Electronic Consultations in Nephrology: Pilot Implementation and Evaluation

Mendu, Mallika L.; McMahon, Gearoid M.; Licurse, Adam; Solomon, Sonja R; Greenberg, Jack J.; Waikar, Sushrut S.

doi:10.1053/j.ajkd.2016.05.029

Cited by 16 publications

(34 citation statements)

References 7 publications

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“…At the time of our 2015 review, most studies reported high PCP satisfaction with e-consults, including perceived value, improved timeliness of specialty input, and enhanced communication with specialist. Newer studies using PCP surveys support these findings, 11,13,14,[18][19][20][21][22]24,26,[29][30][31][33][34][35][36]41,54,57,60,[62][63][64][65][67][68][69][70][71] and 2 qualitative studies also report generally high PCP satisfaction. 7,39 More recent studies have also described a strong educational benefit to less-experienced PCPs.…”

Section: Patient and Clinician Experiencementioning

confidence: 85%

“…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%

“…In a study of nephrology e-consults at an academic tertiary care center, PCPs responded to a brief survey after each e-consult. 63 If e-consults did not exist, in 69% of cases the PCP would not have sought specialty consultation via email or telephone. A study in a VA hematology unit found that the annual number of face-to-face visits decreased 18% within 2 years after e-consult implementation, but the total number of consults (e-consult plus faceto-face) increased by 80%.…”

Section: Access To Carementioning

confidence: 99%

“…Surveys of specialists in 2 different US academic medical centers found that most report "optimal complexity" 62 and that e-consults are efficient and help avoid referrals. 63 Concerns about e-consults relate to both organizational and clinical concerns. In 3 qualitative interview studies conducted within the VA (1 in anesthesiology, 2 across multiple medical specialties), specialists perceived value to patients, PCPs, and their own clinical practice.…”

Section: Patient and Clinician Experiencementioning

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: Patient and Clinician Experiencementioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Access To Carementioning

confidence: 99%

Section: Patient and Clinician Experiencementioning

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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“…48,49 This held true among 49 PCPs who participated in one nephrology-specific pilot eConsult program, where consult questions were most often related to management of stage 3 CKD, medication-dosing among patients with low estimated glomerular filtration rates, abnormal imaging findings of the GU tract, and workup of electrolyte disorders. 50 Less recognized, but equally important using the lens of educational theory, are eConsult programs’ abilities to promote self-reflection of PCPs as they craft clinical questions and digest specialist responses.…”

Section: Telehealth Applications For Primary Care Provider (Pcp) Educmentioning

confidence: 99%

Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers

Tuot

Boulware

2017

Advances in Chronic Kidney Disease

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Chronic kidney disease (CKD) affects 13% of the U.S. adult population, causes excess mortality, and is associated with significant socio-demographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth versus usual modalities for education.

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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 Consultations in Nephrology: Pilot Implementation and Evaluation

Cited by 16 publications

References 7 publications

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

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

Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers

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

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