新英格兰地区退伍军人事务医疗中心的初级保健提供者对心脏病电子咨询（e-consult）的使用情况。

Cardiology electronic consultation (e-consult) use by primary care providers at VA medical centres in New England.

机构信息

1 Division of General Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, USA.

2 Medical Service, VA Boston Healthcare System, USA.

出版信息

J Telemed Telecare. 2019 Jul;25(6):370-377. doi: 10.1177/1357633X18774468. Epub 2018 May 12.

DOI:10.1177/1357633X18774468

PMID:29754562

Abstract

INTRODUCTION

E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care.

METHODS

This is a retrospective analysis of 750 patients' medical charts with cardiology e-consults requested by medical providers (October 2013-September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists' responses and examined their recommendations.

RESULTS

Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment ( = 44), anti-coagulation/anti-platelet management ( = 33), and EKG interpretation ( = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance ( = 41), the reasons included missing or insufficient clinical information ( = 18), medical complexity ( = 6), and deferment to the patient's non-VA primary cardiologist ( = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults.

DISCUSSION

Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults.

摘要

简介

电子咨询（e-consults）在退伍军人医疗中心实施，以改善获得专科护理的机会。心脏病学电子咨询是最常要求的咨询之一，但对于初级保健提供者（PCPs）如何使用心脏病学电子咨询来获得专科护理知之甚少。

方法

这是对退伍军人医疗保健系统中新英格兰医疗中心的医疗提供者（2013 年 10 月至 2015 年 9 月）请求的 750 名患者的病历进行的回顾性分析。我们描述了患者和转诊提供者的特征以及电子咨询问题。我们审查了心脏病专家的回复并检查了他们的建议。

结果

在 PCPs 请求的 424 次电子咨询中，92.7%用于请求对临床问题的答案，而 7.3%用于行政目的。在有临床问题的 393 次电子咨询中，60 次咨询是关于术前管理的；这些问题最常涉及一般风险评估（ = 44）、抗凝/抗血小板管理（ = 33）和心电图解释（ = 20）。心脏病专家为大多数（89.6%）临床问题提供了答案。在心脏病专家未提供答案或临床指导的 41 次电子咨询中，原因包括缺少或不充分的临床信息（ = 18）、医学复杂性（ = 6）和将患者转介给非退伍军人医疗保健系统的初级心脏病专家（ = 7）。心脏病专家建议将 7.9%的电子咨询患者视为面对面咨询。