Consulta electrónica y modelo evolutivo en la asistencia ambulatoria de procesos cardiovasculares

Abstract

Introduction and objectiveTo describe the process of implantation and results of the electronic consultation (e-consultation) in cardiology, to rationalize the care demand, accessibility and continuity of care between primary care levels and cardiology. MethodsObservational study in a health area of 560,162 inhabitants. The project was carried out in 3 phases: phase 0 (2010), analysis of the demand in conventional cardiology consultations; phase 1 (2011-2012), pilot study of e-consultation and establishment of one high-resolution consultation (T1); and phase 2 (2013-2018), generalization of e-consultation (T0) in the 47 centers of general practice in the area as a requirement to high-resolution face-to-face appointment (T1), with initiation of monographic consultations. The telematic tool used was the institutional electronic medical record of the Health Care Region. ResultsA total of 151,484 consultations were attended (54,062 first and 97,422 successive), 31%/total were discharged. The successive/first ratio was 1.8. The mean attention delay for the first consultations was 84 in phase 0 vs. 32.6 days in phase 2 (P<.001). The e-consultation (T0) avoided average 29% of face-to-face consultations. In high-resolution face-to-face consultations (T1), the problem was solved in 64% in a single act. The efficiency of e-consultation has been increasing (mean delay in answering 11.8 days initially and 0.3 actually) (P<.001). ConclusionsIn our experience, the implantation and generalization of cardiology e-consultation as a gateway to face-to-face cardiology consultations has contributed to rationalize the healthcare demand to the available resources, establishing a safe and more efficient outpatient care model between general practice and cardiology consultation.