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eConsults: An essential piece of telehealth for chronic care management


eConsults are especially vital during the COVID-19 pandemic.

Across the United States, healthcare resources at all levels are being directed toward fighting the COVID-19 pandemic. While this has resulted in encouraging progress, many non-coronavirus patients are finding it difficult to access care due to limited available resources, while others avoid seeking in-person medical treatment for fear of exposure to the virus.

This trend is especially concerning among patients in need of chronic care, who account for 76% of all physician visits. For those with chronic diseases, failure to access care can lead to high-acuity care episodes, a situation that is dangerous and disruptive to patients, in addition to being costly for patients, payors, and providers alike.

To avoid these negative outcomes, and to preserve specialist availability and critical health care resources, health care organizations must find ways to provide safe access to primary care for patients with chronic conditions. One potential avenue for providing this care is through the use of eConsults and other forms of telehealth for chronic care management.

With eConsults, PCPs can provide virtual access to specialist-guided care, replacing the need for face-to-face specialist visits over 70% of the time, and triaging cases to ensure only the highest-acuity patients are referred for in-person appointments. This means patients with chronic conditions can continue to receive care in a safe environment, improving patient outcomes and mitigating a backlog of more urgent care that becomes necessary when untreated conditions worsen.

Coronavirus is further interfering with access to care

The novel coronavirus pandemic has exacerbated several already significant barriers to accessing care. In an article from ABC News, health officer and internist Dave Chokshi, MD, states that, “Even before COVID-19, we knew there were patients we do not see, whether because of financial barriers, racism, fear related to immigration status, or social isolation. [...] But now, that is compounded by additional barriers to seeking care, which span physical and technological challenges as well as concern about becoming infected with COVID-19.”

Regarding patients hesitant to seek care due to fear of exposure to the virus, the data are striking: from February to April we see a sharp and significant drop in the number of ambulatory visits. From April this number begins to rise, but remains roughly one-third lower than what was seen before the pandemic.

In addition, many other barriers to specialist care—such as financial, childcare, and transportation—have been heightened due to job losses, school closures, and stay-at-home orders. On the provider side, many specialists are not taking patients during the pandemic. Meanwhile, others are overbooked even more than usual due to their critical role in combating the pandemic.

Chronic care needs still must be addressed

While stay-at-home orders are important for reducing infections, patients with chronic illnesses must still be able to receive care to avoid severe negative outcomes. According to AristaMD user Maria Barrell, DO, via PatientEngagementHIT, “Patients with a chronic illness who do not continually make key wellness checks could see their disease states deteriorate, launching into an acute care crisis.” Such crises can be costly, risky, and even fatal to those with chronic diseases, and providing care for such patients is critical to their wellbeing.

Such care is also important if health systems are to avoid being overwhelmed. In 2014 Rand Corporation found 60% of US adults had at least one chronic condition. On average, Americans with five or more chronic conditions spend 14 times more on health services than people with no chronic conditions.

Increased acute health crises due to chronic patients not receiving care could therefore result in subsequent surges in ED visits as a downstream effect, with these admissions both taking over critical hospital and healthcare setting capacity amidst COVID-19, as well as contributing to a significant backlog of patients seeking care as the healthcare system is met with a second surge of patients following the height of COVID-19.

“I am worried about hidden illness due to foregone care, and how this might contribute to a ‘second wave’ related to this pandemic,” Chokshi says.

eConsults support chronic care management for PCPs

eConsults are a powerful tool that can support PCPs in providing patients with access to high-quality specialist care within the primary care setting. They can replace the need for a face-to-face visit more than 70 percent of the time for routine referrals, and telehealth technology easily provides support for routine chronic care management such as check-ins and medication adjustments. Further, eConsults offer a method of remotely triaging to confirm which patients are high-acuity and therefore need to see specialists in person. For health organizations and medical centers already leveraging telemedicine to see patients, eConsults enable PCPs to provide necessary specialty care entirely through virtual means.

Implementing an eConsult system results in several short-term benefits amid the COVID-19 pandemic. PCPs can provide quick access to proactive care, resulting in improved patient health and higher overall satisfaction. This is especially true for those with chronic conditions; it’s been demonstrated that proactive care, especially primary care, is effective in reducing the burden of chronic conditions and improving outcomes for such patients.

As a further benefit, providing access to treatment and chronic care management through telehealth mitigates the need for patients to resort to emergency care in settings that are likely impacted with COVID-19 patients, helping reduce the risk of chronic patients being exposed to the virus.

Finally, eConsults can help to optimize specialist appointment queues, reducing wait times following the pandemic when specialists begin taking patients once more and experience a surge of patients with unmet needs.

Even amidst this healthcare crisis, patients with chronic diseases cannot be ignored. This population continues to need proactive, accessible care if their conditions are to be well-managed, and failure to do so will only exacerbate future healthcare strain. eConsults are a promising tool demonstrating the value of telehealth for remote chronic care management, equipping primary care providers to see patients virtually, provide specialty patient care remotely, and to do all of this in a timely manner.

The COVID-19 pandemic is testing healthcare organizations at all levels, prodding at weak points and forcing decision-makers to answer difficult questions about the interaction between providers and patients and how to best equip health systems to respond to crises. While the answers to many of these questions are not quite clear, what does seem certain is that very little will remain the same in healthcare in the coming years—and organizations willing to adapt and remain on the cutting edge will be the ones driving the industry forward as we overcome this healthcare crisis.

Ed Cladera, MD is medical director of AristaMD.

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