Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study

Abstract

Background eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.

Missing Diagnoses during the COVID-19 Pandemic: A Year in Review

“…This has also been the case in the context of our population, where we find that the share of telemedicine-based visits has increased to 56.2%, from 15.4% in the pre-pandemic year. A recent evaluation of the profiles of telemedicine users in Catalonia, Spain [36], indicates that the growth of telemedicine is also linked to increased utilization by new societal groups. Prior to the pandemic, the average profile of a telemedicine user in Catalonia was a middle-aged high-income female from an urban area.…”

Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study

“…It has been observed, for example, that cardiac arrests outside hospital have increased, with patients having worse prognoses [ 9 ], or that patients with heart failure have had fewer admissions, but when admitted, heart failure has been more severe and admission to the intensive care unit is required more often [ 10 ]. It has also been noted that access to telemedicine visits has not been the same for the whole population and that, when this type of care becomes predominant, inequalities in access to care may arise [ 11 , 12 ].…”

Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia

“…In this context, the model of attendance has been redirected towards telemedicine in order to compensate for declining face-to-face visits [2]. Some studies have described an increase of telephones/email/Internet consultations during and after the first wave of COVID-19 [6][7][8]. Although a recent study showed no evidence of a negative association between decrease in outpatient visits and glycemic control in 2020 [14], there are still some concerns about possible effects on screening, follow-up and glycemic control of T2DM, as a large number of face-to-face visits were postponed during the pandemic and the access towards telemedicine could be different in regards some populations, creating some barriers to access [15].…”

“…Another effect of the Covid-19 pandemic on the healthcare system is the drastic reduction of face-to-face visits [2] , [6] , [7] , [8] , raising concerns about how it will affect the management and control of chronic patients, such as patients with type 2 diabetes mellitus (T2DM). Several studies have found a decrease in metabolic control, specially during the lockdown period [9] , [10] , [11] , [12] , [13] .…”