Teleconsultation: an Integrative Review of the Doctor-Patient Interaction Mediated by Technology

Abstract

Medical teleconsultation can apply different technologies to mediate the communication between doctors and patients located in different geographic spaces. Its implementation has been encouraged in several countries, under the assumption of its potential to overcome distances, offering health care in a shorter time, reducing costs and workload. The scarcity of evidence about these allegations, in addition to the need of clarifying the situations in which teleconsultation can be adequate, safe and effective, have generated debates, intensified after the publication of Resolution N. 2.227/2018 by the Federal Council of Medicine, which allowed medical teleconsultation, containing principles and recommendations. This article aims to analyze the international experience of medical teleconsultation, including the media and technologies employed, their use, benefits and limitations, highlighting and associating the controversial points of the resolution recently published by the Federal Council of Medicine. An integrative review of the literature was carried out to identify these experiences from January 2013 to February 2019. Of the 1912 identified references, 42 were analyzed after applying the exclusion and inclusion criteria. Data collection and analysis indicated that telephone, e-mail, e-consulting systems, video or a combination of those have been used in several countries to mediate the doctor-patient relationship. Its use goes ranges from diagnosis to treatment, monitoring, management and prescription, both in acute and chronic conditions. The main benefits include less demand for face-to-face consultations, with the possibility of doctors’ workload management, allowing systems’ reorganization. Moreover, the teleconsultation allows overcoming distance barriers, in a flexible and convenient way for patients, possibly contributing to continuity of care, patient autonomy and resource savings, in the latter case, when it avoids work absenteeism due to face-to-face consultation. Some limitations of the teleconsultation include the inability to perform the physical examination, so it is not recommended for the first consultation. Technical and communication difficulties for each media, as well as its inadequacy for some groups of patients, are other important barriers. Data security regarding diagnosis and clinical precision, patients’ and professionals’ acceptance and the need for organizational adjustments are also considered limitations of the teleconsultation. The success of the teleconsultation depends on the integration of different organizations and professionals, aiming to maximize its potential and improve service design, encompassing clinical, technical, organizational and context issues. Therefore, it is important to investigate in which contexts, situations and conditions the teleconsultation can be beneficial, safe and effective for patient care, as well as the most appropriate means of communication.

The Quality of Medical Care in the Conditions of the COVID-19 Pandemic, with Particular Emphasis on the Access to Primary Healthcare and the Effectiveness of Treatment in Poland

“…In general, an analysis of other studies shows that telemedicine is actually pursuing its primary goal of improving access to care and it does so through innovative and constantly evolving tools. For instance, in Great Britain and Denmark, in order to ensure access to primary healthcare, teleconsultations take place in most primary care facilities as a standard procedure [88][89][90]. It is treated as "a strategic alternative to decentralisation and improving access to medical care, allowing to reduce costs and travel time for patients" [88].…”

“…For instance, in Great Britain and Denmark, in order to ensure access to primary healthcare, teleconsultations take place in most primary care facilities as a standard procedure [88][89][90]. It is treated as "a strategic alternative to decentralisation and improving access to medical care, allowing to reduce costs and travel time for patients" [88].…”

The importance of physical examination in primary health care provided by NPHW is being threatened in COVID19 times

“…[ 5 ] Telemedicine suffers from larger emphasis on history and on some point of care tests and hardly any physical examination, which poses limitations to its effectiveness in reaching a clinical diagnosis. [ 6 7 ]…”

Coping strategies and health promotion through teaching-service integration in the context of the COVID-19 pandemic

“…The contingency plan (CP) for COVID-19 comprises 10 intervention measures ( distance is a critical factor, 4 in addition to being a strategic alternative to decentralization and improving access to medical care, allowing to reduce costs and displacements. 5 The fourth and fifth stages (Table 1) Neto et al 6 , demonstrated satisfactory results in reaching the public using the social network as a tool to promote health education. In this way, supervisors can technically prepare themselves to offer a second formative opinion to participating physicians, strengthening the teaching-service integration, which in health units consists of the integrated work of academics, professors, managers and professionals who make up health institutions, aiming to improve individual and collective attention and reorient the educational process and professional training in the health area.…”