Providing Specialty Consultant Expertise to Primary Care: An Expanding Spectrum of Modalities

Abstract

In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.

Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area

“…18 Given the potential efficiencies, there have been calls to identify which clinical circumstances lend themselves well to asynchronous e-consult. 6 Recognizing the need for specialty care access for underserved patients in the Denver, CO, metropolitan area, Kaiser Permanente (KP) Colorado (KPCO) collaborated with the Colorado Health Institute in 2010 to 2011 to conduct a statewide specialty care needs assessment in the Colorado health care safety net, as well as an associated demand study in three metropolitan Denver federally qualified health centers. 19,20 The needs assessment confirmed barriers to specialty care access, especially for uninsured patients.…”

“…5 Multiple specialty care access programs have been implemented nationally to meet the needs of uninsured and underinsured patients. 6 Specialist consultation can provide information to reduce clinical uncertainty, to increase access to specific procedures, to permit comanagement of complex patients, and to transfer patients from primary to specialty care. 6 Components of specialty care programs include referral hubs, teleconferencing programs, and electronic-consultation (e-consult) programs.…”

“…6 Specialist consultation can provide information to reduce clinical uncertainty, to increase access to specific procedures, to permit comanagement of complex patients, and to transfer patients from primary to specialty care. 6 Components of specialty care programs include referral hubs, teleconferencing programs, and electronic-consultation (e-consult) programs. Specialty care referral hubs connect safety-net primary care clinics to volunteer specialists and are primarily funded by grants and donated services; many specialists are linked to academic medical centers.…”

A Multicenter Cardiovascular MR Network for Tele-Training and Beyond: Setup and Initial Experiences

“…Tele-learning modalities, such as web-based learning, video teaching, and audio lectures were introduced, owing to advances in technology and the increasing demand for flexible learning opportunities that are time and location independent [14]. At the same time, demand is increasing for expert networks in several medical fields, particularly because of higher levels of subspecialization in medicine and centralization of expertise in larger institutions [15]. Existing medical networks are used mainly for facilitation, of communication, knowledge exchange, and research collaboration among institutions [16,17].…”

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

“…Barriers to receipt and provision of evidence‐based AUD treatments may disproportionately impact patients and providers in remote or rural clinics. Rural residence and distance to care are known barriers to rural patients’ receiving specialty care services .…”