Teleconsultation Avoids Referral In 74% Of Dermatology Cases

More words we’d never heard until recently… A “teledermatology” study in The Netherlands has provided an outstanding example of the power of modern day communications technology in reducing healthcare expenditure and also speeding a patient’s access to appropriate treatment.

The study

Dutch researchers studied the results from 1,820 GPs and 166 dermatologists performing teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010. Key measurable parameters were used to assess outcomes in terms of efficiency, quality and cost of care.

Daily teledermatology consultations were performed between GPs and regional dermatologists in the Netherlands.

  • The number of physical referrals from the GP to the dermatologist was used to measure efficiency. In the group of patients where the GP used teleconsultation to prevent a referral, 74% of physical referrals were prevented.
  • To measure the quality of care, the study referred to the percentage of second opinion teleconsultations, the physical referrals resulting from them, the dermatologists’ response times, and the educational effect experienced by the GP. In the group of patients where the GP used teleconsultation for a second opinion, 16% were then physically referred.
  • The prevented referral rate was 68% of the total study population, and the mean response time of dermatologists was 4.6 hours with a median of 2.0 hours. According to the data, the estimated cost reduction was 18% while the GPs indicated that 85% of the teleconsultations provided a beneficial educational effect.

Cost saving was reportedly 18%, although the benefits seem to extend well beyond this headline number. It’s likely that patient time to treatment was reduced by not waiting for referral.

What about other specialties?

The article concludes that there are positive lessons to be learned from the exercise especially by “rural family medicine physicians in USA”. But why be so limiting? Yes a physical exam by the consulting physician may be necessary, especially in other specialities like for example orthopaedics where imaging may need to be employed prior to full consultation, but we think there is significant underlying promise in the idea of linking GPs with clinicians in this way.

And not just in terms of efficiency. How many times have you heard of people being misdiagnosed or not referred when what the GP claimed was trapped wind turned out to be ovarian cancer? Far from being a risky dumbing-down of the referral process, might this new direct interface mean fewer bad diagnoses and a more integrated, patient centred approach with potentially better educated GPs and more efficient referral for patients who really need it.

And here’s the icing on the cake for the consulting physician. What better way to cement your relationship with your referring GP community?

Potential problems?

There are plenty of logistical problems of course, such as the concept of having multiple specialists on tap for GP referrals. In essence, taking this to the ultimate conclusion it challenges the need for what is tantamount to GP triage in many cases, but as a basic principle, if one were designing the system today with today’s technology to hand, it wouldn’t look the way it currently is.

Source:  Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L. Br J Dermatol. 2011 Nov;165(5):1058-65. doi: 10.1111/j.1365-2133.2011.10509.x