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Using a Delphi technique, an electronic medical record template was developed to capture the hidden activities of ENPs defined as secondary consultations.
In parts of Europe and Asia, teleradiology is being used across borders either to serve areas with a shortage of radiologists or to allow secondary consultations with specialists, or both [ 46].
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ED re-presentation rates are lower when an ENP provides a secondary consultation.
Thus, the number of examinations read by subspecialists (either as a primary reading or as a secondary consultation) can be used as a metric relating to the quality of the radiology report [31, 32, 33, 34, 35].
Secondary consultation practices have employed predominantly the whole slide imaging approach and have also been shown to be accurate.
Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs.
The cost of care is high in multimorbidity, due to high rates of primary and secondary care consultations and unplanned hospital admissions.
A substantial proportion of primary and secondary care consultations are for physical symptoms which cannot be adequately explained by organic pathology.
To put consultation rate data into context, the average practice consultation rate per listed patient per month in England was 0.44 in 2006 [ 23]. (Additional file 5) The Get Well UK and Glastonbury reports provided data on secondary care consultations.
This patient and carer were worried about the absence of medical notes at secondary care consultations and particularly concerned that significant results from a 48 h heart monitor test had not been acted on for nearly 9 months (box 1B).
Overall, managed care was associated with a better process of diabetes care, higher use of primary health care, fewer secondary care consultations and lower health care costs compared to usual care.
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