Enhancing Pediatric Specialty Care Access Through E-Consults

Access to pediatric specialty care has become a pressing issue due to a nationwide shortage of specialists, which often results in extended waiting periods for children needing timely medical attention. A recent study published in Clinical Pediatrics has revealed that e-consults, a system that allows primary care pediatricians to communicate directly with specialists, can significantly enhance care for young patients.

E-consults function as secure, asynchronous consultations facilitated through the hospital's electronic health record (EHR) system. This mechanism enables primary care providers to engage in discussions regarding a patient's care with specialists, allowing them to relay important recommendations back to families without necessitating in-person consultations.

According to Ulfat Shaikh, a pediatric professor at UC Davis Health, the shortage of pediatric specialists can result in detrimental wait times and health outcomes, particularly for children with complex chronic conditions. By utilizing e-consults, primary care physicians can obtain second opinions from specialists, thereby reducing the burden of in-person appointments on families.

The research conducted at UC Davis Health's pediatric clinic, which serves around 2,800 children and adolescents annually, focused on improving awareness and utilization of e-consults. During the study period from January to December 2023, pediatricians made consult requests across various specialties, including allergy and immunology, dermatology, endocrinology, gastroenterology, infectious diseases, nephrology, and pulmonology.

One of the key objectives was to increase the adoption of e-consults, which had been in place at UC Davis Health since 2014 but had not reached its full potential. The research team undertook multiple initiatives to educate and engage clinicians about the advantages of this service. They collaborated with specialists to develop tailored e-consult protocols, which were then communicated to pediatric primary care physicians. Furthermore, adjustments were made to the EHR's referral options to remind physicians of the availability of doctor-to-doctor consultations.

The impact of these initiatives was significant. The rate of e-consult usage rose from 14% to 43%. During the study, a total of 65 e-consults were recorded, predominantly concerning conditions such as skin eruptions, infantile hemangiomas, alopecia, and seizures, with dermatology receiving the highest number of consults. Notably, specialists responded to these consultations within an average of one day, in stark contrast to the average 59-day wait for in-person appointments.

In addition to quantitative data, the research team conducted interviews with primary care pediatricians, specialists, and referral coordinators to gain insights into their experiences with e-consults. The findings indicated that these consultations offered significant benefits for all parties involved. Families saved time and resources, as e-consults reduced the need for travel and time away from work and school. Primary care physicians received timely advice, which empowered them to provide enhanced care, while specialists could utilize e-consults to order necessary diagnostic tests before in-person visits, streamlining the overall process.

Given UC Davis Health's extensive rural service area, e-consults represent a vital resource that minimizes the need for families to undertake long journeys for specialist appointments. The study underscores the effectiveness of e-consults in facilitating timely access to pediatric specialty care, improving overall health outcomes and healthcare delivery efficiency.

For further details, refer to the study titled Implementing Electronic Consultations to Increase Pediatric Specialty Access published in Clinical Pediatrics.