Abstract
Purpose: This prospective study focused on an interhospital collaboration for foot and ankle surgery. Collaboration was organised between the referring surgeon and four regional foot and ankle specialists. We evaluated concordance and discordance between expert opinions.
Material and methods: Patients for whom an opinion was requested were selected by the requesting surgeon based on problems involving diagnosis or therapeutic indications. Opinions were requested by email. Individual protocols were established for the clinical report and x-ray file of each type of condition. The final therapeutic decision was made by the requesting surgeon.
Results: Among the 450 patients seen for foot and ankle disorders, opinions were requested from experts for 30. The conditions involved: the forefoot (46%), the middle foot (16%), the hindfoot (7%) and the ankle (31%). Mean time for the response was eleven days (1–60). Experts responded to all requests (120 responses) but in four cases (3%) could not provide an opinion. The index of diagnostic agreement among the experts was 3.2/4. The index for therapeutic indications showed agreement at 2.6/4. Agreement between the therapy proposed to the patient and that proposed by the experts was 2.6/3.
Discussion: We analysed the advantages for the patient, the responsibility of the requesting and responding surgeon, and the problems related to remuneration of this type of counselling. Compared with other technologies, email was found to be simple, reliable, and low-cost with good quality images. This work showed that there was concordance between the opinions and that electronic expertise counselling is certainly very useful for foot disorders. Requests addressed to several experts increases precision and provides complementary information for difficult cases. It is important that the different participants know each other.
Conclusion: This work is the first step towards the development of a care network for foot and ankle disease enabling graduated patient management.
Correspondence should be addressed to SOFCOT, 56 rue Boissonade, 75014 Paris, France.
