Multispecialty telephone and e-mail consultation for patients with developmental disabilities in rural California

The University of California (UC), Davis Health System, and California Department of Developmental Services (CDDS) developed the Physician Assistance, Consultation and Training Network (PACT Net) to assist primary-care providers (PCPs) care for patients with developmental disabilities in rural California. This manuscript describes PACT Net, a warm line using phone and e-mail, and its multispecialty panel. A pilot study evaluated whether or not PCPs needed such a consultation service, whether or not it assisted them in providing care, and their overall satisfaction with the service. PCPs were informed on how to request a consultation. Data were collected from patients (demographics), PCPs (satisfaction with preexisting consultation availability and quality, PACT Net consultation reason, preferred mode of contact, duration, and, satisfaction), and specialists (ease, quality of request, and satisfaction). Satisfaction was measured prospectively using a 7-point Likert scale. Data were collected on 30 consultations, 28 by telephone and 2 by e-mail; other data were by combined methods. The average duration of consultation was 47 minutes, and 24 responses occurred within one business day. The top three services requested for consultation were psychiatry (e.g., management of behavioral disturbance), medical genetics (diagnosis), and gastroenterology (miscellaneous). PCPs rated baseline satisfaction with: (1) pre-existing local services at 3.37, (2) timeliness of the PACT Net consultation at 5.45, (3) quality of the communication at 6.3, and (4) overall quality and utility of the consultation at 6.2. Specialists rated the quality of the communication at 6.45, and the ease of the service at 6.46. Phone and e-mail consultation appears satisfactory to PCPs and specialty providers as a way to enhance specialty input to rural patients.