Background and Aim: Accessing timely specialist physician advice is of critical importance to both Australian general practitioners (GPs) and their patients. The traditional method of referral, triage and subsequent face-to-face (FTF) consultation is facing challenges from an ever-increasing volume of referrals and the needs of underserved populations. In response to increasing outpatient waiting-times, electronic consults (eConsults) have been successfully used internationally to provide GPs with a means of accessing specialist physician advice within 72 hours.1,2 The aim of this study was to determine the perceptions of current Royal Australasian College of Physicians (RACP) adult medicine Fellows towards establishing eConsults in their own clinical practice.

Methods: Semi-structured interviews were conducted with 15 RACP adult medicine Fellows between December 2019 and February 2020. Purposive and snowball sampling strategies were used to recruit physicians from diverse specialties and health-care settings. The data was subjected to a descriptive thematic analysis.

Results: We describe four key themes: 1) Promoting and facilitating GP independence; 2) Consultations appropriate for eConsult; 3) Building local GP-physician networks and improving care integration; and 4) Time and remuneration factors. There was broad consensus that between 10 and 30% of current outpatient referrals to adult medicine physicians would be more appropriately addressed in primary care with specialist support via an eConsult system. RACP Fellows agreed this would improve access to timely specialist advice, place downward pressure on outpatient clinic waiting times and reduce unnecessary patient inconvenience.Specialists identified certain types of consultations that were appropriate for an eConsult, including non-urgent consultations, “routine” reviews, monitoring of stable chronic disease and interpretation of objective data such as laboratory investigations. Specialists viewed multiple or poorly defined questions as generally unsuitable for an eConsult, along with questions that are subjective, contingent on patient values, or based on physician examination findings. Specialists agreed that eConsults would increase the accessibility and visibility of RACP adult medicine Fellows to GPs. The current public hospital outpatient system was seen as impersonal, and the ability of GPs to access timely advice for non-urgent issues was acknowledged to be limited. Building relationships with GPs was seen by specialist physicians as an enabler of more efficient care, facilitating a reduction in low-value therapeutic endeavours.

All RACP adult medicine Fellows indicated they would favour participation in eConsulting in the future, the main caveat for public physicians was ensuring adequate protected time, and for private physicians ensuring adequate remuneration. In the public system, salaried medical officers strongly agreed on requiring dedicated time for eConsults, in order to avoid creep into other rostered activities, and indicated that the hospital would require commensurate activity-based funding. In the private system, fee-for-service specialists indicated they would require an MBS rebate that matched their FTF consulting rate.

Conclusion: eConsults use simple, existing secure messaging technology to improve the accessibility of specialist physician care. Timely and convenient access to specialist advice for GPs is a facilitator of streamlined complex care in the community, a key policy objective of the RACP. These findings elucidate the benefits and barriers related to establishing eConsults in the Australian health-care context, which should be carefully considered by key stakeholders.