Using eConsult to access specialist advice for persons living with dementia – A cross-sectional analysis

Context: Dementia affects nearly half a million Canadians. Though dementia can be managed in primary care, the complexity of the condition and high prevalence of multimorbidity often require advice from a variety of specialists. Travel to see consultants can be disorienting and difficult for persons living with dementia (PLWD). eConsult is a secure web-based platform that may make communication with specialists more accessible for primary care providers (PCPs).

Objective: To examine how eConsult is being used in the care of PLWD.

Study Design and Analysis: Cross-sectional analysis.

Setting or Dataset: eConsult cases closed in 2021 from the Champlain region in Eastern Ontario for PLWD living in the community and in long-term care (LTC).

Population Studied: Our sample included 97 cases from PLWD in the community and 53 cases from LTC.

Intervention/Instrument: We collected basic eConsult service utilization data, including the specialty group consulted and specialist response time, as well as the PCP’s responses to a close-out survey to describe their experience with eConsult.

Outcome Measures: Our team of clinicians coded the questions and responses using validated taxonomies adapted to this study, using iterative discussions to achieve consensus. We provide descriptive statistics of the service utilization and taxonomy results.

Results: PCPs’ questions were directly related to the patient’s dementia in 30% of community cases (n=29), compared to 15% in LTC (n=8). Specialists responded to all cases in a median of less than 1.2 days, and often considered the patient’s dementia in their responses (community: 46% [n=45], LTC: 38% [n=20]). PCPs indicated that an in-person referral was avoided in 39% of community cases (n=38) and 41% of LTC cases (n=22). Geriatrics was the most frequently consulted specialty from the community (18%, n=17), and dermatology from LTC (30%, n=15). Resources, services or assistance for caregivers of PLWD were discussed by PCPs/specialists in 32% of community cases (n=31) and 26% of LTC cases (n=14).

Conclusions: PCPs are using eConsult to access different specialists for different care issues depending on whether the PLWD is living in the community or LTC. eConsult facilitates prompt response and supports PCPs in managing complex conditions, thereby reducing the potential wait times for, and travel burden on, this vulnerable population.