Scaling up eConsult for access to specialists in primary healthcare across four Canadian provinces: study protocol of a multiple case study

• Published in: Health Research Policy and Systems
• Main Authors: Mylaine Breton, Mélanie Ann Smithman, Clare Liddy, Erin Keely, Gerard Farrell, Alexander Singer, Catherine Lamoureux-Lamarche, Maxine Dumas Pilon, Véronique Nabelsi, Isabelle Gaboury, Marie-Pierre Gagnon, Carolyn Steele Gray, Jay Shaw, Catherine Hudon, Kris Aubrey-Bassler, Justin Gagnon, Élizabeth Côté-Boileau, Paula Louise Bush
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2019
• Subjects: Access to healthcare; eConsult; scaling up; primary care; electronic consultation; process research; Public aspects of medicine; RA1-1270; Newfoundland; Canada
• Online Access: https://doi.org/10.1186/s12961-019-0483-5; https://doaj.org/article/19acc962c3bf4c69bcf14ab79a46ea5a

Abstract Background Canada has been referred to as the land of ‘perpetual pilot projects’. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times – one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communication that allows primary care providers to electronically consult with specialists regarding their patients’ medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador. Our aim is to understand and support the scale-up process of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-up process in each province; (2) understand the eConsult scale-up process in each province and compare across provinces; (3) identify policy issues and strategies to scaling up eConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling up eConsult. Methods We will conduct a qualitative multiple case study to investigate the scaling up of eConsult in four Canadian provinces using a grey literature review, key stakeholder interviews (10 interviews/province), non-participant observations, focus groups and deliberative dialogues. We will identify the main components of eConsult to be scaled up using logic models (obj. 1). Scaling up processes will be analysed using strategies adapted from process research (obj. 2). Policy issues and strategies to scale-up eConsult will be analysed thematically (obj. 3). Finally, a symposium will foster pan-Canadian learning on the process of scaling up eConsult (obj. 4). Discussion This study will likely ...