Khalid Laila, Rikin Sharon, Watnick Dana, Lu Tiffany Y, Carrozzi Gianni, Valle Ana, Starrels Joanna L
Montefiore Medical Center, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
J Gen Intern Med. 2025 Sep 2. doi: 10.1007/s11606-025-09811-0.
Electronic consultations (eConsults) allow clinicians to submit questions through the electronic health records (EHR) to request specialist input about individual patients' care, but there is paucity of literature describing eConsult programs specifically for opioid management.
Retrospective qualitative study of eConsults for opioid management in the ambulatory setting.
Clinicians who submitted an eConsult request for opioid management.
We conducted a qualitative content analysis of eConsult requests and responses. First, a priori codes were developed and applied to textual data. Through iterative discussion and memoing, thematic codes were identified and applied to the dataset. Subsequently, breadth and depth of codes were explored, collapsed, and redefined, and relationships between codes were discussed. Following theme development, matrix analysis was used to compare eConsults that resulted with or without a recommendation for an in-person specialist visit.
Forty eConsults were requested by 30 unique referring clinicians mostly from general internal medicine (53%) or family medicine (27%). We identified four themes: (1) clinicians were motivated to reduce harm, (2) clinicians had difficulty labeling opioid misuse and use disorder (OUD), (3) clinicians had difficulty articulating discrete questions, and (4) clinician questions revealed knowledge gaps in opioid management. In-person specialist visits were recommended when clinicians needed help with labeling opioid misuse or OUD or when questions were vague and around complex topics.
Clinicians have unease and discomfort in treating chronic pain and managing opioids. eConsults are most helpful for low-complexity, discrete questions from clinicians focused on reducing harm. eConsult implementation should integrate EHR enhancements and clinician training in assessing opioid misuse and OUD and articulating discrete questions.
电子会诊（eConsults）使临床医生能够通过电子健康记录（EHR）提交问题，以请求专科医生对个体患者的治疗提供意见，但专门描述用于阿片类药物管理的电子会诊项目的文献较少。
对门诊环境中阿片类药物管理电子会诊的回顾性定性研究。
提交阿片类药物管理电子会诊请求的临床医生。
我们对电子会诊请求和回复进行了定性内容分析。首先，制定先验编码并应用于文本数据。通过反复讨论和记录，确定主题编码并应用于数据集。随后，探讨、合并和重新定义编码的广度和深度，并讨论编码之间的关系。在主题开发之后，使用矩阵分析比较导致或未导致建议专科医生亲自出诊的电子会诊。
30名不同的转诊临床医生共提交了40次电子会诊请求，这些临床医生大多来自普通内科（53%）或家庭医学（27%）。我们确定了四个主题：（1）临床医生有减少伤害的动机，（2）临床医生难以识别阿片类药物滥用和使用障碍（OUD），（3）临床医生难以清晰表达具体问题，（4）临床医生的问题揭示了阿片类药物管理方面的知识差距。当临床医生在识别阿片类药物滥用或OUD方面需要帮助，或者问题模糊且围绕复杂主题时，建议进行专科医生亲自出诊。
临床医生在治疗慢性疼痛和管理阿片类药物方面存在不安和不适。电子会诊对临床医生提出的关注减少伤害的低复杂性、具体问题最有帮助。电子会诊的实施应整合电子健康记录的改进以及临床医生在评估阿片类药物滥用和OUD以及清晰表达具体问题方面的培训。
