Examining the Role of a Comprehensive eConsult System to Enhance Access to Nephrology Care

Rationale & Objective: A stagnant US nephrology workforce and rising chronic kidney disease (CKD) prevalence underscore the need for improved nephrology expertise accessibility. We examined nephrology consultation patterns in one health care setting with a comprehensive eConsult program in which all specialty care requests are initiated via eConsult. Results may inform the development of interventions to better support referring clinicians. Study Design: A cross-sectional study examining a random sample of ambulatory nephrology eConsults (12.8%, n = 450/3,514) submitted January 1, 2020 to December 31, 2023. Setting & Population: A publicly funded institution providing health care services to residents of San Francisco, California. Predictor: Characteristics of eConsults, including clinical question type (ie, management, diagnosis, and medication safety), inquiry topics (ie, CKD, proteinuria, and hypertension) and referring provider (ie, MD/DO or advanced practice provider). Outcomes: Disposition of eConsults (ie, not scheduled for nephrology visit, scheduled immediately after eConsult review, or scheduled after asynchronous dialogue between referring provider and nephrologist reviewer). Analytical Approach: Univariate and multivariable logistic regression models (adjusted for patient age, sex, and kidney function) assessed associations between eConsult characteristics and disposition, defined as a binary outcome (scheduled vs not scheduled). Results: Nearly half of eConsults (47%, n = 211) were resolved without nephrology appointments. Of the eConsults, 31% (n = 139) were scheduled immediately and 22% (n = 100) after consultative dialogue. CKD (53%, n = 239), proteinuria (26%, n = 115), and hypertension (17%, n = 75) were the most queried topics. Compared with diagnostic submissions, management-related eConsults were more likely to be scheduled (adjusted OR, 2.07; 95% CI, 1.25-3.45), whereas medication-related questions were less likely to be scheduled (adjusted OR, 0.14; 95% CI, 0.03-0.64). Limitations: Generalizability of findings is limited by the single-center design. Conclusions: By resolving nearly half of consult requests asynchronously, eConsult can enhance nephrology expertise accessibility for populations experiencing high CKD burden and limited availability of synchronous nephrology care.