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.
Paul Wallace comments: “The findings of this trial have important implications for the design and implementation of virtual outreach services within health-care systems, and suggest that appropriate selection of patients, significant service reorganisation and provision of logistical support for arranging and conducting consultations will be required to enable such services to operate efficiently. The extent to which virtual outreach is actually implemented will probably also be dependent on factors such as demand by patients, costs, incentives for general practitioners to allocate additional time to this activity, and the attitudes of staff working in general practice and hospital settings.”
Contact: Professor Paul Wallace, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK; T) (24-27 May) +39 06 487 7548; M) +39 347 271 3436; (27-30 May) +44 (0 )20 7830 2340; M) +44 (0)7768 798859; F) +44 (0)20 7431 9114; E) p.wallace@pcps.ucl.ac.uk
Journal
The Lancet