Conference Coverage

eConsult gastroenterology model could improve access


 

AT THE WORLD CONGRESS OF GASTROENTEROLOGY

– A review of gastroenterology electronic consultations, or eConsults, at a tertiary care academic medical center suggests that such referrals could improve timely access to specialist care, while cutting costs.

The findings underscore the need for careful study of this burgeoning care delivery model, which is a form of telemedicine, Jennifer Wang, MD, said at the World Congress of Gastroenterology at ACG 2017.

The review of 130 eConsults conducted between Jan. 1, 2015, and May 8, 2017, looked at questions asked, gastroenterology content, eConsult response time, change in referral plans, and indirect cost savings through avoided referrals and travel, according to Dr. Wang of the University of Virginia, Charlottesville, which is one of five centers that are part of an eConsult model project.

Of the 130 eConsults, 68 (52%) were resolved without face-to-face consultation with a gastroenterologist; the patients followed up with a primary care physician. The remaining 62 cases led to a face-to-face visit in the GI clinic.

The mean response time to eConsult was 54 hours, compared with a greater than 30-day wait time for an initial consultation in the ambulatory GI clinic, she said.

The most frequently queried subjects were etiology of chronic diarrhea (14%), colon cancer screening modality (12%), and chronic abdominal pain management (9%). The most common type of question asked pertained to diagnosis (70%).

The total mileage saved between patients’ homes and the GI clinic was estimated to be 1,583 miles. “You can also imagine the cost saved by not having to miss a day of work,” Dr. Wang said.

The model is not only cost effective, but can potentially be life saving, she added.

In one case, a 40-year-old woman with a 6-month history of abdominal pain was diagnosed with lymphoma during an eConsult and underwent biopsy and chemotherapy immediately, whereas the 30-day wait for a face-to-face visit would have delayed her diagnosis, Dr. Wang explained.

The eConsult model is being tested as a means of providing primary care physicians with direct, efficient, and timely access to specialist expertise in the management of their patients and potentially avoiding the need for face-to-face referrals, Dr. Wang said.

Increased demand for eConsult is anticipated, and therefore its financial and medical-legal implications should be further studied, she said. One question is how specialists can be incentivized to provide eConsults.

“I think the key would be to come up with a sustainable payment model and reimbursement strategy, and to have protected time for specialists to review eConsults,” she said.

Dr. Wang reported having no financial disclosures.

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