THE IMPACT OF A WEB BASED DIAGNOSIS CHECKLIST SYSTEM ON SPECIALIST REFERRALS FROM PRIMARY CARE: RESULTS OF A SURVEY OF GENERAL PRACTITIONERS

Monday, October 25, 2010
Vide Lobby (Sheraton Centre Toronto Hotel)
Jason Maude, Isabel Healthcare, Haslemere, United Kingdom, Padmanabhan Ramnarayan, Great Ormond Street Hospital, London, United Kingdom and Amanda Tomlinson, Isabel Healthcare, London, United Kingdom

Statement of problem:

To look at the impact of a web based diagnosis checklist system (Isabel) on referrals for specialist care in a UK primary care setting. It is generally estimated that 30-50% of such referrals are inappropriate leading to inefficient use of specialist resources and delays in patient care.

Description of the intervention or program:

25 general practitioners (GPs) from 4 GP surgeries in southwest London used the Isabel system over a period of 6 months during 2010. The GPs used Isabel to enter patient clinical features in free text and were provided with a set of up to 20 diagnostic possibilities as a checklist for consideration. A voluntary web based survey form was added at the end of the consultation to collect information regarding users’ views on the diagnostic advice provided. The form contained 4 questions covering the impact of Isabel on their differential, referral and management.

Findings to date:

Over a 6-month period GPs entered 335 queries into the Isabel system. 49 survey’s were completed. In 47% of cases Isabel helped confirm the GPs’ differential and in 36% it broadened their differential. In 29% of cases they no longer needed to either refer a patient to a specialist or use the consultant advice line. In 36% of cases it helped them refer the patient more appropriately. In 40% of cases they ordered an additional test, in 4% of cases they ordered a medication, in 6% of cases they cancelled a medication and in 2% they cancelled a diagnostic test. Over the period of the pilot the average monthly number of referrals made by the practices fell by 15%.

Lessons learned:

These preliminary results show that a diagnosis checklist system, such as Isabel, could be a useful tool to improve the appropriateness of referrals from primary care to hospital-based specialists. This is especially relevant since a number of other strategies in this area,such as referral management centres, have failed to show significant effects.