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

The Article in Brief

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

J. Nwando Olayiwola , and colleagues

Background The exchange of information between primary care clinicians and specialists to whom they refer patients is often not optimal. This study tests the efficacy and effectiveness of electronic consultations (eConsults) in reducing wait times and improving access to cardiac care for underserved populations.

What This Study Found Electronic consultations appear to improve access to and timeliness of referrals to cardiac care. eConsults also reduce overall specialty utilization and streamline specialty referrals without an increase in adverse cardiovascular outcomes. Two-thirds or patients referred to a cardiologist by the e-consultation pathway never required a face-to-face visit. Electronic consultations were completed, on average, almost a month sooner than face-to face consultations, even for those deemed urgent by the referring physician. After six months, there were fewer cardiac-related emergency department visits for the intervention group.

Implications

• These results suggest that a substantial number of consultations can be safely and more efficiently managed through a secure electronic exchange of information without compromising the quality of care and with improved convenience for the patient.