eConculta: Impact of Virtual Visits in Primary Care (eConsulta)

Before and After Study to Assess the Impact of the Use of Virtual Consultation on Frequency of Patient Attendance, and Satisfaction of Patients and Professionals

eConsulta is a before and after quasi-experimental study without control group and its purpose is to asses the impact of virtual visits in primary care on the frequency of attendance of the patients to the primary care centre. The use of virtual consultations should lower the number of face to face visits to primary care. It also should create satisfaction to both users: primary care professionals and patients.

Study Overview

• Status: Completed
• Conditions: Adult
• Intervention / Treatment: Other: eConsulta

Detailed Description

Excess on primary care face to face demands generates a work overload for the professionals, and it could lead to a lower quality of care and less job satisfaction. Not all primary care demands need a face to face encounter so incorporating new technologies into daily practice care such as communication doctor/nurse-patient through a website could be part of the solution. So we designed a study in order to assess the impact of the use of virtual consultation on frequency of attendance and the satisfaction of patients and professionals with the service.

It is a before after quasi-experimental multi-centre study with no control group. Agreed voluntarily to participate 13 primary care centres, 20 primary care physicians, 17 nurses them having 16.720 reference adult patients. We designed a website where participants can access the internet and consult their doctor/nurse, who will answer within 48 hours at maximum. The intervention will last 6 months.

We believe that the site can be useful by both patient and professional. For some types of patient, the use of the site may increase its accessibility, reduce face to face consultations and improve satisfaction, while the professional makes a more efficient practice.

• Study Type: Interventional
• Enrollment (Actual): 16720
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Barcelona, Spain, 08001
    • EAP Gòtic
  • Barcelona, Spain, 08005
    • EAP Ramón Turró
  • Barcelona, Spain, 08018
    • EAP El Clot
  • Barcelona, Spain, 08020
    • EAP Sant Martí
  • Barcelona, Spain, 08027
    • EAP La Sagrera
  • Barcelona, Spain, 08029
    • EAP Montnegre
  • Barcelona, Spain, 08030
    • EAP Sant Andreu
  • Barcelona, Spain, 08032
    • EAP El Carmel
  • Barcelona, Spain, 08032
    • EAP Horta
  • Barcelona, Spain, 08037
    • EAP Pare Claret
  • Barcelona, Spain, 08038
    • EAP Dr. Carles Ribas
  • Barcelona, Spain, 08041
    • EAP Congrés
  • Barcelona, Spain, 08041
    • EAP Guinardó Baix

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 18 years or over
• having a primary care centre assigned
• to have both physician and nurse participating in the project
• to use the same electronic clinical recording software

Exclusion Criteria:

• none

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: eConsulta; Those patients who are offered to use the eConsulta, a web where they can virtually consult with their primary care doctor or nurse.	Other: eConsulta; It is a web specifically designed for the project where elected patients can consult virtually with their primary care physician and within 48 hours have an answer.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of primary care face to face visits of the patients during the 6 month intervention, compared to the number of face to face visits of the same patient, in a 6 month previous period.	Number of face to face visits of each patient (who used the eConsulta web site) to primary care physician or nurse during the 6 months of the intervention (from 01/06/2010 to 01/12/2010) compared to the number of visits of the same patients the same period 1 or 2 years before, depending on the appearance of a swine flu outbreak (2009 if there is a swine flu outbreak or 2008 if there is not). The information source of the number of visits will be the electronic clinical record, which is the same in all the practices participating.	Visits done from 01/06/2010 to 01/12/2010 compared to the himself the same period 1 or 2 years before (depending on the flu)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measure the doctor/nurse satisfaction	Satisfaction with the whole service with a 10 point scale. Items: Are you satisfied with the eConsulta?; It is easy to use the web?; Has it been easy to integrate it with the daily practice?	At the end of the study, 01/12/2010
Measure the patient satisfaction	Satisfaction with the whole service with a 10 point scale. Items: Are you satisfied with the eConsulta?; It is easy to use the web?; Would you use it in the future?	At the end of the study, 01/12/2010

Collaborators and Investigators

• Sponsor: Institut Catala de Salut
• Investigators: Principal Investigator: Josep Casajuana, Institut Català de la Salut; Study Chair: Maria A Casas, Institut Català de la Salut; Study Chair: Rosa Chumillas, Institut Català de la Salut; Study Chair: Mireia Fàbregas, Institut Català de la Salut; Study Chair: Ana I Garaikoetxea, Institut Català de la Salut; Study Chair: Maria I Garrido, Institut Català de la Salut; Study Chair: Yolanda Lejardi, Institut Català de la Salut; Study Chair: María J Martínez, Institut Català de la Salut; Study Chair: Maria C Piorno, Institut Català de la Salut; Study Chair: Joan Camús, Institut Català de la Salut

Publications and helpful links

General Publications

• Spielberg AR. On call and online: sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship. JAMA. 1998 Oct 21;280(15):1353-9. doi: 10.1001/jama.280.15.1353.
• Weiss N. E-mail consultation: clinical, financial, legal, and ethical implications. Surg Neurol. 2004 May;61(5):455-9; discussion 459. doi: 10.1016/j.surneu.2003.09.029.
• Leong SL, Gingrich D, Lewis PR, Mauger DT, George JH. Enhancing doctor-patient communication using email: a pilot study. J Am Board Fam Pract. 2005 May-Jun;18(3):180-8. doi: 10.3122/jabfm.18.3.180.
• Messikomer CM. "Our options have changed. .. we will not call you back". Communicating with my primary care physician. Perspect Biol Med. 2007 Summer;50(3):435-43. doi: 10.1353/pbm.2007.0035.
• Roter DL, Larson S, Sands DZ, Ford DE, Houston T. Can e-mail messages between patients and physicians be patient-centered? Health Commun. 2008;23(1):80-6. doi: 10.1080/10410230701807295.
• Kjaer NK, Jepsen KL, Ruwald S, Jepsen NP, Nielsen HH. [E-mail communication in general practice]. Ugeskr Laeger. 2005 Nov 21;167(47):4461-5. Danish.
• Kuszler PC. A question of duty: common law legal issues resulting from physician response to unsolicited patient email inquiries. J Med Internet Res. 2000 Jul-Sep;2(3):E17. doi: 10.2196/jmir.2.3.e17. No abstract available.
• Bovi AM; Council on Ethical and Judicial Affairs of the American Medical Association. Ethical guidelines for use of electronic mail between patients and physicians. Am J Bioeth. 2003 Summer;3(3):W-IF2. doi: 10.1162/152651603322874771.

Helpful Links

• eConsulta

Study record dates

Study Major Dates

• Study Start: January 1, 2009
• Primary Completion (Actual): December 1, 2010
• Study Completion (Actual): December 1, 2010

Study Registration Dates

• First Submitted: May 11, 2010
• First Submitted That Met QC Criteria: May 17, 2010
• First Posted (Estimate): May 18, 2010

Study Record Updates

• Last Update Posted (Estimate): February 8, 2011
• Last Update Submitted That Met QC Criteria: February 7, 2011
• Last Verified: January 1, 2011

More Information

Terms related to this study

• Keywords: Primary Health Care; Health Services Research; Patient Satisfaction; Job Satisfaction; User-Computer Interface; Office Visits
• Other Study ID Numbers: eConsulta