Electronic Consultations as an Educational Tool to Improve the Care of Transgender Patients in Primary Care.

Electronic consultations (eConsults) have demonstrated benefits in many areas of clinical care including educational value for primary care clinicians (PCCs). It has been shown that few PCCs have knowledge and confidence to manage transgender and gender non-binary (TGNB) patients. In this report, we explored the impact of eConsults submitted to a TGNB specialist panel on PCC experience and on their education on TGNB-related topics. We conducted a retrospective review of de-identified data from the RubiconMD electronic consultation platform used by PCCs in 36 U.S. states for eConsults submitted to the TGNB specialty. We found that 90% of eConsults were from federally qualified health centers, other community clinics, and rural areas. Primary care clinicians reported outcomes as "educational" for 50% and "improved care plan" for 88% of eConsults. These results suggest that eConsults play an important role in educating PCCs on TGNB care and may also lead to improved PCC and patient experiences.

Leveraging Electronic Consultations to Address Severe Subspecialty Care Access Gaps in Nigeria.

Nigeria, Africa's most populous nation, is experiencing a dire challenge in meeting the specialty care access needs for its people, with extremely limited capacity to deliver subspecialty healthcare. Telemedicine/telehealth has been offered as a part of the solution to resolve health inequities, maldistribution and "brain drain" for health care services. In this preliminary communication, we assessed the impact of a telehealth innovation, subspecialty clinician-to-clinician electronic consultations (eConsult), on general practitioners (GPs) serving a diverse patient population in Nigeria. We found high levels of utilization of the eConsult platform by Nigerian physicians for a variety of cases and subspecialties. The most commonly used specialties were Obstetrics/Gynecology, Pediatric specialties and subspecialties, and Dermatology. Nigerian GPs spent more time generating and submitting their eConsults than American counterparts, but high levels of physician satisfaction and education from the eConsults. GPs reported the reduction in unnecessary services and improved care plans in the majority of cases, suggesting the tremendous potential for eConsults to build capacity for clinicians in nations where subspecialty care services are scarce.