Electronic consultations (eConsults): a proof of concept trial in Australia

Working Together to Improve Type 2 Diabetes Care: A Participatory Design Project to Address Identified Needs of People With Diabetes and Their Health-care Professionals

OBJECTIVES

Diabetes care in Australia is often fragmented and provider-centred, resulting in suboptimal care. Innovative solutions are needed to bridge the evidence-practice gap, and technology can facilitate the redesign of type 2 diabetes care. We used participatory design to increase the chances of fulfilling stakeholders' needs. Using this method, we explored solutions aimed at redesigning diabetes care, focussing on the previously identified needs.

METHODS

The participatory design project was guided by stakeholders' contributions. Stakeholders of this project included people with type 2 diabetes, health-care professionals, technology developers, and researchers. Information uncovered at each step influenced the next: 1) identification of needs, 2) generation of solutions, and 3) testing of solutions. Here, we present steps 2 and 3. In step 2, we presented previously identified issues and elicited creative solutions. In step 3, we obtained stakeholders' feedback on the solutions from step 2, presented as care pathways.

RESULTS

Suggested solutions included a multidisciplinary wellness centre, a mobile app, increased access to education, improved care coordination, increased support for general practitioners, and a better funding model. The revised care pathways featured accessible community resources, a tailored self-management and educational app, a care coordinator, a digital dashboard, and specialized support for primary care to deal with complex cases.

CONCLUSIONS

Using a participatory design, we successfully identified multiple innovative solutions with the potential to improve person-centred and integrated type 2 diabetes care in Australia. These solutions will inform the implementation and evaluation of a redesigned care model by our team.

Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil

INTRODUCTION

eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction.

METHODS

Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis.

RESULTS

Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service.

CONCLUSION

Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.

Patient Acceptance and Intention to Use e-Consultations During the COVID-19 Pandemic in the Eastern Province of Saudi Arabia

Background

Over the last decade, the use of digital technology has increased immeasurably and transformed both our personal and professional lives. The medical profession quickly embraced this development, especially after the spread of the COVID-19 pandemic. Medical consultations were transitioned to online settings as a substitute for face-to-face consultations. This exponential acceleration of the use of remote online consultations (e-consultations) was deemed necessary to respond to the impact of the global pandemic. This study identifies the factors that influence actual patient use and the intention to use e-consultations in Saudi Arabia.

Methods

A cross-sectional survey was distributed online via social media platforms targeting the population living in Saudi Arabia from August to December 2020. The questionnaire measured patient perceptions of and attitudes toward utilizing e-consultations using a validated questionnaire informed by the technology acceptance model (TAM). Analyses were performed in SPSS to identify the external factors that influence patients' actual use of e-consultations and to assess the TAM factors (usefulness, social influence, and ease of use) that influence the intention to use e-consultations across both actual users and never-users.

Results

A total of 150 participants completed the questionnaire; the average age was 38 years old, 85% of the participants were females, and 67% reported never using e-consultations. Additionally, motivation, trust, attitude, and social influence were significantly related to participants' intention to use e-consultations.

Conclusion

Participants' trust in and perception of the usefulness of e-consultations were significant factors in their intention to use e-consultation services. Policymakers' attention to those factors could play a role in increasing public acceptance and the use of e-consultations to improve distance medical care.