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Impact of Question Content on e-Consultation Outcomes
Christopher Tran1,2, Clare Liddy3,4, Nicole Pinto5
11 Department of Medicine, University of Ottawa , Ottawa, Ontario, Canada .
Summary
Electronic consult (e-consult) services reduce specialist wait times. Specific question types and dermatology cases were linked to higher rates of avoided referrals, improving primary care efficiency.
Area of Science:
- Health Informatics
- Primary Care Medicine
- Telemedicine
Background:
- Electronic consult (e-consult) services enable direct primary care provider (PCP) communication with specialists.
- These services aim to reduce patient wait times and travel for face-to-face specialist consultations.
- The relationship between e-consult content and avoided referrals requires further investigation.
Purpose of the Study:
- To explore the association between specific e-consult content and the avoidance of face-to-face specialist referrals.
- To identify factors within e-consults that correlate with successful referral avoidance.
Main Methods:
- Analysis of 1,055 cases from the Champlain Building Access to Specialists through eConsultation service (April 2011-May 2013).
- Evaluation of question type (diagnosis, management), formulation (specified interventions/outcomes), and specialty.
- Identification of avoided referrals via PCP close-out surveys and analysis of discrepancies between PCP and specialist referral recommendations.
Main Results:
- 426 (40%) referrals were avoided among the analyzed cases.
- Highest avoided referral rates were observed for diagnosis questions (44%), nonspecific requests (44%), unspecified interventions/outcomes (47%), and dermatology cases (49.5%).
- Specialists agreed on referral necessity in 82% of cases; discrepancies often involved PCPs referring when not recommended by specialists.
Conclusions:
- Referral outcomes are significantly influenced by the type and formulation of e-consult questions, as well as the specialty involved.
- Discrepancies in referral decisions highlight potential knowledge gaps for PCPs and specialists.
- Findings can inform professional development to optimize e-consult utilization and referral appropriateness.
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