Article Figures & Data
Figures
- Figure 1.
Classification of addiction medicine electronic consultation cases by question type (diagnosis, drug treatment, and management)
Tables
PARTICIPANT CHARACTERISTIC NO. OF CASES PERCENTAGE OF CASES PCP (n=99) Type • MD 113 87.6 • NP 16 12.4 Region of practice • Champlain 123 95.3 • Toronto Central 4 3.1 • Mississauga Halton 2 1.6 Patient (n=129) Gender • Female 60 46.5 • Male 69 53.5 Age • ≤20 1 0.8 • 20 to 39 47 36.4 • 40 to 59 60 46.5 • 60 to 79 19 14.7 • ≥80 2 1.6 Concurrent conditions • Mental health conditions 73 56.5 -Depression 44 34.1 -Anxiety 38 29.5 -PTSD 12 9.3 -Insomnia 7 5.4 • Chronic pain 49 38.0 • Concurrent substance use* 37 28.7 • No reported concurrent condition 29 22.5 NP—nurse practitioner, PCP—primary care provider, PTSD—posttraumatic stress disorder.
↵* Concurrent substance use includes patient cases where PCPs submitted electronic consultations regarding the use of a primary substance and reported concurrent substance use, as well as cases where PCPs submitted electronic consultations regarding the use of multiple substances. Concurrent substance use includes use of substances that do not necessarily meet the criteria for a diagnosed substance use disorder. Some cases may consist of multiple concurrent conditions, so the sum exceeds the total number of cases (n=129).
- Table 2.
Primary substance(s) for which primary care providers sent an electronic consultation to addiction medicine specialists
SUBSTANCE NO. OF CASES PERCENTAGE OF CASES Opioid 49 38.0 Alcohol 45 34.9 Stimulant 11 8.5 Cannabis 8 6.2 Polysubstance use 8 6.2 Benzodiazepines 3 2.3 Other substances 2 1.6 Tobacco 1 0.8 Non-substance addiction (ie, gambling) 1 0.8 - Table 3.
Categorization of addiction medicine electronic consultation cases by clinical topic
CATEGORY CLINICAL TOPIC DESCRIPTION NO. OF CASES PERCENTAGE OF CASES Chronic pain and controlled substances Chronic pain management Treatment of noncancer chronic pain 37 28.7 Prescribing controlled substances PCP-prescribed controlled substances (narcotic, stimulant, benzodiazepine) that are non–opioid agonist treatments 31 24.0 Opioid tapering–medication management Medical approach to decreasing prescribed opioid dosage over time 17 13.2 Harm reduction Strategies aimed at reducing negative consequences associated with drug use (including safe supply) 9 7.0 Opioid tapering–patient communication and decision making Advice for discussing opioid tapering with patients 2 1.6 Long-term management Anti-craving Medical management for chronic relapse prevention (generally for alcohol) 33 25.6 Accessing resources Community-based or inpatient patient programs to assist in substance use management 21 16.3 OAT Medical management of opioid use disorder; use of OATs (ie, buprenorphine, methadone, SROM) 18 14.0 Abstinence Advice to achieve patient goal of refraining from problematic substance use 10 7.8 Short-term management Withdrawal Advice on prevention and management of symptoms developed when patient stops or cuts down on a substance for which they have developed physical tolerance 28 21.7 Rehabilitation or detoxification Management of physical and psychological effects of stopping an addictive substance (inpatient or outpatient) 15 11.6 Intoxication Pattern of physical, behavioural, or psychological changes produced by active drug use 7 5.4 Concurrent disorders Concurrent psychiatric disorders Medical history includes psychiatric conditions that are complicating substance use management 25 19.4 Medical complications Substance use–related medical complications (eg, liver cirrhosis with alcohol use disorder) 11 8.5 Concurrent medical disorders Medical history includes conditions that are complicating substance use management 8 6.2 Other NA Unlisted clinical topics including safety (return to work, driving), urine drug screens, and non–substance addiction 19 14.7 NA—not applicable, OAT—opioid agonist therapy, PCP—primary care provider, SROM—slow-release oral morphine.
- Table 4.
Referral outcomes of electronic consultations as reported by primary care providers
RESULT OF ELECTRONIC CONSULTATION NO. OF CASES PERCENTAGE OF CASES I was able to confirm a course of action that I originally had in mind 36 27.9 I got good advice for a new or additional course of action that I will be implementing 88 68.2 I got good advice for a new or additional course of action that I am not able to implement 4 3.1 None of the above 1 0.8 Referral was originally contemplated but now avoided at this stage 42 32.6 Referral was originally contemplated and is still needed 29 22.5 Referral was not originally contemplated and is still not needed 50 38.8 Referral was not originally contemplated, but electronic consultation resulted in a referral being initiated 4 3.1 Other 4 3.1
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