Abstract
Timely access to diabetes specialty care is often limited by resources, especially within a safety-net health system serving a large under/un-insured and ethnically diverse patient population. Implementation of a diabetes electronic consultation (e-consult) service offers several potential benefits, including timely access to diabetes specialists' input, improvement in patients' glycemic control, decreased need for in-person referral or visit (a potential benefit to patients and providers) , and an opportunity to support primary care providers with targeted education. We performed a retrospective electronic medical record review of completed diabetes e-consults within a 3-year period (2018-2021) at a large safety-net health system in Dallas, TX to determine the effectiveness of e-consult service. A total of 277 e-consult encounters were completed for 266 patients (age 52.8±12 years, 65% female, 46% Hispanic, 56% Caucasian, 39% Black, 91% with type 2 diabetes) . The average specialist response time following an e-consult request was 2 days, with recommendations fully or partially implemented for 78% of the e-consults. For the 145 patients with reliable hemoglobin A1c (HgbA1c) data at baseline and within 6 months, the HgbA1c improved from an average of 10.1±2.1% to 9.3±1.8% (paired t-test, p=<0.05) , with an average HgbA1c change of -0.7±1.8%. Only 51% of these patients were subsequently referred for in-person diabetes clinic visit. Moreover, review of the e-consults questions helped identify common knowledge gaps in diabetes care among the primary care providers, and led to the development of monthly educational webinar series for primary care providers. In conclusion, implementation of diabetes e-consult service improved timely access to diabetes specialty care as well as patients' glycemic control, and also created an educational opportunity to improve overall diabetes care within a large safety-net health system.