HbA1c-Triggered Endocrinology Electronic Consultation for Type 2 Diabetes Management

Area of Science:

• Endocrinology
• Primary Care
• Digital Health

Background:

• Electronic consultations (eConsultations) can enhance specialty care access and address knowledge gaps for primary care physicians (PCPs) managing type 2 diabetes (T2DM).
• Therapeutic inertia is a common challenge in T2DM management within primary care settings.
• eConsultation offers a potential solution to improve T2DM patient outcomes.

Purpose of the Study:

• To develop and implement an unsolicited endocrinology eConsult system for PCPs managing T2DM patients with HbA1c levels between 8.5-10.5%.
• To evaluate the impact of unsolicited eConsults on clinical outcomes and management practices.

Main Methods:

• A cluster-randomized matched cohort study involving 161 PCPs affiliated with Massachusetts General Hospital.
• PCPs were randomized to either an intervention group receiving unsolicited endocrinology eConsults or a control group.
• The primary outcome was the mean change in HbA1c at 6 months, with secondary outcomes including medication prescribing rates and in-person visit frequency.

Main Results:

• The intervention group showed a non-significant decrease in HbA1c compared to the control group (0.89 vs 0.69 decrease).
• Significant increases in the prescription of glucose-lowering medications, including GLP-1 RA, SGLT2i, and metformin, were observed in the intervention arm.
• The intervention arm experienced fewer in-person endocrinology visits (13 vs 29) and higher acceptance of medication adjustment recommendations by PCPs.

Conclusions:

• Implementing an unsolicited endocrinology eConsult system for T2DM patients is feasible for PCPs.
• This approach led to increased prescribing of glucose-lowering medications and reduced face-to-face specialist visits.
• While not significantly impacting HbA1c at 6 months, eConsultation shows promise in optimizing T2DM management.