Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
J Gen Intern Med. 2020 Nov;35(Suppl 2):832-838. doi: 10.1007/s11606-020-06101-9. Epub 2020 Aug 10.
eConsult programs have been instituted to increase access to specialty expertise. Opt-in choice eConsult programs maintain primary care physician (PCP) autonomy to decide whether to utilize eConsults versus traditional specialty referrals, but little is known about how this intervention may impact PCP eConsult adoption and traditional referral demand.
We assessed the feasibility of implementing an opt-in choice eConsult program and examined whether this intervention reduces demand for in-person visits for primary care patients requiring specialty expertise.
Stepped-wedge, cluster randomized trial conducted from July 2018 to June 2019.
Sixteen primary care practices in a large, urban academic health care system.
Our intervention was an opt-in choice eConsult available in addition to traditional specialty referral; our implementation strategy included in-person training, audit and feedback, and incentive payments.
Our implementation outcome measure was the eConsult rate: weekly proportion of eConsults per PCP visit at each site. Our intervention outcome measure was traditional referral rate: weekly proportion of referrals per PCP visit at each site. We also assessed PCP experiences with questionnaires.
Of 305,915 in-person PCP visits, there were 31,510 traditional referrals to specialties participating in the eConsult program, and 679 eConsults. All but one primary care site utilized the opt-in choice eConsult program, with a weekly rate of 0.05 eConsults per 100 PCP visits by the end of the study period. The weekly rate of traditional referrals was 11 per 100 PCP visits at the end of the study period; this represents a significant increase in traditional referral rate after implementation of eConsults. PCPs were generally satisfied with the eConsult program and valued prompt provider-to-provider communication.
Implementation of an opt-in choice eConsult program resulted in widespread PCP adoption; however, this did not decrease the demand for traditional referrals. Future studies should evaluate different strategies to incentivize and increase eConsult utilization while maintaining PCP choice.
电子咨询计划的实施旨在增加获得专业知识的途径。选择加入的电子咨询计划保持了初级保健医生（PCP）自主决定是否使用电子咨询与传统专科转诊的权力，但对于这种干预措施如何影响 PCP 电子咨询的采用和对传统转诊的需求知之甚少。
我们评估了实施选择加入的电子咨询计划的可行性，并研究了这种干预措施是否减少了需要专科专业知识的初级保健患者对门诊就诊的需求。
2018 年 7 月至 2019 年 6 月期间进行的一项逐步楔形、集群随机试验。
一家大型城市学术医疗保健系统中的 16 个初级保健实践。
我们的干预措施是一种选择加入的电子咨询服务，除了传统的专科转诊外还可提供；我们的实施策略包括面对面培训、审核和反馈以及奖励支付。
我们的实施结果衡量指标是电子咨询率：每个地点每位 PCP 就诊时每周电子咨询的比例。我们的干预结果衡量指标是传统转诊率：每个地点每位 PCP 就诊时每周转诊的比例。我们还通过问卷调查评估了 PCP 的体验。
在 305915 次面对面的 PCP 就诊中，有 31510 次传统转诊到参与电子咨询计划的专科，还有 679 次电子咨询。除了一个初级保健地点外，所有其他地点都使用了选择加入的电子咨询计划，在研究结束时每周的电子咨询率为每 100 名 PCP 就诊 0.05 次。在研究结束时，每周的传统转诊率为每 100 名 PCP 就诊 11 次；这代表在实施电子咨询后，传统转诊率显著增加。PCP 通常对电子咨询计划感到满意，并重视及时的医患沟通。
选择加入的电子咨询计划的实施导致了 PCP 的广泛采用；然而，这并没有减少对传统转诊的需求。未来的研究应评估不同的策略，以激励和增加电子咨询的使用，同时保持 PCP 的选择。
