC) graph with a widely accepted gold standard may also provide useful insights into the appropriate cut-offs when using eConsult data to identify frailty.eConsult is a tool that is used in primary care, and its utility for improving access to specialist advice for older patients has been demonstrated [33,34,48]. Primary care has been proposed as the ideal place to proactively screen for and identify frailty [17,49,50], particularly given the relatively frequent presentation of older adults to their PCPs [51]. ...
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... The implementation aim was addressed through qualitative interviews, analysis of eOncoNote system usage metrics, and data abstracted from the hospital EMR. Results from the pRCT [17] and qualitative interviews [18] have been reported separately. This paper focuses on the findings from the PCP survey and eOncoNote system usage data. ...
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