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A neurology teleconsulting network was implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for videoconferencing were installed, connected by ISDN lines at 128 kbit/s. Fifty-three general practitioners (GPs) were surveyed. The survey showed that the GPs had difficulties in using computers, but they had definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they would probably use the technique. During the study, 90 neurology teleconsultations took place over 55 weeks. The average consultation rate was 1.6 teleconsultations per week (SD 1.3, range 0-6). The conferences lasted 10-45 min. Longer teleconsultations were mainly due to technical difficulties in using computers on the part of users with a low level of computer literacy. The patients were 42 males and 46 females, with a mean age of 38 years (SD 20, range 1-84); two patients were discussed twice. The benefits consisted mainly of advice on patient medication, diagnosis and the prevention of unnecessary specialist consultations or laboratory examinations. Doctor-doctor teleconsultation allows the rapid resolution of queries which otherwise cause stress to patients and increase the cost and complexity of care.

This paper begins by discussing the influence of neurological diseases in the practice of general practitioners. A thorough review of the literature allows us to conclude that the frequency of neurological complaints in general practice varies between 7% and 15% and that complaints of sleep disorders reach about 26% in those cases. However, general practitioners do not refer all these neurological cases to a neurologist. They screen the cases and refer only 9% of all observed patients. Next, we briefly analyse the impact of telemedicine in general practice. Given this technique's novelty, we present a predictive model for the utility of teleconsultation, which we are currently developing and testing. We then summarise the current status of general practitioners' referrals to our hospital's neurological outpatient clinic, given previous measures that targeted waiting list reduction and adequate referral. After this overview, we present our methodology, which includes the development and implementation of the technologies needed for teleconsultation and the discussion and application of medical protocols for clinical data, benefits and costs. Simultaneously, we investigated the real need for teleconsultation in Neurology according to the literature and to several, more or less optimistic, models of acceptance. Based on this method, teleconsultation began its regular operation in July 1998. We discuss the result of the first 14 weeks of operation. We observed that referral developed according to calculated predictions and that there were clear advantages regarding diagnostics, medication, exam requests, cost avoidance and patient trips to the central hospital. The data collected predicts that this method is useful, efficient and able to substantially reduce costs.