Teleconsultations' Impact on Referral Streamlining and Waitlist Reduction: A Large-Scale Retrospective Cohort Study of Over 200,000 Cases.

Abstract

Introduction: Long waiting lists for elective medical consultations present significant challenges within health care systems globally. Remote consultation (teleconsultation) between a primary care physician and a specialist doctor can resolve some of these demands, reducing waiting lists. This study aims to evaluate the effectiveness of teleconsultations in reducing unnecessary specialist referrals and waitlist time within the referral process with primary care doctors. Methods: A retrospective cohort study was conducted from January 2017 to December 2019. The regulation process of specialized consultations waiting lists was made by two groups: (1) those regulated by RegulaSUS associated with the provision of teleconsultation and (2) those regulated by the usual procedures of the Ambulatory Regulation Center of the State of Rio Grande do Sul (contemporaneous controls group). The primary outcome evaluated the proportion of patients managed within primary health care (PHC) without requiring in-person specialist care, and the waitlist times during the regulation process were compared between the different groups. Results: The analysis encompassed 245,643 referral requests for specialized consultations across 23 medical specialties. The RegulaSUS project reduced the need for in-person specialized medical consultation by 29% (31.6% vs. 44.5%, p < 0.001). The median waitlist time was 1,140.4 (interquartile range [IQR], 1,393.6-476.6) days in individuals in the RegulaSUS and 1,271.0 (IQR, 778.4-1,723.0) control (p < 0.0001). Discussion: The RegulaSUS teleconsultations demonstrated an effective approach to increasing the resolution of primary care physicians, reducing unnecessary specialist referrals, and reducing waitlist time for specialized medical consultations. This initiative is a model for efficient referral management, prioritizing patients needing specialized care while optimizing health care resource allocation in PHC settings.