ArticlePDF Available

Teleconsulta y videoconsulta ¿para siempre?

Authors:
  • Sanitas Digital Hospital

Abstract

La salud digital surge al aplicar tecnologías de la información y telecomunicación para promover la salud, y engloba un conjunto de utilidades como telemedicina o salud móvil, entre otras, que permiten desarrollar modelos de cuidado innovadores, centrados en el paciente y que mejoran la accesibilidad, la calidad y la eficacia1. La salud digital ha demostrado ser un aliado imprescindible para dar respuesta a las necesidades de los pacientes durante la crisis sanitaria causada por la enfermedad por coronavirus 2019 (COVID-19)2, pero también ofrece herramientas valiosas para solucionar otros retos del sistema sanitario, como la atención a la cronicidad y la escasez de profesionales sanitarios. Además favorece la evolución de la relación médico-paciente al permitir una atención más centrada en la autonomía, experiencia y necesidades del paciente, motivos por los que organismos nacionales e internacionales ya recomiendan desarrollar estrategias para potenciar su implementación3. Una de las principales áreas de la salud digital es la telemedicina, definida como la prestación a distancia de servicios sanitarios asistenciales, a través de sistemas y tecnologías de la información y comunicación, que puede realizarse entre médico-paciente o entre profesionales sanitarios3. La telemedicina puede ser prestada en tiempo real (o de forma sincrónica), como la teleconsulta o consulta telefónica (llamada sólo de audio) o videoconsulta (con audio y vídeo), donde el paciente y profesional (o 2 profesionales) están disponibles en el mismo momento, o también puede prestarse en tiempo no real (o de forma asincrónica), mediante el almacenamiento y envío de información, que será valorada posteriormente por el profesional, como son el uso del correo electrónico, chats o intercambio de imágenes como la teledermatología o telerradiología, o telemonitorización4.
ARTICLE IN PRESS
G Model
MEDCLI-5802;
No.
of
Pages
3
Medicina
Clínica
xxx
(xxxx)
xxx–xxx
w w
w.elsevier.es/medicinaclinica
Editorial
Teleconsulta
y
videoconsulta
¿para
siempre?
Teleconsultation
and
videoconsultation
forever?
César
Morcillo
Serra
y
Ana
Aroca
Tanarro
Hospital
Digital
Sanitas,
Madrid,
Espa
̃
na
La
salud
digital
surge
al
aplicar
tecnologías
de
la
información
y
telecomunicación
para
promover
la
salud,
y
engloba
un
conjunto
de
utilidades
como
telemedicina
o
salud
móvil,
entre
otras,
que
per-
miten
desarrollar
modelos
de
cuidado
innovadores,
centrados
en
el
paciente
y
que
mejoran
la
accesibilidad,
la
calidad
y
la
eficacia
1.
La
salud
digital
ha
demostrado
ser
un
aliado
imprescindible
para
dar
respuesta
a
las
necesidades
de
los
pacientes
durante
la
crisis
sanitaria
causada
por
la
enfermedad
por
coronavirus
2019
(COVID-
19)
2,
pero
también
ofrece
herramientas
valiosas
para
solucionar
otros
retos
del
sistema
sanitario,
como
la
atención
a
la
cronici-
dad
y
la
escasez
de
profesionales
sanitarios.
Además
favorece
la
evolución
de
la
relación
médico-paciente
al
permitir
una
aten-
ción
más
centrada
en
la
autonomía,
experiencia
y
necesidades
del
paciente,
motivos
por
los
que
organismos
nacionales
e
interna-
cionales
ya
recomiendan
desarrollar
estrategias
para
potenciar
su
implementación
3.
Una
de
las
principales
áreas
de
la
salud
digital
es
la
telemedi-
cina,
definida
como
la
prestación
a
distancia
de
servicios
sanitarios
asistenciales,
a
través
de
sistemas
y
tecnologías
de
la
información
y
comunicación,
que
puede
realizarse
entre
médico-paciente
o
entre
profesionales
sanitarios
3.
La
telemedicina
puede
ser
prestada
en
tiempo
real
(o
de
forma
sincrónica),
como
la
teleconsulta
o
con-
sulta
telefónica
(llamada
sólo
de
audio)
o
videoconsulta
(con
audio
y
vídeo),
donde
el
paciente
y
profesional
(o
2
profesionales)
están
disponibles
en
el
mismo
momento,
o
también
puede
prestarse
en
tiempo
no
real
(o
de
forma
asincrónica),
mediante
el
almacena-
miento
y
envío
de
información,
que
será
valorada
posteriormente
por
el
profesional,
como
son
el
uso
del
correo
electrónico,
chats
o
intercambio
de
imágenes
como
la
teledermatología
o
telerradiolo-
gía,
o
telemonitorización
4.
La
videoconsulta
es
uno
de
los
ejemplos
de
telemedicina
más
desarrollados
en
los
últimos
a
̃
nos,
gracias
a
las
mejoras
en
la
conec-
tividad
y
al
desarrollo
y
uso
generalizado
de
teléfonos
y
aplicaciones
móviles,
que
crean
el
canal
digital,
donde
la
atención
médica
puede
ser
entregada
en
cualquier
lugar.
La
videoconsulta
aporta
ciertas
ventajas,
pues
brinda
mucha
más
información
que
las
visitas
tele-
Autor
para
correspondencia.
Correo
electrónico:
cmorcillo@sanitas.es
(C.
Morcillo
Serra).
fónicas,
al
permitir
el
contacto
visual.
Facilita
la
comunicación
y
la
posibilidad
de
realizar
una
inspección
visual
del
paciente,
ver
su
estado
general,
examinar
la
presencia
de
edemas
en
las
extre-
midades
inferiores,
comprobar
el
esfuerzo
respiratorio,
observar
si
hay
lesiones
cutáneas
o
identificar
medicamentos
5.
Para
optimizar
la
exploración
física
se
puede
mostrar
al
paciente
(o
acompa
̃
nante)
cómo
autoexplorarse
y
usar
aplicaciones
móviles
o
dispositivos
que
permitan
la
obtención
de
signos
vitales.
La
videoconsulta
ha
demos-
trado
ser
más
efectiva
que
la
cita
telefónica
en
el
tratamiento
de
determinados
trastornos
como
la
depresión
6,
pero
en
general
la
teleconsulta
ofrece
una
calidad
de
atención
comparable
a
la
de
las
visitas
por
vídeo.
En
ocasiones
usar
menos
tecnología
aporta
ven-
tajas
y
es
en
estos
contextos
donde
la
visita
telefónica
es
de
mayor
utilidad.
Algunos
de
estos
escenarios
son
las
consultas
con
personas
mayores
o
con
discapacidad
visual,
pacientes
con
ingresos
limita-
dos,
con
planes
de
datos
telefónicos
restringidos,
sin
una
correcta
alfabetización
digital,
o
cuando
el
contacto
visual
genera
ansiedad
o
vergüenza,
al
tratar
temas
delicados.
La
flexibilidad
de
una
visita
telefónica,
que
facilita
el
contacto
allí
donde
esté
el
paciente,
se
adapta
mejor
a
la
ajetreada
vida
de
muchos
y
evita
absentismos
7.
La
pandemia
por
la
COVID-19
ha
impulsado
una
rápida
trans-
formación
de
la
atención
clínica,
acelerando
la
implementación
de
nuevas
modalidades
de
atención
virtual,
que
han
pasado
de
ser
una
novedad
a
una
expectativa
de
futuro
8.
Durante
la
pandemia
la
con-
sulta
digital
ha
demostrado
ser
una
alternativa
efectiva
que
facilita
la
atención
médica
centrada
en
el
paciente
de
una
forma
accesible
y
segura
8,
pero
más
allá
de
que
se
pueda
considerar
un
medio
de
gran
utilidad
en
situaciones
excepcionales,
aporta
ventajas
que
replan-
tearán
su
utilización
en
el
día
a
día
de
los
procesos
asistenciales
fuera
de
la
excepcionalidad
de
una
pandemia.
Estas
ventajas
bene-
fician
tanto
al
paciente
como
al
profesional
y
al
sistema
sanitario;
sin
duda
mejora
la
experiencia
del
paciente
en
el
autocuidado
de
su
salud,
lo
que
queda
demostrado
por
las
altas
tasas
de
satisfacción
10
.
Los
usuarios
destacan
su
facilidad
de
uso,
flexibilidad,
comodidad
y
ahorro
en
tiempo
y
económico
al
reducir
desplazamientos,
con
la
consecuente
repercusión
ecológica
al
disminuir
la
emisión
de
CO
2,
además
de
una
mayor
seguridad
al
minimizar
el
riesgo
de
conta-
gios,
como
hemos
vivido
con
la
COVID-19.
Estas
ventajas
también
las
experimenta
el
personal
sanitario,
al
facilitar
la
conciliación
y
trabajo
remoto,
siendo
una
alternativa
asistencial
bien
aceptada
https://doi.org/10.1016/j.medcli.2021.09.008
0025-7753/©
2021
Elsevier
Espa
̃
na,
S.L.U.
Todos
los
derechos
reservados.
Cómo
citar
este
artículo:
C.
Morcillo
Serra
and
A.
Aroca
Tanarro,
Teleconsulta
y
videoconsulta
¿para
siempre?
Med
Clin
(Barc).,
https://doi.org/10.1016/j.medcli.2021.09.008
ARTICLE IN PRESS
G Model
MEDCLI-5802;
No.
of
Pages
3
C.
Morcillo
Serra
and
A.
Aroca
Tanarro
Medicina
Clínica
xxx
(xxxx)
xxx–xxx
por
los
profesionales
10
.
La
mayoría
de
los
que
han
realizado
visitas
virtuales
consideran
que
permiten
ofrecer
una
atención
médica
de
calidad
9,
afirman
tener
la
intención
de
continuar
con
esta
modali-
dad
de
atención
una
vez
terminada
la
pandemia
11
y
creen
que
su
implantación
será
permanente
8.
También
aporta
beneficios
a
las
organizaciones
sanitarias
al
trasladar
la
atención
de
los
centros
de
poblacional,
la
experiencia
de
Sanitas
apoya
esta
hipótesis;
a
pesar
de
ofrecer
servicios
de
telemedicina
desde
el
a
̃
no
2016,
en
ese
momento
solo
el
3%
de
las
consultas
eran
digitales.
Tras
la
pan-
demia
este
porcentaje
ha
ascendido
al
25%,
con
más
de
un
millón
de
consultas
virtuales
realizadas
desde
la
aparición
de
la
COVID-19.
Esta
cifra
se
mantiene
una
vez
normalizada
la
situación,
debido
a
la
César
Morcillo
Serra
Ana
Aroca
Tanarro
1
2
3
3
4
5
6
7
8
8
10
10
9
11
8
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Outline
31/10/21 22:48
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An integrated delivery system introduced video-visit capability for all clinicians in 2014. More than 150,000 patients participated in video visits from 2015 through 2017. Patient satisfaction was high; 93% of surveyed patients reported that their video visit met their needs.
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Introduction: Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit. Methods: We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program. Results: For traditional nephrology referrals placed during the study period (July 2016-March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit. Discussion: Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists.
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Objectives: Most outpatient parenteral antimicrobial therapy (OPAT) services use a hospital-based model of care in which patients remain in proximity to large hospitals facilitating clinical review. We aimed to evaluate clinical outcomes and complication rates for patients living in geographically isolated locations managed by telemedicine-supported OPAT. Methods: This was a retrospective cohort study. Results: Between 2011 and 2015, we delivered 88 episodes of care involving 83 adult patients resulting in 2261 days of OPAT. The median age was 56 years, 8 of 83 (10%) were indigenous Australian and the median Charlson comorbidity index score was 2 (IQR 1-4). The median distance of patients' residence from our hospital was 288 km (IQR 201-715) and the median duration on the programme was 26 days (IQR 14-34). Bone and joint infections accounted for 75% of infections treated. Favourable clinical outcomes (improvement or cure) were achieved in 87% of patients and the unplanned, OPAT-related readmission rate was 8%. Nineteen percent and 10% of patients had drug-related and line-related adverse effects, respectively. Conclusions: Despite a complex case mix, our adverse event and readmission rates are similar to the published literature describing a non-telemedicine model to deliver OPAT. High rates of favourable clinical outcomes and likely cost benefits suggest that telemedicine-supported OPAT is an efficacious and safe substitute for inpatient care in our setting.