Original article
Universal electronic consultation (e-consultation) program of a cardiology service. Long-term resultsPrograma de consulta electrónica universal (e-consulta) de un servicio de cardiología. Resultados a largo plazo

https://doi.org/10.1016/j.rec.2020.11.017Get rights and content

Abstract

Introduction and objectives

Many health systems have initiated electronic consultation (e-consultation) programs, although little is known about their impact on accessibility, safety, and satisfaction. The aim of this study was to assess the clinical impact of the implementation of an outpatient care model that includes an initial e-consultation and to compare it with a one-time face-to-face consultation model.

Methods

We selected patients who visited the cardiology service at least once between 2010 and 2019. Using an interrupted time series regression model, we analyzed the impact of incorporating e-consultation into the health care model (started in 2013), and evaluated waiting times, emergency services, hospital admissions, and mortality.

Results

We analyzed 47 377 patients: 61.9% were attended in e-consultation and 38.1% in one-time face-to-face consultations. The waiting time for care was shorter in the e-consultation model (median [IQR]: 7 [5-13] days) than in the face-to-face model (median [IQR]: 33 [14-81] days), P < .001. The interrupted time series regression model showed that the introduction of e-consultation substantially decreased waiting times, which held steady at around 9 days, although with slight oscillations. Patients evaluated via e-consultation had fewer hospital admissions (0.9% vs 1.2%, P = .0017) and lower mortality (2.5% vs 3.9%, P < .001).

Conclusions

An outpatient care program that includes an e-consultation reduced waiting times significantly and was safe, with a lower rate of hospital admissions and mortality in the first year.

Resumen

Introducción y objetivos

Muchos sistemas sanitarios han iniciado programas de consulta electrónica, aunque poco se conoce de su impacto en acceso, seguridad y satisfacción. El objetivo de este estudio es evaluar el impacto clínico de la puesta en marcha de un modelo de atención ambulatoria que incluye una consulta electrónica (e-consulta) inicial comparándolo con un modelo presencial de acto único.

Métodos

Se seleccionó a pacientes con al menos 1 consulta al servicio de cardiología entre 2010 y 2019. Mediante un modelo de regresión de series temporales interrumpidas, se analizó el impacto de la incorporación de la e-consulta en el modelo asistencial (iniciado en 2013), evaluando: tiempo de espera de la atención, asistencias a urgencias, ingresos hospitalarios y mortalidad.

Resultados

Se analizó a 47.377 pacientes: el 61,9% de ellos atendidos incorporando la e-consulta y el 38,1% en el modelo de consulta presencial de acto único. La mediana [intervalo intercuartílico] de la demora a la atención en el modelo de e-consulta, 7 [5-13] días, fue menor que en el modelo presencial: 33 [14-81] días (p < 0,001). El modelo de regresión para series temporales interrumpidas mostró que la incorporación de la e-consulta aporta una disminución muy importante en la demora de la atención, que se mantiene en torno a los 9 días, aunque con ligeras oscilaciones. Los pacientes valorados vía e-consulta tuvieron menos ingresos hospitalarios (el 0,9 frente al 1,2%; p = 0,0017) y mortalidad (el 2,5 frente al 3,9%; p < 0,001).

Conclusiones

Un programa de atención ambulatoria que incluye una e-consulta ha mostrado importantes reducciones en los tiempos de espera y es un modelo seguro, con menores tasas de ingresos hospitalarios y mortalidad en el primer año.

Section snippets

INTRODUCTION

The integration of electronic medical records among health care levels allows professionals at different care levels to share access to patients’ clinical information, improves communication, and enables the possible development of new clinical management modalities for outpatient care that optimize health care resources. This approach crystallizes the integration among levels by avoiding fragmentation of care and promotes coordination, continuity of care, and integrated patient management.1

Patients

The ASISC provides health care coverage to 446 603 people; 352 331 are older than 14 years. This population is characterized by its considerable geographical dispersion, which involves 46 local governments. In total, 107 812 people are older than 65 years; they represent 24.2% of the regional population. To provide health care to the population older than 14 years, the health care area is equipped with 301 PC physicians, who perform their duties in 56 health care centers and 21 peripheral

RESULTS

A total of 47 377 patients were attended in the study period (38.1% under the one-time consultation model and 61.9% under the e-consultation model). Of those attended via e-consultation, 21.4% did not require a face-to-face consultation, 30.4% required 1 face-to-face consultation, and 48.2% required 2 or more face-to-face consultations (figure 2).

The characteristics of the patients attended by care model are shown in table 1. There were no differences in age or sex between the 2 models.

DISCUSSION

Here, we describe the results of a universal e-consultation program in a cardiology service for referrals made by PC physicians. The clinical characteristics of the patients were similar in the 2 outpatient care models (table 1). Our data show that the implementation of an e-consultation program in the outpatient care model effectively reduces waiting times and is safe, with a significant reduction in emergency department attendance, hospital admissions, and mortality. In addition, the model

CONCLUSIONS

An outpatient care program in a cardiology service that includes e-consultation improves access to health care and thereby reduces waiting times for specialized care. This model is safe and is associated with lower rates of emergency department attendance, hospital admission, and mortality in the first year vs a one-time face-to-face care program. We believe that our experience could help in the design of outpatient care management programs that improve health care access and patient prognosis.

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CONFLICTS OF INTEREST

The authors report no conflicts of interest in relation to this article.

Acknowledgments

We thank Dr Francisco Gude Sampedro of the Clinical Epidemiology Unit of the Health Research Institute of Santiago de Compostela (IDIS) for advice and help with the statistical analysis and manuscript drafting.

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