title: Veteran, primary care provider, and specialist satisfaction with electronic consultation.
abstract: BACKGROUND
  Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access.
  
  
  OBJECTIVE
  The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceived facilitators and barriers to using the e-consult program.
  
  
  METHODS
  We conducted semistructured telephone interviews with veteran patients (N=15), Community Based Outpatient Clinic (CBOC) PCPs (N=15), and VA Pittsburgh specialty physicians (N=4) who used the e-consult program between December 2009 to August 2010. Participants answered questions regarding satisfaction in eight domains and identified factors contributing to their responses.
  
  
  RESULTS
  Most participants were white (patients=87%; PCPs=80%; specialists=75%) and male (patients=93%; PCPs=67%; specialists=75%). On average, patients had one e-consult (SD 0), PCPs initiated 6 e-consults (SD 6), and VAPHS specialists performed 17 e-consults (SD 11). Patients, PCPs, and specialty physicians were satisfied with e-consults median (range) of 5.0 (4-5) on 1-5 Likert-scale, 4.0 (3-5), and 3.5 (3-5) respectively. The most common reason why patients and specialists reported increased overall satisfaction with e-consults was improved communication, whereas improved timeliness of care was the most common reason for PCPs. Communication was the most reported perceived barrier and facilitator to e-consult use.
  
  
  CONCLUSIONS
  Veterans and VA health care providers were satisfied with the e-consult process. Our findings suggest that while the reasons for satisfaction with e-consult differ somewhat for patients and physicians, e-consult may be a useful tool to improve VA health care system access for rural patients.
authors.affiliation: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States. keri.rodriguez@va.gov.
authors.forename: Keri L
authors.identifier: http://orcid.org/0000-0002-1477-3659
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Kelly H
authors.identifier: http://orcid.org/0000-0002-5044-2814
authors.initials: KH
authors.lastname: Burkitt
authors.forename: Nichole K
authors.identifier: http://orcid.org/0000-0003-3171-4850
authors.initials: NK
authors.lastname: Bayliss
authors.forename: Jennifer E
authors.identifier: http://orcid.org/0000-0002-0509-7214
authors.initials: JE
authors.lastname: Skoko
authors.forename: Galen E
authors.identifier: http://orcid.org/0000-0001-8541-9449
authors.initials: GE
authors.lastname: Switzer
authors.forename: Susan L
authors.identifier: http://orcid.org/0000-0002-1752-9811
authors.initials: SL
authors.lastname: Zickmund
authors.forename: Michael J
authors.identifier: http://orcid.org/0000-0003-3470-9846
authors.initials: MJ
authors.lastname: Fine
authors.forename: David S
authors.identifier: http://orcid.org/0000-0003-2718-7138
authors.initials: DS
authors.lastname: Macpherson
keywords: access; patient satisfaction; referral and consultation; rural health; veterans