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Kern LM, Riffin C, Phongtankuel V, Aucapina JE, Banerjee S, Ringel JB, Tobin JN, Fisseha S, Meiri H, Bell SK, Casale PN. Gaps in the coordination of care for people living with dementia. J Am Geriatr Soc 2024. [PMID: 39073783 DOI: 10.1111/jgs.19105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND One-third of people living with dementia (PLWD) have highly fragmented care (i.e., care spread across many ambulatory providers without a dominant provider). It is unclear whether PLWD with fragmented care and their caregivers perceive gaps in communication among the providers involved and whether any such gaps are perceived as benign inconveniences or as clinically meaningful, leading to adverse events. We sought to determine the frequency of perceived gaps in communication (coordination) among providers and the frequency of self-reported adverse events attributed to poor coordination. METHODS We conducted a cross-sectional study in the context of a Medicare accountable care organization (ACO) in New York in 2022-2023. We included PLWD who were attributed to the ACO, had fragmented care in the past year by claims (reversed Bice-Boxerman Index ≥0.86), and were in a pragmatic clinical trial on care management. We used an existing survey instrument to determine perceptions of care coordination and perceptions of four adverse events (repeat tests, drug-drug interactions, emergency department visits, and hospital admissions). ACO care managers collected data by telephone, using clinical judgment to determine whether each survey respondent was the patient or a caregiver. We used descriptive statistics to summarize results. RESULTS Of 167 eligible PLWD, surveys were completed for 97 (58.1%). Of those, 88 (90.7%) reported having >1 ambulatory visit and >1 ambulatory provider and were thus at risk for gaps in care coordination and included in the analysis. Of those, 23 respondents were patients (26.1%) and 64 were caregivers (72.7%), with one respondent's role missing. Overall, 57% of respondents reported a problem (or "gap") in the coordination of care and, separately, 18% reported an adverse event that they attributed to poor care coordination. CONCLUSION Gaps in coordination of care for PLWD are reported to be very common and often perceived as hazardous.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, New York, New York, USA
| | | | | | | | | | | | - Jonathan N Tobin
- Clinical Directors Network, New York, New York, USA
- Center for Clinical and Translational Science, The Rockefeller University Center for Clinical and Translational Science, New York, New York, USA
| | | | | | - Sigall K Bell
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Paul N Casale
- Weill Cornell Medicine, New York, New York, USA
- NewYork Quality Care, New York, New York, USA
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Ortega Carpio A, Rioja Ulgar J, Mestraitua Vázquez A, Arco Prados Y, Córdoba Gómez J, Carmona Romero F. [Interlevel incident management: The experience of a primary care district]. Semergen 2024; 50:102179. [PMID: 38301400 DOI: 10.1016/j.semerg.2023.102179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024]
Abstract
AIM Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC). DESIGN Multicenter cross-sectional descriptive study. SITE: Primary care. PARTICIPANTS Professionals from a Health District and its reference hospitals. INTERVENTIONS ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician. MAIN MEASUREMENTS ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ. RESULTS We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%). CONCLUSIONS 3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.
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Affiliation(s)
- A Ortega Carpio
- Distrito Huelva-Costa Condado-Campiña, La Palma del Condado, Huelva, España.
| | - J Rioja Ulgar
- Distrito Huelva-Costa Condado-Campiña, La Palma del Condado, Huelva, España
| | | | - Y Arco Prados
- Distrito Huelva-Costa Condado-Campiña, La Palma del Condado, Huelva, España
| | - J Córdoba Gómez
- Servicio de Atención a la Ciudadanía, Distrito Huelva-Costa Condado-Campiña, La Palma del Condado, Huelva, España
| | - F Carmona Romero
- Servicio Administrativo, Distrito Huelva-Costa Condado-Campiña, La Palma del Condado, Huelva, España
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Curry MA, Cruz RE, Belter LT, Schroth MK, Jarecki J. Assessment of Barriers to Referral and Appointment Wait Times for the Evaluation of Spinal Muscular Atrophy (SMA): Findings from a Web-Based Physician Survey. Neurol Ther 2024; 13:583-598. [PMID: 38430355 PMCID: PMC11136895 DOI: 10.1007/s40120-024-00587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. Clinical trial data suggest early diagnosis and treatment are critical. The purpose of this study was to evaluate neurology appointment wait times for newborn screening identified infants, pediatric cases mirroring SMA symptomatology, and cases in which SMA is suspected by the referring physician. Approaches for triaging and expediting referrals in the US were also explored. METHODS Cure SMA surveyed healthcare professionals from two cohorts: (1) providers affiliated with SMA care centers and (2) other neurologists, pediatric neurologists, and neuromuscular specialists. Surveys were distributed directly and via Medscape Education, respectively, between July 9, 2020, and August 31, 2020. RESULTS Three hundred five total responses were obtained (9% from SMA care centers and 91% from the general recruitment sample). Diagnostic journeys were shorter for infants eventually diagnosed with SMA Type 1 if they were referred to SMA care centers versus general sample practices. Appointment wait times for infants exhibiting "hypotonia and motor delays" were significantly shorter at SMA care centers compared to general recruitment practices (p = 0.004). Furthermore, infants with SMA identified through newborn screening were also more likely to be seen sooner if referred to a SMA care center versus a general recruitment site. Lastly, the majority of both cohorts triaged incoming referrals. The average wait time for infants presenting at SMA care centers with "hypotonia and motor delay" was significantly shorter when initial referrals were triaged using a set of "key emergency words" (p = 0.036). CONCLUSIONS Infants directly referred to a SMA care center versus a general sample practice were more likely to experience shorter SMA diagnostic journeys and appointment wait times. Triage guidelines for referrals specific to "hypotonia and motor delay" including use of "key emergency words" may shorten wait times and support early diagnosis and treatment of SMA.
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Affiliation(s)
- Mary A Curry
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA.
| | | | - Lisa T Belter
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Mary K Schroth
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Jill Jarecki
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
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Ron D, Gunn CM, Havidich JE, Ballacchino MM, Burdick TE, Deiner SG. Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients. Jt Comm J Qual Patient Saf 2024; 50:326-337. [PMID: 38360446 DOI: 10.1016/j.jcjq.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician dissatisfaction. METHODS Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center. RESULTS In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information. CONCLUSION Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.
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Kern LM, Bynum JPW, Pincus HA. Care Fragmentation, Care Continuity, and Care Coordination-How They Differ and Why It Matters. JAMA Intern Med 2024; 184:236-237. [PMID: 38285559 PMCID: PMC10923120 DOI: 10.1001/jamainternmed.2023.7628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
This Viewpoint considers why fragmentation occurs and suggests a potential path forward for developing evidenced-based strategies that can reduce the occurrence of fragmentation and its associated harms.
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Hauzer M, Grimberg R, Samuels N, Keshet Y, Mordechai A, Dagash J, Ben-Arye E. Exploring primary care physician feedback following an integrative oncology consultation. Support Care Cancer 2023; 31:606. [PMID: 37787815 DOI: 10.1007/s00520-023-08079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To explore responses from primary care physicians (PCPs) from an integrative physician (IP) consultation and recommended integrative oncology (IO) treatment program. METHODS Chemotherapy-treated patients were referred by their oncology healthcare professional to an IP, a physician dually trained in complementary medicine and supportive cancer care. The consultation summary and patient-centered IO treatment program was then sent to the patient's PCP, with PCP-to-IP responses analyzed qualitatively using ATLAS.Ti software for systematic coding and content analysis. Trial Registration Number NCT01860365 published May 22, 2013. RESULTS Of the 597 IP consultations conducted, 470 (78.7%) summaries were sent to patients' PCPs, with only 69 (14.7%) PCP-to-IP responses returned. PCPs were more likely to respond if the patient was Hebrew-speaking (78.3% vs. 65.1%, P = 0.032). Systematic coding identified four predominant themes among PCP narratives: addressing the patient's medical condition and leading QoL-related concerns; patient-centered reflections; available resources providing support and promoting resilience; and PCP attitudes to the IO treatment program. CONCLUSION PCP-IP communication can provide valuable insight into the patient's bio-psycho-social care, addressing the patient's health-belief model, emotional concerns, caregiver-related factors, preferences, and barriers to adherence to IO care. PRACTICE IMPLICATIONS Healthcare services should consider promoting IP-PCP communication in order to facilitate better patient outcomes from an IO treatment program.
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Affiliation(s)
- Michael Hauzer
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel.
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ran Grimberg
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee Academic College, Galilee, Israel
| | - Alperin Mordechai
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel
| | - Jamal Dagash
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Palliative Care-Home Care Hospice, Clalit Health Services, Haifa and Western Galilee District, Jerusalem, Israel
| | - Eran Ben-Arye
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
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Sunjaya A, Martin A, Arnott C, Jenkins C. Management of chronic breathlessness in primary care: what do GPs, non-GP specialists, and allied health professionals think? Aust J Prim Health 2023; 29:375-384. [PMID: 36683165 DOI: 10.1071/py22018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND To explore the perspectives of GPs, non-GP specialists, and allied health professionals on the role of primary care in diagnosing and managing chronic breathlessness, the barriers faced, and the resources needed to optimise care of patients with chronic breathlessness. METHODS This was a qualitative study involving focus group discussions that included 35GPs, non-GP specialists, and allied health professionals. Topics explored included: (1) views on the role of primary care in diagnosing and managing chronic breathlessness; (2) barriers to optimal assessment in primary care; and (3) facilitators to further optimise the care of patients with chronic breathlessness. RESULTS All participants considered that primary care has a central role to play in the assessment and management of chronic breathlessness, but greater access to referral services, suitable funding structures, and upskilling on the use of diagnostic tests such as spirometry and electrocardiography are required for this to be realised. Both GPs and non-GP specialists described great potential for developing better linkages, including new ways of referral and online consultations, greater ease of referral to allied health services, even if conducted virtually, for patients with functional causes of breathlessness. Participants identified a need to develop integrated breathlessness clinics for patients referred by GPs, which would ensure patients receive optimal care in the shortest possible time frame. CONCLUSIONS GPs are crucial to achieving optimal care for breathless patients, especially given the multifactorial and multimorbid nature of breathlessness; however, there are significant gaps in services and resources at present that limit their ability to perform this role.
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Affiliation(s)
- Anthony Sunjaya
- Respiratory Program, The George Institute for Global Health, Sydney, NSW 2050, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Allison Martin
- Respiratory Program, The George Institute for Global Health, Sydney, NSW 2050, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Clare Arnott
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; and Cardiovascular Division, The George Institute for Global Health, Sydney, NSW 2050, Australia
| | - Christine Jenkins
- Respiratory Program, The George Institute for Global Health, Sydney, NSW 2050, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Moniz-Cook E, Mountain G. The memory clinic and psychosocial intervention: Translating past promise into current practices. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1052244. [PMID: 37214129 PMCID: PMC10192709 DOI: 10.3389/fresc.2023.1052244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/16/2023] [Indexed: 05/24/2023]
Abstract
Disproportionate negative effects since the pandemic have amplified the already limited post-diagnostic support for older people with dementia. This paper summarizes an exploratory randomized controlled study of a proactive family-based intervention compared with "usual" post-diagnostic dementia care. Memory clinic practitioners collaborated with the family doctor (GP) to coordinate this. At 12-month follow-up, positive effects on mood, behavior, carer coping and maintenance of care at home were found. Current approaches to deliver post-diagnostic support in primary care may require rethinking since (i) GP workloads have increased with low numbers of GPs per head of population in parts of England; and (ii) unlike many other long-term conditions, ongoing stigma, fear and uncertainty associated with dementia adds to the huge complexity of timely care provision. There is a case for return to a "one-stop facility", with a single pathway of continuing multidisciplinary coordinated care for older people with dementia and families. Future longitudinal research could compare structured post-diagnostic psychosocial intervention coordinated by skilled practitioners in a single locality memory service "hub", against other approaches such support organized mostly within primary care. Dementia-specific instruments for outcome measurement are available for use in routine practice, and should be included in such comparative studies.
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Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
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Hong YR, Mainous AG, Revere L, Mathews S. Gastroenterology Specialist Supply and Early-Onset Colorectal Cancer Incidence and Mortality in the U.S., 2014-2018. GASTRO HEP ADVANCES 2023; 2:810-817. [PMID: 39130125 PMCID: PMC11307945 DOI: 10.1016/j.gastha.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims The burden of early-onset colorectal cancer (EoCRC) has been increasing among young adult populations in the U.S. The aim of this study was to investigate the relationship between the incidence and mortality of EoCRC and the supply of gastroenterology (GI) specialists and primary care physicians (PCP). Methods This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation. Results Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval, -11.0 to -0.1) but not with EoCRC mortality (P = .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval, -46.1 to -7.8) but not with EoCRC incidence (P = .077). Conclusion Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
- Cancer Control and Population Sciences Program, UF Health Cancer Center, Gainesville, Florida
| | - Arch G. Mainous
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Lee Revere
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Simon Mathews
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Rodgers B, Rodgers KA, Chick JFB, Makary MS. Public Awareness of Interventional Radiology: Population-Based Analysis of the Current State of and Pathways for Improvement. J Vasc Interv Radiol 2023; 34:960-967.e6. [PMID: 36764444 DOI: 10.1016/j.jvir.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/28/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023] Open
Abstract
PURPOSE To evaluate the awareness of interventional radiology (IR) among the public and identify methods for improvement. MATERIALS AND METHODS Participants (N = 1,000) were anonymously surveyed using Amazon's Mechanical Turk crowdsourcing platform about medical and IR-specific knowledge, preferred methods of acquisition of medical information, and suggestions for improving awareness of IR. The survey consisted of 69 questions, including both Likert Scale and free text questions. RESULTS Of the participants, 92% preferred undergoing a minimally invasive procedure over surgery. However, 39.8% recognized IR as a medical specialty, and less than 50% of these participants correctly identified IR as procedurally oriented. Of those who discussed or underwent an IR procedure (n = 113), most were also offered to undergo the procedure performed by a surgeon (n = 66). Furthermore, 71% (n = 20) of those who underwent the procedure performed by a surgeon reported that lack of awareness of IR played a role in their decision. Almost half of the respondents (n = 458) were interested in learning more about IR, particularly the diseases treated and procedures performed (42% and 37%, respectively). Short (<10-minute) educational videos and increased patient education by primary care providers (PCPs) were among the most suggested ways to improve awareness. Regarding the ambiguity of the name "interventional radiology," most respondents (n = 555) reported this to be true, and "minimally invasive radiologist" was the most preferred alternative (21.18%). CONCLUSIONS Lack of awareness of IR may underlie underutilization. When presented with the knowledge that IR improves patient outcomes, minimally invasive procedures by an interventional radiologist are more often desired by the public than surgical options. Educational videos and patient education by PCPs may increase awareness of IR.
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Affiliation(s)
- Brandon Rodgers
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kyleigh A Rodgers
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Bifulco L, Guidotti O, Velez I, Grzejszczak L, Angelocci T, Okunade L, Anderson D. Impact of eConsults on Clinical Care in Primary Care: A Cross-Sectional Analysis of Primary Care Provider Behavior. J Prim Care Community Health 2023; 14:21501319231202201. [PMID: 37753619 PMCID: PMC10524039 DOI: 10.1177/21501319231202201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION/OBJECTIVES Asynchronous electronic consultations (eConsults) support primary care providers (PCPs) by providing rapid specialist feedback and improve medically underserved patients' access to care. METHODS This cross-sectional study assessed all eConsults requested over a one-year period at a multi-site federally qualified health center in Texas. We analyzed eConsult content and quality and conducted chart reviews for a randomly selected subsample (n = 100) to determine whether PCPs implemented specialists' recommendations within 90 days. Semi-structured interviews with PCPs assessed their ability and willingness to follow recommendations. RESULTS There were 367 eConsults submitted by 25 PCPs across 15 adult medical and surgical specialties. Of the 100 charts reviewed n = 77 (77.0%) contained documentation indicating that the PCP had followed at least 1 of the specialist's recommendations within 90 days. In two-thirds of the cases (n = 66, 66%) the reviewing specialist indicated that a face-to-face referral was not needed. PCPs were most likely to follow recommendations for new medications and least likely to document that they had obtained additional patient history. PCPs noted that they were sometimes unable to follow recommendations when patients could not afford or access treatment or did not return for follow up care, or when they felt that the specialist did not address their specific question. CONCLUSIONS eConsults delivered to medically underserved patients in primary care help PCPs provide timely care for their patients. PCPs utilized a broad range of eConsult specialties and generally implemented eConsult specialists' recommendations within 90 days.
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Sunjaya AP. Uplifting Primary Care Through the Electronic Health Record. Ann Fam Med 2022; 20:303-304. [PMID: 35879075 PMCID: PMC9328708 DOI: 10.1370/afm.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
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