Resumo Em 1999, o relatório “Errar é humano: construir um sistema de saúde mais seguro” do Instituto de Medicina dos Estados Unidos concluiu que a atividade de atendimento especializado não era uma prática infalível e que havia maior probabilidade de causar eventos adversos. Para reduzir os danos dos sistemas de cuidados de saúde, os países desenvolvidos concentraram seu interesse nos cidadãos a partir dos primeiros anos do século XXI. Todas as estratégias de modernização terão como objetivo melhorar a qualidade do atendimento. Nesse contexto, a segurança do paciente é um componente-chave da qualidade assistencial. Em 2003, o Hastings Center publicou o relatório “Promover a segurança do paciente: uma base ética para a deliberação de políticas”, que faz uma reflexão ética das obrigações morais subjacentes à cultura de segurança desenvolvida na sequência da publicação do relatório “Errar é humano”.
Background:
Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are no described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility, and hospital admissions) of an electronic consultation (e-consultation) outpatient care program.
Methods:
Epidemiological and clinical data were obtained from the 41 258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person consultation (2010–2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients’ in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation on (1) delay time (days) in care and (2) hospital admissions. We also analyzed (3) total number and referral rate (population-adjusted referred rate) in both periods (in-person consultation and e-consultation), and (4) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital.
Results:
During the e-consultation, the demand increased (7.2±2.4% versus 10.1±4.8% per 1000 inhabitants,
P
<0.001), and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (−0.96 [95% CI, −0.951 to −0.966],
P
<0.001) was maintained with e-consultations (−0.064 [95% CI, 0.043–0.085],
P
<0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (incidence rate ratio, 1.011 [95% CI, 1.003–1.018]), was stabilized (incidence rate ratio, 1.000 [95% CI, 0.985–1.015];
P
=0.874).
Conclusions:
Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend.
A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.
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