Utilization, benefits, and impact of an e-consultation service across diverse specialties and primary care providers

Abstract

Background: Access to specialist advice remains a barrier for primary care providers (PCPs) and their patients. Virtual consultations have been used to expedite access. There are few studies demonstrating the utilization and impact of such services. We established a regional e-consultation service that was used across a wide range of specialty services and PCPs.

Materials and methods: We prospectively collected all e-consultations submitted from April 1, 2011 to June 30, 2012. Utilization data collected included number of e-consultations submitted, specialist response, and time required for the specialist to complete the e-consultation. Perceived benefit to the PCPs and their patients and the impact on care delivery were determined from a close-out survey.

Results: Fifty-nine PCPs submitted 406 e-consultations to 16 specialty services. The specialist provided an answer without requesting further information in 89% of cases, with >90% of cases taking <15 min for the specialist to complete. Seventy-five percent of cases were answered in <3 days. The service was perceived as highly beneficial to providers and patients in>90% of cases. In 43% of submitted cases a traditional referral was originally contemplated but was now avoided.

Conclusions: We successfully implemented an e-consultation service across diverse PCPs and specialty services that was highly valued. Almost half of referrals submitted would have required a face-to-face consultation if the service had not been available. Thus e-consultation has tremendous potential for improving access to specialist advice in a much more timely manner than the traditional referral-consultation process.

Fig. 1.

Distribution of primary care practices that participated in the e-consultation service.

Fig. 2.

Distribution of e-consultations by specialty service. ENT, ear, nose, and throat; OBS/GYN, obstetrics/gynecology.

Fig. 3.

Impact of e-consultation on the course of action by the primary care provider by specialty service (n=406). OBS/GYN, obstetrics/gynecology; Peds, pediatrics.

Fig. 4.

Impact of e-consultation on need for face-to-face referral by specialty service (n=406).