E-consults in providing value-based care to the underserved populations-: Real-world experience of the patients and primary care providers.


A new study discussing the benefits of e-consults in – the underserved, underinsured population and brings to the forefront the pervasive disparities in healthcare access. This is a study elucidating real-world implementation of a novel e-Consult program and captured frontline user perspectives. Quality healthcare cannot be only for the rich and affluent.

Highlights and testimonials from this cross-sectional evaluation of the Primary care provider PCP-users in a Federally Qualified Health Centers (FQHCs) of e-Consults, and patients who received an e-Consult are astute and enlightening.

These are the main messages and key takeaways:

Minimizing/avoiding financial stress:

* Patients pointed to out-of-pocket cost in the underserved patient populations as the major barrier to specialty care, as many specialists required office visit payment to be provided in advance.
* PCP noted the emotional and financial stress patients experience when seeking specialty care: “Patients just want to be reaffirmed sometimes….and that’s what an e-Consult can be very important for. Especially if the patients don’t have insurance, and they have difficulty getting where they want to go, or they can’t afford co-pays to see a lot of different specialists.”

Expanding access to care:

PCPs also commented on general specialist shortages, which made it even more difficult for uninsured patients to obtain an appointment: “Endocrinology is a little harder to get a face-to-face sometimes; they have a lot of hoops to jump through to get to see an Endocrinologist…We had a shortage where at one time it could take a year to see a Rheumatologist, and still have to do a workup.
e-Consults also helped address geographic access challenges for certain patients.

Seeking specialty care while uninsured:

Several patients from these FHQC clinics serving the underinsured populations expressed that they felt marginalized or disregarded when trying to obtain care from specialists. A patient described having to choose between good quality care and affordable care.

Expanding scope of primary care:

A PCP described using eConsults to make small but important changes to patients’ medications – a treatment plan that utilized a specialist’s expertise, but could be implemented in primary care:

“If I can just get a Cardiologist to look at a patient – this is what his blood pressure has been looking like, and these are the medications that he’s on, and these are his labs. You know, they’ll go in and rearrange medications. ‘Oh, yeah, turn this one down, turn this one up, stop this one, start this one.’ And that changes everything for the patient, and it’s not something that I would have identified.”

PCPs recognized the #educational benefits of e-Consults and how they helped expand their scope of practice: “I learn from recommendations. I actually have somewhere where I write stuff down based on patient profile, so I can use that knowledge”

Expediting specialty care when needed:

A PCP described patients’ appreciation that eConsults could expedite specialty
care when it was truly needed: “Most of the time [patients are] grateful…If they need a follow up face-to face visit, they understand that [submitting an eConsult]
really cuts down on the waiting time, and it just strengthens the actual need for a face-to-face consult.”

Another PCP discussed using an eConsult to help convince a patient to prioritize visiting a specialist.

Overall, Technology-enhanced care tools, including eConsults, have the potential to diminish access and health outcome disparities, and bolster capacity to adapt care to patients’ needs.

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