Shared Care: Using an Electronic Consult Form to Facilitate Primary Care Provider–Specialty Care Coordination

Rea, Corinna J.; Wenren, Larissa M.; Tran, Katherine D.; Zwemer, Eric; Mallon, Daniel; Bernson-Leung, Miya E.; Samuels, Ronald C.; Toomey, Sara L.

doi:10.1016/j.acap.2018.03.010

Cited by 30 publications

(34 citation statements)

References 33 publications

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“…They anticipated benefits not only from gaining specialist advice more rapidly through this system but also from avoiding the time burden of scheduling and attending an in-person visit. These perceived benefits are supported by previous studies highlighting resolution of specialty care needs without in-person visits and improved time to appointment when visits are needed [8,15]. Although adult patients and primary care providers tempered similar perceptions with concerns about the electronic consultation process potentially adding delays to definitive care [9,13], parent interviewees did not voice such concerns.…”

Section: Discussionmentioning

confidence: 59%

“…Using a qualitative analysis of semistructured interviews, we identified caregiver perspectives on potential benefits and risks of electronic consultations in pediatric care, information desired by caregivers about electronic consultations before use, and reactions to potential strategies to enhance parent engagement with electronic consultations. With the adoption of electronic consultations just beginning in pediatric health care systems [14,15], these results are important for envisioning optimal parent engagement and proactively developing approaches to increase the acceptability, uptake, and impact of this emerging model of specialty care.…”

Section: Discussionmentioning

confidence: 99%

“…The Canadian Champlain Building Access to Specialists through eConsultations eConsult service reported on over 1000 pediatric electronic consultations between 2014 and 2016, where 36% of the electronic consultations were resolved without an in-person visit and PCPs reported high satisfaction [14]. At Boston Children's Hospital, a pilot electronic consultation from 2014 to 2016 significantly reduced wait time for specialty appointments and improved appointment completion rates, with PCPs also reporting improved communication and care [15]. For the adaption and implementation of new technology in general, input from the end user is needed to optimize acceptability and impact.…”

Section: Introductionmentioning

confidence: 99%

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Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

2020

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Background Electronic consultations, which use store-and-forward transfer of clinical information between a primary care physician and a specialist, improve access to specialty care. Adoption of electronic consultations is beginning in pediatric health care systems, but little is known about parent perspectives, informational needs, and preferences for interaction with this new model of care. Objective This study aimed to examine parent perspectives about electronic consultations, including perceived benefits and risks, anticipated informational needs, and preferences for parent engagement with electronic consultations. Methods We recruited caregivers of pediatric patients (aged 0-21 years) attending visits at an academic primary care center. Caregivers were eligible if their child had ever been referred for in-person specialty care. Caregivers participated in a semistructured interview about electronic consultations, including general perspectives, desired information, and preferences for parental engagement. Interviews were transcribed and qualitatively analyzed to identify parent perspectives on electronic consultations in general, information parents would like to receive about electronic consultations, and perspectives on opportunities to enhance parent engagement with electronic consultations. Results Interviewees (n=20) anticipated that electronic consultations would reduce the time burden of specialty care on families and that these had the potential to improve the integrity and availability of clinical information, but interviewees also expressed concern about data confidentiality. The most detailed information desired by interviewees about electronic consultations related to data security, including data confidentiality, availability, and integrity. Interviewees expressed concern that electronic consultations could exclude parents from their child’s health care decisions. Interviewees saw value in the potential ability to track the consultation status or to participate in the consultation dialogue, but they were more ambivalent about the idea of read-only access to consultation documentation. Conclusions Parents identified the potential risks and benefits of pediatric electronic consultations, with implications for communication with families about electronic consultations and for incorporation of features to enhance parent engagement.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

2020

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“…Among six studies of facilitated appointment scheduling, five studies tested direct scheduling interventions to promote appointment attendance 9‐13 and one study compared attendance rates under three scheduling models: first available appointments, appointments within 2‐ and 4‐week windows 14 . Chan et al implemented an internet‐based referral system that enabled emergency department (ED) physicians to directly schedule patient follow‐up appointments with local community clinics and provide patients with printed appointment information and directions as part of their ED discharge paperwork, compared with usual care that required patients to schedule their own follow‐up appointments post‐discharge 9 .…”

Section: Resultsmentioning

confidence: 99%

Interventions to increase appointment attendance in safety net health centers: A systematic review and meta‐analysis

Crable

Biancarelli

Aurora

et al. 2020

Evaluation Clinical Practice

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Rationale, aims and objectives Missed appointments are a persistent problem across healthcare settings, and result in negative outcomes for providers and patients. We aimed to review and evaluate the effectiveness of interventions designed to reduce missed appointments in safety net settings. Methods We conducted a systematic review of interventions reported in three electronic databases. Data extraction and quality assessment were conducted according to PRISMA guidelines. Eligible studies were analyzed qualitatively to describe intervention types. A random effects model was used to measure the pooled relative risk of appointment adherence across interventions in the meta‐analysis. Results Thirty‐four studies met inclusion criteria for the qualitative synthesis, and 21 studies reported sufficient outcome data for inclusion in the meta‐analysis. Qualitative analysis classified nine types of interventions used to increase attendance; however, application of each intervention type varied widely between studies. Across all study types (N = 12 000), RR was 1.08, (95% CI 1.03, 1.13) for any intervention used to increase appointment attendance. No single intervention was clearly effective: facilitated appointment scheduling [RR = 3.31 (95% CI: 0.30, 37.13)], financial incentives [RR = 1.88 (0.73, 4.82)] case management/patient navigator [RR = 1.09, (0.96, 1.24)], text messages [RR = 1.02 (0.96, 1.08)], transportation, [RR = 1.05 (0.98, 1.13)], telephone reminder calls [RR 1.12, (0.87, 1.45)], in‐person referrals, [RR = 1.01 (0.90, 1.13)], patient contracts [RR = 0.87 (0.52, 1.46)] or combined strategies, [RR = 1.16 (1.03, 1.32)]. No strategy was clearly superior to others, p interaction = .50. Conclusions Strategies to improve appointment adherence in safety net hospitals varied widely and were only modestly effective. Further research harmonizing intervention delivery within each strategy and comparing strategies with the most potential for success is needed.

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“…In April 2014 the clinic created a referral process through the Electronic Medical Record (EMR) that enabled PCPs to request expedited appointments as well as routine appointments in RASH clinic, and also to ask for advice regarding specific cases. 15 RASH providers also reviewed referrals to dermatology and offered to see those patients in RASH clinic when appropriate. The RASH clinic started as a monthly half-day session, but as demand grew, it occurred twice monthly and then weekly.…”

Section: Rash Clinic Modelmentioning

confidence: 99%

An Innovative Model for Providing Dermatology Services Within Primary Care

Rea

Delano

Hawryluk

et al. 2021

Academic Pediatrics

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Shared Care: Using an Electronic Consult Form to Facilitate Primary Care Provider–Specialty Care Coordination

Cited by 30 publications

References 33 publications

Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

Interventions to increase appointment attendance in safety net health centers: A systematic review and meta‐analysis

An Innovative Model for Providing Dermatology Services Within Primary Care

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