Feasibility of an asynchronous general practitioner-to-general physician eConsultant outpatient substitution program: A Queensland pilot study.

 The eConsultant model for complex chronic disease management is an established outpatient substitution model in North America. This model is being investigated for its feasibility within the Australian setting. In a pilot study conducted in one urban and four rural/remote general practices in one state, the general practitioner (GP) sent a request for advice (RFA), a clinical summary with a specific clinical question/s, via secure messaging to a physician working remotely. The aim is to provide support from a general physician within three business days (72 hours) for GPs and patients who would otherwise require an outpatient department (OPD) referral. The eConsultant has three response options: an answer to the problem, a request for further information, or a request to refer the patient for a face-to-face OPD appointment.

Results of the study showed that the mean time for general physician reply was 2.1 days, and mean time from initial to subsequent GP/patient review was 14.8 days. Only 13.3% of eConsultations required a subsequent face-to-face outpatient department appointment. The mean turnaround time for patients to discuss the specialist advice with their GPs was 15 days less than Category 1, 75 days less than Category 2, and 350 days less than Category 3 recommended waiting list timeframes. All RFAs received an answer from the eConsultant. In 87% of cases, patients avoided a face-to-face specialist visit, with the associated savings in cost and time for travel particularly noted by patients and providers in rural/remote areas.

This pilot study shows the potential for implementation of an internationally validated model of care, with benefits to Queensland patients, practices, and the health system. The RFA process is designed to follow as closely as possible the GP’s usual practice for secondary care support, and GPs documented a mean time of 14.3 minutes to generate and send the RFA. The model has benefits such as timely access to care, avoidance of unnecessary specialist visits, and potential for quality care for patients with complex comorbidity.

Job J, Donald M, Borg SJ, Nicholson C, Chaffey J, O’Hara K, Fagermo N, Jackson CL. Feasibility of an asynchronous general practitioner-to-general physician eConsultant outpatient substitution program: A Queensland pilot study. Aust J Gen Pract. 2021 Nov;50(11):857-862. doi: 10.31128/AJGP-11-20-5707. PMID: 34713290.