Mayo cuts appointments by 40 per cent

Online consultations could reduce the need for face-to-face appointments with GPs by 40%, the largest ever study of online visits in primary care has found.

Doctors at the Mayo Clinic in Rochester, US, ran a pilot study giving patients the option to complete an online structured medical history that would be reviewed by a doctor within 24 hours.

More than 2,500 “e-visits” were made by 4,282 patients in the two year trial, which ran until November last year and resulted in only 13% of patients being asked to book a face-to-face appointment. Doctors estimated the online consultations made surgery appointments unnecessary in 40% of cases.

Professor John Bachman, professor of primary care at the Mayo Clinic and lead author of the study, told EHI Primary Care that the use of a structured questionnaire, provided by Instant Medical History, had been a key difference between the Mayo Clinic trial and other online consultation projects, which had used online forms or secure emails.

He added: “Instant Medical History takes patients through a questionnaire for any condition and it then presents a very good, logical history to the physician in a structured format.

"We found that in only 20% of cases did the doctor have to ask for additional information; and in many cases reviewing the information and responding was very quick for the doctors.”

Professor Bachman, who presented the study results at the Royal Society of Medicine in London this week, said the pilot service had been mainly used by women aged between 20 and 65.

They had used it to consult for themselves, their children and their parents. The study gave patients the option to set up family accounts that linked members to one central account.

Professor Bachman added: “Patients liked it, they found it easy to use and the barriers about getting hold of their physician dropped immediately.”

The consultation tool was used for 293 different conditions and the top three most frequent reasons for using the service were sinusitis, depression and back pain.

Patients who lived furthest from the clinic were most likely to use it and in 2% of cases patients uploaded photographs to the questionnaire to aid diagnosis.

The average time delay from completion of a questionnaire to review by a doctor was four to six hours.

Professor Bachman said an analysis of outcomes showed there was no difference between those using the e-visit service and those who had been seen in the clinic.

He said the trial had also found use of the service saved time for doctors and time and money for patients, who paid $35 for an e-visit compared to $120 – $130 for a surgery appointment.

The Mayo Clinic, the largest private clinic in the world, now plans to roll-out the consultation service via an online patient portal to 350 doctors. Professor Bachmann said it would eventually be available to all 2,500 doctors working for the clinic, covering 528,000 patients.

In the UK, Cheshire GP Dr Amir Hannan, who has pioneered patient access to records, has tested use of Instant Medical History with a small group of his patients.

He told EHI Primary Care that he felt the system needed to be tweaked for a UK audience but that his patients had found it helpful.

He is also interested in its potential use in nursing homes, where he is already hoping to pilot access to records.

He added: “ It’s a very natural way of doing things to go through a set of questions and then send it to your clinician. I think we now need to try it out on groups of different people and see how we can take it forward.”

Link: You Tube : Professor Bachman presents his findings on online consultations.