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European journal of haematology, 2018-04, Vol.100 (4), p.351-355
Ort / Verlag
England: Wiley Subscription Services, Inc
Erscheinungsjahr
2018
Quelle
Wiley Online Library
Beschreibungen/Notizen
Importance
Electronic consultation (e‐consult) is an important component of care for patients in the Veterans Health Administration who require subspecialty consultation but not urgent face‐to‐face evaluation. Monoclonal gammopathy of undetermined significance (MGUS) is a common reason for e‐consult. While often benign, MGUS requires careful evaluation and persistent surveillance over time.
Objective
To identify areas to improve MGUS care delivery by e‐consult.
Methods
We performed a retrospective review of our e‐consult database and identified a cohort of 152 MGUS patients triaged for e‐consult over a 5‐year period (2010‐2014).
Results
The median time to completion of an e‐consult was 2 days. Ninety‐six percent of MGUS e‐consults had a hemoglobin >10 g/dL, and 90% had a creatinine <2 mg/dL. While the majority of e‐consults were low risk, paraprotein surveillance varied over time and tracked with consult utilization. With a median follow‐up of 44 months, there were 6 documented progression events, representing a mean rate of progression of 1% per year.
Conclusions
E‐consult is a helpful mechanism for the evaluation of MGUS, reducing the need for outpatient appointments. However, timely risk stratification and persistent surveillance over time are critical for e‐consult to work well.