Keeping care connected: e-Consultation program improves access to nephrology care

Abstract

Introduction Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit. Methods We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program. Results For traditional nephrology referrals placed during the study period (July 2016-March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit. Discussion Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists.

Electronic consultations (E-consults) and their outcomes: a systematic review

“…At the time of our 2015 review, most studies reported high PCP satisfaction with e-consults, including perceived value, improved timeliness of specialty input, and enhanced communication with specialist. Newer studies using PCP surveys support these findings, 11,13,14,[18][19][20][21][22]24,26,[29][30][31][33][34][35][36]41,54,57,60,[62][63][64][65][67][68][69][70][71] and 2 qualitative studies also report generally high PCP satisfaction. 7,39 More recent studies have also described a strong educational benefit to less-experienced PCPs.…”

“…More than half of the included studies were from 1 of 2 settings: 26 from the Champlain BASE program and 13 from VA settings. 7,[37][38][39][40][41][42][43][44][45][46][47][48] Of the remaining 24 studies, there were 12 from community health centers or large public health care systems, 43,[49][50][51][52][53][54][55][56][57][58][59] 8 from academic medical centers, [60][61][62][63][64][65][66][67] 2 from a nongovernmental humanitarian organization, 68, 69 1 from a not-for-profit integrated health care delivery system, 70 and 1 from a private company providing e-consult services. 71 Most studies were observational in design and lacked a control group.…”

“…Sleep medicine e-consultation followed by the specialists' order of a sleep study and positive airway pressure therapy, if indicated, resulted in a decrease over 4 years in the interval between sleep consult and positive airway pressure prescription from 60 days to 7 days. 38 More than a dozen studies report a response time (i.e., the time between when the e-consult is requested and when the responding specialist provides the response) of a few days or less, 11,13,14,16,20,21,28,32,34,35,40,46,47,51,56,61,62,67,69 whereas face-toface visits generally require days to weeks to be completed.…”

A systematic scoping review of change management practices used for telemedicine service implementations

“…Saurman et al, 2014 [ 68 ] Telemental health emergency services → remote and regional areas VC, T New South Wales, Australia 4 S 35. Schettini et al, 2019 (first online in 2017) [ 69 ] Nephrology e-Consult program → primary care providers S&F North Carolina, USA 3 NR 36. Scott et al, 2012 [ 70 ] Specialist care advice to treat complex chronic health conditions → rural primary care providers VC Pacific Northwest, USA 4 S 37.…”

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

“…1 Advantages of econsults include improved patient access to specialist care, potential cost savings, 2 and convenience for both health care providers and patients. 1 The utility and feasibility of e-consults has been demonstrated across multiple specialties, including cardiology, 3,4 gastroenterology, 5 endocrinology, 6 infectious disease, 7 nephrology, 8 and dermatology. 9 Although the only data currently available addressing allergy/ immunology (A/I) e-consults come from the outpatient setting, 10 the inpatient setting is prime to incorporate asynchronous evaluations.…”