Programa de consulta electrónica universal (e-consulta) de un servicio de cardiología. Resultados a largo plazo

Rey-Aldana, Daniel; Cinza‐Sanjurjo, Sergio; Romero, Manuel Portela; López-Barreiro, José L.; Garcia-Castelo, Alberto; Pazos-Mareque, José M.; Mazón‐Ramos, Pilar; González-Juanàtey, José Ramón

doi:10.1016/j.recesp.2020.11.007

Cited by 29 publications

(55 citation statements)

References 8 publications

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“…Although there are previous experiences in other medical specialties, to the best of our knowledge, this is the first time an e-consultation model is applied to pulmonology [ 22 – 27 ]. In total, 43.5% of cases were solved via e-consultation, slightly exceeding our estimates, and in an intermediate range with respect to previous studies (range: 21.4–69%) [ 6 , 22 , 23 ]. The proportion of cases solved via e-consultation is expected to decrease over the years as a result of two effects: learning, as clinicians will progressively improve their patient management skills; and dissuasive, due to an increasing awareness that minor respiratory problems are rarely referred to a face-to-face consult.…”

Section: Discussioncontrasting

confidence: 74%

“…In another experience in a Unit of Cardiology, Wasfy et al confirmed that the e-consultation model is safe and effective and improves the efficacy of outpatient care [ 27 ]. Finally, Rey-Aldana et al implemented an e-consultation model in a Unit of Cardiology in our healthcare district and concluded that this model is safe since it improved waiting time and reduced hospital admissions and mortality during the first year of implementation [ 6 ]. In our case, there are no data available in the literature about health outcomes in terms of ED admissions, hospitalizations, and mortality, which we will investigate in future studies.…”

Section: Discussionmentioning

confidence: 99%

“…Although waiting lists are unavoidable, long waitlists may compromise the principle of equity and raise ethical concerns about distributive justice, inequalities, or discrimination [ 5 ]. Telemedicine based on electronic physician-to-physician consultations (e-consultations) may help reduce waiting lists, thereby improving healthcare equity, effectiveness, and clinical outcomes [ 6 ]. Through e-consultations, physicians provide clinical information and send consultations securely to specialists (in this case, a pulmonologist), via the electronic health record of patients with good reported results in other specialties [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Telemedicine based on electronic physician-to-physician consultations (e-consultations) may help reduce waiting lists, thereby improving healthcare equity, effectiveness, and clinical outcomes [ 6 ]. Through e-consultations, physicians provide clinical information and send consultations securely to specialists (in this case, a pulmonologist), via the electronic health record of patients with good reported results in other specialties [ 6 , 7 ]. By this method, the specialist decides whether a patient needs a face-to-face appointment with specialty care, or otherwise the case can be managed in primary healthcare (PH) following the specialist's advice.…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation

Álvarez-Dobaño

Toubes

Novo-Platas³

et al. 2022

Canadian Respiratory Journal

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Introduction. This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods. A prepost intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results. In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 ( p < 0.001 ). In total, 43.5% of cases were solved via physician-to-physiciane-consultation. A total of 2,223 patients needed a face-to-face visit, with a mean wait time of 7.5 days. The mean of patients in the waiting listing decreased from 450.8 in 2019 to 44.8 in 2021 (90% reduction). The annual time devoted to e-consultations and first face-to-face visits following an e-consultation diminished significantly after the intervention (1,724 hours versus 2,312.8; 25.4% reduction). Each query solved via e-consultation represented a saving of €652.8, resulting in a total annual saving of €827,062. Conclusions. Physician-to-physiciane-consultations reduce waiting times, improve access of complex patients to specialty care, and ensure that cases are managed at the appropriate level. E-consultation reduces costs, which benefits both, society and the healthcare system.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation

Álvarez-Dobaño

Toubes

Novo-Platas³

et al. 2022

Canadian Respiratory Journal

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“…The characteristics and outcomes of our outpatient care programme have already been published. 5 This e-consultation is made via our integrated electronic health record, which comprises all the patient information from all the levels of care (primary care and hospitals) in the Spanish region of Galicia. The e-consultation must contain all the clinically relevant information, and the cardiologist, who sees the e-consultation a few days later, can also check all the additional tests performed in the primary care setting (mainly electrocardiogram, chest X-ray, and blood tests), as well as all the previous relevant information about the patient's disease (i.e.…”

Section: Patientsmentioning

confidence: 99%

An electronic consultation program impacts on heart failure patients' prognosis: implications for heart failure care

et al. 2022

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Aims e-consults are asynchronous, clinician-to-clinician exchanges that answer focused, non-urgent, patient-specific questions using the electronic medical record. We instituted an e-consultation programme (2013)(2014)(2015)(2016)(2017)(2018)(2019) for all general practitioners (GPs) referrals to cardiologists that preceded patients' in-person consultations when considered. In our study, we aimed to analyse the clinical characteristics, 1 year prognosis and the prognostic determinants of patients with a previous diagnosis of HF referred for an e-consult, categorized by their previous HF-related hospitalization status (recent hospitalization, <1 year before; remote hospitalization, >1 year before or never been hospitalized because of HF), and to analyse the impact of reducing the time elapsed between e-consultation and response by the cardiologist in terms of prognosis. Methods and resultsEpidemiological and clinical data were obtained from 4851 HF patients referred by GPs to the cardiology department for an e-consultation 2013 and 2020. The delay of time to e-consults were solved was 8.6 + 8.6 days with 84.3% solved in <14 days. For the 1 year prognosis evaluation after the e-consult were assessed the cardiovascular hospitalizations, HF-related hospitalizations, HF-related mortality, cardiovascular mortality, and all-cause mortality. Compared with the group without a previous hospitalization, patients with recent and remote HF hospitalization were at higher risk of a new HF-related hospitalization (

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Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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Programa de consulta electrónica universal (e-consulta) de un servicio de cardiología. Resultados a largo plazo

Cited by 29 publications

References 8 publications

Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation

Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation

An electronic consultation program impacts on heart failure patients' prognosis: implications for heart failure care

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

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