• J Nwando Olayiwola, Daren Anderson, Nicole Jepeal, Robert Aseltine, Christopher Pickett, Jun Yan, and Ianita Zlateva.
• Center for Excellence in Primary Care, San Francisco General Hospital, San Francisco, California Department of Family and Community Medicine, University of California San Francisco, San Francisco, California OlayiwolaJ@fcm.ucsf.edu.
• Ann Fam Med. 2016 Mar 1; 14 (2): 133-40.

PurposeCommunication between specialists and primary care clinicians is suboptimal, and access to referrals is often limited, which can lead to lower quality, inefficiency, and errors. An electronic consultation (e-consultation) is an asynchronous, non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform. The purpose of this study was to conduct a randomized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care.MethodsPrimary care clinicians were randomized into a control (9 traditional) or an intervention (17 e-consultation) arm for referrals to cardiologists. Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients. Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm, sex, race, and age.ResultsThirty-six primary care clinicians participated in the study, referring 590 patients. In total, 69% of e-consultations were resolved without a visit to a cardiologist. After adjusting for covariates, median days to a review for an electronic consultation vs a visit for control patients were 5 and 24, respectively. A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group.ConclusionE-consultation referrals improved access to and timeliness of care for an underserved population, reduced overall specialty utilization, and streamlined specialty referrals without any increase in adverse cardiovascular outcomes. e-consultations are a potential solution for improving access to specialty care.© 2016 Annals of Family Medicine, Inc.

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