چکیده (انگلیسی):

Background:Joint consultations–such as teleconsultations–provide opportunities for continuing education of
general practitioners (GPs). It has been reported this form of interactive case-based learning may lead to fewer GP
referrals, yet these studies have relied on expert opinion and simple frequencies, without accounting for other
factors known to influence referrals. We use a survey-based discrete choice experiment of GPs’ referral preferences to
estimate how referral rates are associated with participation in joint teleconsultations, explicitly controlling for a number
of potentially confounding variables.
Methods:We distributed questionnaires at two meetings of the Portuguese Association of General Practice. GPs were
presented with descriptions of patients with dermatological lesions and asked whether they would refer based on the
waiting time, the distance to appointment, and pressure from patients for a referral. We analysed GPs’ responses to
multiple combinations of these factors, coupled with information on GP and practice characteristics, using a binary
logit model. We estimated the probabilities of referral of different lesions using marginal effects.
Results:Questionnaires were returned by 44 GPs, giving a total of 721 referral choices. The average referral rate for the
11 GPs (25%) who had participated in teleconsultations was 68.1% (range 53-88%), compared to 74.4% (range 47-100%)
for the remaining physicians. Participation in teleconsultations was associated with reductions in the probabilities
of referral of 17.6% for patients presenting with keratosis (p = 0.02), 42.3% for psoriasis (p < 0.001), 8.4% for melanoma
(p = 0.14), and 5.4% for naevus (p = 0.19).
Conclusions:The results indicate that GP participation in teleconsultations is associated with overall reductions in
referral rates and in variation across GPs, and that these effects are robust to the inclusion of other factors known to
influence referrals. The reduction in range, coupled with different effects for different clinical presentations, may suggest
an educational effect. However, more research is needed to establish whether there are causal relationships between
participation in teleconsultations, continuing education, and referral rates.