299: Virtual Asynchronous Teleconsultation Embedded in Care Pathways: Transforming Access to Specialists

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Digital Health Technologies

Background and Aims: Wait times at Canadian multidisciplinary pain clinics often exceed benchmarks, leaving patients struggling to access timely specialist advice for chronic pain and causing delays in treatment. Asynchronous teleconsultation enables primary care providers (PCPs) appropriate, timely and equitable access to specialists' advice in shared models of care, reducing the need for people to receive treatment in hospital settings. However, little is known about the implementation and impact of asynchronous teleconsultation tailored to chronic pain. In this study, we examine the implementation and scale-up of asynchronous teleconsultation for chronic pain and evaluate its impact in urban and rural areas of Quebec.

Methods: As part of a multi-phased mixed-methods study, participatory design workshops were conducted with key stakeholders (specialists, family physicians and nurse practitioners) during the planning phase to identify needs, conceptualize a prototype, and validate its functionalities. In the implementation and scale-up phase, semi-structured interviews were conducted with decision-makers and healthcare providers to understand barriers and facilitators at micro, meso, and macro levels. Surveys were distributed to end users to evaluate appropriateness, acceptability, feasibility, effectiveness, value proposition, and outcomes related to the Quintuple Aim. The Framework Method will guide thematic analysis, while quantitative data will be analyzed using descriptive statistics.

Results: Preliminary data indicate that asynchronous teleconsultation improves access to equitable and secure care in urban and rural community-based settings, The average specialist response time was 9 days (versus 1 year for in-person referrals) and referral was avoided in 76% of cases. An iterative co-design approach, coupled with evidence-based implementation strategies (e.g., education, network engagement, rapid-cycle evaluation), facilitated the acceptance, adaptation, and integration of technology into complex care pathways. An agile governance strategy and multi-stakeholder partnerships facilitates successful technology implementation and sustainability by enabling engagement of key actors in addressing key domains including policy, funding, infrastructure, informed consent and digital literacy.

Conclusions: Integrating teleconsultation into chronic pain care pathways reduced wait times, enhanced access, and improved coordination, demonstrating feasibility and scalability of digitally enabled care across community and specialist settings. User-centered co-design and evidence-based strategies can be used to effectively guide the development and implementation of teleconsultation and strengthen patient-centered care, when and where they need it. Integrating cross-functional teams and promoting an iterative and agile approach, enables scaling of teleconsultation across organizations. Building a network of relationships among political, health system and community partners is vital for bridging the gap between specialist and community settings.

References: N/A

Presenting Author: Regina Visca
Submitting Author: Regina Visca

Senior Author: Yoram Shir

IASP 2026 Global Year theme of Neuropathic Pain: No

• Yoram Shir: MD, PhD - McGill University
• Jonathan Yen: MD, PhD - McGill University
• Krista Brecht: BScN, MScN(A) - McGill University Health Centre