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. 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 (a process called 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 needs to see the patient again in hospital for a direct examination. However, fewer tests and investigations were ordered in the virtual outreach group by an average of 0.79 per individual, and patients expressed greater satisfaction from virtual outreach consultations compared with standard outpatient appointments.
Contact: Richard Lane