Jaatinen P et al. 2002 "Teleconsultation as a replacement for referral to an outpatient clinic."

Jaatinen PT, Aarnio P, Remes J, et al. Teleconsultation as a replacement for referral to an outpatient clinic. J Telemed Telecare 2002;8(2):102-106.
"We conducted a randomized case control study of referrals from a primary care centre in Finland. All the consultations and referrals from seven general practitioners (GPs) dealt with by internists and surgeons at Satakunta Central Hospital in Pori and geriatricians at Satalinna Hospital in Harjavalta over five months were included. For patients in the control group, a conventional referral letter was sent to the hospital outpatient clinic. For patients in the intervention group, the GPs had to decide whether they wanted an electronic consultation with the hospital or wanted to refer the patient (i.e. to transfer responsibility for treatment). Communication with the hospital specialist was then via a secure Web-based system. Ninety-three patients consented to participate in the study. None refused, although there were 15 non-attenders. Satisfaction data were collected from questionnaires completed by the patients and doctors. All the patients treated by teleconsultation said that they wanted the same procedure in future and 63% of the control group said they would prefer a teleconsultation next time. The doctors quickly learned to exploit the telemedicine model successfully. The responsibility for treatment was maintained in the health centre in 52% of cases using teleconsultation, without any visit to hospital being required. The GPs and the hospital doctors agreed on the follow-up treatment. Telereferral increased the possibility of the GP maintaining responsibility for the treatment. The reduced number of hospital visits in the telemedicine model should produce significant cost savings."
To determine the success of and patient satisfaction with teleconsultation (between the specialist and GP about the patient's condition) or telereferral (transfer of responsibility for treatment to the specialist via an electronic form) in lieu of paper referrals.
Tools Used
Type Clinic
Primary care and specialty care
Small, medium and large
Urban and rural
Other Information
The primary care center was in a small town, while the specialists were in urban areas.
Type of Health IT
Type of Health IT Functions
There was a Web-based server containing information about the patient, documents (such as lab reports), and treatment feedback. The GP could send a teleconsultation and telereferral form containing information about the patient to the specialist, who could then also access the Web server. Physicians were sent e-mail messages informing of them of the referral or providing feedback about treatment. Tests were performed in or near the primary care center and results were posted on the Web server.
Workflow-Related Findings
Total visit time was approximately 1 hour for the telemedicine group and 3.5 hours for the control group. The teleconsultation group traveled 2.5 miles on average, the telereferral group 3.5 miles on average and the control group 20 miles.
"The patients were satisfied with the teleconsultation and all wanted to use the same procedure in the future."
"The history of the patient was given almost as well by teleconsultaion or teleferral as with a conventional visit to the outpatient clinic."
"It was difficult to convey the status and the overall picture in a teleconsultation or teleferral. The patient status conveyed to the hospital specialist was only adequate."
"The better the idea about the patient's problem that the hospital specialist could get, the more likely it was that responsibility for the patient's treatment did not need to be transferred."
Study Design
Randomized controlled trial (RCT)
Study Participants
All the consultations and referrals from seven GPs to internists and surgeons at the clinics of Satakunta Central Hospital and the geriatricians of Satalinna Hospital over a five-month period were included in the study for a total of 78 patients.