Contribution of a synchronic teleneurology program to decrease the patient number waiting for a first consultation and their waiting time in Chile

Abstract

Backround There is a shortage of medical specialists in Chile, including neurologists; currently, there are 56,614 patients waiting for a first adult Neurology appointment in the country. The Teleneurology Program at the Hospital Las Higueras de Talcahuano (HHT) was implemented in 2015 to help reduce both the number of patients waiting for a first consultation and their waiting times. Methods: This retrospective study analyzed a cohort of 8269 patients referred to the HHT Neurology clinic between 2013 and 2018, from primary, secondary, and tertiary health centers. Cox regression analyses were performed to determine the factors influencing each outcome (number of patients waiting for a consultation and waiting time), such as age, gender, referral health establishment and the type of consultation (whether in situ at the HHT or by synchronic telepresence through the Teleneurology Program). Results: Out of the 8269 patients included in the study, 1743 consulted the neurologist through the Teleneurology Program, while 6526 received a consultation in situ at the HHT. Since its implementation (2015) until the end of 2018, the Teleneurology program contributed to decrease the number of patients waiting for their first appointment from 3084 to 298. Waiting time for the first consultation was 60% shorter for patients enrolled in the Teleneurology program than those with consultation in situ at HHT (6.23 ± 6.82 and 10.47 ± 8.70 months, respectively). Similar differences were observed when sorting patient data according to the referral health center. Cox regression analysis showed that patients waiting for a traditional in situ first adult Neurology consultation at the HHT had a higher risk (OR = 6.74) of waiting 90% longer than patients enrolled in the Teleneurology Program, without significant differences due to gender or age. Conclusions: Data from this study show a significant contribution of the Teleneurology Program at the HHT to decrease the number of patients waiting for a first consultation with a neurologist, as well as shorter waiting times, when derived from primary and secondary health centers.

Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano—Chile

“…The neurologist group dedicated, as a group, 74 h per week to consultation in situ at HHT and 17 h per week to the teleneurology program. The general practitioners dedicated, as a group, 21 h per week for (i) coordination of care and follow-up of patients waiting for an appointment, (ii) extension of chronic patient prescriptions, and (iii) follow-up of patients with a prolonged medical license or in the process of requesting a disability pension (9). This allows the team of neurologists to focus exclusively on the resolution of the patients' neurological problems.…”

“…The shortage of medical specialists has exacerbated the country's geographical difficulties in delivering tertiary healthcare; however, this situation provides an opportunity for telemedicine to improve patient access to professional medical services. Therefore, the implementation and the development of telemedicine in the Chilean public healthcare system is a good means of overcoming the shortage of experts and the transportation problems for ambulatory patients (9) and acute stroke patients (10).…”

“…The Talcahuano Health Service started the teleneurology program in March 2015 to help manage adult neurological patients waiting for their first consultation (9). The program runs in a synchronous mode, in which the ambulatory patient consults a general practitioner, who has been trained for this purpose in a local medical institution and connects the patient with a neurologist at the Hospital Las Higueras de Talcahuano (HHT) via an HDTV video conference system (11).…”

“…The teleneurology program allows the remote care of patients at local primary and secondary medical institutions and has been shown to improve access to medical care from neurologists, with high levels of user satisfaction (11)(12)(13). Furthermore, the teleneurology program has also produced very good results with regard to reducing the waiting list for a first consultation, providing follow-up visits for patients with adequate control of their condition (9) and maintaining access to services during the coronavirus disease 2019 pandemic (14)(15)(16).…”

“…Therefore, it is necessary to reorganize the different levels of the healthcare system to face these challenges. The systematic use of teleneurology has been shown to be effective for many neurological disorders (9,20,21). Recent studies have provided a detailed description of the types of pathologies that can be efficiently treated through telemedicine (20)(21)(22); however, in Chile, there are no published reports that describe the most common neurological pathologies that could be treated by teleneurology in outpatient clinics.…”