Juliana Alarcón’s research while affiliated with Fundación Valle Del Lili and other places

Background Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. Objective We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. Design A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. Setting A high-complexity teaching hospital located in Cali, Colombia. Participants Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. Outcome measures Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient’s perspective. Results A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. Conclusion Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.

Introduction As a result of the new coronavirus pandemic, a highly complex academic hospital in Latin America implemented a telemedicine service for the care of obstetric, pediatric, and adult patients. In 2020, regional emergency services collapsed due to the increase in demand for care, generating the need to open expansion services and seek strategies to provide timely care to consulting patients. Objective We retrospectively describe the clinical experience of patients who consulted the emergency department via telemedicine across a videoconference tool using digital platforms. Methods A descriptive study with retrospective data collection was conducted to describe the implementation of the teleconsultation care model for patients. We constructed the clinical process indicators to evaluate the model. Results A total of 4652 teleconsultations were registered. Telemedicine consultation was above 50% in the country and department and above 90% in Cali city. The average waiting time for care was estimated to be 1:59:52 h. A total of 275 patients were transferred to the emergency room after consultation. The principal reasons for consultation in the institutional telemedicine program were respiratory and gastrointestinal symptoms. Teleconsultations related to SARS-COV 2 infections reported 3775 patients (3127 with unidentified virus and 648 with the identified virus). Conclusions Telemedicine is a tool that provides support and guidance to patients who consult emergency departments, reducing barriers to access health care and decreasing emergency department collapse.

Introduction As a result of the new coronavirus pandemic, a highly complex academic hospital in Latin America implemented a telemedicine service for the care of obstetric, pediatric, and adult patients. In 2020, regional emergency services collapsed due to the increase in demand for care, generating the need to open expansion services and seek strategies to provide timely care to consulting patients. Objective We retrospectively describe the clinical experience of patients who consulted the emergency department via telemedicine across a videoconference tool using digital platforms. Methods A descriptive study with retrospective data collection was conducted to describe the implementation of the teleconsultation care model for patients. We constructed the clinical process indicators to evaluate the model. Results A total of 4652 teleconsultations were registered. Telemedicine consultation was above 50% in the country and department and above 90% in Cali city. The average waiting time for care was estimated to be 1:59:52 h. A total of 275 patients were transferred to the emergency room after consultation. The principal reasons for consultation in the institutional telemedicine program were respiratory and gastrointestinal symptoms. Teleconsultations related to SARS-COV 2 infections reported 3775 patients (3127 with unidentified virus and 648 with the identified virus). Conclusions Telemedicine is a tool that provides support and guidance to patients who consult emergency departments, reducing barriers to access health care and decreasing emergency department collapse.

Background Noncommunicable diseases such as diabetes mellitus (DM) have gained attention worldwide. Latin America experienced a rise in rates of DM. During the COVID-19 pandemic, a telemedicine program was implemented in a quaternary care academic complex in Latin America to continue the follow-up of patients with diabetes. Objective The aim of this study is to describe the clinical experience of DM patient management through telemedicine and the HbA1c behavior of patients followed-up through this modality. Materials and methods We conducted a retrospective cohort study including all patients with type 1 or 2 diabetes who were treated via telemedicine from March to December 2020. A Wilcoxon statistical test was used to compare the changes in glycosylated hemoglobin between the first teleconsultation and after 6 months of telemedicine follow-up. Results A total of 663 patients were included, 17.65% (117) of whom had type 1 diabetes and 82.35% (546) of whom had type 2 diabetes. Patients with both types of diabetes, presented with stable HbA1c values regardless of the length of follow-up. Conclusion The use of telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care to maintain acceptable control levels within glycemic control goals.

Introduction Contingency measures due to the COVID-19 pandemic limited access to routine prenatal care for pregnant women, increasing the risk of pregnancy complications due to poor prenatal follow-up, especially in those patients at high obstetric risk. This prompted the implementation and adaptation of telemedicine. Objective We aim to evaluate the maternal and perinatal outcomes of patients who received prenatal care in-person and by telemedicine. Methods We conducted a retrospective observational cohort study of pregnant women who received exclusive in-person and alternate (telemedicine and in-person) care from March to December 20,202, determining each group's maternal and neonatal outcomes. Results A total of 1078 patients were included, 156 in the mixed group and 922 in the in-person group. The patients in the mixed group had a higher number of prenatal controls (8 (6–9) vs 6 (4–8) p < 0.001), with an earlier gestational age at onset (7.1 (6–8.5) vs 9.3 (6.6–20.3), p < 0.001), however, they required a longer hospital stay (26 (16,67%) vs 86 (9,33%), p = 0.002) compared to those attended in-person; there were no significant differences in the development of obstetric emergencies, maternal death or neonatal complications. Discussion Incorporating telemedicine mixed with in-person care could be considered as an alternative for antenatal follow-up of pregnant women in low- and middle-income countries with barriers to timely and quality health care access.

Background Difficulties in cancer services access increase the burden of disease and mortality in rural areas, and telehealth can be a useful tool to address these inequalities. Objective We aimed to describe the outcomes of patients in rural and urban areas with solid tumors managed by oncologists through telemedicine. Methods We conducted a retrospective cohort study of patients with solid tumors from March to December 2020. A total of 1270 subjects with solid tumors were included, 704 living in urban areas and 566 in rural areas. Results The most frequent tumors were breast (51.8%) and prostate (12.4%). The trend of telemedicine care was similar for both populations; in-person care was more frequent in the urban population. There were no differences in referral to the emergency room, need for hospitalization, and mortality for both groups. Conclusion Telemedicine is a care modality that reduces barriers in the care of patients with solid tumors, evidencing similar outcomes regardless of living in rural or urban areas.

BACKGROUND Due the unprecedented need for continuity in child health care during the confinement time subsequently to the Covid 19 pandemic, a high complex university hospital in the southwestern region of Colombia implemented a telemedicine program. OBJECTIVE We aim to describe the clinical experience using telemedicine for pediatric consultation and the behavior of routinary parameters evaluated during pediatric consultation METHODS A retrospective descriptive study was conducted. A total of 1.200 pediatric patients followed via telemedicine in clinical routine check-ups were included. Qualitative variables were summarized with absolute frequencies and percentages quantitative variables were presented with the measures of central tendency, and their respective measures of dispersion were represented according to a Shapiro Wilk test. RESULTS Of the 1.200 patients including boys and girls, 26% of girls and 27% of boys had some type of alteration, even though many caregivers did not give enough information about weight and height. CONCLUSIONS Our preliminary experience suggests that telemedicine provides support in the care of pediatric patients, however, it requires strategies to assess parameters measured routinely in the pediatric consultation. This study is a basis for developing further experience, strategies and research about caregivers and patient satisfaction, economic effect on families and the health system, and the role of telemedicine in pediatrics in low- and middle-income countries

Introduction: Contingency measures due to the COVID-19 pandemic limited access to routine prenatal care for pregnant women, increasing the risk of pregnancy complications due to poor prenatal follow-up, especially in those patients at high obstetric risk. This prompted the implementation and adaptation of telemedicine. Objective: We aim to evaluate the maternal and perinatal outcomes of patients who received prenatal care in-person and by telemedicine. Methods: We conducted a retrospective observational cohort study of pregnant women who received exclusive in-person and alternate (telemedicine and in-person) care from March to December 20202, determining each group's maternal and neonatal outcomes. Results: A total of 1078 patients were included, 156 in the mixed group and 922 in the in-person group. The patients in the mixed group had a higher number of prenatal controls (8 (6-9) vs 6 (4-8) p<0.001), with an earlier gestational age at onset (7.1 (6-8.5) vs 9.3 (6.6-20.3), p<0.001), however, they required a longer hospital stay (26 (16,67%) vs 86 (9,33%), p=0.002) compared to those attended in-person; there were no significant differences in the development of obstetric emergencies, maternal death or neonatal complications. Discussion: Incorporating telemedicine mixed with in-person care could be considered as an alternative for antenatal follow-up of pregnant women in low- and middle-income countries with barriers to timely and quality health care access.

Background: Obesity is a major public health concern worldwide. Latin America has experienced rapid growth in obesity incidence during the last few decades. Driven by confinement measures, a telemedicine program was implemented in March 2020 to give continuity to obese patients' care through a weight loss program led by the endocrinology department in a tertiary care medical center in Latin America. Objective: This study aimed to describe the clinical experience of using digital health for monitoring and attention of obese patients and description of weight change outcomes of these patients followed via telemedicine during March 2020-December 2020. Methods: A retrospective cohort study was conducted including 202 patients. A Skillings-Mack test was performed to conduct a subgroup analysis of the medians of the weight over the follow-up period, and a mixed multiple linear regression model was performed to estimate the expected average change in weight over time Results: We observed good adherence to the program, represented by a weight loss of -4.1 kg at three months of follow-up, which was maintained even during the sixth month of follow-up. Conclusions: Digital Health strategies such as telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care and showing satisfactory results in the management of obese patients.

Introducción: Hasta el momento el sobrepeso y la obesidad han sido descritos como factores de riesgo para infectarse, requerir hospitalización y morir por COVID-19. Sin embargo, la literatura no es siempre congruente con estos resultados. Objetivo: Evaluar el impacto del IMC >25 kg/m2 en el ingreso hospitalario para el manejo de la enfermedad por COVID-19, en pacientes pertenecientes a un programa de riesgo cardiovascular en la ciudad de Cali, Colombia, durante el año 2020. Métodos: A través de un estudio observacional analítico, se evaluó el riesgo de requerir hospitalización ante la infección por SARS-CoV2 en dos cohortes de pacientes pertenecientes a un programa de riesgo cardiovascular, incluyendo en el grupo expuesto sujetos con IMC >25 kg/m2. Se calculó el riesgo relativo y para evaluar posibles variables confusoras se utilizó el test de homogeneidad de Mantel-Haenszel. Resultados: El IMC >25 Kg/m2 se encontró como un factor protector para el ingreso hospitalario (RR: 0.5; IC 95%: 0.30-0.80), sin identificarse modificación o confusión en el desenlace por otras variables clínicas como la edad >60 años, el sexo masculino, HTA, DM2 o la obesidad. Conclusión: el IMC >25 kg/m2 se encontró como un factor protector para el ingreso hospitalario entre pacientes adultos pertenecientes a un programa de riesgo cardiovascular