TOPLINE:

An electronic consultation (eConsult) program that enabled primary care providers to consult with rheumatology specialists improved access to rheumatology care, with 75% of internal consultations provided at the hospital network completed electronically without in-person consultation and 73% of these completed within 3 days.

METHODOLOGY:

• An eConsult is an asynchronous electronic consultation between a primary care provider and a specialist, allowing the specialist to quickly offer advice on evaluation and management.
• Researchers used data from electronic health records and Medicaid claims to evaluate the impact of an eConsult program on access to and quality of rheumatology care and healthcare utilization within the University of Colorado Hospital network.
• They included 10,433 traditional referrals (26.8% male recipients) and 670 eConsults (29.1% male recipients) for rheumatology consultation between 2018 and 2022. The eConsults were divided into 595 internal referrals from providers within the hospital network and 75 external referrals from partner clinics.
• Referral providers were either from primary care or another specialty. Outcome measures included referral completion rates and time to completion, rates of disease-modifying therapy initiation for rheumatoid arthritis, and rates of healthcare utilization such as emergency department or hospital visits.
• Semistructured interviews were conducted with six members of the eConsult team to identify perceived successes, barriers, and areas for improvement in the eConsult program.

TAKEAWAY:

• Osteoarthritis was the most common reason for both eConsults and traditional referrals. Overall, 75% of internal eConsults were completed electronically without in-person follow-up, and 73% of these were completed within 3 days.
• Compared with traditional referrals, eConsults converted to traditional referrals had significantly higher completion rates at 90 days (26% vs 11%) and 180 days (36% vs 20%; P < .001 for both).
• Among patients with an associated rheumatoid arthritis diagnosis, initiation of disease-modifying antirheumatic drugs occurred in 72.7% of those with completed eConsults within 30 days and in 31.4% of those with traditional referrals completed within 180 days.
• Among patients with Medicaid, 10% of eConsult recipients and 16.8% of traditional referral recipients visited the emergency department for a rheumatology-related condition within 60 days of referral. Rheumatology team members stated that eConsults were functioning effectively and suggested increasing their use in primary care.

IN PRACTICE:

“eConsults resulted in more timely provision of specialty care or advice to patients compared to traditional referrals,” the authors wrote. “The rheumatology eConsult program described in this study successfully delivered rheumatology specialty care to patients in urban and resource-limited settings, with primary care providers receiving actionable recommendations within 72 hours in the vast majority of cases,” they added.

SOURCE:

This study was led by Sarah J. Billups, PharmD, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado. It was published online on November 28, 2025, in Arthritis Care & Research.

LIMITATIONS:

Data for external eConsult recipients were missing. The study design was nonrandomized. The analysis focused on quality improvement and program evaluation, thereby limiting the generalizability of the findings. 

DISCLOSURES:

The study received funding from the Centers for Medicare & Medicaid Services. One author reported being supported by the Rheumatology Research Foundation. Some authors reported receiving research support, grants, honoraria, consulting fees, travel reimbursements; having a patent with no royalties; or holding other ties with various organizations including the funding source.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.