Improved appropriateness of electronic consultations in primary care with ongoing liver disease education

Abstract

Introduction

This study evaluates the short-term impact of two educational strategies on the appropriateness of electronic consultations (e-consults) submitted by primary care physicians (PCPs) to hepatologists for chronic liver disease (CLD) management. We compared a synchronous education program delivered in-person and online by hepatologists with an asynchronous approach based on e-consult feedback.

Methods

We conducted a 24-month prospective observational cohort study, analyzing e-consults related to the most prevalent CLD submitted by 326 PCPs to 10 hospital-based specialists in the Department of Gastroenterology and Hepatology. E-consults were categorized into three consecutive 8-month periods based on PCPs’ training exposure: Group I (no training), Group II (synchronous continuing medical education) and Group III (asynchronous education via e-consult feedback).

Results

A total of 9934 consecutive e-consults were analyzed, which 663 pertained to CLD cases, submitted by 205 (63%) of 326 eligible PCPs, involving 629 patients (median age: 55 years; 61.8% male). Overall, 68% of e-consults were deemed appropriate, with 58.2% resulting in a specialist care appointment. Appropriateness significantly improved following both synchronous and asynchronous training compared to the pre-training period (75.2% vs. 69.1% vs. 60.1%; p < 0.05). E-consults submitted by trained PCPs were significantly more likely to be appropriate (OR = 2.001; 95% CI: 1.360–2.946; p < 0.001).

Conclusion

Both synchronous and asynchronous training significantly improved e-consult appropriateness and reduced unnecessary referrals. Asynchronous education via e-consult feedback emerged as a practical and effective alternative. These findings underscore the importance of educational programs in optimizing e-consult utilization, warranting further research on long-term impacts.