Digital consultation region Rotterdam, The Netherlands

IntroductionSometimes, a general practitioner is unsure whether to refer a patient to the hospital. They can either still refer the patient, or call with a medical specialist for consultation. But some of these referrals are unnecessary, and calling with a medical specialist is not always convenient. Therefore, general practitioner centers and hospitals in the region Rotterdam developed a regional infrastructure for digital consultation.Description of practice change implementedBy introducing ‘digital consultation’, a GP can digitally request a non-urgent consultation from a medical specialist. The medical specialist can answer the consultation when it is convenient (within 3 to 5 days) and formulate a well-considered advice. The answer is sent back to the GP’s patient file.Aim and theory of changeThe aim of this project is to prevent unnecessary referrals, increasing the knowledge and skills of GP’s and efficient use of everyone’s time.Targeted population and stakeholdersThe target population is patients; timely and proper patient care and better care close to home. Stakeholders are GP’s and medical specialists, for their way of working together is changed.TimelineAfter a pilot period of two years, digital consultation became regular care in 2019.HighlightsThe hospital receives an average of 36 consults per month. Regional research suggests that approximately 75% of all the digital consults in the region do not result in a referral to a hospital. Also, both GP’s and medical specialists state that digital consultation is an ideal alternative to telephone calls and patients are satisfied to save a trip to the hospital when it is not needed.Comments on sustainabilityTo ensure sustainability, health insurances have provided a compensation for both the GP and the medical specialist. This makes the doctors feel rewarded for their contribution. Also, the fee is important to develop the digital infrastructure and in keeping the used applications fast and easy.Comments on transferabilityDigital consultation is eminently transferable. Everything that is needed is a well working digital infrastructure, effort of the doctors and a support structure. It does take time to instruct the users of the application and promote this new way of working together.ConclusionsIn conclusion, digital consultation is a sustainable solution for the increasing costs of care by reducing unnecessary referrals to the hospital. For patients, it results in the right care in the right place.