title: Providing specialty consultant expertise to primary care: an expanding spectrum of modalities.
abstract: In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.
authors.affiliation: Office of Specialty Care, Veterans Health Administration, Washington, DC; Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Kirsh
authors.affiliation: Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Eastern Colorado Health Care System Medical Center, Aurora, CO; Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, CO.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Organizational Behavior, Weatherhead School of Management, Cleveland, OH. Electronic address: david.aron@va.gov.
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
mesh_terms: D003253:Consultants / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D017216:Telemedicine / Q000379:methods*; D014481:United States