EHub: Enhancing the emergence of the electronic consultation

Abstract

BackgroundAlternatives to face-to-face consulting (F2F) with patients have been developed including telephone consulting and e-consulting. One area of concern about both alternatives is that they may act to increase total consultation time by generating additional F2F consultation activity.AimTo determine the proportion of clinical e-consults where a GP requested a follow-up F2F consultation and to determine whether e-consultation training reduced the proportion of GP requests for a follow-up F2F consultation.MethodA longitudinal study was conducted observing ‘remote closure’ rates (the proportion of clinical e-consults with no F2F follow-up appointment) before and after the launch of a dedicated at scale electronic consultation ‘eHub’ with a bespoke technical and clinical training programme. Remote closure rates were available for 42 months prior and 22 months following the intervention. A follow-up GP consultation was defined as the doctor requesting the patient to make a F2F appointment.ResultsThe remote closure rates were 63% (3019/4778) before and 87% (6957/7993) after the intervention. χ2 with Yates correction 1024.9; P<0.001.ConclusionThe consultation as a core competency of GP training requires specific skills for e-consulting. We have devised a training package for e-consultation training. Following implementation of a package of intensive e-consultation training, remote closure rates of 87% were obtained. Some of the observed increase in remote closure rates may have been attributable to increased familiarity of both GPs and patients with new models of consultation. We plan to test our e-consulting educational package in other settings with low e-consultation closure rates.