Ontario is expanding an eConsult service that allows primary care physicians to ask for advice and receive support from specialists in many fields through a secure electronic system. It was first piloted in the Champlain LHIN around Ottawa. With funding from the Ontario Ministry of Health and Long-term Care, eConsult it is now rolling out to Local Health Integration Networks (LHINs) across Ontario through the OTN (Ontario Telehealth Network).
Over 75% of the medical appointments people living with HIV in Ontario make are with family doctors, and 50% of people living with HIV see only family physicians for their care. eConsult will be an important resource for primary care providers treating people living with HIV. Family doctors have the skills and perspective to provide holistic care, integrating HIV care with routine screening and health monitoring, but sometimes they need more specialized input. In some cases, getting advice from a specialist through eConsult may help doctors and their patients avoid specialist referrals, which may take months to arrange and often require travel and expense when people live in smaller centres.
Complexities can arise in HIV care especially when a person has other health conditions that complicate their HIV treatment or when they have a history of using many different medications. Many family doctors in Ontario who treat people with HIV have a large number of patients living with HIV and abundant experience with potential issues. However, about a quarter of family doctors seen by people living with HIV have fewer than 5 people living with HIV in their practice. This is especially true in smaller, more remote centres. A pilot evaluation of the HIV service led by Dr. Clare Liddy and supported by OHTN CIHR New Investigator Claire Kendall and OHTN Research Chair Paul MacPherson showed that eConsult may be particularly valuable for these practices. The evaluation showed that the service was most used by primary care providers when their patients had complex and potentially-conflicting needs. The service helped the doctor make decisions, provided prompt support (specialist advice in an average of two days) and avoided specialist visits.
Drs. Liddy, Kendall and their colleagues are now working with OHTN to identify additional HIV specialists to support the system as it rolls out across Ontario.
| IMPACT: The eConsult service will benefit people living with HIV in rural and remote areas and improve HIV specialist access across the province. |