The impact of inter‐clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care

Mazón‐Ramos, Pilar; Cinza‐Sanjurjo, Sergio; Garcia‐Vega, David; Romero, Manuel Portela; Rodríguez‐Mañero, Moisés; Aldana, D. Rey; Morandeira, Agustín Pía; Lage-Fernández, Ricardo; Gude‐Sampedro, Francisco; González-Juanàtey, José Ramón

doi:10.1111/eci.13904

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…We have previously published our experience using a universal e‐consultation programme between PCPs and CDs for over 10 years, which has shown promising results in managing referrals. Our study has demonstrated that this programme is associated with a reduction in waiting lists and better health outcomes, for all patients 4,14 including those with a previous diagnosis of cardiac disease such as HF 23 and AF 24 . In addition, this programme has significantly improved the accessibility of the CD for patients who live far from the hospital, particularly those over 80 years old 25 .…”

Section: Discussionmentioning

confidence: 68%

“…Our study has demonstrated that this programme is associated with a reduction in waiting lists and better health outcomes, for all patients 4,14 including those with a previous diagnosis of cardiac disease such as HF 23 and AF. 24 In addition, this programme has significantly improved the accessibility of the CD for patients who live far from the hospital, particularly those over 80 years old. 25 Our study has also highlighted that clinician-to-clinician programmes, such as e-consultation, can enhance healthcare equity and quality, which is especially important for vulnerable patients, including women.…”

Section: Allmentioning

confidence: 99%

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Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Mazón‐Ramos

Aldana

Garcia‐Vega

et al. 2023

Eur J Clin Investigation

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AimsTo assess the longer‐term results (hospital admissions and mortality) in women versus men referred to a cardiology department from primary care using an e‐consultation in our outpatient care programme.MethodsWe selected 61,306 patients (30,312 women and 30,994 men) who visited the cardiology service at least once between 2010 and 2021: 69.1% (19,997 women and 20,462 men) were attended in e‐consultation (from 2013 to 2021) and 30.9% (8920 women and 9136 men) in in‐person consultations (from 2010 to 2012) without gender differences in the proportion of patients attended in each period. Using an interrupted time series regression model, we analysed the impact of incorporating e‐consultation into the healthcare model and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all‐cause hospital admissions and mortality during the one‐year after cardiology consultation.ResultsThe introduction of e‐consultation substantially decreased waiting times to cardiology care; during the in‐person consultation period, the mean delay for cardiology care was 57.9 (24.8) days in men and 55.8 (22.8) days in women. During the e‐consultation period, the waiting time to cardiology care was markedly reduced to 9.41 (4.02) days in men and 9.46 (4.18) in women. After e‐consultation implantation, there was a significant reduction in the 1‐year rate of hospital admissions and mortality, both in women and men iRR [IC 95%]: 0.95 [0.93–0.96] for HF, 0.90 [0.89–0.91] for CV and 0.70 [0.69–0.71] for all‐cause hospitalization; and 0.93 [0.92–0.95] for HF, 0.86 [0.86–0.87] for CV and 0.88 [0.87–0.89] for all‐cause mortality in women; and 0.91 [0.89–0.92] for HF, 0.90 [0.89–0.91] for CV and 0.72 [0.71–0.73] for all‐cause hospitalization; and 0.96 [0.93–0.97] for HF, 0.87 [95% CI: 0.86–0.87] for CV and 0.87 [0.86–0.87] for all‐cause mortality, in men.ConclusionCompared with the in‐person consultation period, an outpatient care programme that includes an e‐consultation significantly reduced waiting time to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year, without significative gender differences.

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Section: Discussionmentioning

confidence: 68%

Section: Allmentioning

confidence: 99%

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Mazón‐Ramos

Aldana

Garcia‐Vega

et al. 2023

Eur J Clin Investigation

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“…3,6 However, data evaluating the effectiveness of e-consultation on clinical outcomes have been scarce. 6 In the present issue, Mazón-Ramos and colleagues 7 report the first study to show the prognostic benefit of e-consultation in AF management in the primary care setting. In this nonrandomized before-after design study, the authors collected data on 10,488 patients with newly diagnosed AF who were referred by a pool of 301 primary care physicians to cardiologists between 2010 and 2019.…”

Section: Improving Atrial Fibrillation Outcomes Through Interclinicia...mentioning

confidence: 87%

Improving atrial fibrillation outcomes through interclinician electronic consultation

Johner

Gencer

2022

Eur J Clin Investigation

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“…Several publications have described our experience using this care model in our health care area, demonstrating that the use of an universal electronic consultation between PCPs and cardiologists as the first step to attend to referrals is associated with a reduction in the elapsed time to care and better health care outcomes [8,11] particularly in high risk patients such as those with HF and previous hospitalization for a worsening HF event [9,10,25].…”

Section: Discussionmentioning

confidence: 99%

Impact on Accessibility to Care and Outcomes of a Clinician-to-Clinician Electronic Consultation Program in Heart Failure Patients with Previous Hospital Admissions: Implications for Heart Failure Care

Garcia‐Vega¹,

Mazón‐Ramos²,

Portela‐Romero³

et al. 2023

Preprint

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(1) Objectives. Patients with heart failure (HF) who experience hospitalizations for worsening HF (HFH) are at high risk of subsequent events. We aimed to evaluate the impact of an outpatient care management program that includes a clinician-to-clinician e-consultation using an integrated electronic medical record in a healthcare area with a widely dispersed population on delay time in care, hospital admissions, and mortality in a high-risk group of patients with HF and previous episodes of HFH. (2) Methods. We selected 6,444 HF patients who visited the cardiology service at least once between 2010 and 2021. Of these, 4,851 were attended in e-consult, and 2,008 in one-time in-person consultations. In 2,230 HF patients, there was documentation of a previous episode of HFH. Using an interrupted time series regression model, we analysed the impact of incorporating e-consult into the health care model in the group of patients with HFH and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all-cause hospital admissions and mortality, calculating the incidence relative risk (iRR). (3) Results. In the group of patients with previous HF hospitalizations, the introduction of e-consult substantially decreased waiting times to cardiology care. The time elapsed to care after e-consult implementation was significantly reduced compared with the previous in-person period (8.6 [8.7] vs 55.4 [79.9] days, p&lt;0.001). In that group of patients, after e-consult implantation, hospital admissions for HF were reduced (iRR [CI95%]: 0,837 [0,840-0,833]), 0,900 [0,862-0,949] for CV and 0,699 [0,678-0,726] for all-cause hospitalizations. There was also lower mortality (iRR [CI95%]: 0.715 [0.657-0.798] due to HF, 0,737 [0.764-0.706] for CV and 0,687 [0.652-0,718] for all-cause). The improved outcomes after e-consultation implementation were significantly higher in the group of patients with previous HFH and were independent of the patient’s clinical characteristics managed during the in-person or e-consultation periods. (4) Conclusions. In HF patients with previous HFH, an outpatient care program that includes an e-consult significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year.

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The impact of inter‐clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care

Cited by 6 publications

References 19 publications

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Improving atrial fibrillation outcomes through interclinician electronic consultation

Impact on Accessibility to Care and Outcomes of a Clinician-to-Clinician Electronic Consultation Program in Heart Failure Patients with Previous Hospital Admissions: Implications for Heart Failure Care

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