{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:05:13Z","timestamp":1785510313401,"version":"3.56.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI19\/01756"],"award-info":[{"award-number":["PI19\/01756"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Telemed Telecare"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study evaluates the short-term impact of two educational strategies on the appropriateness of electronic consultations (e-consults) submitted by primary care physicians (PCPs) to hepatologists for chronic liver disease (CLD) management. We compared a synchronous education program delivered in-person and online by hepatologists with an asynchronous approach based on e-consult feedback.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a 24-month prospective observational cohort study, analyzing e-consults related to the most prevalent CLD submitted by 326 PCPs to 10 hospital-based specialists in the Department of Gastroenterology and Hepatology. E-consults were categorized into three consecutive 8-month periods based on PCPs\u2019 training exposure: Group I (no training), Group II (synchronous continuing medical education) and Group III (asynchronous education via e-consult feedback).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 9934 consecutive e-consults were analyzed, which 663 pertained to CLD cases, submitted by 205 (63%) of 326 eligible PCPs, involving 629 patients (median age: 55 years; 61.8% male). Overall, 68% of e-consults were deemed appropriate, with 58.2% resulting in a specialist care appointment. Appropriateness significantly improved following both synchronous and asynchronous training compared to the pre-training period (75.2% vs. 69.1% vs. 60.1%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05). E-consults submitted by trained PCPs were significantly more likely to be appropriate (OR = 2.001; 95% CI: 1.360\u20132.946;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both synchronous and asynchronous training significantly improved e-consult appropriateness and reduced unnecessary referrals. Asynchronous education via e-consult feedback emerged as a practical and effective alternative. These findings underscore the importance of educational programs in optimizing e-consult utilization, warranting further research on long-term impacts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1357633x251392338","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T15:42:34Z","timestamp":1765208554000},"page":"620-628","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved appropriateness of electronic consultations in primary care with ongoing liver disease education"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1294-1134","authenticated-orcid":false,"given":"Francisco Javier","family":"P\u00e9rez Hern\u00e1ndez","sequence":"first","affiliation":[{"name":"Northern Area"},{"name":"Tacoronte Health Center, Primary Care Management of Santa Cruz de Tenerife, Tacoronte, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanira","family":"Gonz\u00e1lez M\u00e9ndez","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Canarias"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Amaral","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Canarias"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2214-0044","authenticated-orcid":false,"given":"Juan Adolfo","family":"Ortega S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Canarias"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia Elena","family":"Morales Arr\u00e1ez","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Canarias"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"de la Barreda 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