Longer-Term Results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area

Author:

Rey-Aldana Daniel1ORCID,Mazón-Ramos Pilar2ORCID,Portela-Romero Manuel3ORCID,Cinza-Sanjurjo Sergio4ORCID,Alvarez-Alvarez Belen2,Agra-Bermejo Rosa2,Rigueiro-Veloso Pedro2ORCID,Espasandín-Domínguez Jenifer5ORCID,Gude-Sampedro Francisco6ORCID,González-Juanatey José R.2ORCID

Affiliation:

1. CS A Estrada, Área Sanitaria Integrada Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain (D.R.-A.).

2. Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.).

3. CS Concepción Arenal, Área Sanitaria de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), CIBERCV, Spain (M.P.-R.)

4. CS Porto do Son, Área Sanitaria Integrada Santiago de Compostela (IDIS), CIBERCV, Spain (S.C.-S.)

5. Unidad de Epidemiología Clínica, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain (J.E.-D.).

6. Unidad de Epidemiología Clínica. Complejo Hospitalario Universitario de Santiago de Compostela, IDIS, redIAPP, Spain (F.G.-S.).

Abstract

Background: Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are no described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility, and hospital admissions) of an electronic consultation (e-consultation) outpatient care program. Methods: Epidemiological and clinical data were obtained from the 41 258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person consultation (2010–2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients’ in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation on (1) delay time (days) in care and (2) hospital admissions. We also analyzed (3) total number and referral rate (population-adjusted referred rate) in both periods (in-person consultation and e-consultation), and (4) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital. Results: During the e-consultation, the demand increased (7.2±2.4% versus 10.1±4.8% per 1000 inhabitants, P <0.001), and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (−0.96 [95% CI, −0.951 to −0.966], P <0.001) was maintained with e-consultations (−0.064 [95% CI, 0.043–0.085], P <0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (incidence rate ratio, 1.011 [95% CI, 1.003–1.018]), was stabilized (incidence rate ratio, 1.000 [95% CI, 0.985–1.015]; P =0.874). Conclusions: Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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