Trial reportJournal of general internal medicine2020
Impact of an Opt-In eConsult Program on Primary Care Demand for Specialty Visits: Stepped-Wedge Cluster Randomized Implementation Study.
Trial report in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Telemedicine and artificial intelligence in family medicine practice: a systematic review and meta-analysis of barriers and enablers in routine primary care.Frontiers in digital health · 2026Pooled it
- "I Am Reluctant to Continue, Yet Know She Could Go into Withdrawal": A Qualitative Analysis of Clinician Requests for eConsults in Opioid Management in the Ambulatory Setting.Journal of general internal medicine · 2026Article
- Implementation of a stroke/TIA e-consult increases outpatient stroke Teleneurology consults placed in VHA compared to community care.Frontiers in health services · 2026Article
- Formalizing the curbside: digitally enhancing access to specialty care.Proceedings (Baylor University. Medical Center) · 2023Article
- Identifying Content Themes in Primary Care Physician and Rheumatologist Communications Within Electronic Consultations: A Qualitative Study.ACR open rheumatology · 2021Article
- Medical student remote eConsult participation during the COVID-19 pandemic.BMC medical education · 2021Article
- Responding to the Call: a New JGIM Area of Emphasis for Implementation and Quality Improvement Sciences.Journal of general internal medicine · 2020Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundeConsult programs have been instituted to increase access to specialty expertise. Opt-in choice eConsult programs maintain primary care physician (PCP) autonomy to decide whether to utilize eConsults versus traditional specialty referrals, but little is known about how this intervention may impact PCP eConsult adoption and traditional referral demand.
objectiveWe assessed the feasibility of implementing an opt-in choice eConsult program and examined whether this intervention reduces demand for in-person visits for primary care patients requiring specialty expertise.
designStepped-wedge, cluster randomized trial conducted from July 2018 to June 2019.
participantsSixteen primary care practices in a large, urban academic health care system.
interventionOur intervention was an opt-in choice eConsult available in addition to traditional specialty referral; our implementation strategy included in-person training, audit and feedback, and incentive payments. MAIN MEASURES: Our implementation outcome measure was the eConsult rate: weekly proportion of eConsults per PCP visit at each site. Our intervention outcome measure was traditional referral rate: weekly proportion of referrals per PCP visit at each site. We also assessed PCP experiences with questionnaires. KEY
resultsOf 305,915 in-person PCP visits, there were 31,510 traditional referrals to specialties participating in the eConsult program, and 679 eConsults. All but one primary care site utilized the opt-in choice eConsult program, with a weekly rate of 0.05 eConsults per 100 PCP visits by the end of the study period. The weekly rate of traditional referrals was 11 per 100 PCP visits at the end of the study period; this represents a significant increase in traditional referral rate after implementation of eConsults. PCPs were generally satisfied with the eConsult program and valued prompt provider-to-provider communication.
conclusionsImplementation of an opt-in choice eConsult program resulted in widespread PCP adoption; however, this did not decrease the demand for traditional referrals. Future studies should evaluate different strategies to incentivize and increase eConsult utilization while maintaining PCP choice.
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