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Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study
  1. Aminu K Bello1,
  2. Anita E Molzahn2,
  3. Louis P Girard3,
  4. Mohamed A Osman1,
  5. Ikechi G Okpechi4,
  6. Jodi Glassford5,
  7. Stephanie Thompson1,
  8. Erin Keely6,
  9. Clare Liddy7,
  10. Braden Manns3,
  11. Kailash Jinda1,
  12. Scott Klarenbach1,
  13. Brenda Hemmelgarn3,
  14. Marcello Tonelli3
  1. 1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
  3. 3Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  4. 4Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
  5. 5Closed Loop Referral Management, eReferral and Alberta Referral Pathways, Calgary, Alberta, Canada
  6. 6C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
  7. 7Division of Endocrinology and Metabolism, The Ottawa Hospital-Riverside Campus, Ottawa, Ontario, Canada
  1. Correspondence to Dr Aminu K Bello; aminu1{at}


Objectives 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.

Methods 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).

Findings 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.

Conclusions 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.

  • electronic consultation
  • kidney care
  • CKD
  • rural/remote communities
  • quality of care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors Authorship followed International Committee of Medical Journal Editors (ICMJE) guidelines. AKB and MT were responsible for the inception and design of the project and prepared the initial draft of the manuscript. AEM, LPG, JG, ST, EK, CL, BM, KJ, SK and BH provided methodological input, and participated in the acquisition, analysis, interpretation and reporting of data. MAO and IGO participated in the acquisition, analysis, interpretation and reporting of data. All authors read and approved the final version of the manuscript.

  • Funding This study was funded by a grant from the MSI Foundation, Edmonton, Alberta and Alberta Innovates Health Solutions–Collaborative Research and Innovation Opportunities (CRIO). Authors have no other disclosures to make.

  • Disclaimer The funders had no role in the design, collection, analysis, interpretation, writing or submission of the manuscript.

  • Competing interests None declared.

  • Ethics approval Health Research Ethics Boards at the University of Alberta and the University of Calgary, Alberta, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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