[General practitioners' use of internal medicine e-consultations]

Abstract

Objective: Consultations between general practitioners (GPs) and hospital specialists are traditionally conducted by phone. A conversation by phone where a GP seeks advice regarding a patient, who is unknown to the specialist, can have limitations. An e-consultation service for internal medicine allows GPs to consult an internal medicine specialist for clinical queries. In this study we evaluated GP use of internal medicine e-consultations.

Design: Observational study.

Method: Eligible patients were all those for whom the GP used an internal medicine e-consultation, provided by Zuyderland Medical Centre, location Sittard-Geleen, the Netherlands, in the period 2017-2018. Data on patient demographics, content of the GP clinical query, and any preceding diagnostics were collated. Furthermore, the internal medicine specialist response was categorised, including the presence of any patient referral advice.

Results: 136 (88.6%) of all 154 GPs in the region used an e-consultation at least once, and the clinical queries covered all areas of internal medicine. A total of 1047 eligible patients were discussed by GPs in an e-consultation; 19.6% of them attended the internal medicine out-patient clinic within three months of the index episode. The use of e-consultations by GPs led to a 70% reduction in referrals when compared to the situation where e-consultations were not available.

Conclusion: GPs used internal medicine e-consultations for a wide range of questions covering all areas of internal medicine. In more than 80% of cases, the GP continued to manage the patient, resulting in a reduction of the actual number of patient referrals to the internal medicine out-patient clinic.