Transforming the endocrine consult: asynchronous provider consultations

To analyze the impact of virtual consultations on the spectrum and volume of endocrine consults, access to endocrine care, and downstream healthcare utilization.

A program (eConsults) designed to enable and reimburse asynchronous consultations between primary care physicians (PCPs) and specialists at the University of California, San Francisco, was launched in 2012. All eConsults (n = 158) submitted to endocrinology over the first year were analyzed for clinical focus and use of structured referral templates. PCP compliance with specialist recommendations was measured and stratified by provider type. Impact on endocrine referral volume was calculated using simple linear regression. Changes in wait times to endocrine care were analyzed comparing administrative data from the year of and the year prior to the introduction of eConsults. Downstream endocrine office visits, emergency department visits, and hospitalizations were captured by chart abstraction for all standard endocrine eConsults (n = 113).

The proportion of endocrine referrals sent as eConsults (15 to 22%) was significantly higher than the combined average for all other participating specialties (7.4%) (P<.001). Overall, 76.0% of endocrinologist recommendations were fully implemented. There was no induced demand in total volume of referrals to endocrinology, and introduction of eConsults significantly improved access to endocrine care (odds ratio, 3.6; 95% confidence interval, 2.7 to 4.9). Rates of downstream healthcare utilization within 6 months of a completed eConsult were low.

Use of virtual consultations in a fee-for-service, academic medical center setting significantly improved access to endocrine care and the quality of referrals. Increasing recognition and reimbursement of nontraditional consultation models will be essential to scaling and disseminating these programs.