Reforming our health care system: time to rip off the band‐aid?

Jackson, Claire; O’Halloran, Diana

doi:10.5694/mja2.51261

Cited by 7 publications

(2 citation statements)

References 5 publications

(4 reference statements)

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“…3,6 In addition, there is a recognition that patients with complex, chronic diseases require ongoing team management co-ordinated by the primary care physician/general practitioner (GP) who can provide continuity of care in partnership with other health providers. 7 The eConsult model of care is an outpatient substitution approach which has been evaluated, and implemented extensively internationally. [8][9][10][11] It provides an asynchronous, digital, clinician-to-clinician advice service, giving GPs remote access to specialist support for patient care within 3 business days.…”

Section: Introductionmentioning

confidence: 99%

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

Job¹,

Nicholson²,

Donald³

et al. 2023

Preprint

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Background The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. Methods A cost analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a health system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. Results The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. Conclusions The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.

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Section: Introductionmentioning

confidence: 99%

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

Job¹,

Nicholson²,

Donald³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The Australian health care system is well regarded on the global stage in terms of the balance between investment in health care and outcomes delivered, particularly in terms of universal access, quality and safety 1 . However, there is considerable fragmentation and poor coordination of care and communication between hospitals and primary care, which limits further improvement 2,3 . Geographical barriers, workforce shortages and issues relating to acceptability of services limit health care access for residents of rural, regional and remote communities, Aboriginal peoples and Torres Strait Islanders, and together with an inadequate focus on prevention, limit progress towards health equity 4 …”

mentioning

confidence: 99%