Article Figures & Data
Tables
Totala No. (%) Dartmouth-Hitchcock No. (%) Iowa No. (%) San Diego No. (%) Virginia No. (%) Wisconsin No. (%) Sex Female 40 (77) 7 (100) 7 (78) 10 (91) 6 (46) 10 (83) Male 12 (23) 0 (0) 2 (22) 1 (9) 7 (54) 2 (17) Age, y 18-24 3 (5.8) 2 (29) 1 (11.11) 0 (0) 0 (0) 0 (0) 25-34 2 (3.8) 0 (0) 0 (0) 0 (0) 0 (0) 2 (17) 35-44 5 (9.6) 0 (0) 2 (22.22) 1 (9) 0 (0) 2 (17) 45-54 5 (9.6) 0 (0) 1 (11.11) 2 (18) 1 (7.7) 1 (8) 55-64 4 (7.7) 1 (14) 1 (11.11) 0 (0) 1 (7.7) 1 (8) >65 33 (63.5) 4 (57) 4 (44.44) 8 (73) 11 (84.6) 6 (50) Patient at AMC, y 0-1 3 (5.77) 2 (29) 1 (11) 0 (0) 0 (0) 0 (0) 1-5 4 (7.69) 0 (0) 2 (22) 0 (0) 0 (0) 2 (17) 6-8 3 (5.77) 0 (0) 0 (0) 2 (18) 1 (8) 0 (0) >9 42 (80.77) 5 (71) 6 (67) 9 (82) 12 (92) 10 (83) Education Levelb <High school grad 1 (2.6) 0 (0) 0 (0) 1 (9.09) …b 0 (0) High school grad or GED 3 (7.7) 2 (28.57) 1 (11) 0 (0) … 0 (0) Some college or 2-year degree 10 (25.6) 2 (28.57) 3 (33) 2 (18.18) … 3 (25) 4-year college degree 10 (25.6) 2 (28.57) 0 (0) 4 (36.36) … 4 (33) >4-year degree 15 (38.5) 1 (14.29) 5 (56) 4 (36.36) … 5 (42) Access to Specialty Care Deciding to Use the eConsult Service Most participants agreed that eConsult would improve access to care for both eConsult and standard referral patients
Convenience
Since eConsults do not require payment, appointment scheduling, or travel, they were anticipated to reduce financial and time burdens on patients
eConsults were expected to make in-person specialty visits more efficient
Reliance on primary care
An established, trusting relationship with a primary care clinician, and with the medical center more generally, appeared to enhance the acceptability of eConsult
Digital literacy
Most participants used the patient portal to communicate with their clinicians and to view personal health information; high digital literacy appeared to enhance acceptability of eConsult
Fears and concerns
Participants wanted reassurance that eConsult would be used appropriately and that patients would continue to have direct access to specialists when needed or preferredNo consensus about the extent to which patients should be involved in eConsult decision making
Preference for involvement increased when a hypothetical copay was introduced
Communicating the specialist’s response
Preferred medium of communication depended on level of urgency of specialist’s recommendations
Some participants wanted to see the specialist’s response verbatim; others felt that the primary care clinician’s summary would be sufficient
Would a copay for eConsult be acceptable?
A copay would be acceptable to some participants, but a majority said that they would rather see the specialist in person if a copay was levied for eConsult.eConsult = electronic consultation
Additional Files
Supplemental Appendix
Supplemental Appendix
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Patients Assess an eConsult Model's Acceptability at 5 US Academic Medical Centers
Sara L. Ackerman , and colleagues
Background Electronic consultation (eConsult), involving asynchronous primary care clinician-to-specialist consultation, is being adopted at a growing number of health systems. A new study shifts focus from clinician to patient perspectives on the idea of eConsult and patient preferences for involvement in eConsult decision making.
What This Study Found A study across five academic medical centers examined the reaction of patients to the use of electronic consultation for primary care for provider-to-specialist consultation. This focus group study of adult primary care patients was conducted to better understand patients' opinions, as most previous studies focused on clinical and financial impacts and clinician responsibility. Fifty-two participants across five focus groups were introduced to the eConsult model and were asked to discuss potential benefits and drawbacks, as well as acceptability of a hypothetical copay and preferences for involvement in future eConsult decision making and communication. Participants reacted favorably to the eConsult concept; quicker access to specialty care and convenience were cited as key benefits, with approval rates particularly high among those having a trusted primary care clinician. Some patients wanted to be involved in the eConsult decision making and communication. They also expressed a decreased enthusiasm about eConsults if they had a copay. Participants were also concerned about potential misuse of the system and about the exclusion of the patient's illness narrative in the eConsult exchange.
Implications
- The authors argue that the success of eConsult models hinges not only on the engagement and buy-in of primary care clinicians and specialists, but on patient-clinician relationships.
- Furthermore, they recommend that eConsult program implementation projects build in patient outreach strategies and include patients' perspectives in clinician education efforts. The authors note that talking with patients at an early phase of the eConsult implementation process enabled them to share findings with implementation teams as they developed clinician and patient outreach strategies.
- They also recommend that future research assess eConsult experiences and decision-making preferences of more diverse patients, including those with limited digital literacy and without a regular primary care clinician.
