Electronic Consultation: An Effective Alternative to In-Person Clinical Care for Patients With Diabetes Mellitus

Patel, Pooja; Jiang, Baichun; Marcelli, Marco; Mediwala, Sanjay; Vasudevan, Madhuri M.

doi:10.1177/1932296818807472

Cited by 10 publications

(23 citation statements)

References 4 publications

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“…Studies with comparison groups should report on demographic and clinical characteristics of the patients. Such data, as reported in some of the quasi-experimental studies we reviewed, 48,53,62 would reassure readers that the potential impact of selection bias is lessened. In systems where specialists make the final decision about whether patients are seen by e-consult or face-to-face visit, wide variation in individual specialists' threshold to recommend referral 51,61 will also impact outcomes in the different groups.…”

Section: Discussionmentioning

confidence: 68%

“…53 A nonrandomized study of e-consults versus face-to-face referral for diabetes management at a single center found similar reductions in A1C at 6 months in unadjusted analyses. 48 In both of these studies, patient characteristics were similar between the e-consult and the control groups.…”

Section: Quality and Safety Outcomesmentioning

confidence: 79%

“…One study reported data from a pilot randomized controlled trial; 53 3 studies reported results from cluster randomized controlled trials; 49,56,70 3 studies were pre-post evaluations with a comparison group; 62,66,72 and 1 study employed a retrospective cohort design with a comparison group. 48 Most results were positive. Below we present an overview of the GRADE scoring assessment, summaries of the evidence for each outcome, and the rationale for the GRADE scores assigned to the quality of evidence for each of those outcomes.…”

Section: Methodsmentioning

confidence: 98%

“…More than half of the included studies were from 1 of 2 settings: 26 from the Champlain BASE program and 13 from VA settings. 7,[37][38][39][40][41][42][43][44][45][46][47][48] Of the remaining 24 studies, there were 12 from community health centers or large public health care systems, 43,[49][50][51][52][53][54][55][56][57][58][59] 8 from academic medical centers, [60][61][62][63][64][65][66][67] 2 from a nongovernmental humanitarian organization, 68, 69 1 from a not-for-profit integrated health care delivery system, 70 and 1 from a private company providing e-consult services. 71 Most studies were observational in design and lacked a control group.…”

Section: Methodsmentioning

confidence: 99%

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Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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Objective Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.

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Section: Discussionmentioning

confidence: 68%

Section: Quality and Safety Outcomesmentioning

confidence: 79%

Section: Methodsmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

View full text Add to dashboard Cite

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“…Another study of the Dallas Veterans Affairs hospital showed that e-consultation resulted in a greater HbA1c reduction of 1.21% versus a reduction of 0.79% in for those seen in person in the endocrinology clinic. [ 44 ].…”

Section: Telehealthmentioning

confidence: 99%

The Use of Diabetes Technology to Address Inequity in Health Outcomes: Limitations and Opportunities

Agarwal

Simmonds²,

Myers

2022

Curr Diab Rep

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Purpose of Review The management of diabetes has been revolutionized by the introduction of novel technological treatments and modalities of care, such as continuous glucose monitoring, insulin pump therapy, and telehealth. While these technologies have demonstrated improvement in health outcomes, it remains unclear whether they have reduced inequities from racial/ethnic minority or socioeconomic status. We review the current literature to discuss evidence of benefit, current limitations, and future opportunities of diabetes technologies. Findings While there is ample evidence of the health and psychological benefit of diabetes technologies in large populations of people with type 1 and type 2 diabetes, there remain wide disparities in the use of diabetes technologies, which may be perpetuating or widening inequities. Multilevel barriers include inequitable prescribing practices, lack of support for social determinants of health, mismatch of patient preferences and care models, and cost. Summary We provide a review of disparities in diabetes technology use, possible root causes of continued inequity in outcomes, and insight into ways to overcome remaining gaps.

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Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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Electronic Consultation: An Effective Alternative to In-Person Clinical Care for Patients With Diabetes Mellitus

Cited by 10 publications

References 4 publications

Electronic consultations (E-consults) and their outcomes: a systematic review

Electronic consultations (E-consults) and their outcomes: a systematic review

The Use of Diabetes Technology to Address Inequity in Health Outcomes: Limitations and Opportunities

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

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