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

  • June C. Carroll
    Correspondence
    Correspondence and requests for materials should be addressed to June C. Carroll, Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, L4-255 60 Murray Street, Toronto, ON M5T 3L9, Canada
    Affiliations
    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
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  • Clare Liddy
    Affiliations
    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
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  • Amir Afkham
    Affiliations
    Ontario Health East, Ottawa, Ontario, Canada
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  • Erin Keely
    Affiliations
    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
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  • Elaine S. Goh
    Affiliations
    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
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  • Gail E. Graham
    Affiliations
    Department of Pediatrics, University of Ottawa, Ontario, Canada

    Department of Genetics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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  • Joanne A. Permaul
    Affiliations
    Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
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  • Judith Allanson
    Affiliations
    Department of Pediatrics, University of Ottawa, Ontario, Canada

    Department of Genetics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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  • Ruth Heisey
    Affiliations
    Department of Family & Community Medicine, University of Toronto, Ontario, Canada

    Department of Family and Community Medicine, Women’s College Hospital, Toronto, Ontario, Canada
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  • Tutsirai Makuwaza
    Affiliations
    Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
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  • Donna P. Manca
    Affiliations
    Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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  • Mary Ann O’Brien
    Affiliations
    Department of Family & Community Medicine, University of Toronto, Ontario, Canada
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  • Eva Grunfeld
    Affiliations
    Department of Family & Community Medicine, University of Toronto, Ontario, Canada

    Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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  • on behalf ofCanIMPACT
Published:August 10, 2022DOI:https://doi.org/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

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