Preconsultation exchange in the United States: use, awareness, and attitudes.
OBJECTIVE
Demand for specialty care exceeds supply in many healthcare systems in the United States. Preconsultation exchange has the potential to increase access to specialty care, and increase its timeliness and efficiency, by triaging need and urgency and streamlining the previsit workup. We sought to characterize attitudes toward, use of, and concerns regarding preconsultation exchange among US internists.


METHODS
Prospective cross-sectional survey.


METHODS
We administered a Web-based survey to a large national panel of US internists maintained by the American College of Physicians.


RESULTS
Response rate was 55% (N=451) with minimal differences between responders and nonresponders. Of responders, only 13% were initially familiar with the term "preconsultation exchange," but once defined, 28% were classified as frequent users, 40% as occasional users, and 32% as rare/never users. Internists used preconsultation exchange to: guide the prespecialty visit workup (78%), answer clinical questions without a patient visit to the specialist (71%), triage referral urgency (67%), and transfer referrals to a more appropriate specialty (47%). Responders supported multiple benefits of preconsultation exchange, but also reported concerns regarding reimbursement, liability, physicians taking personal responsibility for patient care, and inadequate exchange of clinical information. Compared with primary care physicians, specialists recognized more benefits of preconsultation exchange, but also expressed more concerns. The majority of responders reported increased willingness to use preconsultation exchange if specific remedies were applied.


CONCLUSIONS
Most US internists participate in preconsultation exchange and agree with its potential benefits. However, important concerns and barriers exist. Methods to reduce barriers to preconsultation exchange should be identified.
San Francisco General Hospital, Division of Gastroenterology, 1001 Potrero Ave, Unit NH 3D3, San Francisco, CA 94110. E-mail justin.sewell@ucsf.edu.
Justin L
JL
Sewell
Katherine S
KS
Telischak
Lukejohn W
LW
Day
Neil
N
Kirschner
Arlene
A
Weissman
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003625:Data Collection; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States