Telemedicine could offer fewer follow-up tests and greater satisfaction for patients

A study in this week's issue of THE LANCET has measured the effects of telemedicine (the use of video-conferencing technology between patients, general practitioners, and specialists), and demonstrated that this new approach to specialist referral from primary care could result in a reduced need for follow-up tests and lead to greater satisfaction among patients.

The conventional system of general practitioner (GP) referral of patients to hospital specialists in the UK is often associated with unnecessary duplication of investigations and treatments. Outreach clinics, in which hospital-based specialists provide outpatient services in primary care, have been established to alleviate this problem, but lack of involvement of GPs is thought to have limited their success. Researchers in the UK have now established "virtual" outreach programmes in which both the patient and GP attend a virtual consultation with a specialist via video conferencing. In the largest ever randomised trial of telemedicine, the Virtual Outreach Project Group, led by Paul Wallace from the Royal Free and University College Medical School, London, UK, compared joint teleconsultations between GPs, specialists, and patients (virtual outreach) with standard outpatient referral.

Virtual outreach services were established in London and Shrewsbury, UK, ensuring a mix of patients from urban and semi-rural settings. This involved patients and GPs communicating with a specialist using a video-conferencing procedure. Around 2100 patients were randomly assigned to receive either a virtual outreach consultation or a standard outpatient appointment arising from conventional referral by GPs. Patients in both groups were followed up for six months.

Unexpectedly, more patients in the virtual outreach group (52%) than the standard group (41%) were offered a follow-up appointment; this effect varied substantially between hospitals and specialties, probably because of specialists' differing n

Contact: Richard Lane

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