CURBSIDE CONSULTATION IN ENDOCRINE PRACTICE - A PROSPECTIVE OBSERVATIONAL STUDY

This 12-month observation studied the clinical epidemiology of the ''c urbside'' consultation process in a three-physician, private (fee for service), endocrinology practice that also provides consultative servi ces to a staff-model HMO on a discounted fee-for service basis. During the study, there were 559 curbside consultations (23.8% of which resu lted in patient referrals) and 2001 formal consultations. The areas ad dressed most frequently were the thyroid gland, calcium, diabetes mell itus, the adrenal glands, the gonads, and the pituitary gland, Of the 513 curbside consultations by the three endocrinologists, 63.4% were f rom primary care providers, 8.3% from other endocrinologists, and 15.3 % from other subspecialists. Physicians in the HMO accounted for a lar ger proportion of curbside consultations than of formal patient referr als (22.2% vs. 12.9%; P < 0.00001). The proportion of curb side consul tations resulting in formal referrals (31.6%) was higher for physician s in the HMO than for physicians in fee-for-service practice, although this difference was not statistically significant (p = 0.04). The dat a suggest that curbside consultations constitute an appreciable worklo ad, that a minority of such consultations result in patient referrals, and that curbside consultation is used to a greater extent in the man aged care setting. (Questions about the impact of this on re source us e and outcomes await further study.