By Sara Heath
– Patients are widely accepting of the use of eConsults in the primary care setting, citing quicker patient access to specialty care and convenience as the key benefits of the technology, according to a new study published in the Annals of Family Medicine.
eConsults are a popular strategy for connecting disparately located providers to facilitate better consultations. As health IT has worked to enhance patient care, eConsults have emerged to largely to help primary care providers chat with specialty providers during a patient encounter.
The tools, which usually consist of an asynchronous telephone or telehealth connection between the two, help the primary care provider address a specialized medical issue without having to refer the patient to another provider. eConsults can also alert a primary care provider of a dire situation in which the patient must immediately see a specialist.
And since these technologies have risen in prominence, they have generated some net positive affects.
“Evaluations of eConsult programs have demonstrated cost savings, reductions in referral rates, and improvements in specialty care access time,” the researchers reported. “Assessments of clinicians’ experiences suggest that voluntary-use eConsult models have been widely embraced, with primary care clinicians reporting increased access to specialist expertise and improved inter-clinician communication.”
But despite the positive clinical and financial impacts, little has been historically known about how patients feel about eConsults.
This latest study, which conducted focus groups at five academic medical centers, revealed that patients are largely accepting of the technology. Nearly all 52 patients included across all study sites confirmed that eConsults can enhance healthcare access.
Patients cited quicker access to specialty care and convenience as the biggest attractions to an eConsult.
“In particular, avoiding an unnecessary visit with a specialist could reduce the costs of medical care, including expenses related to missed work, childcare, transportation, parking, and copays,” the team explained.
And even when an eConsult indicated that the patient should see the specialist in person, study participants noted that these visits would likely be more productive than it would have been without the prior eConsult.
The focus groups also indicated eConsults could make it easier for them to access a specialty provider in person.
“First, eConsults would likely remove patients with lower-complexity problems from the primary care–specialty care referral pipeline, thereby opening up specialty appointments to those who need them more,” the team reported. “Second, if an eConsult prompts a recommendation that the patient be seen in person by a specialist, an appointment could possibly be obtained more quickly because the patient is already known to the specialist through eConsult.”
Although the focus groups highlighted general support for eConsults among patients, there were some caveats.
For one, there were mixed opinions about whether a patient should have a say in whether an eConsult is used at all. Some patients expressed interest in being involved in the decision to access an eConsult, although not all. Many patients agreed that an eConsult could mirror a regular consult, which they acknowledged happens frequently without patients knowing.
Patients who had deep trust with their primary care providers were more likely to be receptive to an eConsult than patients who did not.
Specifically, those who mostly visit their primary care provider, as opposed to having a slate of specialists who manage a chronic illness, saw eConsults as novel. Those who often see specific specialists saw less use for an eConsult because they can visit that specialist more easily as a regular, returning patient.
Patient interest in an eConsult also waned when patients faced a hypothetical copay, showing that patients do not want to pay extra for a consult during their primary care appointment. That comes even when a patient would have to pay a copay when visiting a specialist in person and separately from her primary care appointment.
Patient concerns also included overuse of the eConsult – such as for a condition that clearly needs in-person care – and miscommunication of patient health history.
Ultimately, these findings about patient perceptions of eConsults could help reframe how primary care providers use them during care encounters.
“The active engagement of our focus group participants in discussions about innovations in care delivery suggests that patient involvement in outreach and education efforts could help to improve eConsult models and enhance their uptake,” the research team concluded. “We hope that our findings will prompt more eConsult designers and implementers to develop meaningful collaborations with patients.”
