Details

Autor(en) / Beteiligte

• Burwick, Nicholas
• Stein, Jacob
• Garcia, David A.
• Broudy, Virginia C.
• Richard, Robert E.

Titel

Monoclonal gammopathies: Electronic subspecialty consultation

Ist Teil von

• 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.