Keeping care connected: e-Consultation program improves access to nephrology care

2017 ◽  
Vol 25 (3) ◽  
pp. 142-150 ◽  
Author(s):  
Priscille Schettini ◽  
Kevin P Shah ◽  
Colin P O’Leary ◽  
Malhar P Patel ◽  
John B Anderson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Wait Time ◽  
Specialty Care ◽  
Completion Rate ◽  
Wait Times ◽  
Pilot Program ◽  
Completion Rates ◽  
Face To Face ◽  
Referral Completion

Introduction Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit. Methods We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program. Results For traditional nephrology referrals placed during the study period (July 2016–March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit. Discussion Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists.

scholarly journals Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

2021 ◽  
Vol 8 ◽  
pp. 237437352110077
Author(s):  
Daliah Wachs ◽  
Victoria Lorah ◽  
Allison Boynton ◽  
Amanda Hertzler ◽  
Brandon Nichols ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Wait Time ◽  
Primary Care Providers ◽  
Wait Times ◽  
Care Providers ◽  
Female Physicians ◽  
Online Ratings ◽  
And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

scholarly journals Specialist Wait Time Reporting Using Family Physicians’ Electronic Medical Record Data: A Mixed Method Study of Feasibility and Clinical Utility

2021 ◽  
Author(s):  
Michelle Naimer ◽  
Babak Aliarzadeh ◽  
Chaim M. Bell ◽  
Noah Ivers ◽  
Liisa Jaakkimainen ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Method ◽  
Clinical Utility ◽  
Family Physicians ◽  
Wait Time ◽  
Mixed Method Study ◽  
Wait Times ◽  
Specialist Care ◽  
Time Data ◽  
Time Information

Abstract Background: More than 50% of Canadian patients wait longer than four weeks to see a specialist after referral from primary care. Access to accurate wait time information may help primary care physicians choose the timeliest specialist to address a patient’s specific needs. We conducted a mixed-methods study to assess if primary to specialist care wait times can be extracted from electronic medical records (EMR), analyzed the wait time information, and used focus groups and interviews to assess the potential clinical utility of the wait time information. Methods: Two family practices were recruited to examine primary care physician to specialist wait times between 2016 and 2017, using EMR data. The primary outcome was the median wait time from physician referral to specialist appointment for each specialty service. Secondary outcomes included the physician and patient characteristics associated with wait times as well as qualitative analyses of physician interviews about the resulting wait time reports.Results: Wait time data can be extracted from the primary care EMR and converted to a report format for family physicians and specialists to review. After data cleaning, there were 7141 referrals included from 4967 unique patients. The 5 most common specialties referred to were Dermatology, Gastroenterology, Ear Nose and Throat, Obstetrics and Gynecology and Urology. Half of the patients were seen by a specialist within 42 days, 75% seen within 80 days and all patients within 760 days. There were few patient or provider differences amongst the wait times for referrals. Overall, wait time reports were perceived to be important since they could help family physicians decide how to triage referrals and might lead to system improvements. Conclusions: Wait time information from primary to specialist care can aid in decision-making around specialist referrals, identify bottlenecks, and help with system planning. This mixed method study is a starting point to review the importance of providing wait time data for both family physicians and local health systems. Future work can be directed towards developing wait time reporting functionality and evaluating if wait time information will help increase system efficiency and/or improve provider and patient satisfaction.

scholarly journals P084: Waiting makes me sick: is it time for formal triage in primary care?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
J. MacKay ◽  
P.R. Atkinson ◽  
M. Howlett ◽  
E. Palmer ◽  
J. Fraser ◽  
...  
Keyword(s):  
Primary Care ◽  
Wait Time ◽  
Patient Survey ◽  
Wait Times ◽  
Cross Sectional ◽  
Triage System ◽  
Care Appointment ◽  
Open Scheduling ◽  
Primary Care Practices ◽  
Advanced Access

Introduction: Patient morbidity and mortality are influenced by delay in access to care and lack of continuity of care. Patients frequently present to the emergency department (ED) for care despite being registered with a primary care (PC) provider. Advanced access is an open scheduling system promoted by the College of Family Physicians of Canada that triages primary care (PC) patients to be seen within 24 hours, reducing care delay. We wished to determine the prevalence of formal triage systems in PC appointment allocation. Methods: We performed linked cross sectional surveys to quantify the number of ambulatory patients presenting to a tertiary urban ED (with an annual census of 56,000 visits) who felt unable to access primary care. PC practices were also surveyed to assess use of formal triage methods and measure access using the metric of time to third next available appointment. Descriptive statistics were calculated. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 324 patients reported reasons for their ED visit. Perception that wait time for PC was “too long” was reported in 73/324 (23%); 86% reported wait times of greater than 48 hours. The PC practice response rate was 63.8% (46/ 72). The mean time to third next available appointment was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). No PC practice reported utilizing a formal triage system when booking appointments. Conclusion: No primary care practices in the surveyed region used a formal triage system to allocate appointments, despite a range of wait times that extended up to 50 days. The safety of primary care appointment allocation may be improved with introduction of a formal triage system, especially if overall wait times cannot be reduced.

The next generation of quality improvement at MSK: Turning chemotherapy process delays into chemo express.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18230-e18230
Author(s):  
Jennifer Tota ◽  
Kathleen Levine ◽  
Jeanine Gordon ◽  
Abigail Baldwin ◽  
Jodi Wald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Patient Experience ◽  
Wait Time ◽  
Wait Times ◽  
Pilot Program ◽  
Treatment Results ◽  
Average Wait Time ◽  
Major Bottleneck ◽  
Work Done

e18230 Background: Chemotherapy wait times can dramatically affect patient experience. MSK’s largest outpatient facility has 76 infusion spaces and 250-300 daily visits. A retrospective review of the facility’s infusion area wait times suggested that the lab (where all patients go to get their vitals and blood drawn) was a major bottleneck leading to process delays in infusion. Methods: We conducted a pilot program using a multi-pronged approach. Our goal was to decrease wait time from 40 minutes to an average of 15 minutes. Our initiative was defined as follows: (1) to redefine lab parameters that are relevant for toxicity and to only consider drawing those necessary labs; additionally, we created guidelines for timing of the labs prior to infusion treatment, (2) to introduce a program known as “ChemoExpress” which offers patients the opportunity to get blood work done prior to the day of their infusion appointment. After the labs result, the outpatient RN calls the patient, assesses symptoms and “clears them” for treatment cueing the pharmacy to prepare and “premix” the drug on the day of treatment. Results: 150 patients have enrolled in ChemoExpress. Patient satisfaction was high based on patient satisfaction surveys (n = 20). Average wait time was 9 minutes (76% less) in ChemoExpress participants as compared to an average wait of 39 minutes for those who did not participate in ChemoExpress. Conclusions: Implementing a process that enables patients to have their bloodwork drawn prior to the day of treatment and drugs prepared in advance of their treatment appointment results in greater efficiency in the overall workflow. It also offers the patient a lower wait time and a more efficient and satisfying experience.

Evaluation of a Telehealth Clinic as a Means to Facilitate Dermatologic Consultation: Pilot Project to Assess the Efficiency and Experience of Teledermatology Used in a Primary Care Network

2010 ◽  
Vol 14 (1) ◽  
pp. 7-12 ◽  
Author(s):  
David A. Ludwick ◽  
Charles Lortie ◽  
John Doucette ◽  
Jaggi Rao ◽  
Christine Samoil-Schelstraete
Keyword(s):  
Primary Care ◽  
Pilot Project ◽  
Care Process ◽  
Wait Times ◽  
Referral Process ◽  
Consultation Process ◽  
Face To Face ◽  
Specialist Referral ◽  
Field Notes ◽  
Patients Experience

Background: Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention. Objective: To determine if telehealth combined with interdisciplinary team–based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians. Methods: Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured. Results: Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations. Conclusions: Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.

scholarly journals Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting

2018 ◽  
Vol 9 ◽  
pp. 215013271875921 ◽  
Author(s):  
Lisa A. Mueller ◽  
Alexa Sevin Valentino ◽  
Aaron D. Clark ◽  
Junan Li
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Time Frame ◽  
Primary Objective ◽  
Completion Rate ◽  
Primary Care Settings ◽  
Significant Difference ◽  
Referral Completion ◽  
Time Frames

Objectives: The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service. Methods: Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014–September 2015) and after (January 2016–October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist. Results: The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002). Conclusion: The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.

Teletriage for Provision of Dermatologic Care

2014 ◽  
Vol 18 (3) ◽  
pp. 170-173 ◽  
Author(s):  
Jenna Lester ◽  
Martin A. Weinstock
Keyword(s):  
Primary Care ◽  
Access To Care ◽  
Medical Center ◽  
Pilot Program ◽  
Face To Face ◽  
Program Testing ◽  
Innovative Methods ◽  
The Creation ◽  
Primary Care Clinicians ◽  
Management Recommendations

Background: The scarcity of dermatologists has prompted the creation of innovative methods for delivering dermatologic care. Methods: Teletriage is a method used in teledermatology to efficiently assess skin complaints in patients who do not have prompt access to conventional dermatologic care. Their primary care clinicians are provided with management recommendations, reassured that the lesion of concern is benign, or recommended to send their patient for a face-to-face dermatology visit. The Providence VA Medical Center conducted a pilot program testing the utility of teletriage for patients with skin complaints from June 2011 to August 2011. Results: The pilot program revealed that with the teletriage protocol, face-to-face visits were reduced by 38%. This program suggests that teletriage could be a useful tool for providing efficient dermatologic care, and has led to broader implementation. Conclusion: Teletriage is a potentially useful approach for efficiently addressing specific dermatologic complaints and improving access to care for those complaints.

Cardiology electronic consultation (e-consult) use by primary care providers at VA medical centres in New England

2018 ◽  
Vol 25 (6) ◽  
pp. 370-377 ◽  
Author(s):  
Eun Ji Kim ◽  
Jay D Orlander ◽  
Melissa Afable ◽  
Sumeet Pawar ◽  
Sarah L Cutrona ◽  
...  
Keyword(s):  
Primary Care ◽  
New England ◽  
Clinical Information ◽  
Primary Care Providers ◽  
Specialty Care ◽  
Care Providers ◽  
Face To Face ◽  
Provider Characteristics ◽  
Medical Centers ◽  
Clinical Questions

Introduction E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care. Methods This is a retrospective analysis of 750 patients’ medical charts with cardiology e-consults requested by medical providers (October 2013–September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists’ responses and examined their recommendations. Results Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment ( n = 44), anti-coagulation/anti-platelet management ( n = 33), and EKG interpretation ( n = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance ( n = 41), the reasons included missing or insufficient clinical information ( n = 18), medical complexity ( n = 6), and deferment to the patient’s non-VA primary cardiologist ( n = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults. Discussion Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults.

scholarly journals 635 Can Virtual Clinics Streamline Urology Referrals from Primary to Secondary Care?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S C Madathilethu ◽  
P B Sarmah ◽  
M F Khan
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Wait Time ◽  
Outpatient Clinics ◽  
Wait Times ◽  
Retrospective Data ◽  
Imaging Findings ◽  
Flexible Cystoscopy ◽  
The Uk ◽  
Patient Referrals

Abstract Introduction The COVID-19 pandemic caused the UK to enter lockdown from 23rd March to 8th May 2020, necessitating Urology clinics to be conducted virtually. Our study aimed to assess whether new Urology referrals could be triaged and have an outcome arranged virtually before being seen by a specialist in clinic, thereby reducing referral to investigation wait-times. Method Retrospective data was collected from 23rd March to 8th May 2020 of new patient referrals consulted virtually in Urology outpatient clinics. Referrals were grouped into categories of presentation and outcome. Results 642 new patients were consulted virtually during the study period. 181 (28.1%) had further imaging requested; of these, the presentations with the greatest proportion of patients with this outcome were those referred with imaging findings (50%), UTI/cystitis (43.1%) and scrotal symptoms (34.3%). 116 patients (18.1%) were added to the waiting list for procedures; 85 were for flexible cystoscopy, for which the commonest indications were UTI/cystitis (36; 55.4%) and haematuria (15; 55.5%). Conclusions Certain urological presentations can be triaged straight to investigation by when directly referred from Primary Care, thus reducing referral to investigation wait-time and increasing outpatient protocol efficiency.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

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