Abstract
In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20–33) regarding specialised consultation, 47 days (95% CI: 17–74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.
Highlights
In Spain, as of 30 June 2017, the average waiting time for a specialist consultation is of 58 days [1], and the perception of patients about the evolution of these waiting lists is negative: 46.3% of patients think that it remains the same as the previous year and 28% of patients believe that it has worsened
Female Age in years a Distance to hospital in kilometres b Health insurance cards adjusted by age b N of referrals in 2014 a Rurality degree b a: Median; b: Mean (± standard deviation)
We found that DETELPROG, as compared to face-to-face referral, considerably decreases the waiting days for the resolution the process for which the patient is referred, avoiding face-to-face specialised consultation in almost all cases
Summary
In Spain, as of 30 June 2017, the average waiting time for a specialist consultation is of 58 days [1], and the perception of patients about the evolution of these waiting lists is negative: 46.3% of patients think that it remains the same as the previous year and 28% of patients believe that it has worsened. Less than 9% of patients think that it has improved, according to a recent Health Department survey [2] This problem is present in the vast majority of developed countries [3,4,5], as Canada, as resulted in the Commonwealth Fund Survey [5], or United Kingdom, Norway, Finland, the Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and the United States of America (USA), where various programmes aimed at solving one of the major favouring factors are being implemented: poor communication between primary care and specialised care [4,5]. With real-time telephone consultations, communication problems [15] were detected of incomplete or fragmented information [7,9,10,11,12,13,14,15,19,20,21,22,23], difficulties to choose the professional to be consulted [24], unpredictable interruptions that are time consuming, as they are not scheduled, etc. [18]
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