Article Figures & Data
Figures
- Figure 1
Inclusion and exclusion of cases for analysis.
eConsult = electronic consultation; ED = emergency department.
- Figure 2
Distribution of specialty groups consulted for 291 completed eConsult cases
eConsult = electronic consultation; ENT = ear, nose, and throat; OB/GYN = obstetrics/gynecology.
Note: “Other” category contains specialties accounting for less than 2% of the eConsults: general surgery, radiology, genetics, vascular surgery, sports medicine, allergy & immunology, thoracic surgery, pain medicine, bariatric care, addictions, neurosurgery, and ophthalmology.
- Figure 3
Recommendations given by specialists and adherence of primary care clinicians to the recommendations for 291 completed eConsult cases.
- Figure 4
Communication of eConsult results to the patient by primary care clinicians and distribution of communication methods used.
eConsult = electronic consultation; PCC = primary care clinician.
aTelephone call by a clerk (2 cases), face-to-face contact with a nurse (1 case), unclear which method was used (2 cases).
Tables
Characteristic Number (%) Primary care clinicians Type Family physician 255 (88) Nurse practitioner 36 (12) Sex Female 154 (53) Male 137 (47) Patients Sex Female 161 (55) Male 130 (44) Age-group Child/adolescent (0-17 years) 60 (21) Adult (18-64 years) 167 (57) Older adult (≥65 years) 64 (22) Location Urban 282 (97) Rural 5 (2) Unidentified 4 (1) - Table 2
Types and Examples of Questions Asked by Primary Care Clinicians Via the eConsult Service
Question Type Questions, No. (%) Question Example Diagnosis 182 (63) Interpretation of clinical findings 104 (36) My patient is a 17-year-old girl who has a fine vesicular rash since a week. Please assess this rash. Could this be a viral exanthema or scabies? (Pictures are attached.) Interpretation of prior testing 70 (24) This patient has a mildly elevated prolactin level of 37. Macro prolactin testing is pending. If this elevation is not due to macro prolactin, is this level something to worry about? Diagnostic work-up 8 (3) This 36-year-old and 24-weeks-pregnant female has a TSH of 3.7 and free T4 of 13. We are planning to order TPO antibodies; is there any other bloodwork you would recommend? Management 78 (27) General management 70 (24) I’m sending this eConsult regarding a patient with persistent rectal bleeding from internal hemorrhoids. I am wondering if you have suggestions to stop and pre- vent the bleeding. Should I refer? 8 (3) I have a healthy 45-year-old male who describes issues with erectile dysfunction for the past 7 years. Because of his young age, I am unsure of the approach to take at this time. Would this be someone who should be seen by urology? Drug treatment 28 (10) Drug of choice for particular condition 15 (5) What would you recommend for treatment for hair loss related to PCOS? Indications for initiating therapy 7 (2) Would this 79-year-old man benefit from anticoagulation with warfarin? Change in dose or stopping drug 4 (1) This patient is requesting to come off her lithium, which she has been on for many years. Her mood has been stable for a long time. Can you advise on the best way to decrease and eventually stop the lithium? Adverse effects/interactions 2 (1) Is it safe to start Celexa in a pregnant patient with a declining mood and history of depression? Procedure 3 (1) This girl has a small mole that has been the same for a long time, but recently bled without any trauma. The lesion is not painful or pruritic. It is a well-demarcated, round, homogenous 2-mm mole on her arm. Given the bleeding, would you recommend a biopsy? eConsult = electronic consultation; PCOS = polycystic ovary syndrome; free T4 = free thyroxine; TSH = thyroid stimulating hormone; TPO = thyroid peroxidase.
The Article in Brief
Primary Care Clinician Adherence to Specialist Advice in Electronic Consultation
Clare Liddy , and colleagues
Background Electronic consultation (eConsult) services can improve access to specialist advice, however, little is known about whether and how often primary care clinicians adhere to the advice they receive. This study evaluates how primary care clinicians use recommendations conveyed by specialists in an eConsult service and how eConsult affects clinical management of patients in primary care.
What This Study Found In a retrospective chart audit of 291 eConsults, primary care clinicians adhered to specialist advice in 82 percent of cases. Questions asked of specialists most often related to diagnosis (63 percent). Other questions addressed management (27 percent), drug treatment (10 percent), and procedure (1 percent). The eConsult�s results were communicated to patients in 79 percent of cases, most often by face-to-face meeting (38 percent), phone call (32 percent), or through a patient portal (9 percent). Communication occurred in a median of 5 days. The most consulted specialties were dermatology (32 percent), orthopedics (8 percent), and neurology (7 percent).
Implications
- In light of the high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, the authors suggest that eConsult delivers good quality care and improves patient management.
