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E-consultation between primary and secondary care givers to arrange health care services more efficiently.


- candidate number21160
- NTR NumberNTR4954
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR16-dec-2014
- Secondary IDs14-N-69 
- Public TitleE-consultation between primary and secondary care givers to arrange health care services more efficiently.
- Scientific TitleE-consultation between primary and secondary care givers to arrange health care services more efficiently.
- ACRONYM
- hypothesisE-consultation between General Practitioners (GPs) and internists regarding patients in which the GP is doubtful regarding management or referral, will decrease the number of referrals to the internal outpatient clinic.
- Healt Condition(s) or Problem(s) studiedGeneral practice, Internal medicine, E-consultation
- Inclusion criteriaPatients with symptoms in the internal medicine spectrum. The GP is doubtful regarding management or referral. The patient is 18 years or older. Informed consent. GPs associated to Medical Coordination Centre Omnes.
- Exclusion criteriaThe patient is already under treatment of the internist for the present symptom(s). The patient should be referred urgently or in a crisis situation. The GP is sure that the patient should not be referred. The GP is sure that the patient should be referred.
- mec approval receivedyes
- multicenter trialno
- randomisedyes
- masking/blindingNone
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-jan-2015
- planned closingdate31-dec-2015
- Target number of participants200
- InterventionsE-consultation (E-meedenkconsult) via the GP internet programme ZorgDomein. In the e-consultation the GP presents the patient case to the internist and the internist gives advice after four working days. The internists will give advice for all patients in the study (intervention and control patients). However the GPs will only receive the advice on intervention patients.
- Primary outcomeNumber of referrals to the internal outpatient clinic after six months.
- Secondary outcomeMatches between the intended management choice of the GPs, the advices of the internists and the subsequent GP management. Relevant clinical events, health care consumption, pharmacotherapy, additional testing, referrals to other specialists. Health care costs.
- TimepointsTwo weeks and six months.
- Trial web site
- statusplanned
- CONTACT FOR PUBLIC QUERIESMD Luc G. Gidding
- CONTACT for SCIENTIFIC QUERIESMD Luc G. Gidding
- Sponsor/Initiator Medical Coordination Centre Omnes
- Funding
(Source(s) of Monetary or Material Support)
Medical Coordination Centre Omnes
- Publications
- Brief summary
- Main changes (audit trail)Amendment 2-aug-2016 approved by METC

We started this randomized controlled trial (RCT) in February 2015. Beforehand, we calculated that a minimum of 200 participants was needed to be able to draw statistically significant and relevant conclusions in the sample size calculation. Between February 1, 2015 and March 8, 2016 only 77 e- consultations were registered by the GPs. At this rate it would have taken much too long to reach the estimated target of 200 participants and we would have denied the GPs the option of e-consultation as regular care for too long.

Therefore we decided to stop the RCT and offer the GPs the option of e-consultation as regular care from September 2016 onwards. To monitor possible effects of e-consultation for this patient population, we will use routinely used medical data sources in an observational retrospective design with a comparison of two groups; the group of patients for whom e-consultation was used and the group patients directly referred to internal medicine.

Research questions
How often are patients, for whom e-consultations between GPs and internists are deployed, referred to internal medicine within six months after the e-consultation? How does this group of patients differ from the group directly referred to internal medicine?

Data collection
We will only use routinely used medical data sources. Relevant data on diagnostic procedures, referrals and secondary care of both groups will be collected from digital systems Zorgdomein, GLIMS en SAP. These evaluations will be performed twice; at the start of 2017 and 2018.

The Medical Ethical Committee of Zuyderland Medical Centre approved this amendment on august 2, 2016.
- RECORD16-dec-2014 - 12-okt-2016


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