Physician-to-physician universal electronic consultation program (e-consultation) in a Cardiology Department: Impact on elapsed time to cardiology care and cardiovascular outcomes

Abstract Background Many health systems have initiated electronic consultation programs, although little is known about their impact on accessibility, safety and satisfaction. In 2019, we began to analyse our model1. The first results showed that it was an efficient model2 and safe, with a reduction in emergency department visits, mortality and hospitalization3. In the last 3 years we have live a lot of changes. In one hand, all models need a continuous evaluation of their results, and confirm that the outcomes are similar to the beginning. In the other hand, we lived a world pandemic and our health models have changed in these years. In an e-consultation, the Primary Care Physician, who referred the patient, uses the shared electronic records and the Cardiologist who answer also uses the same electronic records to review all the clinical information and to send an answer. The Cardiologist can resolve directly the referral or to make an appointment with the patient in person in cases where it is necessary4. Purpose The aim of this study is to assess the clinical impact of the implementation of a model of ambulatory care that includes an initial electronic consultation (e-consultation), comparing it with a face-to-face single act model. Methods We selected patients with at least one visit to the Cardiology Service between 2010 and 2021. Using an interrupted time series regression model, we analysed the impact of incorporating the e-consultation into the healthcare model (started in 2013), evaluating: waiting time for care, hospitalizations and mortality in the first year. Results We analysed 61,306 patients: 66,0% attended by incorporating the e-consultation and 34,0% in the one-time face-to-face consultation model. The delay time for care in the e-consultation model (mean [SD]: 8.4 days [9.1]) was shorter than in the face-to-face model (mean [SD]: 50.6 days [72.2]), p < 0.001. The regression model for interrupted time series showed that the incorporation of e-consultation contributed a very important decrease in the delay of attention, remaining around 8 days, although with slight oscillations. The e-consultation model represented a reduction in hospitalizations (iRR [95%CI]: 0.635 [0.635-0.641]), cardiovascular hospitalizations (iRR [95%CI]: 0.857 [0.846-0.868]), Figure 1, mortality (iRR [95%CI]: 0.936 [0.923-0.951]) and cardiovascular mortality (iRR [95%CI]: 0.979 [0.964-0.996]), Figure 2. Conclusions An outpatient care program that includes an e-consultation has shown to reduce waiting times significantly and is a safe model with a lower rate of hospitalizations and mortality in the first year.Figure 1Figure 2