eConsult Communications Reveal the Common Questions from Primary Care Physicians about Rheumatology Care

ATLANTA—Clear communication with primary care physicians (PCPs) can be key to supporting timely care for patients with inflammatory conditions. However, knowledge gaps among PCPs about rheumatic diseases may delay patient diagnosis.

Recently, a team of rheumatologists began evaluating electronic consultation (eConsult) communications to more fully understand common misconceptions among PCPs. The goal was to determine PCP knowledge gaps and identify areas in need of clarification, according to the study’s lead author Ruchi Jain, MD, a rheumatologist at Montefiore Medical Center, Bronx, N.Y. Dr. Jain presented the preliminary findings of this research at the 2019 ACR/ARP Annual Meeting in November.¹

“Often, PCPs are on the front lines of patient care. By understanding rheumatic disease, they can deliver higher quality care, especially when there may be limitations to access, such as long wait times to see a rheumatologist,” Dr. Jain says.

In some situations, consult inquiry may be able to answer a simple question, without a patient undergoing an outpatient evaluation by a rheumatologist. eConsult can be used by a PCP to communicate electronically with a specialist, such as a rheumatologist, through a secure, web-based email, enabling the PCP to receive referral advice and to help the PCP choose the patient’s course of care and treatment. These interactions were the subject of investigation for this study, Dr. Jain explains.

A Closer Look at eConsult
To formally evaluate eConsult data for this study, Dr. Jain and colleagues performed a qualitative analysis of eConsult encounters that occurred between 2018 and 2019. Researchers used conventional content analysis to explore key themes in eConsult communications, including the questions and clinical histories of patients provided by PCPs and the recommendations provided by the consulting rheumatologist.

Often, when a patient is referred to a rheumatologist in the outpatient setting by a PCP through traditional channels, the referral form will just say “gout management” or “joint pain.” But through eConsult, “we can assess the clinical information provided by the PCP and see where the knowledge gaps truly are and tailor our recommendations to [enable] PCPs to take better care of their patients,” she says.

During this study, examples of PCP misconceptions and knowledge gaps included overdiagnosis of polymyalgia rheumatica (PMR), understanding the role of autoantibodies along with the usefulness of serological tests in patients with non-specific joint pains/arthralgias and differentiating between inflammatory and non-inflammatory arthropathy.

Some elements of the analysis surprised Dr. Jain, such as the amount of time PMR was given consideration as a diagnosis by PCPs.