• Clare Liddy, Paul Drosinis, Adam Fogel, and Erin Keely.
• Clinician Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute in Ottawa, Ont, Associate Professor in the Department of Family Medicine at the University of Ottawa, and Primary Care Lead of the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service. cliddy@bruyere.org.
• Can Fam Physician. 2017 Aug 1; 63 (8): e381-e386.

ObjectiveTo identify the proportion and evaluate the content of eConsults (electronic consultations) in which the Champlain BASE (Building Access to Specialists through eConsultation) eConsult process prompted a referral to a specialist that was not originally contemplated by the primary care provider (PCP).DesignCross-sectional study of all eConsults submitted between April 15, 2011, and January 31, 2015.SettingChamplain Local Health Integration Network, a large health region in eastern Ontario.ParticipantsPrimary care providers registered to use the Champlain BASE eConsult service.Main Outcome MeasuresAnswers from a close-out survey-completed by PCPs at the conclusion of each eConsult-stating that specialist referral was not originally contemplated but that the eConsult process had prompted referral. The logs containing the communication exchanged between the PCPs and the specialists were reviewed, and each prompted referral case was categorized by the type of question asked, if pharmaceutical advice was given, if the referral was redirected to a different specialty group, and if the referral was urgent.ResultsA total of 188 (3.4%) of 5601 eConsults completed during the study period were cases in which PCPs stated that they had originally not contemplated referring the patient to a specialist but that the Champlain BASE eConsult process had prompted referral. Prompted referrals were most often directed to cardiologists (10.6%), dermatologists (10.6%), infectious disease specialists (9.0%), hematologists (9.0%), and urologists (8.5%). The most common questions were about diagnosis (34.0%), drug treatment (18.0%), and management (15.0%). Pharmaceutical advice was given in 28.0% of prompted referral cases, and in 26.0% of cases, the face-to-face referral was redirected to another specialty group. In 5.0% of cases, the specialist stated the referral was urgent. The median specialist response time was 0.96 days (interquartile range 0.17 to 3.80 days).ConclusionBy providing PCPs with increased access to specialists, the Champlain BASE eConsult service serves an important role in identifying and preventing the potential detrimental consequences of delayed medical referrals across specialty groups.Copyright© the College of Family Physicians of Canada.

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