Table 3

Themes identified in qualitative interviews with primary care physicians for implementation of multidisciplinary, proactive e-consults for patients with type 2 diabetes and chronic kidney disease

Clinical prioritization
  • Elevated problem that would otherwise not been prioritized

  • PCP autonomy preserved for initiation of GDMT

  • PCPs appreciated reminder and specialists enjoyed helping

Implementation barriers external to the implementation strategies
  • Inconsistent patient visits limit initiation of GDMT

  • Cost and prior authorization barriers remain a barrier

  • Patient hesitancy to change medication remains a barrier

  • Additional patient monitoring needed after initiation of new medications remains a barrier

Content of recommendation
  • Appreciation of evidence-based and detailed note content

  • PCPs used note as a reference while writing their own notes

  • Appreciation of specialists’ chart review and ability to adapt notes for needs of complex patients

PCP characteristics
  • PCPs felt they were not always up to date on recommendations

  • PCP specialization affected confidence

  • PCP willingness to learn novel treatments

Multidisciplinary collaboration
  • Improved PCP access to specialists

  • E-consults need to balance being prescriptive and collaborative

  • Added to PCP burden with no specialist follow-up

Workflow
  • Timing allowed for real-time application

  • Need for follow-up mechanism to ensure implementation of GDMT

  • Messages may get lost in EHR inbox

  • EHR, electronic health record; GDMT, guideline-directed medical therapy; PCP, primary care provider.