Implementation of web-based hospital specialist consultations to improve quality and expediency of general practitioners\u2019 care: a feasibility study

Thomas Van Der Velden,Tjard R Schermer,Marc A Ten Dam,Mirjam Harmsen,Guido Adriaansens,Bianca W M Schalk

doi:10.1186/s12875-019-0960-5

Abstract

BackgroundRising healthcare costs due to unnecessary referrals to secondary healthcare services underscore the need for optimizing current referral procedures. This study investigates whether the use of web-based consultation (WBC) in general practice is a feasible alternative to decrease referrals.MethodsPatients with lumbosacral radicular syndrome, knee complaints, or thyroid dysfunction, who visited the general practitioner (GP) between May 2015 and December 2016 were included for a WBC. We determined whether the GP would refer a patient to an outpatient clinic in the absence of a WBC and then compared this decision with the referral advice from a specialist. We further assessed the user-friendliness of the WBC service based on average recorded user time and feedback from the GPs.ResultsSeventy eligible WBCs submitted by GPs were analyzed. Our data showed a 46% absolute reduction in in-persons referrals in our study population. These findings confirmed the feasibility of using WBC. The median time spent to submit a WBC was five and 10 min for GPs and specialists respectively. On average, the WBC service saved €286 per WBC. The results of a questionnaire showed that GPs found WBC to be a user-friendly option which could help reduce the number of in-person referrals.ConclusionWe demonstrated that WBC is not only feasible but has the potential to reduce nearly half of all in-person referrals to outpatient clinics. WBC decreased healthcare expenses and proved to be a user-friendly and safe alternative to the standard referral process. WBC may potentially have a profound impact on healthcare expenditure if applied in a wider medical setting. For follow-up research, we recommend including a control group for comparative analyses.

Highlights

Rising healthcare costs due to unnecessary referrals to secondary healthcare services underscore the need for optimizing current referral procedures
For each web-based consultation (WBC), we investigated whether the patient had visited the hospital’s outpatient clinic for the medical condition within 2 months after the WBC in order to establish whether or not the patient had been referred for secondary care
During the study period, a total of 112 WBCs with a response from one of the hospital specialists were conducted. These WBCs were submitted by 67 general practitioner (GP) from 46 general practices

Summary

Introduction

Rising healthcare costs due to unnecessary referrals to secondary healthcare services underscore the need for optimizing current referral procedures. This study investigates whether the use of web-based consultation (WBC) in general practice is a feasible alternative to decrease referrals. Healthcare expenditure represents an increasingly substantial proportion of national costs in well-developed countries [1]. Hospital care largely contributes to these rising costs. In the Netherlands, access to more expensive specialized hospital care is only granted via referral by the general practitioner (GP). Web-based consultation (WBC) with medical specialists has proven to be a less expensive and more patient-friendly alternative compared to an in-person referral to a hospital-based medical specialist [4]. A recent systematic literature review concluded that WBC services are primarily focused on a single specialty, in particular dermatology or nephrology. In order for WBCs to have a greater impact on referral

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