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E-consultation can improve 'suboptimal' communication between PCPs, specialists

At a time when communication between primary care physicians and specialists is “suboptimal,” e-consultation referrals improved access to and the timeliness of care among typically underserved patients, according to data published in the Annals of Family Medicine.

In addition, the use of e-consultation streamlined specialty referrals to cardiologists without an increase in adverse cardiovascular outcomes.

“Timely access and good communication between clinicians are essential for quality, efficiency and patient safety,” J. Nwando Olayiwola, MD, MPH, of the Center for Excellence in Primary Care, San Francisco General Hospital, and colleagues wrote. “In a national survey, however, only 34% of specialists reported routinely receiving information from referring primary care clinicians, and only 62% of the clinicians reported reliably receiving information back from the specialist. This suboptimal exchange of information leads to an increase in medical errors, wasteful spending and poor quality of care.”

To test the efficacy and effectiveness of e-consultations with regard to wait times and access to specialty care, the researchers conducted a randomized controlled study of 36 primary care physicians from 12 Connecticut practices, referring 590 patients, many of whom are medically underserved.

The researchers randomly placed 19 of the physicians into the control group, which communicated with specialists in cardiology for referrals through traditional means, and 17 were placed into the e-consultation group. They used a Cox proportional hazards model to analyze the two end points, and the hazard of either a visit or an e-consultation was linked to study group, sex, race and age.

According to the researchers, 69% of e-consultations were resolved without a visit to the cardiologist. Median days to a review for an e-consultation, compared with a visit for patients with physicians in the control group, were 5 and 24, respectively. A follow-up at 6 months found fewer cardiac-related ED visits among patients with physicians in the e-consultation group.

“These findings have critical policy implications as health systems seek new ways to improve quality and reduce cost,” Olayiwola and colleagues wrote. “There is also growing recognition that the e-consultation pathway may be fundamental to the success of accountable care organization as part of a comprehensive strategy to streamline costs, improve quality and better coordinate care.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.