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E-consults frequently change physicians’ plans for treatment
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E-consultations provided primary care physicians with access to infectious disease specialists and often changed physicians’ plans for face-to-face referrals, according to findings published in Open Forum Infectious Diseases.
“The use of an electronic consultation, or e-consultation, connects primary care physicians directly to specialists for a fast, secure answer to a patient problem,” Ruchi Murthy, MD, of the department of medicine at the University of Ottowa, Canada and colleagues wrote. “E-consults may replace the need for a face-to-face referral or allow investigations to be completed before the specialist visit. Although there are several large e-consult systems internationally that include infectious diseases, there is only one published study of e-consults directed to infectious disease specialists, which was completed at the Mayo Clinic.”
The researchers reviewed data from the Champlain BASE (Building Access to Specialist Advice through E-consultation) service, evaluating 4,531 e-consults completed from April 15, 2013 to Jan. 29, 2015. Murthy and colleagues analyzed response time, change in referral plans and changes in planned course of action.
Five percent of e-consults were related to infectious diseases (n = 224), the researchers wrote. Interpretation of a clinical test was the most common type of question in e-consults (18%; n = 41), followed by general management (16.5%; n = 37) and either indications or goals of treating specific conditions (16.5%; n = 37). Tuberculosis and Lyme disease were the most frequently consulted infectious diseases, Murthy and colleagues reported (14.3%; n = 32 for both), followed by parasitology (12.9%; n = 29).
More than half of cases had been responded to (63%) within 24 hours, and 82% took less than 15 minutes to finish, the researchers wrote. In 32% of cases, the primary care physician had originally planned for a face-to-face consultation, which was no longer necessary. In another 8% of cases, the physician referred the patient to a specialist after not originally planning to do so. Overall, physicians either learned new information or changed course of action in 55% of cases.
“Infectious disease services, for some conditions, can be delivered through e-consults effectively,” the researchers wrote. “Exploring their applicability in different situations such as antimicrobial stewardship is needed. Studies to further define the types of questions asked, impact on patient outcomes and health care costs are needed.” – by Andy Polhamus
Disclosure: Murthy reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
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