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J Allergy Clin Immunol Pract. 2019 Jun 3. pii: S2213-2198(19)30496-9. doi: 10.1016/j.jaip.2019.05.039. [Epub ahead of print]

Electronic Consultations in Allergy/Immunology.

Author information

1
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: nphadke@partners.org.
2
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
3
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Mongan Institute , Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
4
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
5
Performance Analysis and Improvement Unit, Massachusetts General Hospital, Boston, Massachusetts, USA; Massachusetts General Physicians Organization, Boston, Massachusetts, USA.
6
Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Physicians Organization, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
7
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Mongan Institute , Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Allergic condition management more often requires allergist guidance than allergy testing; necessary testing may be unavailable at initial allergy consultations. Electronic consultations (e-consults) provide expedited, problem-focused, potentially cost-saving care in other medical specialties, but have not yet been studied in Allergy/Immunology.

OBJECTIVE:

To describe e-consult use at an academic allergy/immunology practice.

METHODS:

E-consult data (August 10, 2016 through July 31, 2018) and in-person consult data (August 1, 2014 through July 31, 2018) were reviewed to determine consult volume, outcomes, indications, and timing. Referral reasons and wait times were compared with chi-squared tests.

RESULTS:

E-consults grew from 1% to 10% of all new consults with concurrent growth in in-person consults. Of 306 completed e-consults, 41 (13.4%) made diagnostic, therapeutic, or alternative referral recommendations with 30 (73%) recommendations followed; 183 (59.8%) patients required an in-person Allergy/Immunology consult, and only 5 (<2%) patients saw an allergist without an e-consult recommendation to do so. E-consults were used more often than in-person consults for adverse drug reactions (66% vs 9%, p<0.001), especially penicillin allergy (132, 61% of all e-consults) and immunodeficiency (15% vs 2%, p<0.001). Allergists completed e-consults in a median of 11 minutes with a median turn-around time of 22 hours. E-consult implementation was associated with a decreased median in-person consult wait time (1.5 fewer calendar days, p<0.05).

CONCLUSION:

E-consults were increasingly used, particularly for historical adverse drug reactions and immunodeficiency. Implementation of an e-consult program resulted in decreased in-person wait times despite an increase in overall consult volume, supporting this model's ability to provide expedited, problem-focused care.

KEYWORDS:

Telehealth; access; adverse drug reaction; asynchronous care delivery; e-consult; electronic consultation; immunodeficiency evaluation; quality improvement

PMID:
31170540
DOI:
10.1016/j.jaip.2019.05.039

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