Table 3.
Primary Care Provider Expressions of Provider Decision-Making
| a. Patient factors | |
| “There are some patients though who really want to see a specialist and I’m perfectly fine with that…” (Interview #20) | |
| “Most people who feel strongly that they want an actual face-to-face visit I just write it.” (Interview #27) | |
| “For patients who will not make it to another visit, helpful to have that available.” (Interview #14) | |
| “Especially for my patients who do not speak English where they have to negotiate the system, get a translator” (Interview #23) | |
| “If I am so overwhelmed with this patient’s six other problems that I really want the cardiologist or the nephrologist to take care of this other issue and have them see the patient in person then I will refer them …” (Interview #28) | |
| b. Clinical factors | |
| “I use it when I reach a data sparse area.” (Interview #40) | |
| “when things are complicated and they really do need to be seen… versus if it is a more straightforward question” (Interview #30) | |
| “…cases where I am fairly convinced that the physical exam is not going to lend much to the decision-making and that would be evaluation of results or it would be very specific questions…” (Interview #18) | |
| “something that you could just look through all the history and the labs and stuff and then give me the answer.” (Interview #23) | |
| “If it something that I think can be handled in a primary care clinic I will let the patient know that I will electronically contract the specialist and then will summarize the suggestion.” (Interview #20) | |
| “…if I feel like I possibly could manage it on my own in primary care but I just need a little bit of guidance from the specialist.” (Interview #21) | |
| c. Specialist triage | |
| “at least an attending is aware of this patient and knows the case and has sort of triaged themselves how urgent it is for the patient to be seen...” (Interview #30) | |
| “– they can get as much as they need in order to decide if maybe they can just answer the question or send – say, “This is somebody we should see in clinic,” if it’s more complex.” (Interview #22) | |
| d. Backdoor consults | |
| “Sometimes I know the patient needs to be seen but I feel that when I send an econsult then they can recommend tests in advance before seen, more efficient.” (Interview #13) | |
| “eConsults help expedite [the] patient getting in for an appointment”. (Interview #40) |