Evaluación cualitativa de experiencia piloto PROCASER, como método para mejorar la pertinencia de interconsultas desde Atención Primaria con uso de Telemedicina / Qualitative evaluation of the pilot trial of PROCASER, a telemedicine-based method to improve the appropriateness of consultations from Primary Care

RESUMEN

Entendiendo la problemática de Lista de Espera (LE) y el alto número de interconsultas no pertinentes, surge el Proyecto centros de atención de Salud en Red, "PROCASER". OBJETIVO PRINCIPAL Evaluar el resultado de esta experiencia piloto como herramienta para la gestión de interconsultas. DISEÑO Y MÉTODO: Estudio descriptivo de tipo transversal. Muestra no probabilística por conveniencia, tamaño muestral de 28 profesionales. Durante cinco meses se desarrollaron reuniones semanales por videoconferencia en la que médicos generales de cuatro centros de APS (Atención Primaria de Salud) se conectaron por teleasistencia con un médico especialista del centro de referencia (Hospital Dr. HHA Temuco-Chile), rotatorio según semana y patología a tratar. Se presentaron casos clínicos de LE desde APS con mismo diagnóstico según semana, permitiendo resolver la interconsulta, evaluar pertinencia y reforzar conceptos según patología. Se desarrollaron 14 reuniones, resolvieron 38 casos clínicos y reforzaron conceptos de 16 patologías. Al término del proyecto se aplicó un cuestionario vía internet a los médicos participantes. RESULTADOS: 79% respondieron esta encuesta; 95% consideró que se potenció la comunicación entre médicos APS con especialistas; 100% que se reforzaron conceptos y criterios de derivación; 91% afirmó que en caso de mantenerse la actividad de forma anual, pudiese disminuir el número de interconsultas no pertinentes. CONCLUSIÓN: Si bien aún no es factible conocer el impacto real, PROCASER pudiese ser a futuro una nueva forma de asociar la telemedicina a un nuevo método de trabajo para mejorar la pertinencia de derivación y disminuir las LE.

ABSTRACT

In light of the issue of wait lists (WL) and the high number of unnecessary consultations, the Network of Primary Health Care Centers Project (known as "PROCASER", for its acronym in Spanish) was born. MAIN OBJECTIVE: To evaluate the results of a pilot trial of PROCASER as a method to manage consultations. DESIGN AND METHODS: Cross-sectional descriptive study, with a non-probabilistic convenience sample of 28 general practitioners. Over the course of five months, weekly meetings were held via videoconference between general practitioners from four primary health care centers (PHC) and a specialist from the referral center (Hospital Dr. HHA in Temuco, Chile); which specialist participated depended on the pathology discussed. Each week, clinical cases from the WL that shared a diagnosis were presented by the PHC physicians to the specialist to discuss the consultation, evaluate its pertinence, and reinforce concepts about the pathology. There were a total of 14 meetings, during which 38 clinical cases were resolved, and 16 pathologies were discussed. At the end of the project, an onli¬ne survey to evaluate the program was administered to the participating physicians. RESULTS: Of the participating physicians, 79%, answered the survey. Of those, 95% felt that com-munication between medical specialists APS was enhanced by PROCASER, 100% said that their knowledge of pathologies and their referral criteria were strengthened; and 91% said that if the program were continued on an annual basis, it could reduce the number of irrelevant consultations. CONCLUSION: While it is not yet possible to know the real impact, Although the quantitative results are not yet available, the results of the survey suggest that PROCASER could be a new way to as-sociate telemedicine to a work method to improve the relevance of consultations and decrease WL.