897-P: Use of In-Person and E-Consults for Type 2 Diabetes in an Academic Primary Care Network

Objective: Electronic consults (e-consults) are asynchronous clinician-to-clinician communications within an electronic health record (EHR) . We compared characteristics of patients for whom electronic versus in-person consults for type 2 diabetes (T2D) were ordered in an academic primary care network.

Methods: E-consult and in-person consults ordered for T2D between January 1 and December 31, 20by primary care providers who ordered both referral types were included. Patient characteristics were extracted from an EHR repository. E-consult content was reviewed by a physician. Characteristics of e-consults and in-person consults were compared with chi-squared tests and t-tests.

Results: E-consults accounted for 48.4% of consults (156 of 322) . Compared with in-person consult patients, e-consult patients were older (62.1±14.1 vs. 56.7±13.9 years, p<0.001) , more likely to be prescribed a sulfonylurea (37.8% vs. 23.5%, p=0.009) , and less likely to be prescribed insulin (42.3% vs. 54.2%, p=0.033) . There were no differences in sex, self-reported race/ethnicity, or the prevalence of coronary artery disease (22.4% vs. 24.1%, p=0.779) , heart failure (10.9% vs. 8.4%, p=0.575) , or chronic kidney disease (25.6% vs. 17.5%, p=0.099) in electronic and in-person consult patients. In-person consult patients had a higher hemoglobin A1c (9.3±1.7% vs. 8.8±2.0%, p=0.032) . Nearly all e-consult referrals asked for guidance on medication selection (96%) with a significant number requesting advice on newer medications (SGLT2i: 21%; GLP-1 RA: 27%) . Completed e-consults often provided guidance and education on use, cardiorenal benefits, and/or side effects of newer medications (SGLT2i: 28%; GLP-1 RA: 47%) .

Conclusions: In-person and e-consult patients had similar baseline characteristics and cardiovascular comorbidities. E-consults were often used to inquire and to educate about newer diabetes medications. E-consults hold promise as a method to disseminate new endocrine knowledge.