title: Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study.
abstract: We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery.
  
  
  
  This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers).
  
  
  
  The e-Consult system was generally acceptable across all stakeholder groups. The key barriers identified were length of time required for referring physicians to complete the e-Consult due to lack of integration with current electronic medical records, and concerns that increased numbers of requests might overwhelm nephrologists and lead to a delayed response or an unsustainable system. The key facilitators identified were potential improvement of care coordination, dissemination of best practice through an educational platform, comprehensive data to make decisions without the need for face-to-face consultation, timely feedback to primary care providers, timeliness/reduced delays for patients' rapid triage and identification of cases needing urgent care and improved access to information to facilitate decision-making in patient care.
  
  
  
  Stakeholder perceptions regarding the e-Consult system were favourable, and the key barriers and facilitators identified will be considered in design and implementation of an acceptable and sustainable electronic consultation system for kidney care delivery.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Aminu K
authors.initials: AK
authors.lastname: Bello
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Molzahn
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Girard
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Osman
authors.affiliation: Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
authors.forename: Ikechi G
authors.initials: IG
authors.lastname: Okpechi
authors.affiliation: Closed Loop Referral Management, eReferral and Alberta Referral Pathways, Calgary, Alberta, Canada.
authors.forename: Jodi
authors.initials: J
authors.lastname: Glassford
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Thompson
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
authors.affiliation: Division of Endocrinology and Metabolism, The Ottawa Hospital-Riverside Campus, Ottawa, Ontario, Canada.
authors.forename: Clare
authors.initials: C
authors.lastname: Liddy
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Kailash
authors.initials: K
authors.lastname: Jinda
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta; D000553:Ambulatory Care / Q000379:methods*; D001290:Attitude; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D005260:Female; D017144:Focus Groups; D006801:Humans; D007668:Kidney; D008137:Longitudinal Studies; D008297:Male; D000072104:Nephrologists; D009398:Nephrology; D017060:Patient Satisfaction; D058007:Physicians, Primary Care; D036301:Qualitative Research; D019114:Remote Consultation; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D055815:Young Adult
keywords: CKD; electronic consultation; kidney care; quality of care; rural/remote communities