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Ann Fam Med. 2016 Mar;14(2):133-40. doi: 10.1370/afm.1869.

Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster-Randomized Controlled Trial.

Author information

1
Center for Excellence in Primary Care, San Francisco General Hospital, San Francisco, California Department of Family and Community Medicine, University of California San Francisco, San Francisco, California OlayiwolaJ@fcm.ucsf.edu.
2
Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut.
3
Rollins School of Public Health, Emory University, Atlanta, Georgia.
4
Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, Connecticut.
5
Pat and Jim Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, Connecticut.
6
Department of Statistics, University of Connecticut, Storrs, Connecticut.

Abstract

PURPOSE:

Communication between specialists and primary care clinicians is suboptimal, and access to referrals is often limited, which can lead to lower quality, inefficiency, and errors. An electronic consultation (e-consultation) is an asynchronous, non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform. The purpose of this study was to conduct a randomized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care.

METHODS:

Primary care clinicians were randomized into a control (9 traditional) or an intervention (17 e-consultation) arm for referrals to cardiologists. Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients. Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm, sex, race, and age.

RESULTS:

Thirty-six primary care clinicians participated in the study, referring 590 patients. In total, 69% of e-consultations were resolved without a visit to a cardiologist. After adjusting for covariates, median days to a review for an electronic consultation vs a visit for control patients were 5 and 24, respectively. A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group.

CONCLUSION:

E-consultation referrals improved access to and timeliness of care for an underserved population, reduced overall specialty utilization, and streamlined specialty referrals without any increase in adverse cardiovascular outcomes. e-consultations are a potential solution for improving access to specialty care.

PMID:
26951588
PMCID:
PMC4781516
DOI:
10.1370/afm.1869
[Indexed for MEDLINE]
Free PMC Article

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