Teleconsultation as a replacement for referral to an outpatient clinic

We conducted a randomized case control study of referrals from a primary care centre in Finland. All the consultations and referrals from seven general practitioners (GPs) dealt with by internists and surgeons at Satakunta Central Hospital in Pori and geriatricians at Satalinna Hospital in Harjavalta over five months were included. For patients in the control group, a conventional referral letter was sent to the hospital outpatient clinic. For patients in the intervention group, the GPs had to decide whether they wanted an electronic consultation with the hospital or wanted to refer the patient (i.e. to transfer responsibility for treatment). Communication with the hospital specialist was then via a secure Web-based system. Ninety-three patients consented to participate in the study. None refused, although there were 15 non-attenders. Satisfaction data were collected from questionnaires completed by the patients and doctors. All the patients treated by teleconsultation said that they wanted the same procedure in future and 63% of the control group said they would prefer a teleconsultation next time. The doctors quickly learned to exploit the telemedicine model successfully. The responsibility for treatment was maintained in the health centre in 52% of cases using teleconsultation, without any visit to hospital being required. The GPs and the hospital doctors agreed on the follow-up treatment. Telereferral increased the possibility of the GP maintaining responsibility for the treatment. The reduced number of hospital visits in the telemedicine model should produce significant cost savings.