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• W4379523003 abstract "Background Antinuclear antibodies (ANA) are autoantibodies associated with several autoimmune diseases but are also present in healthy individuals due to their role in the body’s biological immune response. Thus, testing for ANA in an ambulatory setting could be inappropriately ordered and misinterpreted. Yet, delay in proper management of patients with rheumatologic presentations could result in increased morbidity and health care expenditure. Electronic consultation, or eConsults, could be utilized by primary care providers (PCPs) as a convenient tool to expedite access to rheumatology specialists and optimize care. Objectives To assess the efficacy of eConsults in terms of resource utilization and time to referral when compared to in-person referrals of ANA+ patients. Methods In this retrospective cohort study, we reviewed the charts of 131 ANA+ patients within the Yale New Haven Health System seen from August 2019 to September 2022. The charts were divided into cases referred by eConsult and by in-person referrals. Time from chart order to eConsult or in-person consultation, diagnosis after consult completion, and laboratory workup results were evaluated. Relative risks (RR) were calculated to compare the efficacy of eConsults vs. in-person referrals in diagnosing connective tissue diseases (CTD) and initiating appropriate referrals. A chi-square test of independence was conducted to determine if there was an association between ESR/CRP levels and conversion to in-person follow-up appointments in eConsult patients. Results Among the 131 ANA+ patients seen by their PCPs, 91 (69.5%) were referred through eConsult and 40 (30.5%) were in-person referrals to a rheumatologist. The average time from the initial eConsult request to completion of the consult was 1.46 ± 2.54 days while in-person consults required longer wait times of 76.63 ± 48.61 days. Figure 1. Flow Diagram of ANA+ patients referred for eConsult and In-person Rheumatology specialty clinic Of the 91 eConsult patients, 44 (48.4%) were converted to face-to-face (FTF) consultation with a rheumatologist. Patients evaluated through eConsults were less likely to be referred to a rheumatologist (RR = 0.61, 95% CI 0.46 – 0.80) when compared to in-person referrals. Patients referred through eConsults were twice as likely to be diagnosed with CTD relative to those that were not scheduled for an FTF visit after an eConsult was completed (RR = 2.49, 95% CI 1.28 – 4.84). For the converted patients, 21 (47.7%) were diagnosed with CTD. For those that did not convert to a FTF referral, only 9 (19.1%) were eventually diagnosed with a CTD. Of the 40 in-person patient referrals, 31 (77.5%) were scheduled to follow-up with a rheumatologist; the majority of which (N = 30, 96.8%) were ultimately diagnosed with CTD. Elevated ESR/CRP levels were found in 19 (43.2%) eConsult patients that had converted and 16 (34%) patients that did not convert to FTF. For eConsult patients, there was no significant relationship found between ESR/CRP levels and conversion to a FTF appointment (χ 2 (1, N = 74) = 3.299, p = 0.07). Conclusion Electronic consultation is an easy and timely method for referral to the rheumatology clinic. In this study, ANA+ patients requiring an urgent consultation were identified earlier through an eConsult compared to an in-person referral. eConsults were also capable of identifying cases that required specialist treatment; 80.9% of patients that weren’t referred would not receive a CTD diagnosis in the future. Thus, eConsults should be considered an effective and efficient tool in properly referring patients with rheumatologic presentations and parsing out cases that would not require specialist care. References [1]Malcolm EJ, Brandon Z, Wilson LE, Shoup JP, King HA, Lewinski A, Greiner MA, Malone S, Miller J, Keenan RT, Tarrant TK, Phinney D, Cho A, Bosworth HB, Shah K. eConsults’ Impact on Care Access and Wait Times in Rheumatology. J Clin Rheumatol. 2022 Apr 1;28(3):147-154. [2]Abeles AM, Abeles M. The clinical utility of a positive antinuclear antibody test result. Am J Med. 2013 Apr;126(4):342-8. Acknowledgements: NIL. Disclosure of Interests None Declared." @default.
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• W4379523003 date "2023-05-30" @default.
• W4379523003 modified "2023-09-27" @default.
• W4379523003 title "POS0074-HPR EFFICACY OF E-CONSULTS COMPARED TO IN-PERSON REFERRALS OF ANA POSITIVE PATIENTS TO RHEUMATOLOGY CLINIC" @default.
• W4379523003 doi "https://doi.org/10.1136/annrheumdis-2023-eular.5070" @default.
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