• Jessica F Waldura, Sarah Neff, Christine Dehlendorf, and Ronald H Goldschmidt.
• Department of Family and Community Medicine, San Francisco General Hospital, University of California, San Francisco, USA. walduraj@nccc.ucsf.edu
• J Gen Intern Med. 2013 Jun 1; 28 (6): 793-800.

BackgroundTelemedicine can facilitate communication between primary care clinicians and specialists. Generalists who use telemedicine for consultation (teleconsultation) may be able to practice more independently and reduce the number of formal referrals to specialists. In the United States, a federally funded human immunodeficiency virus (HIV) teleconsultation service (HIV Warmline) offers clinicians live telephone access to HIV specialists; however, its impact on clinicians' self-perceived clinical competence and referral rates has not been studied.ObjectiveTo determine if primary care clinicians who used the HIV Warmline felt more capable of managing HIV in their own practices.DesignOnline survey.ParticipantsPrimary care physicians and mid-level practitioners who used the HIV Warmline for teleconsultation between 1/2008 and 3/2010.Main MeasuresParticipants compared the HIV Warmline to other methods of obtaining HIV clinical support, and then rated its impact on their confidence in their HIV skills and their referral patterns.Key ResultsRespondents (N = 191, 59% response rate) found the HIV Warmline to be quicker (65%), more applicable (70%), and more trustworthy (57%) than other sources of HIV information. After using the HIV Warmline, 90% had improved confidence about caring for HIV, 67% stated it changed the way they managed HIV, and 74% were able to avoid referring patients to specialists. All valued the availability of live, free consultation.ConclusionsPrimary care clinicians who called the HIV Warmline reported increased confidence in their HIV care and less need to refer patients to specialists. Teleconsultation may be a powerful tool to help consolidate HIV care in the primary care setting, and could be adapted for use with a variety of other medical conditions. The direct impact of teleconsultation on actual referral rates, quality of care and clinical outcomes needs to be studied.

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