E-consults between primary care and internal medicine: implementation, accessibility, benefits, and implications.

Area of Science:

• Internal Medicine
• Primary Care
• Health Informatics

Background:

• Electronic consultations (e-consults) facilitate communication between primary care physicians and specialists.
• Assessing the clinical utility and safety of e-consults is crucial for optimizing patient care pathways.

Purpose of the Study:

• To evaluate the clinical usefulness and safety of e-consults for patients referred from primary care to internal medicine.
• To analyze patient outcomes and safety events associated with e-consult utilization.

Main Methods:

• Retrospective cohort study of 11,434 e-consults from September 2019 to December 2023.
• Assessed initial consultations, emergency department visits, hospital admissions, survival rates, and reviewed complaints/claims.
• Compared outcomes for patients receiving in-person appointments versus written responses.

Main Results:

• E-consults demonstrated a mean response time of 2.55 days.
• 49.4% of patients received an in-person appointment, while 50.6% received a written response.
• Patients referred for in-person appointments had higher rates of emergency visits, hospital admissions, and one-year mortality compared to those not receiving appointments. No complaints or claims were registered.

Conclusions:

• E-consults are a clinically useful and safe tool for patient assessment in the primary care to internal medicine referral process.
• The study supports the integration of e-consults into clinical workflows for efficient patient management.
• No adverse events or patient complaints were associated with the use of e-consults.