320 - Impact of Store-and-Forward E-consults on Access to Pediatric Dermatologists, Appointment Attendance, and Treatment: A Retrospective Review

Publication Number: 1304.320

Jessica Hathaway, Columbia University, New York, NY, United States; Priya Pathak, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Melissa Stockwell, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Christine T. Lauren, Columbia University, New York, NY, United States

Background: Dermatologic conditions comprise nearly 30% of pediatric primary care visits, and pediatric dermatology has one of the longest wait times for specialist appointments. Store-and-forward e-consults (e-consults), where specialists asynchronously review records and provide recommendations directly to primary care providers (PCP), may improve access to dermatologic expertise.

Objective: To assess the impact of ambulatory e-consults on patient access to pediatric dermatology.

Design/Methods: We identified patients seen at pediatric practices in an ambulatory care network affiliate with an academic medical center from 2/1/2020 - 2/1/2024 that resulted in an e-consult and/or referral to outpatient dermatology. We also assessed whether diagnosis (atopic dermatitis (AD) vs other) was associated with need for FTF appointment after an e-consult, as well as factors associated with attending a scheduled dermatology visit, including whether there was a preceding e-consult. We also analyzed the impact of prior e-consults on wait times for face-to-face (FTF) dermatology visits. Statistical tests, including chi-square and independent t-tests, were conducted in SPSS.

Results: A total of 3794 pediatric primary care encounters resulted in a dermatologic consult or referral (757 e-consults and 3037 referrals for FTF dermatology without e-consults). Of the 757 with an e-consult, 67.0% had a FTF dermatology visit scheduled. Patients with an e-consult for AD had a higher FTF dermatology scheduling rate compared to those without an AD diagnosis (77.3% vs 64.3%, p=0.002) (Table 1) and were also more likely to attend those visits (66.6% vs 53.5%, p< 0.001) (Table 2). Of the 3105 total FTF visits scheduled, the overall attendance rate was 58.7%. Those with vs without a prior e-consult had higher show rates (66.9 vs. 55.9%, p < 0.001). The mean age of those who attended vs. did not attend visits was also younger (p < 0.001). The mean wait time for all attended FTF dermatology appointments was 102.7 days. The mean wait time was shorter for those with a prior e-consult (69.3 days (+/- 70.6) vs. those without an e-consult (110.5 days (+/- 71.5) (p < 0.001).

Conclusion(s): In this population, in one third of e-consults, a follow-up FTF dermatology visit was not needed. Further, those with a prior e-consult who ended up needing an FTF visit had reduced wait times, suggesting asynchronous access to a dermatologist and their recommendations may at times have rendered a specialist visit unnecessary and, in parallel, facilitated faster a closer follow up when indicated. Altogether, e-consults appeared to improve access to pediatric dermatology.

Patient characteristics for those with and without scheduled FTF dermatology appointments
Abbreviations: AD atopic dermatitis; AI American Indian; AN Alaskan Native; FTF Face-to-Face; NH Native Hawaiian; SO Spanish Origin; SD Standard Deviation

Patient characteristics by attendance to FTF dermatology appointment
Abbreviations: AD atopic dermatitis; AI American Indian; AN Alaskan Native; FTF Face-to-Face; NH Native Hawaiian; SO Spanish Origin; SD Standard Deviation