Background : Electronic consultations (eConsults) provide asynchronous, store-and-forward communication between primary care clinicians (PCCs) and specialists using web-based platforms, electronic health records or mobile applications. eConsults have demonstrated benefits in many areas of patient management including educational value for PCCs. It has been shown that few PCCs have knowledge and confidence to manage Transgender and Gender Non-Binary (TGNB) patients, particularly in safety net settings and rural practices. In this study, we explored the impact of eConsults submitted to the TGNB specialist panel on PCC experience based on PCC-reported eConsult outcomes.
Methods : We conducted a retrospective study analysis using registry data from the RubiconMD electronic consultation platform used by PCCs in 35 US states for eConsults submitted to the TGNB specialist panel. PCCs were asked to select one or more of the following options after each eConsult: improved care plan, educational, avoided unnecessary services, or no effect.
Results : 4 TGNB specialists at Callen-Lorde responded to 57 eConsults over 20 months from 11 states. 89.5% of eConsults were from community clinics, Federally Qualified Health Centers, and rural areas- settings where an in-person consultation with a TGNB specialist is unlikely to have been an easily accessible and timely option. The top three clinical topic categories included hormone therapy (initiation, titration, side effect management, and drug-drug interaction management), gender-affirming surgery, and behavioral health. PCCs reported a positive experience with an average rating on their satisfaction with the eConsult of 4.89 out of 5. PCCs reported outcomes as “improved care plan” for 87.5% of eConsults, “educational” for 50% of eConsults, and “avoided unnecessary services” in 29.2% of eConsults.
Conclusions : Access and delivery of TGNB care have been greatly enhanced through PCCs using eConsults. In half of the cases, PCCs reported that the eConsult was educational and in close to one-third of the cases, the eConsult avoided unnecessary diagnostics/procedures, avoided a referral altogether or avoided a referral to the wrong specialty. Also, the majority of eConsult submissions resulted in an improved care plan for the patient. These results suggest that eConsults play an important role in educating PCCs on TGNB care and may also lead to improved PCC and patient experience.