A retrospective analysis of the use of electronic consultation in general internal medicine

Abstract

BackgroundGeneral internists in Canada are subspecialty providers in the inpatient and outpatient settings. Electronic consultations (eConsult) allow primary care providers (PCPs) to virtually consult specialists to address clinical questions. There is a paucity of literature examining the utility and benefits of eConsults by general internists.AimsTo determine how an eConsult service is used to access general internists.MethodsA retrospective cross‐sectional analysis of internal medicine cases was completed between 1 January 2016 and 31 December 2019 via the ChamplainBASE eConsult service. Two authors derived and validated a general internal medicine (GIM)–specific taxonomy using the validated: (i) Taxonomy of Generic Clinical Questions; and (ii) Internal Classification for Primary Care. Two hundred seventy‐six cases were coded following taxonomy validation. ChamplainBASE utilisation summary and closeout survey data were also analysed.ResultseConsults were responded to in a median of 3.1 days and took 15 min to complete. The eConsult's helpfulness and educational value were rated as 4 to 5/5 and often provided advice for a new or additional course of action. In‐person referral was avoided in 40% of cases. The majority of eConsults consisted of a single question (88%) related to diagnostic clarification. The median remuneration per eConsult was $50.ConclusionsThe majority of eConsults to general internists sought diagnostic clarification and confirmed the view of general internists as expert diagnosticians. eConsults cost less than an in‐person consultation and were viewed favourably by PCPs. Further research can consider the eConsult provider experience and whether eConsults should become a required part of GIM ambulatory practice.

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

“…We screened 181 full-text articles, of which we excluded 108 records after applying exclusion criteria. A total of 72 studies were eligible for data extraction (Figure).…”

“…Of the 72 studies, 34 (47%) were conducted in the US, 31 (43%) in Canada,and 7 (10%) in the rest of the world (Table 2). Of the 72 studies, 31 (43%) focused on multispecialty services, and 14 (19%) focused on internal medicine or a subspecialty of internal medicine . The number of included e-consultations per study ranged from 54 to 3 177 998.…”

“…The number of included e-consultations per study ranged from 54 to 3 177 998. Of all 72 studies, 2 (3%) were RCTs, 4 (5%) were nonrandomized trials, and 66 (92%) were observational . The most frequently mentioned reasons for implementing the e-consultation were improving access to hospital care (63 of 72 studies [88%]), avoiding hospital referrals (28 of 72 studies [38%]), and enhancing clinician communication (9 of 72 studies [13%]).…”

“…Of all 72 studies, 2 (3%) were RCTs, 4 (5%) were nonrandomized trials, and 66 (92%) were observational . The most frequently mentioned reasons for implementing the e-consultation were improving access to hospital care (63 of 72 studies [88%]), avoiding hospital referrals (28 of 72 studies [38%]), and enhancing clinician communication (9 of 72 studies [13%]). Reasons for avoiding hospital referrals included (1) reducing unnecessary referrals (28 of 72 studies [38%]), for example, during the COVID-19 pandemic or for patients unable to travel to the hospital, and (2) controlling health care costs (7 of 72 studies [10%]).…”

Survey of Inpatient Consultations with General Internal Medicine Physicians in a Tertiary Hospital: A Retrospective Observational Study

“…[11][12][13][14][15][16] This difference indicates that GIM is expected to have specialty in diagnosis. 7,17 Indeed, although a small portion, some consultations were for the purpose of checking for missed diagnoses in already diagnosed patients. Patients with atypical symptoms, clinical courses, and symptoms involving multiple organs are likely to be difficult to diagnose.…”