A Primary Care–Driven eConsult Service
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* Kelsey R. Murray
* Michael E. Johansen

The *Annals of Family Medicine* encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1

## HOW IT WORKS

In each issue, the *Annals* selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article and click on “TRACK Discussion/ Submit a comment.”) Discussion questions and information are online at: [http://www.AnnFamMed.org/site/AJC/](http://www.AnnFamMed.org/site/AJC/).

## CURRENT SELECTION

Liddy C, Moroz I, Afkham A, Keely E. Sustainability of a primary care–driven eConsult service. *Ann Fam Med*. 2018;16(2):120-126.

### Discussion Tips

This article explores the growth in use of an eConsult service in Eastern Canada during its first 5 years. Think about a patient you saw in the office and referred to a specialist or about whom you “curbsided” a specialist. Consider how this eConsult service could affect your practice and management of patients.

### Discussion Questions

*   What question does this study ask? Why does it matter?

*   How does this study expand upon previous research and clinical practice on this topic?

*   What study design is used in this article? What are some of the strengths and weaknesses of this study design?

*   How do eConsult services differ from regular consult services or telemedicine services? How are they similar?

*   How does the eConsult service in the article differ from other eConsult services?2

*   What are the main study findings?

*   What context is important in interpreting the findings?

*   How generalizable are the findings?

*   How has the eConsult service described in the article changed over time?

*   Who is affected by these findings, and how might they interpret or use these findings?

*   What are potential positive and negative outcomes of an eConsult service?

*   What are the next steps in applying the findings?

*   How might this study change your practice? What would be the advantages and disadvantages of using an eConsult service in your practice?

*   How might this change health policy? Physician education? Research?

*   How can further research expand upon this topic?

*   © 2018 Annals of Family Medicine, Inc.

## References

1.  Stange KC, Miller WL, McLellan LA, et al. *Annals* Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIzOiIvYW5uYWxzZm0vMTYvMi9paWkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Barnett ML, Yee HF, Mehrotra A, Giboney P. Los Angeles safety-net program eConsult system was rapidly adopted and decreased wait times to see specialists. Health Aff (Millwood). 2017;36(3):492–499.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToiaGVhbHRoYWZmIjtzOjU6InJlc2lkIjtzOjg6IjM2LzMvNDkyIjtzOjQ6ImF0b20iO3M6MjM6Ii9hbm5hbHNmbS8xNi8yL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)