Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial

Wallace, Paul; Haines, Andy; Harrison, R.; Barbour, Joshua B.; Thompson, Simon G.; Jacklin, P; Roberts, J. A. Fraser; Lewis, Leo; Wainwright, Paul

doi:10.1016/s0140-6736(02)08828-1

Cited by 127 publications

(114 citation statements)

References 22 publications

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“…Trials of teleconsultations or specialist outreach sessions (in general practitioner offi ces) as alternatives to referrals show promise. 21 Similarly, a simple intervention consisting of giving primary care physicians cameras and direct access to specialists resulted in a 25% reduction in dermatologist visits by patients. 22 Various attempts to reduce unnecessary specialist visits through better mechanisms of information transfer (such as integrated electronic medical records 23 ) have had modest success, and there have been trials (particularly involving patients with specifi c diseases, such as diabetes) in which consultants do not see the patient but provide education, support, and strategic planning to the primary care physicians.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity and the Use of Primary Care and Specialist Care in the Elderly

Starfield¹

2005

The Annals of Family Medicine

207

167

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PURPOSEThe impact of comorbidity on use of primary care and specialty services is poorly understood. The purpose of this study was to determine the relationship between morbidity burden, comorbid conditions, and use of primary care and specialist services METHODS The study population was a 5% random sample of Medicare beneficiaries, taken from 1999 Medicare fi les. We analyzed the number of ambulatory face-to-face patient visits to primary care physicians and specialists for each diagnosis, with each one fi rst considered as the "main" one and then as a comorbid diagnosis to another. Each patient was categorized by extent of total morbidity burden using the Johns Hopkins Adjusted Clinical Group case-mix system. RESULTSHigher morbidity burden was associated with more visits to specialists, but not to primary care physicians. Patients with most diagnoses had more visits, both to primary care and specialist physicians for comorbid diagnoses than for the main diagnosis itself. Although patients, especially those with high morbidity burdens, generally made more visits to specialists than to primary care physicians, this fi nding was not always the case. For patients with 66 diagnoses, primary care visits for those diagnoses exceeded specialist visits in all morbidity burden groups; for patients with 87 diagnoses, specialty visits exceeded primary care visits in all morbidity burden groups. CONCLUSIONIn the elderly, a high morbidity burden leads to higher use of specialist physicians, but not primary care physicians, even for patients with common diagnoses not generally considered to require specialist care. This fi nding calls for a better understanding of the relative roles of generalists and specialists in the US health services system. INTRODUCTIONT he impact of comorbidity on use of services is poorly understood. One study of Medicare benefi ciaries found a relationship between the number of comorbid chronic conditions and total costs of care, frequency of ambulatory-care-sensitive hospitalizations, and the occurrence of complications of care.1 Another study found the salience of primary care services in the presence of several diagnoses both in children and adults by showing that the average number of primary care visits was greater than the number of visits to specialists, for the diagnosis itself as well as for comorbid conditions.2 Only a few diagnoses were studied, however, and the population was limited to individuals younger than 65 years of age, when comorbidities occur less frequently.To understand better the challenges of coexisting diagnoses, we examined the frequency of primary care physician and specialist visits in persons aged 65 years and older in the context of their overall morbidity burdens. Consistent with our earlier study with a limited number of diagnoses in younger adults, 2 we expected to fi nd that visits to primary care METHODS Data Source and Study PopulationWe conducted a retrospective analysis of administrative claims data for Medicare benefi ciaries using the Standard Ana...

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Section: Discussionmentioning

confidence: 99%

Comorbidity and the Use of Primary Care and Specialist Care in the Elderly

Starfield¹

2005

The Annals of Family Medicine

207

167

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“…The benefits of reducing review appointments to free time for new patients have been recognized, resulting in the use of telemedicine and telephone follow-ups. [1][2][3][4][5] A more efficient and acceptable manner to monitor arthroplasty outcomes that is acceptable to both the patient and the health care system is needed.…”

Section: Recherchementioning

confidence: 99%

An electronic clinic for arthroplasty follow-up: a pilot study

Wood

2011

Can J Surg

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Background: Most outpatient orthopedic follow-up visits for patients who had total joint arthroplasty are routine among those with well-functioning implants. The technology and resources now exist to enable patient assessment without requiring attendance in hospital. We tested an electronic clinic for routine follow-up in a small cohort of arthroplasty patients. Methods:We randomly assigned primary arthroplasty patients scheduled for routine annual outpatient review into 2 groups: group A completed a Web-based assessment 4 weeks after the clinical assessment, whereas group B completed the Web-based assessment first. Standard clinical questionnaires were included. We also collected radiographic data and information on assessment duration and cost.Results: Forty patients participated in the study. The average age of participants was 58 years. There were 12 men and 8 women in each of the 2 groups. The average total time spent by patients on an outpatient visit was 115 minutes, compared with 52 minutes for the electronic assessment. Participants reported the electronic assessment to be more convenient and less costly. Conclusion:This pilot study supports the practical use of an electronic clinic for the follow-up of arthroplasty patients. Further studies examining the complex interaction of factors involved in patient clinics are needed.Contexte : La plupart des consultations de suivi orthopédique en service externe pour des patients qui ont subi une arthroplastie totale sont routinières chez ceux dont les implants fonctionnent bien. La technologie et les ressources nécessaires pour évalu er le patient ailleurs qu'à l'hôpital existent maintenant. Nous avons fait l'essai d'une clinique électronique de suivi de routine pour une cohorte peu nombreuse de patients ayant subi une arthroplastie. Méthodes :Nous avons réparti au hasard en 2 groupes des patients qui avaient subi une arthroplastie primaire et devaient se soumettre à un examen annuel de routine en service externe : les patients du groupe A ont rempli une évaluation sur le web 4 semaines après l'évaluation clinique et ceux du groupe B ont rempli l'évaluation sur le web en premier. Des questionnaires cliniques normalisés étaient inclus. Nous avons aussi réuni des données radiographiques et de l'information sur la durée et le coût de l'évaluation.Résultats : Quarante patients ont participé à l'étude. Les participants avaient en moyenne 58 ans. Il y avait 12 hommes et 8 femmes dans chacun des 2 groupes. Les patients ont passé au total 115 minutes en moyenne en consultation au service externe comparativement à 52 minutes pour l'évaluation électronique. Les participants ont signalé que l'évaluation électronique était plus commode et moins coûteuse. Conclusion :Cette étude pilote appuie l'usage pratique d'une clinique électronique pour le suivi des patients qui ont subi une arthroplastie. Il faudra effectuer d'autres études pour examiner l'interaction complexe entre les facteurs en cause dans les cliniques de suivi des patients.

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“…a GP, a general surgeon or a resident) have been present at the remote site together with the patient [8,10,11,34,35]. Some studies reported that a nurse present at the remote site and a specialist at the hospital could provide satisfactory remote consultations in emergency medicine [36][37][38].…”

Section: Discussionmentioning

confidence: 99%