Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster-Randomized Controlled Trial
Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster-Randomized Controlled Trial
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DOI：
10.1370/afm.1869
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发表时间：
2016-03-01
影响因子：
4.4
通讯作者：
Zlateva, Ianita
中科院分区：
文献类型：
--
作者：
Olayiwola, J. Nwando;Anderson, Daren;Zlateva, Ianita
专家和初级保健临床医生之间的沟通是次优的，转诊的机会往往是有限的，这可能会导致质量下降，效率低下和错误。电子咨询（e-consultation）是初级保健临床医生和专家之间使用安全电子通信平台进行的异步、非面对面咨询。本研究的目的是进行一项随机对照试验的电子咨询，以测试其疗效和有效性，减少等待时间，提高获得专科care.METHODS的初级保健临床医生随机分为对照组（9传统）或干预（17电子咨询）手臂转介心脏病专家。初级保健临床医生从康涅狄格州社区卫生中心的12个实践点招募，主要是医疗服务不足的患者。两个终点进行了分析与考克斯比例风险模型的风险，无论是访问或电子咨询与研究手臂，性别，种族，和age.Results 36初级保健临床医生参加了这项研究，涉及590例患者。总的来说，69%的电子咨询在没有拜访心脏病专家的情况下得到了解决。调整协变量后，电子咨询与对照组患者访视的中位审查天数分别为5天和24天。6个月的随访数据的审查发现较少的心脏相关的急诊科就诊的干预group.CONCLUSION电子咨询转介改善了获得和及时性的护理服务不足的人群，降低整体专业利用率，并简化专业转介没有任何增加心血管不良后果。电子咨询是改善获得专科护理机会的一个潜在解决办法。
PURPOSE Communication between specialists and primary care clinicians is suboptimal, and access to referrals is often limited, which can lead to lower quality, inefficiency, and errors. An electronic consultation (e-consultation) is an asynchronous, non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform. The purpose of this study was to conduct a randomized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care.METHODS Primary care clinicians were randomized into a control (9 traditional) or an intervention (17 e-consultation) arm for referrals to cardiologists. Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients. Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm, sex, race, and age.RESULTS Thirty-six primary care clinicians participated in the study, referring 590 patients. In total, 69% of e-consultations were resolved without a visit to a cardiologist. After adjusting for covariates, median days to a review for an electronic consultation vs a visit for control patients were 5 and 24, respectively. A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group.CONCLUSION E-consultation referrals improved access to and timeliness of care for an underserved population, reduced overall specialty utilization, and streamlined specialty referrals without any increase in adverse cardiovascular outcomes. e-consultations are a potential solution for improving access to specialty care.