Using the Implementation Research Logic Model to implement and evaluate a digital solution to improve timely access to specialist advice.

Introduction: With increasing life expectancy & chronic disease prevalence referrals to specialist outpatients in Queensland, Australia, increased 23% between 2004/5 & 2013/14. This growth, and the associated delay in obtaining specialist input, can lead to a deterioration in health, increasing the likelihood of avoidable hospital attendance. For rural remote patients there is further inequity of access with vast distances and time required for travel. Internationally, eConsultant models have been trialled to address demands on healthcare systems without requiring face-to-face specialist input. (Job et al, 2021) The Implementation Research Logic Model (IRLM) was developed to better specify the conceptual linkages between core elements of project implementation and to enhance the rigor and transparency of describing complex processes of improving the adoption of evidence-based interventions in healthcare delivery systems. (Smith et al, 2020) IRLM combines four evidence-based models and theories to guide the development, implementation, and evaluation of health services from the pilot study phase through to implementation: Consolidated Framework for Implementation Research; Expert Recommendations for Implementing Change; Proctor’s taxonomy of implementation outcomes including adoption; and Normalisation Process Theory to assess sustainability. Who is it for: The focus of the research is to improve equity of access to specialist care, particularly for those living in rural and remote areas, including for Aboriginal and Torres Strait Islander people. The service is also available in metropolitan areas where patients can experience wait times of more than a year for specialist appointments. Who is involved/engaged: The Queensland eConsultant Partnership Program (QePP) was co-created with general practices, four Primary Health Network, Queensland Health, Australian Digital Health Agency, Mater Health and Hospital and Health Services. What did we do: We applied IRLM to implement and evaluate QePP, a digital support service in general practices in Queensland, Australia, which provides specialist support for general practice via secure messaging to improve access and reduce wait times for specialist input (eConsultant). Methods: Our mixed-methods observational implementation studies include prospective tracking of service (fidelity/effectiveness) and implementation outcomes (adoption/sustainability). Semi-structured interviews conducted with GPs/stakeholders inform strategy modifications prior to extending implementation. Tracked implementation activities are coded against proven implementation strategies. Results/ impact: Adoption of the service is ongoing and to date over 300 eConsultant occasions of service have been delivered. IRLM has effectively guided adoption and evaluation of the services informed by qualitative interviews which identified key service enablers and barriers, implementation strategy modifications and user priorities for broader implementation. Learning for international audience: IRLM provides a strong implementation and evaluation methodology that highlights priorities to drive the delivery of health services in a complex environment. Next steps: To scale the number of specialities available state-wide via QePP and further evaluate the programs scalability and sustainability.