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Impact of and Satisfaction with a New eConsult Service: A Mixed Methods Study of Primary Care Providers
Open accessAbstract
OBJECTIVES: We have improved access to specialist care and decreased wait times in our region through the development and implementation of the Champlain BASE (Building Access to Specialists through eConsultation) service. This secure, web-based tool allows primary care providers (PCPs) quick access to specialist advice for their patients and often helps to avoid the need for a face-to-face referral. Our successful implementation of eConsult in our region provides a unique opportunity to examine PCPs' satisfaction and overall perspective on using the service. METHODS: Following the closure of each case, PCPs completed a short survey with multiple-choice and open-ended questions regarding the eConsult. All eConsults submitted between April 15, 2011, and December 31, 2013, were analyzed. We calculated satisfaction scores from the survey and conducted a constant-comparison thematic analysis on those cases where the PCP elected to leave a text response. RESULTS: We analyzed 2,052 eConsults completed during the study period. In 91% and 93% of eConsults, PCPs reported a high value for their patients and themselves, respectively. In 554 eConsults, PCPs elected to leave a written response. Three major themes emerged: PCP appreciation of the eConsult service, perceived benefits for the quality of patient care, and attitudes towards using a new health technology. High satisfaction was expressed with quick response times, helpfulness of responses, and reassurance reported. Most PCPs felt eConsult had a positive impact on patient care by also providing reassurance to patients, reducing burden of time and travel, and offering educational opportunities to PCPs applicable to future cases. CONCLUSION: PCPs showed a high level of satisfaction with eConsult's quick turnaround time and quality of specialist advice. Our results illustrate the advantages of using asynchronous virtual platforms to increase access to specialty care from a PCP perspective.
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“Other eConsult services are independent of individual health records and use a secure web-based portals to link providers, such as the Champlain BASE in Canada, [20][21][22][23][24][25][26][27][28][29][30][31][32] TNMG in Brazil, [33][34][35][36] and KSYOS in The Netherlands, 37 or harness secure intranet e-mail as the means of communication, such as Army Knowledge Online (AKO).38”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [21]
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Self-citationPrimary Care Practitioners’ Perceptions of Electronic Consult Systems: A Qualitative Analysis
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Adoption and impact of an eConsult system in a fee-for-service setting
Gleason, N. J., Prasad, P. A., Ackerman, S., Ho, C. K., Monacelli, J., Wang, M., Collado, D., & Gonzales, R. (2016) · Healthcare · doi:10.1016/j.hjdsi.2016.05.005 · Cited by 54
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Reduced Cost Of Specialty Care Using Electronic Consultations For Medicaid Patients
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Evaluation of an electronic consultation service in psychiatry for primary care providers
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“The Champlain BASE TM (Building Access to Specialists through eConsultation) eConsult service was developed in Ottawa, Ontario to address excessive wait times, which exceeded 9 months in some specialties for non-urgent cases [10].”
MethodSelf-citationEvaluating diverse electronic consultation programs with a common framework
Tuot, D. S., Liddy, C., Vimalananda, V. G., Pecina, J., Murphy, E. J., Keely, E., Simon, S. R., North, F., Orlander, J. D., & Chen, A. H. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3626-4 · Cited by 45
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Joschko, J., Liddy, C., Moroz, I., Reiche, M., Crowe, L., Afkham, A., & Keely, E. (2018) · Family Practice · doi:10.1093/fampra/cmx073 · Cited by 42
Self-citatione-Consults in gastroenterology: An opportunity for innovative care
Venkatesh, R. D., Campbell, E. J., Thiim, M., Rao, S. K., Ferris, T. G. G., Wasfy, J. H., & Richter, J. M. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x18781189 · Cited by 43
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“Relatively recent studies from similar interventions such as AskMyGP or eConsult, both part of the United Kingdom’s National Health Service system, have produced mainly qualitative evidence that seems to indicate that their performance meets expectations in terms of access to the health care system but not in terms of…”
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“Nevertheless, the ageing population and the increasing prevalence of chronic diseases, among other factors, have translated into growing demand for specialty care worldwide,(2,3) with cumulative evidence of a rapid increase both in number of referrals and in wait times for appointments.(7) In systems that rely on prim…”
BackgroundNabelsi, V., Lévesque-Chouinard, A., Liddy, C. E., & Pilon, M. D. (2019) · JMIR Medical Informatics · doi:10.2196/13354 · Cited by 41
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InfluentialSelf-citationKeely, E. J., Archibald, D., Tuot, D. S., Lochnan, H. A., & Liddy, C. E. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001472 · Cited by 43
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Self-citationWu, D. C., Zhao, X., & Wu, J. (2023) · Journal of Medical Internet Research · doi:10.2196/39089 · Cited by 34
“Previous studies measured patient satisfaction from text messages by coding keywords [27,29,30].”
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Early experiences with cardiology electronic consults: A systematic review
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Keeping care connected: e-Consultation program improves access to nephrology care
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Improving Access to Rheumatologists: Use and Benefits of an Electronic Consultation Service
Rostom, K., Smith, C., Liddy, C. E., Afkham, A., & Keely, E. (2017) · The Journal of Rheumatology · doi:10.3899/jrheum.161529 · Cited by 31
Self-citationAsk the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system
Fogel, A., Khamisa, K., Afkham, A., Liddy, C., & Keely, E. (2017) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x16644095 · Cited by 29
“This was echoed by comments from many PCPs who noted that the eConsult service served as a valuable educational tool.(27) Our analysis of the clinical topic and questions that were directed to the haematology eConsultants can provide insight into the challenging clinical scenarios facing PCPs.”
BackgroundResultSelf-citationPatients Assess an eConsult Model’s Acceptability at 5 US Academic Medical Centers
Ackerman, S., Dowdell, K., Clebak, K. T., Quinn, M., & Shipman, S. A. (2020) · The Annals of Family Medicine · doi:10.1370/afm.2487 · Cited by 27
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Electronic Health Record Innovations for Healthier Patients and Happier Doctors
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“In a mixed methods study Liddy et al 15 report clinician satisfaction for a web-based e-consult service designed to improve primary care clinician and patient access to specialist consultation.”
BackgroundImproving Access to Specialist Care for an Aging Population
Liddy, C., Drosinis, P., Joschko, J., & Keely, E. (2016) · Gerontology and Geriatric Medicine · doi:10.1177/2333721416677195 · Cited by 24
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InfluentialConceptual Framework to Evaluate Health Care Professionals’ Satisfaction in Utilizing Telemedicine
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“…and ability to lower costs for care have been described in previous studies using a range of methods, including cross-sectional analyses of usage data and close-out survey responses, thematic analyses and costing evaluations (Keely et al. 2013; Liddy et al. 2013a, 2013b, 2015a, 2016, 2017a).”
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“Shifting tasks from specialized hospital care to primary care can lead to many advantages in terms of quality of care, short waiting lists, low health care costs, low costs for patients, and few hospital referrals [2,3].”
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Self-citationImproving Access to Gastroenterologist Using eConsultation: A Way to Potentially Shorten Wait Times
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“In a recent analysis of PCPs’ open text responses to the mandatory closeout survey, eConsult’s ability to serve as an educational tool emerged as a frequent theme.(6) Many PCPs noted that the advice they received from specialists was applicable to multiple cases and would likely improve their ability to treat future p…”
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BackgroundSelf-citationPayment Reform to Enhance Collaboration of Primary Care and Cardiology
Farmer, S. A., Casale, P. N., Gillam, L. D., Rumsfeld, J. S., Erickson, S. M., Kirschner, N. M., de Regnier, K., Williams, B. R., Martin, R. S., & McClellan, M. (2017) · JAMA Cardiology · doi:10.1001/jamacardio.2017.4308 · Cited by 17
“Clinician-to-clinician consultations may increase physician satisfaction by offering an efficient andcost-effectivecommunication tool that is lessdisruptive towork flow than real-time contact.(20) Clinician-to-clinician consultation can reinforce PCP-driven management and may reduce costs.”
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de Man, G., Moroz, I., Mercer, J. G., Keely, E., & Liddy, C. E. (2019) · The Annals of Family Medicine · doi:10.1370/afm.2355 · Cited by 17
“Indications for initiating therapy 7 (2) Would this 79-year-old man benefit from anticoagulation with warfarin?”
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Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ™ eConsult Service
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“These findings correspond with those for the Champlain BASE eConsult service, both overall and specifically with regard to chronic pain cases.(14,19,32) Notably, PCPs have expressed high levels of satisfaction with cases submitted to chronic pain specialists.”
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“In addition to improved timely access to specialist advice, an eConsult service has added educational value for PCPs. Primary care providers identi fi ed education opportunities as a bene fi t of the eConsult service, which has been described in other studies [3,15].”
ResultSelf-citationPrimary Care Psychiatry eConsults at a Rural Academic Medical Center: Descriptive Analysis
Avery, J., Dwan, D., Sowden, G. L., & Duncan, M. S. (2021) · Journal of Medical Internet Research · doi:10.2196/24650 · Cited by 14
“The opportunity for collaboration between a PCP and psychiatrist can be achieved through eConsults [7]. eConsults are provider-to-provider communications within a shared electronic medical record or web-based platform.”
InfluentialChuen, V. L., Dholakia, S., Kalra, S., Watt, J. A., Wong, C. L., & Ho, J. M.-W. (2023) · Age and Ageing · doi:10.1093/ageing/afad231 · Cited by 13
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Self-citationImplementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia
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Electronic consultations and clinician burnout: An antidote to our emotional pandemic?
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“PCPs reported overall positive perceptions of their relationships with other eConsult providers when surveyed, expressing gratitude toward specialists and the quality of their responses.(12) For example, eConsult specialists were able to provide support in unfamiliar situations or help confirm diagnoses.”
BackgroundPai, A. P., Kotak Dinesh, M., Facher, N., Reader, K., Kong, K., & Kolevska, T. (2019) · Blood · doi:10.1182/blood-2018-11-887349 · Cited by 13
Liddy, C. E., de Man, G., Moroz, I., Afkham, A., Mercer, J. G., & Keely, E. (2019) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2019.0014 · Cited by 12
Self-citationFuster-Casanovas, A., & Vidal-Alaball, J. (2022) · International Journal of Integrated Care · doi:10.5334/ijic.6489 · Cited by 12
Use of eConsult to enhance genetics service delivery in primary care: A multimethod study
Carroll, J. C., Liddy, C. E., Afkham, A., Keely, E., Goh, E. S., Graham, G. E., Permaul, J., Allanson, J. E., Heisey, R., Makuwaza, T., et al. (2022) · Genetics in Medicine · doi:10.1016/j.gim.2022.07.003 · Cited by 12
Self-citationSatisfacción del personal de salud y pacientes sobre un servicio de telesalud de un hospital de Perú
Barriga‐Chambi, F., Ccami‐Bernal, F., Alarcón-Casazuela, A. L., Copa-Uscamayta, J., Yauri-Mamani, J., Oporto-Arenas, B. M., & Quispe-Juli, C. U. (2022) · Revista Peruana de Medicina Experimental y Salud Pública · doi:10.17843/rpmesp.2022.394.11287 · Cited by 12
“Few countries in LAC have well-established telehealth policies and regulations, therefore knowing about the satisfaction of patients and health personnel - as an element of feed-back - would allow redirecting regulations in order to improve healthcare via telehealth (11) .”
BackgroundOlayiwola, J. N., Knox, M. J., Dubé, K., Lu, E. C., Woldeyesus, T., James, I. E., Willard‐Grace, R., & Tuot, D. S. (2017) · Health Services Research · doi:10.1111/1475-6773.12776 · Cited by 12
“eCR systems have been implemented across the United States and internationally (Esquivel et al. 2012; Palen et al. 2012; Scherpbier-de Haan et al. 2013; Liddy et al. 2015; Tuot et al. 2015a) and have successfully created a paradigm shift from a focus on “access to specialty visits to access to specialty expertise” (Ch…”
BackgroundMethodPoulin, P. A., Romanow, H. C., Cheng, J., Liddy, C. E., Keely, E. J., & Smyth, C. E. (2017) · Journal for Healthcare Quality · doi:10.1097/jhq.0000000000000117 · Cited by 12
Self-citationLiddy, C. E., Moroz, I., Mihan, A., & Keely, E. (2019) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2019.02.180169 · Cited by 13
Self-citationvan der Velden, T., Schalk, B. W. M., Harmsen, M., Adriaansens, G., Schermer, T. R., & ten Dam, M. A. (2019) · BMC Family Practice · doi:10.1186/s12875-019-0960-5 · Cited by 12
Job, J., Donald, M., Borg, S. J., Nicholson, C., Chaffey, J., O'Hara, K., Fagermo, N., & Jackson, C. L. (2021) · Australian Journal of General Practice · doi:10.31128/ajgp-11-20-5707 · Cited by 11
“27 Data compiled from this pilot study are informing broader implementation and research of the eConsultant model via QePP, an ongoing partnership between the Centre for Health System Reform and Integration, the WQPHN, the Mater, Queensland Health and the Australian Digital Health Agency.”
MethodMcKellips, F., Keely, E., Afkham, A., & Liddy, C. E. (2017) · British Journal of General Practice · doi:10.3399/bjgp17x693125 · Cited by 11
Self-citationLiddy, C. E., Moroz, I., Joschko, J., Horsley, T., Kuziemsky, C. E., Kovacs, K., Kossey, S., Mitera, G., & Keely, E. (2018) · Healthcare policy · doi:10.12927/hcpol.2018.25551 · Cited by 11
Self-citationJorge, M. S. B., Costa, L. S. P., Carvalho, M. R. R., Mamede, R. S. D. B., de Morais, J. B., & de Paula, M. L. (2020) · Revista CEFAC · doi:10.1590/1982-0216/20202233519 · Cited by 10
Electronic consultations ( eConsults ): a proof of concept trial in Australia
Russell, A. W., Adkins, P., Hayes, L., Prior, E., McCormack, C., & DiGregorio, J. (2021) · Internal Medicine Journal · doi:10.1111/imj.15495 · Cited by 10
Breton, M., Smithman, M. A., Liddy, C. E., Keely, E., Farrell, G., Singer, A. G., Lamoureux‐Lamarche, C., Pilon, M. D., Nabelsi, V., Gaboury, I., et al. (2019) · Health Research Policy and Systems · doi:10.1186/s12961-019-0483-5 · Cited by 10
“Poor access to specialists can lead to anxiety, pain, deterioration in health, delays in diagnostics, duplication of services and dissatisfaction of both patients and providers [16, 19].”
BackgroundSelf-citationUnlocking Service Flow—Fast and Frugal Digital Healthcare Design
Knight, J., Ross, E., Gibbons, C., & McEwan, T. (2019) · Intelligent systems reference library · doi:10.1007/978-3-030-26292-1_9 · Cited by 9
Liddy, C. E., Joschko, J., & Keely, E. (2015) · Health Reform Observer - Observatoire des Réformes de Santé · doi:10.13162/hro-ors.v3i2.2747 · Cited by 8
“PCPs have ranked the service as having extremely high value for their patients and themselves (Liddy et al. 2015b).”
BackgroundInfluentialSelf-citationChoosing a Model for eConsult Specialist Remuneration: Factors to Consider
Liddy, C. E., Armstrong, C. D., McKellips, F., Drosinis, P., Afkham, A., & Keely, E. (2016) · Informatics · doi:10.3390/informatics3020008 · Cited by 8
Self-citationMeeker, D., Friedberg, M. W., Knight, T. K., Doctor, J. N., Zein, D., Cayasso-McIntosh, N., Goldstein, N. J., Fox, C. R., Linder, J. A., Persell, S. D., et al. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07002-1 · Cited by 8
Teleconsultation as a strategy to support primary health care professionals: A scoping review
Almeida, R. D. S., Amorim, F. F., Teixeira, J. S., Fortaleza, C. S., Salgado, C. A., Silva, J. S., da Silva, P. R. G., Peccin, M. S., Göttems, L. B. D., & Imoto, A. M. (2025) · Health Policy and Technology · doi:10.1016/j.hlpt.2024.100971 · Cited by 9
Electronic Advice Request System for Nephrology in Alberta: Pilot Results and Implementation
Bello, A. K., Zaidi, D., Braam, B. G., Chou, S. H., Courtney, M. J., Deved, V., Glassford, J., Jindal, K. K., Klarenbach, S. W., Osman, M. S., et al. (2019) · Canadian Journal of Kidney Health and Disease · doi:10.1177/2054358119879778 · Cited by 7
Archibald, D., Grant, R., Tuot, D. S., Liddy, C. E., Sewell, J. L., Price, D. W., Grad, R. M., Shipman, S. A., Campbell, C., Guglani, S., et al. (2023) · BMC Family Practice · doi:10.1186/s12875-022-01948-9 · Cited by 7
“It was developed in 2010 in the Champlain Local Health Integrated Network (LHIN) in Ottawa, Ontario to reduce wait times and improve access to specialist care [23].”
BackgroundSelf-citationZammit, D., Tomaselli, G., Buttiġieġ, S. C., Garg, L., & Macassa, G. (2023) · Sustainability · doi:10.3390/su15054428 · Cited by 7
Tran, C., Archibald, D., Humphrey-Murto, S., Wood, T. J., Dudek, N., Liddy, C., & Keely, E. (2022) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x21998216 · Cited by 6
Self-citationNabelsi, V., & Lévesque-Chouinard, A. (2024) · JMIR Formative Research · doi:10.2196/52921 · Cited by 7
“Other researchers have studied PCPs’ [46-48] and specialists’ [16,49-51] level of satisfaction with eConsult services [52].”
BackgroundHakimjavadi, R., Karunananthan, S., Levi, C., LeBlanc, K. A., Guglani, S., Helmer‐Smith, M., Keely, E., & Liddy, C. E. (2022) · Nursing Open · doi:10.1002/nop2.1476 · Cited by 6
“APNs currently using the service have expressed high levels of satisfaction with eConsult, citing the tool's ability to reassure patients and facilitate high- quality interactions with specialists (Liddy et al., 2015).”
BackgroundSelf-citationTsoi, K. K. F. (2019) · Conference proceedings/Conference proceedings - IEEE International Conference on Systems, Man, and Cybernetics · doi:10.1109/smc.2019.8914229 · Cited by 6
Who Uses eConsult? Investigating Physician Characteristics Associated with Usage (and Nonusage)
Bilodeau, H., Armstrong, C. D., Keely, E., & Liddy, C. E. (2017) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2017.0225 · Cited by 6
Self-citationRussell, C., Sandu, V., Moroz, I., Tran, C. S., Keely, E., & Liddy, C. E. (2019) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2019.0161 · Cited by 6
Self-citationBello, A. K., Zaidi, D., Braam, B. G., Courtney, M. J., Glassford, J., Jindal, K. K., Klarenbach, S. W., Kurzawa, J., Osman, M. S., Scott‐Douglas, N., et al. (2019) · Canadian Journal of Kidney Health and Disease · doi:10.1177/2054358119878715 · Cited by 6
“This short survey was adapted from a previous study evaluating PCPs’ perspectives on the use of eConsult.(25) The survey was tested by 5 PCPs and 3 nephrologists in Alberta for satisfaction, validity, and comments as well.”
Improving the electronic nexus between generalists and specialists: A public health imperative?
Young, M. J., & Pham, J. (2016) · Healthcare · doi:10.1016/j.hjdsi.2016.10.002 · Cited by 6
Does total triage and remote-by-default consulting impact vulnerable groups: A pilot studyPreprint
Verity, A., Naidu, D., & Brown, V. T. (2020) · medRxiv · doi:10.1101/2020.11.04.20220046 · Cited by 6
Implementation and evaluation of an electronic consult program at a large academic health system
Arora, A., Fekieta, R., Spatz, E. S., Roy, B., Marco, K., Sharifi, M., Pashankar, D. S., & Khokhar, B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0310122 · Cited by 5
The Effect of Digitalization in Healthcare on Service Sustainability
Köse, A. (2024) · Advances in logistics, operations, and management science book series · doi:10.4018/979-8-3693-7442-9.ch005 · Cited by 5
Electronic consults for improving vancomycin use
Linsenmeyer, K. D., Strymish, J. M., Smith, D. B., BRENNAN, M. D., & Gupta, K. (2017) · Journal of Hospital Infection · doi:10.1016/j.jhin.2017.12.002 · Cited by 5
Singer, A. G., Ireland, L., Sepehri, Z., Brown, K., Turner, K., Liddy, C. E., Keely, E., & Oppenheimer, L. (2023) · BMC Health Services Research · doi:10.1186/s12913-022-08913-3 · Cited by 4
Self-citation
Metadata
- Authors
- Liddy, C., Afkham, A., Drosinis, P., Joschko, J., & Keely, E.
- Affiliations
- University of Ottawa (CA)
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2015-05-01
- Volume
- 28
- Issue
- 3
- Pages
- 394-403
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2114857658
- Semantic Scholar
- 4765f46d70f33732b8d539dc434da8928f812ba5
- Cited by
- 140
- References
- 25
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 16 · 2022: 9 · 2021: 11 · 2020: 12 · 2019: 21 · 2018: 21 · 2017: 20 · 2016: 9 · 2015: 3
- FWCI
- 38.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Champlain Local Health Integration Network
- Ontario Ministry of Health and Long-Term Care
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- e-consultation, access to specialist care, specialist referral, waiting time, health technology adoption, quality of care
- MeSH terms
- Attitude of Health Personnel, Female, Health Services Accessibility, Humans, Job Satisfaction, Male, Medical Informatics Applications, Ontario, Primary Health Care, Quality of Health Care, Remote Consultation
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