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The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment

The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment
The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment
Background: Joint consultations - such as teleconsultations - provide opportunities for continuing education of general practitioners (GPs). It has been reported this form of interactive case-based learning may lead to fewer GP referrals, yet these studies have relied on expert opinion and simple frequencies, without accounting for other factors known to influence referrals. We use a survey-based discrete choice experiment of GPs' referral preferences to estimate how referral rates are associated with participation in joint teleconsultations, explicitly controlling for a number of potentially confounding variables. Methods: We distributed questionnaires at two meetings of the Portuguese Association of General Practice. GPs were presented with descriptions of patients with dermatological lesions and asked whether they would refer based on the waiting time, the distance to appointment, and pressure from patients for a referral. We analysed GPs' responses to multiple combinations of these factors, coupled with information on GP and practice characteristics, using a binary logit model. We estimated the probabilities of referral of different lesions using marginal effects. Results: Questionnaires were returned by 44 GPs, giving a total of 721 referral choices. The average referral rate for the 11 GPs (25%) who had participated in teleconsultations was 68.1% (range 53-88%), compared to 74.4% (range 47-100%) for the remaining physicians. Participation in teleconsultations was associated with reductions in the probabilities of referral of 17.6% for patients presenting with keratosis (p = 0.02), 42.3% for psoriasis (p <0.001), 8.4% for melanoma (p = 0.14), and 5.4% for naevus (p = 0.19). Conclusions: The results indicate that GP participation in teleconsultations is associated with overall reductions in referral rates and in variation across GPs, and that these effects are robust to the inclusion of other factors known to influence referrals. The reduction in range, coupled with different effects for different clinical presentations, may suggest an educational effect. However, more research is needed to establish whether there are causal relationships between participation in teleconsultations, continuing education, and referral rates. © 2015 Cravo Oliveira et al.; licensee BioMed Central.
Continuing education Discrete choice experiment Primary care Referral rates Teleconsultation Telemedicine adult animal education educational status female general practitioner health care survey human interdisciplinary communication male medical education organization and management patient referral Portugal primary health care procedures questionnaire Rana clamitans standards statistics and numerical data total quality management Animals Education, Medical, Continuing General Practitioners Health Care Surveys Humans Quality Improvement Referral and Consultation Remote Consultation Surveys and Questionnaires
1471-2296
Cravo Oliveira, T.
407beffa-18a0-4035-838a-3dd94c162728
Barlow, James
51253e7e-517c-48b6-98b0-ac82b00a600f
Bayer, S.
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Cravo Oliveira, T.
407beffa-18a0-4035-838a-3dd94c162728
Barlow, James
51253e7e-517c-48b6-98b0-ac82b00a600f
Bayer, S.
28979328-d6fa-4eb7-b6de-9ef97f8e8e97

Cravo Oliveira, T., Barlow, James and Bayer, S. (2015) The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment. BMC Family Practice, 16, [50]. (doi:10.1186/s12875-015-0261-6).

Record type: Article

Abstract

Background: Joint consultations - such as teleconsultations - provide opportunities for continuing education of general practitioners (GPs). It has been reported this form of interactive case-based learning may lead to fewer GP referrals, yet these studies have relied on expert opinion and simple frequencies, without accounting for other factors known to influence referrals. We use a survey-based discrete choice experiment of GPs' referral preferences to estimate how referral rates are associated with participation in joint teleconsultations, explicitly controlling for a number of potentially confounding variables. Methods: We distributed questionnaires at two meetings of the Portuguese Association of General Practice. GPs were presented with descriptions of patients with dermatological lesions and asked whether they would refer based on the waiting time, the distance to appointment, and pressure from patients for a referral. We analysed GPs' responses to multiple combinations of these factors, coupled with information on GP and practice characteristics, using a binary logit model. We estimated the probabilities of referral of different lesions using marginal effects. Results: Questionnaires were returned by 44 GPs, giving a total of 721 referral choices. The average referral rate for the 11 GPs (25%) who had participated in teleconsultations was 68.1% (range 53-88%), compared to 74.4% (range 47-100%) for the remaining physicians. Participation in teleconsultations was associated with reductions in the probabilities of referral of 17.6% for patients presenting with keratosis (p = 0.02), 42.3% for psoriasis (p <0.001), 8.4% for melanoma (p = 0.14), and 5.4% for naevus (p = 0.19). Conclusions: The results indicate that GP participation in teleconsultations is associated with overall reductions in referral rates and in variation across GPs, and that these effects are robust to the inclusion of other factors known to influence referrals. The reduction in range, coupled with different effects for different clinical presentations, may suggest an educational effect. However, more research is needed to establish whether there are causal relationships between participation in teleconsultations, continuing education, and referral rates. © 2015 Cravo Oliveira et al.; licensee BioMed Central.

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Accepted/In Press date: 27 March 2015
e-pub ahead of print date: 21 April 2015
Published date: 21 April 2015
Additional Information: Export Date: 7 June 2017 Correspondence Address: Cravo Oliveira, T.; Research Assoc., Imperial College Business School, Imperial College London, South Kensington CampusUnited Kingdom References: Davis, D., Galbraith, R., Continuing medical education effect on practice performance: Effectiveness of continuing medical education: American college of chest physicians evidence-based educational guidelines (2009) Chest, 135, pp. 42S-48S. , 19265075; Davis, D.A., Thomson, M.A., Oxman, A.D., Haynes, R.B., Changing physician performance. A systematic review of the effect of continuing medical education strategies (1995) JAMA, 274, pp. 700-705. , 1:STN:280:DyaK2MznvFWltg%3D%3D 7650822; Davis, D., O'Brien, M.A., Freemantle, N., Wolf, F.M., Mazmanian, P., Taylor-Vaisey, A., Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? (1999) JAMA, 282, pp. 867-874. , 1:STN:280:DyaK1MvgsFOquw%3D%3D 10478694; Smith, F., Singleton, A., Hilton, S., General practitioners' continuing education: A review of policies, strategies and effectiveness, and their implications for the future (1998) Br J Gen Pract, 48, pp. 1689-1695. , 1313248 1:STN:280:DyaK1M7ntVyjsg%3D%3D 10071406; Arnold, L.D., Effective continuing medical education: A challenge for the future (2001) Clin Pediatr Emerg Med, 2, pp. 259-268; Vierhout, W.P.M., Knottnerus, J.A., Van Ooij, A., Crebolder, H., Pop, P., Wesselingh-Megens, A.M.K., Effectiveness of joint consultation sessions of general practitioners and orthopaedic surgeons for locomotor-system disorders (1995) Lancet, 346, pp. 990-994. , 1:STN:280:DyaK28%2FhtFCjug%3D%3D 7475592; MacFarlane, A., Harrison, R., Murray, E., Berlin, A., Wallace, P., A qualitative study of the educational potential of joint teleconsultations at the primary-secondary care interface (2006) J Telemed Telecare, 12, pp. 22-24. , 16884569; Whited, J.D., Teledermatology research review (2006) Int J Dermatol, 45, pp. 220-229. , 16533219; Gagliardi, A., Smith, A., Goel, V., DePetrillo, D., Feasibility study of multidisciplinary oncology rounds by videoconference for surgeons in remote locales (2003) BMC Med Inform Decis Mak, 3, p. 7. , 165596 12816548; Jacklin, P.B., Roberts, J.A., Wallace, P., Haines, A., Harrison, R., Barber, J.A., Virtual outreach: Economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion (2003) BMJ, 327, p. 84. , 164917 1:STN:280:DC%2BD3szisFKitA%3D%3D 12855528; Nordal, E.J., Moseng, D., Kvammen, B., Løchen, M.L., A comparative study of teleconsultations versus face-to-face consultations (2001) J Telemed Telecare, 7, pp. 257-265. , 1:STN:280:DC%2BD3MrisVakuw%3D%3D 11571079; Fertig, A., Roland, M., King, H., Moore, T., Understanding variation in rates of referral among general practitioners: Are inappropriate referrals important and would guidelines help to reduce rates? (1993) BMJ, 307, pp. 1467-1470. , 1679514 1:STN:280:DyaK2c7gvVehtQ%3D%3D 8281091; Harno, K., Paavola, T., Carlson, C., Viikinkoski, P., Patient referral by telemedicine: Effectiveness and cost analysis of an Intranet system (2000) J Telemed Telecare, 6, pp. 320-329. , 1:STN:280:DC%2BD3M7msFOltA%3D%3D 11265100; Mehrotra, A., Forrest, C.B., Lin, C.Y., Dropping the baton: Specialty referrals in the United States (2011) Milbank Q, 89, pp. 39-68. , 3160594 21418312; Colven, R., Shim, M.-H., Brock, D., Todd, G., Dermatological diagnostic acumen improves with use of a simple telemedicine system for underserved areas of South Africa (2011) Telemed J e Health, 17, pp. 363-369. , 3109076 21599529; Taylor, P., Evaluating telemedicine systems and services (2005) J Telemed Telecare, 11, pp. 167-177. , 15969791; Jarvis-Selinger, S., Chan, E., Payne, R., Plohman, K., Ho, K., Clinical telehealth across the disciplines: Lessons learned (2008) Telemed J e Health, 14, pp. 720-725. , 18817503; Loane, M.A., Bloomer, S.E., Corbett, R., Eedy, D.J., Evans, C., Hicks, N., A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: An urban versus rural perspective (2001) BMJ, 7, pp. 108-118. , 1:STN:280:DC%2BD3MzgvFajsw%3D%3D; Wootton, R., Bloomer, S.E., Corbett, R., Eedy, D.J., Hicks, N., Lotery, H.E., Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: Societal cost-benefit analysis (2000) BMJ, 320, pp. 1252-1256. , 27370 1:STN:280:DC%2BD3c3lvFehug%3D%3D 10797038; O'Donnell, C.A., Variation in GP referral rates: What can we learn from the literature? (2000) Fam Pract, 17, pp. 442-471; Oliveira, T.C., Bayer, S., Gonçalves, L., Barlow, J., Telemedicine in Alentejo (2014) Telemed J e Health, 20, pp. 90-93. , 3880063 24180419; Ryan, M., Gerard, K., Using discrete choice experiments to value health care programmes: Current practice and future research reflections (2003) Appl Health Econ Health Policy, 2, pp. 55-64. , 14619274; Ryan, M., Bate, A., Eastmond, C.J., Ludbrook, A., Use of discrete choice experiments to elicit preferences (2001) Qual Health Care, 10, pp. i55-60. , 1765744 11533440; Gerard, K., Lattimer, V., Preferences of patients for emergency services available during usual GP surgery hours: A discrete choice experiment (2005) Fam Pract, 22, pp. 28-36. , 15528284; Forrest, C.B., Nutting, P.A., Von Schrader, S., Rohde, C., Starfield, B., Primary care physician specialty referral decision making: Patient, physician, and health care system determinants (2006) Med Decis Making, 26, pp. 76-85. , 16495203; Newton, J., Hayes, V.I.C., Hutchinson, A., Factors influencing general practitioners' referral decisions (1991) Fam Pract, 8, pp. 308-313. , 1:STN:280:DyaK387pt1ektA%3D%3D 1800192; Chen, F.M., Dermatology referrals in an academic family medicine clinic (2001) South Med J, 94, pp. 475-477. , 1:STN:280:DC%2BD3M3ovFyiug%3D%3D 11372794; Morgan, M., Jenkins, L., Ridsdale, L., Patient pressure for referral for headache: A qualitative study of GPS' referral behaviour (2007) Br J Gen Pract, 57, pp. 29-35. , 2032697 17244421; Louviere, J.J., Hensher, D.A., Swait, J.D., (2000) Stated Choice Methods: Analysis and Applications, , Cambridge University Press Cambridge
Keywords: Continuing education Discrete choice experiment Primary care Referral rates Teleconsultation Telemedicine adult animal education educational status female general practitioner health care survey human interdisciplinary communication male medical education organization and management patient referral Portugal primary health care procedures questionnaire Rana clamitans standards statistics and numerical data total quality management Animals Education, Medical, Continuing General Practitioners Health Care Surveys Humans Quality Improvement Referral and Consultation Remote Consultation Surveys and Questionnaires
Organisations: Decision Analytics & Risk

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Local EPrints ID: 410961
URI: http://eprints.soton.ac.uk/id/eprint/410961
DOI: doi:10.1186/s12875-015-0261-6
ISSN: 1471-2296
PURE UUID: 0711928c-0a32-4828-a4aa-4ebfa4a6e348
ORCID for S. Bayer: ORCID iD orcid.org/0000-0002-7872-467X

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Date deposited: 12 Jun 2017 16:31
Last modified: 16 Mar 2024 02:28

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Contributors

Author: T. Cravo Oliveira
Author: James Barlow
Author: S. Bayer ORCID iD

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