Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster-Randomized Controlled Trial
Open accessAbstract
PURPOSE: Communication between specialists and primary care clinicians is suboptimal, and access to referrals is often limited, which can lead to lower quality, inefficiency, and errors. An electronic consultation (e-consultation) is an asynchronous, non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform. The purpose of this study was to conduct a randomized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care. METHODS: Primary care clinicians were randomized into a control (9 traditional) or an intervention (17 e-consultation) arm for referrals to cardiologists. Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients. Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm, sex, race, and age. RESULTS: Thirty-six primary care clinicians participated in the study, referring 590 patients. In total, 69% of e-consultations were resolved without a visit to a cardiologist. After adjusting for covariates, median days to a review for an electronic consultation vs a visit for control patients were 5 and 24, respectively. A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group. CONCLUSION: E-consultation referrals improved access to and timeliness of care for an underserved population, reduced overall specialty utilization, and streamlined specialty referrals without any increase in adverse cardiovascular outcomes. e-consultations are a potential solution for improving access to specialty care.
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In a randomized controlled trial of cardiology eConsults, patients who had an eConsult were significantly more likely (1.5 times) to receive a consultation with a cardiologist and had lower rates of emergency department utilization than those who had traditional face-to-face consultations.
“The results showed that those who had an eConsult were significantly more likely (1.5 times) to receive a consultation with a cardiologist and had lower rates of emergency department utilization than those who had traditional face-toface consultations.39”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [39]
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Experimental — accuracy not yet measuredIn another study, 75% of providers reported no impact or decreased workload as a result of eConsult.
“In another study, 75% of providers reported no impact or decreased workload as a result of eConsult.39”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [39]
In a cardiology randomized controlled trial comparing time to response between eConsult and traditional referrals, the median number of days to receive a response was 5 days for eConsults versus 24 days for traditional referrals.
“In a cardiology RCT, which compared time to response between eConsult and traditional referrals, the median number of days to receive a response was 5 days for eConsults versus 24 days for traditional referrals.39”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [39]
While an RCT demonstrated the potential of eConsult for reducing adverse cardiovascular outcomes, two retrospective studies reported potential for harm due to lack of patient follow-up.
“While an RCT demonstrated the potential of eConsult for reducing adverse cardiovascular outcomes, 39 2 retrospective studies reported potential for harm due to lack of patient follow-up.40,41”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [39]
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- Authors
- Olayiwola, J. N., Anderson, D., Jepeal, N., Aseltine, R., Pickett, C., Yan, J., & Zlateva, I.
- Affiliations
- San Francisco General Hospital (US)
- Community Health Center (US)
- Emory University (US)
- UConn Health (US)
- University of Connecticut (US)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2016-03
- Volume
- 14
- Issue
- 2
- Pages
- 133-140
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC4781516
- OpenAlex
- W2297353067
- Semantic Scholar
- 54d0da86a558c035080f66c1f497669642448773
- Cited by
- 117
- References
- 23
- Citations by year
- 2025: 3 · 2024: 11 · 2023: 10 · 2022: 13 · 2021: 11 · 2020: 15 · 2019: 18 · 2018: 18 · 2017: 12 · 2016: 5
- FWCI
- 34.22
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Nella and Leon Benoziyo Center for Neurological Diseases, Weizmann Institute of Science
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- e-consultation, cardiologist referral, medically underserved populations, access to specialist care, waiting time, community health centers, emergency department visits, telemedicine
- MeSH terms
- Adult, Cardiology, Communication, Connecticut, Female, Health Services Accessibility, Humans, Male, Medically Underserved Area, Middle Aged, Primary Health Care, Specialization, Proportional Hazards Models, Single-Blind Method, Remote Consultation
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