***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Communication between specialists and primary care clinicians is suboptimal , and access to referrals is often limited , which can lead to lower quality , inefficiency , and errors . An electronic consultation ( e-consultation ) is an asynchronous , non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform . The purpose of this study was to conduct a r and omized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care . METHODS Primary care clinicians were r and omized into a control ( 9 traditional ) or an intervention ( 17 e-consultation ) arm for referrals to cardiologists . Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients . Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm , sex , race , and age . RESULTS Thirty-six primary care clinicians participated in the study , referring 590 patients . In total , 69 % of e-consultations were resolved without a visit to a cardiologist . After adjusting for covariates , median days to a review for an electronic consultation vs a visit for control patients were 5 and 24 , respectively . A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group . CONCLUSION E-consultation referrals improved access to and timeliness of care for an underserved population , reduced overall specialty utilization , and streamlined specialty referrals without any increase in adverse cardiovascular outcomes .  e-consultations are a potential solution for improving access to specialty care AIMS Chronic kidney disease patients overwhelm specialist services and can potentially be managed in the primary care ( PC ) . Opportunistic screening of high risk ( HR ) patients and follow-up in PC is the most sustainable model of care . A ' virtual consultation ' ( VC ) model instead of traditional face to face ( F2F ) consultations was used , aim ing to assess efficacy and safety of the model . METHODS Seventy patients were recruited from PC sites and hospital clinics and followed for 1 year . The HR patients ( eGFR < 30 mL/min/1.73m2 + /- albuminuria > 30 mg/mmol/L ) were r and omized to either VC or F2F .  Patients were monitored in 6 monthly follow-up cycles by a Clinical Nurse Specialist . The specialist team provided virtual or clinical support and included a Nephrologist , Endocrinologist , Cardiologist and Renal ' Palliative ' Supportive Care . RESULTS Sixty one ( 87 % ) patients were virtually tracked or consulted with 14 ( 23 % ) being HR . At 12 months , there was no difference in outcomes between VC and F2F patients . All patients were successfully monitored . General practitioners reported a high level of satisfaction and supported the model , but found software integration challenging . Patients found the system attractive and felt well managed . Specialist consults occurred within a week , and if a second specialist opinion was required , it took another 2 weeks . CONCLUSIONS The programme demonstrated safe , expedited and efficient follow up with a clinical and web based programme . Support from the general practitioners and patients was encouraging , despite logistical issues . Ongoing evaluation of VC services will continue and feasibility to larger networks and more chronic diseases remains the long term goal Background Electronic consultation ( eConsult ) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers , while maintaining high primary care provider ( PCP ) , specialist and patient satisfaction . Little is known about their impact on the efficiency of specialty care delivery , in particular surgical yield ( percent of ambulatory visits result ing in a scheduled surgical case ) . Methods Retrospective cohort of a r and om selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures ( herniorrhaphy , cholecystectomy , anorectal procedures ) in 2014 .  Electronic consultation requests were review ed for the presence/absence of consult domains : symptom acuity/severity , diagnostic evaluation , concurrent medical conditions , and attempted diagnosis . Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit . Surgical yield was also calculated , as was the percentage of patients requiring unanticipated healthcare visits . Results In 2014 , 1743 electronic consultations were su bmi tted to general surgery . Among the 150 abstract ed , the presence of consult domains ranged from 49 % to 99 % . Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit . Seventy-six percent of consult requests ( 114/150 ) were scheduled for a clinic appointment and surgical yield was 46 % ; without an eConsult system , surgical yield would have been 35 % ( p=0.07 ) . Among patients not scheduled for a clinic visit ( n=36 ) , 4 had related unanticipated emergency department visits . Conclusion Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service BACKGROUND Primary care is the main point-of-entry for identifying and treating mental health problems . This research examines the effect of a new model of supporting  primary care providers ( PCPs ) treating mental health disorders , the electronic consultation ( eConsults ) , a st and ard process for communication between PCPs and psychiatrists through an electronic health records system . METHODS A cluster-r and omized evaluation of the psychiatric eConsults model , as implemented in a large integrated delivery system . Web survey data before and after the implementation of psychiatric eConsults were collected on PCPs ' perceptions of their capability and skill to deliver mental health services , and analyzed with linear regression models . RESULTS At baseline PCPs had mixed assessment s of perceived support for delivering mental health services and of the availability of specialist consultations , but had relatively high perceived self-efficacy and skill for identifying , diagnosing and treating depression . PCPs in the Treatment group had statistically significant 18 % , 13 % , and 16 % improvements in perceived support for diagnosing mental health problems , making treatment decisions , and changing treatment regimens , respectively ; and 24 % improved perceived ease of access to consultations for mental health , compared to the Control group . Evidence of effects on self-efficacy and perceived skill around depression was more limited . CONCLUSIONS The psychiatric eConsults model improved PCPs ' perceptions of support for delivering mental health care and perceptions of access to specialist consultations . IMPLICATION S Electronic consultations may be a promising approach to support the delivery of mental health services in primary care setting s. LEVEL OF EVIDENCE Pre- and post-intervention web surveys from a cluster-r and omized trial OBJECTIVES /HYPOTHESIS Prolonged wait times have become common . Electronic consultations ( eConsults ) have been shown in previous studies to reduce unnecessary face-to-face consultations to specialists , but no prior study has investigated the feasibility or efficacy of eConsults in an otolaryngology-head and neck surgery ( OTO-HNS ) practice . STUDY DESIGN Prospect i ve observational study . METHODS The Champlain BASE eConsult system is a secure web portal allowing primary care physicians ( PCPs ) to communicate asynchronously with specialists about a patient , without requiring a formal face-to-face consult . The data from all eConsults sent through this portal to OTO-HNS practice s between July 2011 and January 2015 were collected and analyzed . RESULTS Response time was rapid ; over 40 % of eConsults received a response within 24 hours , and nearly all eConsults were answered within 7 calendar days . The median response time was nearly 29 times faster than traditional face-to-face consultation . Unnecessary face-to-face referrals were avoided in 33.4 % of all eConsults , and in nearly 50 % of cases where the PCP initially planned a formal referral . PCPs reported adopting a new or additional course of action over 50 % of the time following an eConsult . Eighty-eight percent of PCPs reported the service to be valuable for their patients , and 92 % found it valuable for themselves . eConsults require only a limited time commitment from specialists , with over 75 % taking less than 10 minutes to complete . CONCLUSIONS eConsultation is a cost-effective system that can lead to decreased wait times , improved communication between PCPs and otolaryngologists , and help guide the development of targeted continuing professional development modules for PCPs . LEVEL OF EVIDENCE 4 . Laryngoscope , 128:350 - 355 , 2018 OBJECTIVES To evaluate the cost-effectiveness of electronic consultations ( eConsults ) for cardiology compared with traditional face-to-face consults . STUDY DESIGN Cost-effectiveness analysis for a subset of Medicaid-insured patients in a cluster-r and omized trial of eConsults  versus the traditional face-to-face consultation process in a statewide federally qualified health center . METHODS A total of 369 Medicaid patients were referred for cardiology consultations by primary care providers who were r and omly assigned to use either eConsults or their usual face-to-face referral process . Primary care providers in the eConsult arm transmitted consults to cardiologists using a secure peer-to-peer communication platform in an electronic health record . Intention-to-treat analysis was used to assess the total cost of care and cost across 7 categories : inpatient , outpatient , emergency department , pharmacy , labs , cardiac procedures , and " all other . " Costs are from the payer 's perspective . RESULTS Six months after the cardiology consult , patients in the eConsult group had significantly lower mean unadjusted total costs by $ 655 per patient , or lower mean costs by $ 466 per patient when adjusted for non-normality , compared with those in the face-to-face arm . The eConsult group had a significantly lower cost by $ 81 per patient in the outpatient cardiac procedures category . CONCLUSIONS These findings suggest that eConsults are associated with total cost savings to payers due principally to reductions in the cost of cardiac outpatient procedures Background Champlain BASE ™ ( Building Access to Specialists through eConsultation ) is a web-based asynchronous electronic communication service that allows primary -care- practitioners ( PCPs ) to su bmi t “ elective ” clinical questions to a specialist . For adults , PCPs have reported improved access and timeliness to specialist advice , averted face-to-face specialist referrals in up to 40 % of cases and high provider satisfaction . Objective To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults . Design Prospect i ve observational cohort study . Setting Single Canadian tertiary-care academic pediatric hospital ( June 2014–16 ) servicing 1.2 million people . Participants 1 . PCPs already using eConsult . 2.Volunteer  pediatric specialists  provided services in addition to their regular workload . 3.Pediatric patients ( < 18 years-old ) referred for none-acute care conditions . Main outcomes and measures Specialty service utilization and access , impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected . Results 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services . The top three specialties represented were : General Pediatrics 393 cases ( 36.9 % ) , Orthopedics 162 ( 15.2 % ) and Psychiatry 123 ( 11.6 % ) . Median specialist response time was 0.9 days ( range < 1 hour-27 days ) , most consults ( 63.2 % ) required < 10minutes to complete and 21/21(100 % ) specialist survey-respondents reported minimal workload burden . For 515/1064(48.4 % ) referrals , PCPs received advice for a new or additional course of action ; 391/1064(36.7 % ) referrals result ed in an averted face-to-face specialist visit . In 9 specialties with complete data , the median wait-time was significantly less ( p<0.001 ) for an eConsult ( 1 day , 95%CI:0.9–1.2 ) compared with a face-to-face referral ( 132 days ; 95%CI:127–136 ) . The majority ( > 93.3 % ) of PCPs rated eConsult as very good/excellent value for both patients and themselves . All specialist survey-respondents indicated eConsult should be a continued service . Conclusions and relevance Similar to adults , eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions , while reporting high end-user satisfaction . Further study is warranted to assess impact on re source utilization and clinical outcomes The m and ate of Human Reproduction Up date involves several roles : ( i ) to provide a synthesis of evidence that can aid scientists and clinicians in their daily work ; ( ii ) to help reproductive specialists underst and concepts from related disciplines ; and ( iii ) to summarize current knowledge generated by basic science as the foundation of future scientific and clinical advancement . Given that review and synthesis are central to good scientific and clinical practice , and that a grasp of the current state of knowledge is a prerequisite to design ing new studies , it is pertinent to ask which review s are most likely to fulfil the needs of readers . A related question concerns whether systematic review s meet the needs of all review 
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RESULTS We found only modest empirical evidence for effectiveness of e-consults  on important outcomes .
For those outcomes that have been reported , findings are generally positive , with mixed results for clinician experience .