eConsults Support Appropriate GLP-1 Prescribing and Weight Management in Primary Care

In recent years, glucagon-like peptide-1 receptor agonists, or GLP-1 receptor agonists, have emerged as a revolutionary treatment for both type 2 diabetes and obesity. These medications, including well-known options like semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda), have proven to help patients lose weight and better manage blood sugar levels. However, prescribing GLP-1 medications can be complex. Determining the right candidates, managing potential side effects, and ensuring optimal dosing require specialized knowledge and expertise. eConsults provide expert guidance for prescribing and managing GLP-1 medications to ensure that patients receive personalized and up-to-date care. 

eConsults accelerate evidence-based prescribing decisions

eConsults offer rapid access specialist guidance when prescribing and managing GLP-1 medications. In particular, many primary care practitioners (PCPs) may not have specialized training in obesity medicine, which can make it difficult to navigate the personalized care strategies required for effective weight management. 

Through eConsult platforms, PCPs can consult with endocrinologists or obesity specialists for insights on patient suitability and appropriate dosing for diabetes and weight management. This real-time access to expert advice helps ensure that treatment plans are tailored to each patient’s unique needs, taking into account their medical history, comorbid conditions, and treatment goals. 

Recent research demonstrates that eConsults improve access to GLP-1 prescriptions. One study published in Diabetes reported that patients of PCPs utilizing eConsults had higher percent reduction in HbA1c, lower total costs, and higher GLP1 utilization than patients of PCPs who did not use eConsults.¹ Another report from Boston University School of Medicine found that eConsults initiated twice as many GLP-1 prescriptions and better health outcomes when compared to traditional referrals.² 

Explore an example of a PCP seeking advice on the suitability of GLP-1 therapy for a patient with uncontrolled diabetes, obesity, hypertension, and hyperlipidemia in this real RubiconMD eConsult. 

eConsults Guide GLP-1 Prescriptions in Complex Cases

eConsults are a particularly valuable resource when managing complex cases for patients with multiple conditions and medication regimens. Some GLP-1 medications can impact the absorption or efficacy of other drugs, particularly those with narrow therapeutic ranges, like levothyroxine for thyroid disorders or certain blood pressure medications. 

Consultation with an endocrinologist or cardiologist can help a PCP ensure that GLP-1s are safe without exacerbation of cardiovascular risk or interference with other treatments. eConsults not only improve the timeliness of clinical decision making, but also reduce the risk of trial-and-error prescribing. By providing real time guidance on the safety and appropriateness of GLP-1 prescriptions, eConsults help PCPs manage complex cases with greater confidence and diminished risk. 

In this real RubiconMD eConsult, a PCP seeks prescription guidance for a GLP-1 medication for a noncompliant patient with uncontrolled diabetes and multiple comorbidities. 

Read the transcript of an eConsult in which a specialist provides medication review for a patient experiencing nausea from a GLP-1 agonist.

eConsults Support Insurance Approvals

PCPs must frequently navigate complex and time-consuming processes to secure coverage for GLP-1 medications as weight loss therapies. One of the key barriers is the need for prior authorization from insurance companies, which can delay access to these medications and add an administrative burden on both providers and patients. 

Collaboration with specialists through systems like eConsults can provide PCPs with the guidance needed to navigate the complexities of prescribing GLP-1s to manage obesity effectively. By offering expert recommendations and supporting patient education, specialists help overcome these barriers and ensure enhanced care.

In this RubiconMD eConsult, a specialist offers GLP-1 cost-saving insights including dosing and sourcing from the manufacturer. 

Conclusion

By providing PCPs with direct, timely access to endocrinologists or obesity specialists, eConsults provide more informed prescribing decisions for GLP-1 medications. By facilitating practitioner collaboration, eConsults make advanced treatments like GLP-1 medications more accessible and improve continuity of care over time. Benefiting both patients and healthcare providers alike, eConsults offer a powerful tool for the prescription of GLP-1 medications in primary care settings.

References:

1. Esra Karslioglu-French, Justin Kanter, Mary E. Winger, Kelly R. Williams, Tammi Grumski, James Schuster, Ellen Beckjord; 1034-P: Targeted Automatic eConsults (TACos) to Enhance Care for Individuals with Diabetes—A Payor–Provider Partnership. Diabetes 14 June 2024; 73 (Supplement_1): 1034–P.
2. Fantasia KL, Stockman MC, Ju Z, Ortega P, Crable EL, Drainoni ML, Walkey AJ, Bergstrom M, O’Brien K, Steenkamp D. Professional continuous glucose monitoring and endocrinology eConsult for adults with type 2 diabetes in primary care: Results of a clinical pilot program. J Clin Transl Endocrinol. 2021 Mar 30;24:100254. doi: 10.1016/j.jcte.2021.100254. PMID: 33898271; PMCID: PMC8054187.