ABSTRACT
Importance: Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. Objective: To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. Evidence Review: A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. Findings: The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. Conclusions and Relevance: In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.
Subject(s)
Remote Consultation , Humans , Canada , Caregivers , Hospitals , Physicians, Family , Remote Consultation/methods , Digital Health , Health Services Accessibility , SpecializationABSTRACT
Digital interdisciplinary consultation is an asynchronous form of consultation in which the general practitioner (GP) can consult a medical specialist. We provide an overview of the various platforms available in the Netherlands and we performed a literature review on the effect on referrals, patient satisfaction and satisfaction of the GP and medical specialist. Until October 2022, we traced nine different platforms that enable digital interdisciplinary consultation between the GP and medical specialist in the Netherlands. We identified nine randomized controlled trials (RCTs) and three systematic reviews until the COVID-19 period. The RCTs did not show a significant effect on our outcome measures. Observational studies on the other hand show a reduction of referrals by the use of digital interdisciplinary and have high satisfaction rates among GPs, medical specialists and patients because it is perceived as efficient and it improves access to specialized care for the patient.
