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The use of electronic consultations is associated with lower specialist referral rates: a cross-sectional study using population-based health administrative data


Background — The referral-consultation process can be difficult to navigate. Electronic consultations (eConsults) can help streamline referrals by facilitating inter-provider communication.

Objective — We evaluated the potential effect of eConsult on specialist referral rates in Ontario among family physicians providing comprehensive care.

Methods — We conducted a retrospective 1:3 matched cohort study examining total referrals and referrals to all available medical specialties from primary care providers between 1 April 2014 and 31 March 2015. We used multivariable random effects Poisson regression analysis to compare referral rates between eConsult and non-eConsult users while adjusting for relevant patient and provider characteristics. Referral rates were expressed per physician, per 100 patients and per 100 patient encounters.

Results — There were 113197 referrals across all medical specialties made by 119 eConsult physicians and 352 matched controls. Referral rates per physician were significantly lower in the eConsult group for all specialty groupings [unadjusted rate ratio (RR) = 0.87, 95% confidence interval (CI) = 0.80–0.95; adjusted RR = 0.92, 95% CI = 0.85–1.00]. Referral rates per patient were lower among eConsult physicians (unadjusted RR = 0.91, 95% CI = 0.84–0.98) but this difference was not statistically significant after adjustment (adjusted RR = 0.96, 95% CI = 0.90–1.02). No statistically significant difference was observed when referrals were expressed per 100 patient encounters.

Conclusion — This is the first Canadian study to examine the potential effect of eConsult on overall referrals at a population level. Our findings demonstrate that using eConsult service is associated with fewer referrals from primary to specialist care, with considerable potential for cost savings to our single-payer system.



Liddy C, Moroz I, Keely E, Taljaard M, Mark Fraser A, Deri Armstrong C, Afkham A, Kendall C. Fam Pract. 2018; 35(6):698-705. Epub 2018 Apr 4.

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