Telemedicina, una nueva herramienta para la gestión del dolor. Resultados de su implementación en una estructura organizativa de gestión integral (EOXI)

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Abstract

RESUMEN Introducción: En diciembre de 2014, en el contexto del Plan de Atención del Dolor Crónico del SERGAS, se aplicó la primera experiencia de teleconsultas en unidades de dolor (UD). Se escogió la Estructura Organizativa de Gestión Integrada (EOXI) de Vigo para su aplicación. Material y métodos: Se realizó un estudio descriptivo longitudinal retrospectivo de todas las teleconsultas enviadas a la UD en el periodo comprendido entre el 1 de enero de 2015 hasta el 31 de diciembre de 2018. Resultados: Entre enero de 2015 y diciembre de 2018 se han solicitado un total de 2218 teleconsultas. Fueron realizadas desde 42 centros de salud de un total de 42 del EOXI. De las 2218 teleconsultas recibidas, el 49 % fueron preferentes. Respecto a la capacidad de resolución, el 26 % (586) de los pacientes son dados de alta de forma telemática y el 74 % (1632) son citados en la UD. Los tiempos de respuesta medios para el periodo de tiempo estudiado fueron: 21 días para las teleconsultas preferentes y de 22 para las ordinarias. Conclusiones: La teleconsulta contribuye a que se conozca y mejore la coordinación entre diferentes niveles asistenciales, evitando derivaciones innecesarias a consulta presencial, mejorando la accesibilidad del paciente y descongestionando los servicios hospitalarios. Pone de manifiesto la importancia de unos protocolos consensuados de remisión y la necesidad de actualizar la información sobre la cartera de servicios. Permite detectar defectos de comunicación entre Atención Primaria y UD. Permite poner en marcha acciones correctoras.

Translated abstract

ABSTRACT Introduction: On 2014 the Galician Health Service (SERGAS)starts the first teleconsult experience applied to pain unit, and the Sanitary Area of Vigo was chosen for its pilot implementation. Material and methods: A retrospective longitudinal descriptive study was undertaken during the lapse time January 2015 to December 2018. Results: In the period of study a total of 2218 teleconsults were requested from the 42 primare care centers of the Sanitary Area. 49% of the teleconsults were preferent. 26% (586) of the requests were rejected and 74% (1632) were evaluated at the Pain Unit. The mean time for response were: 21 days for preferents and 22 for non-preferents. Conclusions: Teleconsult allows an improvement in the relationship between specialized and primary care levels. Remarks the importance on consensuated protocols for patient referal. Remarks the need of an updated and well documented portfolio of services. It allows to correct errors of information transmission between assistance levels and implement correction actions.

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Telemedicine: a new health care delivery system.

R L Bashshur, T G Reardon, G Shannon (2000)

The resurgence of telemedicine can be attributed to its potential for addressing intransigent problems in health care, including limited accessibility, cost inflation, and uneven quality. After discussing definitions and the genesis of telemedicine, this review focuses on conceptual issues and an assessment of past research. The scope and methodological rigor necessary for sustained development and policy making have been limited in this area of research, owing to the nature of extant telemedicine projects and the lack of a comprehensive research strategy that specifies the objectives of telemedicine research regarding accessibility, cost, and quality. Research strategies and a framework for analysis are discussed. Without a commitment to the types of research objectives, framework, and strategy presented here, the considerable promise of telemedicine, as an innovative system of care, may not be fully realized.

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Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review

Richard Wootton, Kambiz Bahaadinbeigy, David Hailey (2011)

Background A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine. Method The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant. Discussion Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.