Abstract
Keywords
Problem/Significance
Innovation
Search for LTC homes by location.
Implementation
Evaluation
Quantitative Data Collection
Search for LTC homes by location.
Qualitative Data Collection
Quantitative Data Analysis
Qualitative Data Analysis
Results
Search for LTC homes by location.
Search for LTC homes by location.


Thematic Analysis
Contextual factors
Perceived value
Considerations for implementation and adoption
Comment
Conclusions and Implications
Acknowledgments
Appendices for manuscript entitled “The Feasibility of Using Electronic Consultation in Long-Term Care Homes”
Supplementary Material 1: Close-out Survey Questions Completed After Each eConsult Case by the Primary Care Provider
- Q1: Which of the following best describes the outcome of this eConsult for your patient?
- 1.I was able to confirm a course of action that I originally had in mind
- 2.I got good advice for a new or additional course of action that I will be implementing
- 3.I got good advice for a new or additional course of action that I am not able to implement
- 4.None of the above (please comment)
- 1.
- Q2: As a result of this eConsult would you say that:
- 1.Referral was originally contemplated but now avoided at this stage
- 2.Referral was originally contemplated and is still needed
- 3.Referral was not originally contemplated and is still not needed
- 4.Referral was not originally contemplated, but eConsult process resulted in a referral being initiated
- 5.Other (please explain)
- 1.
- Q3: How helpful and/or educational was this response in guiding your ongoing evaluation or management of the patient?
- Q4: This eConsult addresses an important clinical problem that should be incorporated into upcoming CME events
- Q5: We would value any additional feedback you provide [Comments for the specialist will be forwarded to her/him]:
Supplementary Material 2: Semi-structured Focus Group Guides
2.1. Semi-structured Guide for Physician Focus Groups—Questions
- 1.Think about a situation you have with a current resident where you might need or would like some guidance or support from a specialist colleague. What would the barriers or enablers be to accessing that advice?
- 2.Do you often have residents who could benefit from specialist advice but who aren't considered for specialist intervention due to their physical or behavioural condition? In your opinion, is eConsult an appropriate means for accessing specialist advice to inform the care they are given?
- 3.For those who have tried eConsult, what are the benefits? Are there any drawbacks?
- Probe: When you think about eConsult, do you think about it as an opportunity for education and knowledge sharing?
- 4.Tell us about your experience when you were introduced to eConsult? What was positive about the process? What were the challenges? What still needs to be done?
- 5.As we are expanding eConsult services across the long-term care sector in Ontario, what advice would you have for your colleagues at other long-term care homes?
2.2. Semi-structured Guide for Administrator Focus Groups—Questions
- 1.Can you describe the process (workflow/risk management) you need to follow when you send a resident to a specialist's office? What happens if the resident is able to attend the visit, and what is the process if they are unable to travel because of frailty or behavioural issues? How do you manage?
- 2.If you had a magic wand, what would an ideal specialist referral process look like for your residents? What are the most pressing issues from your perspective?
- 3.Tell us about your experience in introducing eConsult into your home? What has excited you? What still needs to be done?
- 4.As we are expanding eConsult services across the long-term care sector in Ontario, what advice would you have for your colleagues at other long-term care homes?
2.3. Semi-structured Guide for Delegate Focus Groups—Questions
- 1.Can you describe the workflow that you follow when you make an eConsult on behalf of a provider and resident? How does a provider request the eConsult, what information do they give you, and how is that information provided?
- 2.In your roles as nurse champions, what has your experience been with introducing eConsult into your home? What worked well? What were the challenges? What still needs to be done?
- 3.As you have been using eConsult in your home, what have been the benefits? Have there been any drawbacks?
- 4.As we are expanding eConsult services across the long-term care sector in Ontario, what advice would you have for your colleagues at other long-term care homes?Supplementary Table 1Specialty Groups Available on the Champlain BASE eConsult Service as of September 30, 2019
Abdominal Wall Hernia General Surgery Pediatric Refugee and Immigrant Health Addiction–Inpatient SUP Neurosurgery Pediatric Respirology Addiction–Opioids Obs/Gyn–Menopause/Perimenopause Pediatric Rheumatology Addiction Assessment/Treatment Services Obs/Gyn–Vulvo-Vaginal Disease Pediatric Urology Adolescent Medicine Obstetrics Plastic Surgery Adult Refugee and Immigrant Health Ophthalmology Psych–Neurodevelopmental disorders Allergy and Clinical Immunology Orthopaedics Psychiatry Anesthesiology Ostomy and Peristomal Complications Psychiatry–First Episode Psychosis Back and Neck Palliative Care Psychiatry–Perinatal Bariatric Care–Dietitian Parkinson's and Movement Disorders Radiation–Radiotherapy Injury Bariatric Care–Medical Pediatric ADHD Radiology–Abdominal Bariatric Care–Surgical Pediatric Allergy and Clinical Immunology Radiology–Breast Breast Cancer Pediatric Anesthesiology Radiology–Musculoskeletal Breast Surgery Pediatric Cardiology Radiology–Neuroradiology Cancer Genetics Pediatric Chronic Pain Radiology–Thoracic Cancer Survivorship Pediatric Complex Care Respirology Cardiology Pediatric Dermatology Rheumatology CCAC–Champlain Pediatric Endocrinology Sarcoma Chiropody Pediatric ENT Sexual Assault/Domestic Violence Clinical Pharmacist Pediatric Gastroenterology Sleep Medicine Concussion Pediatric hematology/oncology Spinal Surgery Concussion–Pediatric Pediatric HIV Sports Medicine Concussion–Rehabilitation Pediatric Infectious Disease Stroke–TIA Dermatology Pediatric Nephrology Thoracic Surgery Dermatology–Hair Loss Pediatric Neurology Thrombosis Diabetes Education Pediatric Neurosurgery Transgender Care Pain Medicine Pediatric Obesity and Diabetes Tropical Medicine Endocrinology Pediatric Ophthalmology Urogynecology Endocrinology–Osteoporosis Pediatric Orthopaedics Urology ENT Pediatric Palliative Care Urology–Male Sexual Dysfunction Fibromyalgia Pediatric Plastic Surgery Vascular Surgery Gastroenterology Pediatric Psychiatry Wound Care General Pediatrics Pediatric Radiology ADHD, Attention-Deficit Hyperactivity Disorder; CCAC, Community Care Access Centre; ENT, Ear, Nose, Throat; Obs/Gyn, Obstetrics/Gynecology; TIA, Transient Ischemic Attack.
References
- This is Long-Term Care 2019. Toronto: Ontario Long Term Care Association, 2019, p. 2-4.(Available at:) (Accessed October 9, 2019)
- How Canada Compares: Results From the Commonwealth Fund's 2016 International Health Policy Survey of Adults in 11 Countries—Accessible Report. Ottawa: Canadian Institute for Health Information, 2017, p. 39-42.(Available at:) (Accessed October 9, 2019)
- How often, where, and by which specialty do long-term care home residents receive specialist physician care? A retrospective cohort study.J Appl Gerontol. 2020 Feb 6; ([Epub ahead of print])
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- Search for LTC homes by location.(Available at:)http://publicreporting.ltchomes.net/en-ca/HomeName_Select.aspxDate accessed: August 10, 2018
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- Schedule of Benefits: Physician Services Under the Health Insurance Act. Toronto: Ontario MOH, 2019, p. A33.(Available at:) (Accessed December 13, 2019)
- Sustainability of a primary care-driven eConsult service.Ann Fam Med. 2018; 16: 120-126
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Article info
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Footnotes
This work was supported by the Government of Ontario through the Ontario Centre for Learning, Research and Innovation in Long-Term Care hosted at Bruyère, Canadian Institutes of Health Research, and Bruyère Research Institute.
The authors declare no conflicts of interest.
Ethics: The Ottawa Health Science Network Research Ethics Board has waived its review, as this project falls within the context of quality initiative, quality improvement, quality assurance, and/or program evaluation as defined by the Tri-Council Policy Statement, Article 2.5.
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