Volume 53 | Number 4 | August 2018

Abstract List

Jacqueline Nwando Olayiwola M.D., M.P.H., F.A.A.F.P., Margae Knox M.P.H., Kate Dubé M.S.W., Emily Chen‐Yuan Lu M.D., Tem Woldeyesus M.D., Iguehi E. James M.P.H., Rachel Willard‐Grace M.P.H., Delphine Tuot M.D.C.M., M.A.S.


To understand patient, primary care clinician (), and subspecialist perspectives on potential, unexplored roles for patients in electronic consultation and referral () systems.

Data Sources

Primary focus group and survey data collected April–November 2015. Zuckerberg San Francisco General Hospital () is part of an integrated public health delivery system. Its mature system was first implemented in 2005.

Study Design

This mixed‐methods study synthesizes patient, subspecialist, and perspectives through two patient focus groups in English, Spanish, and Cantonese ( = 6); subspecialist focus groups ( = 2); and an electronic survey of all s ( = 222/634, 35 percent response).

Data Collection/Extraction Methods

Focus groups were audio‐recorded and transcribed. Two researchers coded the transcripts to identify recurrent themes. Survey data were analyzed using summary and bivariate statistics.

Principal Findings

Patients expressed minimal desire to directly engage in , instead of emphasizing their 's role in advocating, informing, and finding health solutions. Subspecialists requested more consistent communication to patients about the electronic consultation process. Most s (52 percent) supported patient engagement in the process, particularly patient ability to track consult status and securely message with subspecialists.


Results suggest a continuum of opportunities for patients and their caregivers to engage in systems.