eConsultations to Infectious Disease Specialists: Questions Asked and Impact on Primary Care Providers' Behavior

Abstract

Background: Since 2010, the Champlain BASE (Building Access to Specialist Advice through eConsultation) has allowed primary care providers (PCPs) to submit clinical questions to specialists through a secure web service. The study objectives are to describe questions asked to Infectious Diseases specialists through eConsultation and assess impact on physician behaviors.

Methods: eConsults completed through the Champlain BASE service from April 15, 2013 to January 29, 2015 were characterized by the type of question asked and infectious disease content. Usage data and PCP responses to a closeout survey were analyzed to determine eConsult response time, change in referral plans, and change in planned course of action.

Results: Of the 224 infectious diseases eConsults, the most common question types were as follows: interpretation of a clinical test 18.0% (41), general management 16.5 % (37), and indications/goals of treating a particular condition 16.5% (37). The most frequently consulted infectious diseases were as follows: tuberculosis 14.3% (32), Lyme disease 14.3% (32), and parasitology 12.9% (29). Within 24 hours, 63% of cases responded to the questions, and 82% of cases took under 15 minutes to complete. In 32% of cases, a face-to-face referral was originally planned by the PCP but was no longer needed. In 8% of cases, the PCP referred the patient despite originally not planning to make a referral. In 55% of cases, the PCP either received new information or changed their course of action.

Conclusions: An eConsult service provides PCPs with timely access to infectious disease specialists' advice that often results in a change in plans for a face-to-face referral.

Keywords: access; eConsultation; electronic referral; infectious diseases; wait times..

Figure 1.

Referral outcomes organized by consult type. Categories represented are those that were greater than 2% of all consultations.

Figure 2.

Referral outcomes organized by clinical topics. Diseases represented include all diseases where there were 10 or more eConsults. Abbreviation: NOS, unspecified.

Figure 3.

Course of action based on primary care provider feedback regarding eConsult advice. Diseases represented include all diseases where there were 10 or more eConsults. Abbreviation: NOS, unspecified.

Figure 4.

Overall value of the eConsult rated on a scale from minimal [1] to excellent [5] as determined by primary care provider for patients. Abbreviation: ID, infectious diseases.

Figure 5.

Overall value of the eConsult rated on a scale from minimal [1] to excellent [5] as determined by primary care provider for themselves. Abbreviation: ID, infectious diseases.