P3.A005: Improving Access to Pediatric Gastroenterology Care in Rural Areas: Partnering with Referring Providers through E-consults, Telemedicine, and Educational Resources

Background: Access to pediatric gastroenterology care in rural communities is limited and may result in delayed care, inferior health outcomes, and increased emergency department utilization. With limited pediatric specialists in rural areas, patients face travel barriers to attend in-person appointments. The objectives of this study were to assess the needs of rural primary care providers (PCPs) referring to pediatric gastroenterology and their perceptions of alternatives to in-person care.

Methods: An electronic survey was distributed in January 2023 to 59 pediatric PCPs serving children in rural Oregon to assess perceptions of the current pediatric gastrointestinal (GI) partnership and the utility of e-consults and telemedicine. A follow-up survey was sent in November 2023 to 157 pediatric PCPs serving rural communities to evaluate indications and needs of referral. Semi-structured interviews were conducted to explore PCP attitudes toward implementing telemedicine and e-consults.

Results: 35 referring providers responded to the initial survey (59% response rate). Respondents identified long wait times (33%) and follow-up communication (29%) as weaknesses of the current GI partnership. 87% felt e-consults or telehealth would be helpful for one-time questions in management or PCP reassurance.

The follow-up survey had 95 respondents (61% response rate) with the most common GI conditions that PCPs felt comfortable managing on their own being constipation (56%), reflux (21%), and diarrhea (21%). For constipation (91%) and reflux (69%), the primary indication of referral was for provider or patient reassurance. Figure 1 summarizes providers’ reasoning for referral and potential opportunities to implement non-in-person consults. After reviewing OHSU’s online GI workup resource, 34% of respondents reported they would feel comfortable not referring with a negative workup.

Conclusion: With high referral volumes and long wait times, alternatives to in-person consults are needed. For conditions referred for patient reassurance, PCPs suspect that one-time telemedicine consultation would adequately address families’ concerns and reinforce PCP management, which could decrease the need for long-term follow-up with specialists. Referrals for provider reassurance may be effectively addressed through e-consults. Online diagnostic resources can support PCPs in initiating evaluation and potentially eliminate the need for referral. Within 6 months of sharing online GI resources, there was a 10% reduction in referrals at our institution. This study highlights the importance of collaborating with referring PCPs to tailor support and application of telemedicine and e-consults based on specific needs. Ongoing steps include updating referral forms to allow providers to designate specific referral needs and implementing telemedicine and e-consults to provide specialist input.