A qualitative investigation of uninsured patient and primary care provider perspectives on specialty care eConsults.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Medically Uninsured* ; Medicine*; Humans ; Primary Health Care ; Referral and Consultation ; Health Facilities ; Health Services Accessibility

Background: Uninsured and underinsured patients face specialty care access disparities that prevent them from obtaining the care they need and negatively impact their health and well-being. We aimed to understand how making specialty care electronic consultations (eConsults) available at a multi-site Federally Qualified Health Center (FQHC) in central Texas affected uninsured patients' care-seeking experiences and impacted their ability to receive the needed care.
Methods: We used concepts from Ecological Systems Theory to examine individual, interpersonal, organization-level, social, and health policy environment factors that impacted patients' access to specialty care and the use of eConsults. We conducted thematic analysis of semi-structured, qualitative interviews with patients about seeking specialty care while uninsured and with uninsured patients and FQHC PCPs about their experience using eConsults to obtain specialists' recommendations.
Results: Patients and PCPs identified out-of-pocket cost, stigma, a paucity of local specialists willing to see uninsured patients, time and difficulty associated with travel and transportation to specialty visits, and health policy limitations as barriers to obtaining specialty care. Benefits of using eConsults for uninsured patients included minimizing/avoiding financial stress, expanding access to care, expanding scope of primary care, and expediting access to specialists. Concerns about the model included patients' limited understanding of eConsults, concern about cost, and worry whether eConsults could appropriately meet their specialty needs.
Conclusions: Findings suggest that eConsults delivered in a primary care FQHC addressed uninsured patients' specialty care access concerns. They helped to address financial and geographic barriers, provided time and cost savings to patients, expanded FQHC PCPs' knowledge and care provision options, and allowed patients to receive more care in primary care.
(© 2023. BioMed Central Ltd., part of Springer Nature.)

Scientifica (Cairo). 2012;2012:432892. (PMID: 24278694)
BMC Med. 2019 Feb 15;17(1):25. (PMID: 30764806)
Ann Fam Med. 2020 Jan;18(1):35-41. (PMID: 31937531)
Telemed J E Health. 2020 Nov;26(11):1383-1390. (PMID: 32023182)
Healthc (Amst). 2017 Mar;5(1-2):40-45. (PMID: 27469441)
Milbank Q. 2011 Mar;89(1):39-68. (PMID: 21418312)
Natl Health Stat Report. 2022 Feb;(169):1-15. (PMID: 35166656)
BMC Health Serv Res. 2021 Sep 6;21(1):920. (PMID: 34488758)
Cochrane Database Syst Rev. 2018 Jul 19;7:CD006732. (PMID: 30025154)
JAMA Health Forum. 2021 May 21;2(5):e210456. (PMID: 35977310)
Am J Manag Care. 2018 Jan 1;24(1):e9-e16. (PMID: 29350511)
Am Soc Clin Oncol Educ Book. 2021 Mar;41:25-36. (PMID: 34010056)
Health Aff (Millwood). 2017 Mar 1;36(3):492-499. (PMID: 28264951)
Mayo Clin Proc. 2014 Oct;89(10):1416-26. (PMID: 24889514)
Telemed J E Health. 2019 Mar;25(3):184-198. (PMID: 29927711)
BMC Health Serv Res. 2019 Dec 18;19(1):974. (PMID: 31852493)
J Am Med Inform Assoc. 2020 Mar 1;27(3):471-479. (PMID: 31621847)
Fam Med. 2017 Feb;49(2):91-96. (PMID: 28218933)
J Telemed Telecare. 2019 Sep;25(8):493-498. (PMID: 29991315)
J Health Care Poor Underserved. 2022;33(2):779-789. (PMID: 35574876)
Rural Remote Health. 2016 Jan-Mar;16(1):3440. (PMID: 26745338)
Cult Med Psychiatry. 2017 Mar;41(1):161-180. (PMID: 28025774)
Milbank Q. 2005;83(3):457-502. (PMID: 16202000)
BMC Med Res Methodol. 2013 Sep 18;13:117. (PMID: 24047204)
Milbank Q. 2022 Jun;100(2):504-524. (PMID: 35411969)
J Gen Intern Med. 2022 Feb;37(2):459-466. (PMID: 34845581)
BMJ Glob Health. 2019 Sep 13;4(5):e001629. (PMID: 31565409)
Am J Prev Med. 2021 Oct;61(4):492-500. (PMID: 34229931)
Ann Fam Med. 2016 Mar;14(2):133-40. (PMID: 26951588)
J Am Acad Dermatol. 2018 Feb;78(2):293-302. (PMID: 29061478)
BMJ Open. 2016 Jun 23;6(6):e010920. (PMID: 27338880)
Arch Intern Med. 2012 Jan 23;172(2):163-70. (PMID: 22271124)
Health Aff (Millwood). 2018 Dec;37(12):2031-2036. (PMID: 30633678)
JAMA Intern Med. 2018 Jun 1;178(6):782-789. (PMID: 29801079)

N/A St David's Foundation

Keywords: Access to Care; Health Disparities; Patient perspectives; Primary care; Provider perspectives; eConsults

Date Created: 20231020 Date Completed: 20231031 Latest Revision: 20231123

20231123

PMC10589958

10.1186/s12913-023-10086-6

37864170