Informal consultations provided to general internists by the gastroenterology department of an HMO.
OBJECTIVE
To study the process, outcomes, and time spent on informal consultations provided by gastroenterologists to the primary care general internists of an HMO.


METHODS
Observational study.


METHODS
A large, urban staff-model HMO.


METHODS
Seven gastroenterologists constituting the total workforce of the gastroenterology department of the HMO.


RESULTS
Data on 91 informal consultations were obtained, of which 55 (60%) involved the acute management of a patient with new symptoms or test results, and 36 (40%) were for questions related to nonacute diagnostic test selection or medical therapy. Questions regarding patients previously unknown to the gastroenterology department accounted for 74 (81%) of the consultations. Formal referral was recommended in only 16 (22%) of these cases. As judged by the time data gathered on the 91 consultations, the gastroenterologists spent approximately 7.2 hours per week to provide informal consultation for the entire HMO.


CONCLUSIONS
Gastroenterologists spend a significant amount of time providing informal consultation to their general internist colleagues in this HMO. The role informal consultation plays in the workload of physicians and in the clinical care of populations is an important question for health care system design, policy, and research.
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Mass, USA.
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SD
Pearson
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Moreno
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Y
Trnka
D001900:Boston; D005762:Gastroenterology; D006279:Health Maintenance Organizations; D006801:Humans; D007388:Internal Medicine; D010043:Outcome and Process Assessment, Health Care; D012017:Referral and Consultation; D013997:Time Factors; D016526:Workload