Abstract 956

Telephone consultation from infectious diseases(ID)physicians is becoming more frequent in the era of manage care. Providing such consultative services may enhance community physician allegiance for referral. In order to facilitate community physician access to medical subspecialists, Children's National Medical Center (CNMC) instituted a physicians' access line (PAL) in July 1997. The PAL is a dedicated telephone line having a more expeditious CNMC physician response, with an identified operator who transfers community physician calls directly to the pager of the requested subspecialist. The PAL is in operation from 8:30 a.m. to 5:00 p.m. Monday through Friday. The calls are monitored to assure subspecialist response within 15 minutes. The investigators analyzed 189 consecutive outpatient calls received by two pediatric ID specialists over a four month period, July-October 1998, in order to determine the number, source and content of calls.

The majority of calls 110/189 (58%) originated from community physicians in private practice who called to discuss a patient in their practice (27%), to discuss a patient recently seen by the consultant (12%), to refer a new patient to infectious disease clinic (11%), to request a consultation for an inpatient at a community hospital (3%) or for other reasons (5%). Community hospital based physicians placed 58/189 (31%) of the calls in order to discuss an inpatient at their facility (23%), or to request a formal consultation for one of their inpatients (6%)or for other purposes (2%). CNMC medical staff (6%), health department physicians (2%), other physicians (2%) and homecare agency personnel (1%) comprised the remaining callers. Calls referring a patient to clinic or requesting a formal consultation (20%) were considered to be revenue generating.

The questions most frequently asked by community physicians concerned lyme disease (11%), immunizations (10%), tuberculosis (8%), sepsis (8%), fever (6%), HIV (6%), vaginitis (6%) and other (45%).

In the era of managed care, the PAL may allow community physicians to manage more complex patients with fewer subspecialist referrals. It facilitates patient management and physician education by providing a convenient access to case-oriented subspecialist input.

(All calls were answered within 15 minutes.) The questions raised reflect relevant issues of concern for community physicians and potential topics for continuing medical education programs. The PAL is not designed to replace formal ID consultation. Validity of information provided by the ID subspecialist may be limited by the quality of data provided by the caller. The medicolegal liability of the telephone ID consultant remains an open question.