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      Baja implantación de la teledermatología Translated title: Low teledermatology implantation

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          Abstract

          Resumen Las nuevas tecnologías están cambiando nuestras vidas a nivel individual y como sociedad. Su aplicación en la medicina está transformando nuestra práctica médica dándole una nueva dimensión y planteando nuevos retos tanto a profesionales como a las organizaciones. La aplicación de las nuevas tecnologías a las ciencias de la salud define la telemedicina. En el siguiente trabajo se hace una introducción del inicio de la aplicación de la telemedicina y las nuevas tecnologías a través de la búsqueda en las principales bases de datos: Pubmed, Cochrane y Uptodate con los términos de telemedicina, nuevas tecnologías y teledermatología. Objetivos. Conocer el estado actual de la telemedicina y una de sus principales aplicaciones en el campo de la dermatología, la teledermatología, conocer su grado de implantación, así como sus ventajas y desventajas. Estudio de la implantación del Dercam (proyecto de teledermatología en CLM). Método. Estudio descriptivo de todas las teleconsultas recibidas a través del sistema Dercam, desde marzo 2016 hasta mayo de 2017 en la GAI del Albacete, se recogieron datos sobre los distintos Centros de Salud implicados, las distintas patologías consultadas, tiempo de respuesta, seguimiento por atención primaria o especializada. Coincidencia diagnóstica, seguridad diagnóstica y calidad de la foto. Resultado. Se recibieron un total de 370 teleconsultas (TC) en el sistema Dercam, respecto a un total de 10.903 consultas por vía normal, al Servicio de Dermatología. El mayor número de TC derivadas fueron del centro de salud de Iniesta. El grupo de TC más frecuente fue la patología inflamatoria con un 25,14% seguida de las lesiones pigmentadas benignas con un 24,05%. La mayoría de las altas se registran en el grupo de patología del folículo piloso (66,67%), infecciosa (57,50%) e inflamatoria con un 45,16%. El tiempo de respuesta en la mitad de los casos entre uno y tres días. la coincidencia diagnóstica es del 58,54%, con una seguridad alta en los diagnósticos virtuales realizados por especializada y en la mayoría de las fotos valoradas con calidad media. Conclusiones . El sistema Dercam en la GAI de Albacete se encuentra todavía en una fase incipiente de implantación. Sería importante valorar en que patologías es más rentable su uso para obtener una mayor rentabilidad, todo ello a través de protocolos estructurados implicando a todos los profesionales.

          Translated abstract

          Abstract New technologies are changing our lives at the individual level and as a society. Its application in medicine is transforming our medical practice by giving it a new dimension and posing new challenges for both professionals and organizations. The application of new technologies to health sciences defines telemedicine. In the following work an introduction is made of the beginning of the application of telemedicine and new technologies through the search in the main databases: Pubmed, Cochrane and Uptodate with the terms of telemedicine, new technologies and teledermatology. Objectives. To know the current state of telemedicine and one of its main applications in the field of dermatology, teledermatology, to know its degree of implantation, as well as its advantages and disadvantages. Study of the implementation of Dercam (teledermatology project in CLM). Method. Descriptive study of all teleconsultations received through the Dercam system, from March 2016 to May 2017 in the GAI of Albacete, data were collected on the different Health Centers involved, the different pathologies consulted, response time, follow-up by primary or specialized care. Diagnostic match, diagnostic security and photo quality. Result. A total of 370 teleconsultations (TC) were received in the Dercam system, with respect to a total of 10,903 consultations by normal route, to the Dermatology Service. The highest number of CT derived were from the Iniesta health center. The most frequent group of CT was inflammatory pathology with 25.14% followed by benign pigmented lesions with 24.05%. Most of the discharges are registered in the group of pathology of the hair follicle (66.67%), infectious (57.50%) and inflammatory with 45.16%. The response time in half of the cases between one and three days. The diagnostic coincidence is 58.54%, with a high security in the virtual diagnoses made by specialized and in the majority of the photos valued with medium quality. Conclusions. The Dercam system in the GAI of Albacete is still in an incipient phase of implementation. It would be important to assess in which pathologies its use is more profitable to obtain a greater profitability, all through structured protocols involving all professionals.

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          Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis.

            To assess the effect of mobile phone intervention on glycaemic control in diabetes self-management. We searched three electronic databases (PubMed, EMBASE and Cochrane Library) using the following terms: diabetes or diabetes mellitus and mobile phone or cellular phone, or text message. We also manually searched reference lists of relevant papers to identify additional studies. Clinical studies that used mobile phone intervention and reported changes in glycosylated haemoglobin (HbA(1c) ) values in patients with diabetes were reviewed. The study design, intervention methods, sample size and clinical outcomes were extracted from each trial. The results of the HbA(1c) change in the trials were pooled using meta-analysis methods.   A total of 22 trials were selected for the review. Meta-analysis among 1657 participants showed that mobile phone interventions for diabetes self-management reduced HbA(1c) values by a mean of 0.5% [6 mmol/mol; 95% confidence interval, 0.3-0.7% (4-8 mmol/mol)] over a median of 6 months follow-up duration. In subgroup analysis, 11 studies among Type 2 diabetes patients reported significantly greater reduction in HbA(1c) than studies among Type 1 diabetes patients [0.8 (9 mmol/mol) vs. 0.3% (3 mmol/mol); P=0.02]. The effect of mobile phone intervention did not significantly differ by other participant characteristics or intervention strategies.   Results pooled from the included trials provided strong evidence that mobile phone intervention led to statistically significant improvement in glycaemic control and self-management in diabetes care, especially for Type 2 diabetes patients. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.
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            Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.

            Teledermatology, the application of telemedicine in the field of dermatology, has similar accuracy and reliability as physical dermatology. Teledermatology has been widely used in daily practice in the Netherlands since 2005 and is fully reimbursed. This study prospectively investigated the effect of teledermatology on efficiency, quality and costs of care when integrated in daily practice and applied following patient selection by the general practitioner (GP). Teledermatology consultations between GP and regional dermatologist were performed in daily GP practice in the Netherlands. Efficiency of care was measured by the decrease in the number of physical referrals to the dermatologist. Quality of care was measured by the percentage of teleconsultations for second opinion, physical referrals resulting from these teleconsultations, the response time of the dermatologists and educational effect experienced by the GP. Costs of conventional healthcare without teledermatology were compared with costs with teledermatology. One thousand, eight hundred and twenty GPs and 166 dermatologists performed teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010 were included. In the group of patients where the GP used teleconsultation to prevent a referral (n =26,596), 74% of physical referrals were prevented. In the group of patients where the GP used teleconsultation for a second opinion (n =10,611), 16% were physically referred after teleconsultation. The prevented referral rate in the total population was 68%. The mean response time of dermatologists was 4·6 h (median 2·0). GPs indicated that there was a beneficial educational effect in 85% of the teleconsultations. The estimated cost reduction was 18%. Teledermatology can lead to efficient care probably at lower cost. We are therefore of the opinion that teledermatology following GP selection should be considered as a possible pathway of referral to secondary care. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.
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              Systematic review of telemedicine services for patients affected by chronic obstructive pulmonary disease (COPD).

              The aim of the present study was to conduct a systematic literature review focused on telemedicine services for patients affected by chronic obstructive pulmonary disease (COPD). In particular, it addresses (1) which telemedicine applications and related organizational models have been adopted for patients affected by COPD and (2) the impact of these applications. A computerized literature search was performed utilizing MEDLINE and Cochrane Library databases, selecting articles published between 1996 and 2008 using the following combination of keywords: [COPD] AND [telemedicine OR telehealth OR ehealth OR telecare] and after exclusions, 40 articles were considered. The adoption of telemedicine inevitably resulted in the reconfiguration of the existing practices and sociomaterial relationships. These organizational changes must be understood and addressed.
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                Author and article information

                Journal
                jonnpr
                Journal of Negative and No Positive Results
                JONNPR
                Research and Science S.L. (Madrid, Madrid, Spain )
                2529-850X
                2020
                : 5
                : 3
                : 259-294
                Affiliations
                [2] orgnameUniversidad de Castilla-La Mancha (UCLM) Spain
                [3] orgnameUniversidad de Castilla-La Mancha (UCLM) Spain
                [1] orgnameCentro Médico de Quintanar del Rey España
                Article
                S2529-850X2020000300259 S2529-850X(20)00500300259
                10.19230/jonnpr.3222
                3dce67e9-dd93-4315-85ad-de3cdee98da1

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 15 August 2019
                : 01 August 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 67, Pages: 36
                Product

                SciELO Spain

                Categories
                Original

                Telemedicina,Atención Primaria,Dermatology,Dermatología,Telemedicine,Primary Care

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