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

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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.

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Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology - the use of technology to provide neurological care and education remotely - has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers - especially the digital divide - will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.

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Author and article information

Contributors

Freddy Constanzo:

ORCID: http://orcid.org/0000-0002-7231-4370

teleneurologiahht@gmail.com

Journal

Journal ID (nlm-ta): BMC Med Inform Decis Mak

Journal ID (iso-abbrev): BMC Med Inform Decis Mak

Title: BMC Medical Informatics and Decision Making

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6947

Publication date (Electronic): 5 February 2020

Publication date PMC-release: 5 February 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 20

Affiliations

[1 ]GRID grid.502857.d, Neurology Unit, , Hospital Las Higueras, ; Alto Horno 777, Talcahuano, Chile

[2 ]ISNI 0000 0001 2199 9982, GRID grid.412876.e, Medical Program in Adult Neurology, School of Medicine, , Universidad Católica de la Santísima Concepción, ; Concepción, Chile

[3 ]GRID grid.442215.4, Department of Science, School of Medicine and Science, , Universidad San Sebastián, ; Concepción, Chile

[4 ]GRID grid.440633.6, Department of Statistics, School of Sciences, , Universidad del Bío-Bío, ; Concepción, Chile

[5 ]GRID grid.502857.d, Unit of Teleprocesses, , Hospital Las Higueras, ; Talcahuano, Chile

[6 ]ISNI 0000 0001 2199 9982, GRID grid.412876.e, Department of Basic Sciences, School of Medicine, , Universidad Católica de la Santísima Concepción, ; Concepción, Chile

Author information

Freddy Constanzo http://orcid.org/0000-0002-7231-4370

Article

Publisher ID: 1034

DOI: 10.1186/s12911-020-1034-2

PMC ID: 7003445

PubMed ID: 32024518

SO-VID: 1080f3a8-b515-4b62-9923-f0a6fb32558e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.