Abstract
Examining providers’ use of eConsults for medically underserved patients in Texas
APHA 2022 Annual Meeting and Expo
Background: Electronic specialty consultations (eConsults) allow primary care providers (PCPs) to obtain and implement patient-specific recommendations from specialist providers. Though eConsults have been shown to improve access to specialty care and reduce cost, little is known about the types of recommendations specialists make and the extent to which PCPs follow them. We report preliminary findings from a non-experimental, pragmatic study of an eConsult program for uninsured patients at a large, multi-site Federally Qualified Health Center (FQHC) in South Central Texas.
Methods: A physician and research assistant reviewed 100 randomly selected eConsults completed 6/1/2020-5/31/2021 (27.2% of 367 total eConsults completed across 14 specialties). They categorized and logged each recommendation contained in the specialist eConsult and assessed whether the PCP had implemented or attempted to implement the recommendations within 90 days. Explanatory interviews with patients whose charts were reviewed provided context on the patient’s health history and care experience, and assessed their opinion of eConsults.
Results: Sixty-five of the 100 eConsults sampled (65.0%) contained specialist guidance and recommendations suggesting that a face-to-face visit with the specialist was not needed. Specialist recommendations included lab tests, new medications, changes in medications, imaging studies, additional history, and additional physical examination. In 76.0% of reviewed eConsults (n=76), there was clear evidence that the PCP followed at least some of the specialist’s recommended care plan within 90 days, and in 41% of cases (n=41), the PCP followed all of the specialist’s recommendations within 90 days. Patients appreciated that eConsults may help address time, distance, transportation, and cost barriers for uninsured people who need specialty care, but several did not realize that they had received a specialty eConsult via their PCP. Patients preferred that their PCP use eConsults for straightforward clinical questions only, and preferred to continue seeing specialists for more complex clinical complaints.
Conclusions: These preliminary results indicate that, consistent with other studies, eConsults reduce unnecessary specialty referrals by allowing PCPs to treat common conditions in primary care. They also demonstrate that in the majority of cases, PCPs are acting on the recommendations and making changes to the patient’s work up or care plan. PCPs followed the specialist’s recommendations in the majority of cases sampled. Patients voiced general acceptance of eConsults, but might not have realized their PCP had obtained a specialty consultation to inform their care. Planned interviews with PCPs will obtain their perspective on using eConsults to extend capacity to treat patients in primary care.