# Examining the Role of a Comprehensive eConsult System to Enhance Access to Nephrology Care

## TL;DR

A comprehensive eConsult system helps improve access to nephrology care by resolving nearly half of consult requests without needing in-person appointments.

## Contribution

The study demonstrates how a comprehensive eConsult system can enhance nephrology care accessibility in underserved populations.

## Key findings

- Nearly half of eConsults were resolved without scheduling a nephrology appointment.
- Management-related eConsults were more likely to result in appointments compared to diagnostic or medication-related ones.
- CKD, proteinuria, and hypertension were the most common topics addressed through eConsults.

## Abstract

A stagnant US nephrology workforce and rising chronic kidney disease (CKD) prevalence underscore the need for improved nephrology expertise accessibility. We examined nephrology consultation patterns in one health care setting with a comprehensive eConsult program in which all specialty care requests are initiated via eConsult. Results may inform the development of interventions to better support referring clinicians.

A cross-sectional study examining a random sample of ambulatory nephrology eConsults (12.8%, n = 450/3,514) submitted January 1, 2020 to December 31, 2023.

A publicly funded institution providing health care services to residents of San Francisco, California.

Characteristics of eConsults, including clinical question type (ie, management, diagnosis, and medication safety), inquiry topics (ie, CKD, proteinuria, and hypertension) and referring provider (ie, MD/DO or advanced practice provider).

Disposition of eConsults (ie, not scheduled for nephrology visit, scheduled immediately after eConsult review, or scheduled after asynchronous dialogue between referring provider and nephrologist reviewer).

Univariate and multivariable logistic regression models (adjusted for patient age, sex, and kidney function) assessed associations between eConsult characteristics and disposition, defined as a binary outcome (scheduled vs not scheduled).

Nearly half of eConsults (47%, n = 211) were resolved without nephrology appointments. Of the eConsults, 31% (n = 139) were scheduled immediately and 22% (n = 100) after consultative dialogue. CKD (53%, n = 239), proteinuria (26%, n = 115), and hypertension (17%, n = 75) were the most queried topics. Compared with diagnostic submissions, management-related eConsults were more likely to be scheduled (adjusted OR, 2.07; 95% CI, 1.25-3.45), whereas medication-related questions were less likely to be scheduled (adjusted OR, 0.14; 95% CI, 0.03-0.64).

Generalizability of findings is limited by the single-center design.

By resolving nearly half of consult requests asynchronously, eConsult can enhance nephrology expertise accessibility for populations experiencing high CKD burden and limited availability of synchronous nephrology care.

Access to nephrology care is limited in the United States, particularly in safety-net health systems that serve uninsured and underinsured populations. To inform the development of interventions to better support referring clinicians and improve accessibility of nephrology care, we examined nephrology consultation patterns in one health care delivery system that uses a comprehensive eConsult platform in which all specialty consultation requests are initiated with an eConsult. We found that nearly half of nephrology eConsults were resolved without the scheduling of a nephrology appointment, including consultation requests about CKD diagnostic approaches and medication safety. With triaging and educational functionalities, a comprehensive eConsult program may enhance timely access to nephrology care in low-income populations.