Cardiology electronic consultation (e-consult) use by primary care providers at VA medical centres in New England
| Autor: | Steven R. Simon, Eun Ji Kim, Sumeet Pawar, Judith Strymish, Sarah L. Cutrona, Melissa K Afable, Jay D. Orlander, Varsha G. Vimalananda |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Telemedicine Health Personnel Cardiology Specialty Health Informatics Primary care 03 medical and health sciences 0302 clinical medicine New england New England Internal medicine medicine Humans 030212 general & internal medicine Referral and Consultation Retrospective Studies Veterans Primary Health Care Electronic consultation business.industry Remote Consultation 030503 health policy & services Medicine Female 0305 other medical science business |
| Zdroj: | Journal of Telemedicine and Telecare. 25:370-377 |
| ISSN: | 1758-1109 1357-633X |
| Popis: | Introduction E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care. Methods This is a retrospective analysis of 750 patients’ medical charts with cardiology e-consults requested by medical providers (October 2013–September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists’ responses and examined their recommendations. Results Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment ( n = 44), anti-coagulation/anti-platelet management ( n = 33), and EKG interpretation ( n = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance ( n = 41), the reasons included missing or insufficient clinical information ( n = 18), medical complexity ( n = 6), and deferment to the patient’s non-VA primary cardiologist ( n = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults. Discussion Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|