Subspecialty Care and the Endocrinologist: Let's Get Virtual

Sub-specialists account for more than half of outpatient visits in the United States and two-thirds of health care costs. Cost-effect access to care is now a target, and a general consensus is that asynchronous (meaning electronically transmitted) consultations between primary care providers (PCPs) and specialists such as endocrinologists can improve outcomes. Researchers have documented improvement in wait time, clarity of consultative questions, and PCP satisfaction.

Researchers from the Division of Endocrinology and Metabolism at the University of California, San Francisco analyzed the impact of virtual consultations on the spectrum and volume of endocrine consults. They measured access to endocrine care and downstream health care utilization. Their results—published ahead of print in Endocrine Practice—indicate that virtual consultation offers many advantages for endocrinologists.

These researchers used a program (eConsults) designed to enable and reimburse asynchronous consultations between PCPs and specialists. They reviewed all eConsults (n=158) submitted to endocrinology over a 1-year period. They also analyzed PCP compliance with specialist recommendations, changes in wait times to endocrine care, downstream endocrine office visits, emergency department visits, and hospitalizations.

eConsult’s introduction significantly improved access to endocrine care, and patients. Among PCPs, 45% sent at least one endocrine eConsult during the initial 12 months of the program. PCPS were significantly more likely to use an eConsult for endocrine referrals than for any other and all combined participating specialties. Twenty-two percent of endocrinology consults were sent by eConsult.

When consultative questions are unclear, the specialist often needs to conduct additional testing and schedule return specialist visits. This frustrates patients and PCPs. eConsults were able to reduce this frustration. A total of 84% of consults were completed using a structured referral template, which improved the clarity of consultative questions.

Seventy-six percent of endocrinologist recommendations were fully implemented. Rates of downstream health care utilization were low. Only 6 patients (5.3%) needed to return to the endocrinologist within 6 months. This seems to suggest that referring PCPs considered the clinical question adequately addressed by the eConsult response.

The researchers conclude that at their facility, virtual consultations significantly improved access to endocrine care and the quality of referrals.