Abstract
Introduction
Sometimes, a general practitioner is unsure whether to refer a patient to the hospital. They can either still refer the patient, or call with a medical specialist for consultation. But some of these referrals are unnecessary, and calling with a medical specialist is not always convenient. Therefore, general practitioner centers and hospitals in the region Rotterdam developed a regional infrastructure for digital consultation.
Description of practice change implemented
By introducing ‘digital consultation’, a GP can digitally request a non-urgent consultation from a medical specialist. The medical specialist can answer the consultation when it is convenient (within 3 to 5 days) and formulate a well-considered advice. The answer is sent back to the GP’s patient file.
Aim and theory of change
The aim of this project is to prevent unnecessary referrals, increasing the knowledge and skills of GP’s and efficient use of everyone’s time.
Targeted population and stakeholders
The target population is patients; timely and proper patient care and better care close to home. Stakeholders are GP’s and medical specialists, for their way of working together is changed.
Timeline
After a pilot period of two years, digital consultation became regular care in 2019.
Highlights
The hospital receives an average of 36 consults per month. Regional research suggests that approximately 75% of all the digital consults in the region do not result in a referral to a hospital. Also, both GP’s and medical specialists state that digital consultation is an ideal alternative to telephone calls and patients are satisfied to save a trip to the hospital when it is not needed.
Comments on sustainability
To ensure sustainability, health insurances have provided a compensation for both the GP and the medical specialist. This makes the doctors feel rewarded for their contribution. Also, the fee is important to develop the digital infrastructure and in keeping the used applications fast and easy.
Comments on transferability
Digital consultation is eminently transferable. Everything that is needed is a well working digital infrastructure, effort of the doctors and a support structure. It does take time to instruct the users of the application and promote this new way of working together.
Conclusions
In conclusion, digital consultation is a sustainable solution for the increasing costs of care by reducing unnecessary referrals to the hospital. For patients, it results in the right care in the right place. Also, it supports the collaboration between healthcare professionals.
Discussions
Digital consultation is regular care in only one of the two regions where our hospital is located. We aim to implement a regional infrastructure and financial compensation in the other region as well. Our ambition is to increase the number of digital consultations.
Lessons learned
Although digital consultation is technically relatively easy to implement, it is important not to underestimate the effort it takes to instruct people in a new way of working. A well working support structure for the health care professionals is essential, to support the enhancement of digital skills.