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Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion.

ABSTRACT: OBJECTIVES: To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers. DESIGN: Cost consequences study alongside randomised controlled trial. SETTING: Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales. PARTICIPANTS: 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments. MAIN OUTCOME MEASURES: NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction. RESULTS: Overall six months costs were greater for the virtual outreach consultations ( pound 724 per patient) than for conventional outpatient appointments ( pound 625): difference in means pound 99 ($162; 138) (95% confidence interval pound 10 to pound 187, P=0.03). If the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means pound 108 ( pound 73 to pound 142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost pound 8 ( pound 5 to pound 10, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost pound 11 ( pound 10 to pound 12, P < 0.0001). CONCLUSION: The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported.

SUBMITTER: Jacklin PB

PROVIDER: S-EPMC164917 | biostudies-literature | 2003 Jul

REPOSITORIES: biostudies-literature

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Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion.

Jacklin P B PB Roberts J A JA Wallace P P Haines A A Harrison R R Barber J A JA Thompson S G SG Lewis L L Currell R R Parker S S Wainwright P P

BMJ (Clinical research ed.) 20030701 7406

<h4>Objectives</h4>To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers.<h4>Design</h4>Cost consequences study alongside randomised controlled trial.<h4>Setting</h4>Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales.<h4>Participants</h4>3170 patients identified; ...[more]

PMID: 12855528

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Project description:OBJECTIVE:Musculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion. DESIGN:Systematic review. DATA SOURCES:Electronic database searches were carried out in MEDLINE, MEDLINE In-Process, Cumulative Index of Nursing and Allied Health Literature, Embase, PEDro, PubMed, Web of Science, Cochrane Central and Health Management Information Consortium without language restriction from 1990 onwards. Websites were reviewed for grey literature. ELIGIBILITY CRITERIA:All study designs and documents that considered care pathways for adults with musculoskeletal hip and/or knee pain referred for specialist opinion were screened by two reviewers. Risk of bias was assessed using The Critical Appraisal Skills Programme checklist for randomised controlled trials and the Joanna Briggs Institute checklists. DATA EXTRACTION AND SYNTHESIS:Data extraction and quality assessment were performed by one reviewer and checked by a second. Findings are reported narratively. RESULTS:The titles and abstracts of 1248 articles were screened and 140 full-text articles retrieved. 19 papers reporting 17 studies met the study inclusion criteria. Quality was low due to study design and methodological flaws. Most of the outcomes relate to organisational process at the 'meso' level of a whole systems approach. CONCLUSION:It can be concluded that the pathway is not linear, containing variations and activity loops. The available evidence suggests that, from the point of referral for specialist opinion, a model is required that integrates the skills of all the different healthcare professionals and streamlining is required to ensure that individuals are seen by the healthcare professional that best meets their needs. There is very limited evidence of patient experience informing knee and hip care pathways. PROSPERO REGISTRATION NUMBER:CRD42016035510.

Project description:BackgroundChronic respiratory diseases (CRD), are common public health problems with high prevalence, disability and mortality rates worldwide. Further uneven distribution of the health workforce is a major barrier to the effective diagnosis and treatment of CRDs. Teleconsultation between a specialist and non-specialist could possibly bridge the gap in access to health care and decrease CRD burden in remote areas. This review investigates the evidence for the effective use of specialist to non-specialist teleconsultation in the management of CRDs in remote areas and identifies instances of good practice and knowledge gaps.MethodsWe searched for articles till November 2020, which focused on specialist to non-specialist teleconsultations for CRD diagnosis or management. Two independent reviewers conducted the title and abstract screening and extracted data from the selected papers and the quality was assessed by Joanna Briggs Institute's (JBI) tool. A descriptive and narrative approach was used due to the heterogeneous nature of the selected studies.ResultsWe found 1715, articles that met the initial search criteria, but after excluding duplicates and non-eligible articles, we included 10 research articles of moderate quality. These articles were from nine different studies, all of which, except one, were conducted in high-income countries. The studies reported results in terms of impact on the patients, and the health care providers including primary care physicians (PCP) and specialists. The teleconsulting systems used in all the selected papers primarily used audio modes in addition to other modes like the audio-video medium. The included studies reported primarily non-clinical outcomes including effectiveness, feasibility, acceptability and usability of the teleconsultation systems and only three described the clinical outcomes. The teleconsultation was predominantly conducted in the PCP's office with the specialist located remotely.ConclusionsWe found relatively few, papers which explored specialist to non-specialist teleconsultation in management of CRDs, and no controlled trials. Two of the included papers described systems, which were used for other diseases in addition to the CRD. The available literature although not generalisable, encourages the use of specialist to non-specialist teleconsultation for diagnosis and management of CRDs.

Dataset Information

Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion.

Publications

Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion.

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