VA’s E-Consultation Equals In-Person Endocrinologist Care

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HOUSTON — To improve specialty care accessibility, the Michael E. DeBakey VAMC (MEDVAMC) in Houston began the Diabetes Mellitis Electronic Consultation Service (DMECS) to provide specialty recommendations about diabetes care to primary care physicians (PCPs).

The E-consultation, which is done remotely by an endocrinologist who reviews the patients’ charts and speaks to patients via telephone, often leads to recommendations made via a note to the PCP in the patient’s electronic chart.

Researchers from the VAMC and Baylor College of Medicine sought to determine if e-consultation management for diabetes is as effective as in-person clinic management at the MEDVAMC, using change in HbA1c from preconsultation to six months post-consultation as the measure. Their study was presented at the Endo 2013 conference in San Francisco.1

Researchers conducted a retrospective chart review of patients referred for diabetes consultation at the MEDVAMC from November 1, 2011, to April 20, 2012, dividing patients into two groups: (1) patients seen in person by an endocrinologist and (2) patients evaluated via the e-consultation system. All participants had type 2 diabetes and an HbA1c exceeding 8%.

Meeting criteria for inclusion in the in-person clinic visit group were 93 patients, while 281 patients qualified for the e-consult group. The mean HbA1c for patients seen in person at baseline was 10.3%, dropping to 9.3% at six months. The mean HbA1c for patients evaluated by e-consultation, meanwhile, was 10.1% at baseline and 9.1% at six months.

“There was no statistically significant difference in change in HbA1c from baseline to six months between the two groups: each group lowered HbA1c by one percentage point,” the authors reported.

  1. Patel P, et al. (2013, June). Outcomes of Electronic-consultation versus In-Person Clinic Management for Type 2 Diabetes. Session presented at the Endo 2013 meeting, San Francisco, CA.

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