A comparison of faxed referrals and eConsult questions for rheumatology referrals: a descriptive study

Abstract

he number of patients requiring care from a rheumatologist has increased in recent years, while the number of rheumatologists available to provide clinical care remains inadequate and static. [1][2][3] In Canada, studies have found substantial variability in wait times for rheumatology. A study assessing time to first rheumatologist visit in new rheumatoid arthritis reported a mean wait time of 77 days, with a median wait time of 50 days. 4 Another study reported a mean wait time of 155 (standard deviation 88) days for routine rheumatology referrals. 5 To cope with these issues, some rheumatology practices have limited the number of referrals they accept and implemented strategies designed to improve triage, such as restrictions on accepted diagnoses, centralized intake and standardized referral forms. [5][6][7][8] Unfortunately, these measures can lead to more declined referrals, which cause a greater burden for patients.One solution in Eastern Ontario is the Champlain BASE (Building Access to Specialists Through eConsultation) eConsult Service, an asynchronous, secure Web-based appli-cation that allows primary care providers to submit patientspecific clinical questions to multiple specialty services, including rheumatology. 9,10 User satisfaction is high, with primary care providers commonly citing the service's promptness, quality of replies and added education from specialist

Healthcare disparities in telemedicine for rheumatology care

“…eConsult services are an asynchronous web or electronic health record-based system consultation in which a referring provider can securely share health information with a subspecialist who can offer clinical advice without directly seeing the patient [50 ▪ ]. These programs hold the potential to provide more timely rheumatology consultative services for underserved rural patients [50 ▪ ,51 ▪ ]. eConsult services may allow primary care providers to solicit advice or answers to questions as an alternative to a face-to-face specialist referral, which avoids prolonged wait time, or provide basic recommendations to support patients awaiting in-person evaluation [50 ▪ ,51 ▪ ,52].…”

“…In a descriptive study, rheumatologists agreed that eConsults have the potential to address specific questions (e.g. drug-related questions, or questions about diagnosis, management, or procedures) that otherwise would become routine consultations [51 ▪ ].…”

Experience with Pediatric Neurology e-Consults from a Specialist Perspective at an Academic Center

“…In many cases, these patients do not require any additional workup or treatment, raising concern that PCPs are uncertain about diagnosis or management even in these less acute common conditions. Studies in other specialties have shown that many of traditional referrals can be converted to e-consults, 5,12 which is also true for pediatric neurology. Further discussion and targeted education with PCPs may lead to changes in practice regarding which clinical problems are appropriate for e-consults.…”

“…Patient ages varied from neonates to 19 years old with a mean age of 8.7 years (SD = 6.0) and a median age [IQR] = 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Of these, 20.6% (N = 12) were ≤ age 1 year.…”

“…2 PCPs reported improved knowledge through case-based learning but raised concern over the additional workload. 3,4 Few studies examined e-consults from a specialist perspective [5][6][7][8] including rheumatology, cardiology, and adult neurology. Pediatric neurology may be perceived as a complex specialty that is less suitable for e-consults, especially for younger patients.…”