Catherine Deri Armstrong

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at

A comparison of referral patterns to a multispecialty eConsultation service between nurse practitioners and family physicians: The case for eConsult

207 787 and total potential savings were

Revisiting the relationship between wages and sleep duration: The role of insomnia

246 516. eConsult led to a net societal saving of

Improving access to specialists in remote communities: a cross-sectional study and cost analysis of the use of eConsult in Nunavut

38 729 or

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

11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner.

Choosing a Model for eConsult Specialist Remuneration: Factors to Consider

Purpose:To explore referral patterns of nurse practitioners (NPs) and family physicians (FPs) using an electronic consultation (eConsult) service, and assess their perspectives on the services value to their patients and themselves. Data sources:A mixed methods study including a cross‐sectional analysis of utilization data drawn from all eConsults completed from April 15, 2011 to September 30, 2014, and a content analysis of NP survey responses completed from January 1 to September 30, 2014. Conclusions:A total of 4260 eConsults were included in the cross‐sectional analysis (3686 from FPs and 574 from NPs). In our sample, NPs directed more cases to dermatology and fewer cases to cardiology and neurology (p < .0001) than did FPs, and were more likely to report that an eConsult led to new advice for a new or additional course of action (62.8% vs. 57.5%) and less likely to report it resulted in an avoided referral (35.5% vs. 41.8%, p = .005). NPs reported slightly higher levels of perceived value of eConsults for their patients and themselves. Implications for practice:Differences in use and impact of eConsult exist between NPs and FPs. NPs value the service highly for their patients and themselves. The service reduces potential inequities related to outdated payment and scope of practice policies.

Randomized controlled trial of Anticipatory and Preventive multidisciplinary Team Care For complex patients in a community-based primary care setting

HIGHLIGHTSWorkers reduce sleep time in response to wage rate increases.Sleep time responses depend upon workers sex, sleep problems, and economic context.Male insomnaics are the most responsive to wage rate hikes in an economic downturn.Sleep problems appear to be randomly distributed across the population of workers. ABSTRACT This paper uses the 2005 and 2010 Canadian General Social Surveys (Time Use) to investigate the effect of wages on the sleep duration of individuals in the labour force. The endogeneity of wages is taken into account with an instrumental variables approach; we find that the wage rate affects sleeping time in general, corroborating Biddle and Hamermeshs (1990) main conclusion. A ten percent increase in the wage rate leads to an 11–12 min decrease in sleep per week. But this number masks several effects. The responsiveness of sleep time to wage rate changes depends upon the sex of the individual, whether or not sleep problems are present and general economic conditions. By far the largest adjustment is found for insomniacs in 2010, a year of general economic downturn in Canada. We also investigate the non‐randomness of insomnia in the population by using a Heckman procedure, and find that the sleep time of female non‐insomniacs is even more responsive to wage rate changes once account is taken of this selection bias, but otherwise selection was not a problem in our samples.

The 'Trendiness' of Sleep: An Empirical Investigation into the Cyclical Nature of Sleep Time

ABSTRACT Background: Residents of remote communities face inequities in access to specialists, excessive wait times, and poorly coordinated care. The Champlain BASETM (Building Access to Specialists through eConsultation) service facilitates asynchronous communication between primary care providers (PCP) and specialists. The service was extended to several PCPs in Nunavut in 2014. Objective: To (1) describe the use of eConsult services in Nunavut, and (2) conduct a costing evaluation. Design: A cross-sectional study and cost analysis of all eConsult cases submitted between August 2014 and April 2016. Results: PCPs from Nunavut submitted 165 eConsult cases. The most popular specialties were dermatology (16%), cardiology (8%), endocrinology (7%), otolaryngology (7%), and obstetrics/gynaecology (7%). Specialists provided a response in a median of 0.9 days (IQR=0.3–3.0, range=0.01–15.02). In 35% of cases, PCPs were able to avoid the face-to-face specialist visits they had originally planned for their patients. Total savings associated with eConsult in Nunavut are estimated at

Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

180,552.73 or

Randomized controlled trial of Anticipatory and Preventive multidisciplinary Team Care

1,100.93 per eConsult. Conclusions: The eConsult service provided patients in Nunavut’s remote communities with prompt access to specialist advice. The service’s chief advantage in Canada’s northern communities is its ability to offer electronic access to a breadth of specialties far greater than could be supported locally. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings.