Electronic consultation (e-consultation) between primary care and the neurology department: One-year experience in a healthcare district in Andalusia, Spain

Introduction The COVID-19 pandemic has prompted the implementation of telemedicine programmes to facilitate healthcare. In November 2020 we initiated an e-consultation programme between primary care and the neurology department, with asynchronous response, through a platform integrated into the corporate computer system of the Andalusian Public Health System. We present the results of the first year of operation. Methods We present a descriptive study of the e-consultations received in 2021 from a health area of approximately 300,000 inhabitants aged ≥14 years. The reasons for consultation were pre-established: "primary headache” (PH), "new-onset cognitive impairment” (CI), "complications of dementia” (DEM), and "epilepsy” (EPI). We defined inclusion criteria and the clinical information/tests that had to be provided. General practitioners could choose between e-consultation or face-to-face referral. Results A total of 1806 e-consultations were received (approximately 6/1000 population/year). By reasons for consultation: CI 34.3%, PH 32%, DEM 14.4%, EPI 11.7%, unspecified 7.6%. Responses were sent after an average of 2.25 days and were classified as: "refer for in-person consultation” (47.12%), "resolved” (39.98%), "criteria not met” (12.57%), or "follow-up by e-consultation” (0.33%). As expected, a high proportion of face-to-face referrals were required for CI (73.46%);the main value of the system for these patients was to prioritise appointments and select the most appropriate form of care. For the rest of the reasons for consultation, the proportion of "resolved” e-consultations reached 52.61%. Conclusions Asynchronous e-consultation between primary care and the neurology department is a useful tool in the indicated conditions, offering a rapid, "one-stop” response to a significant proportion of clinical or therapeutic uncertainties, as well as optimising face-to-face appointments. Resumen Introducción La pandemia por Covid-19 ha impulsado la implantación de programas de telemedicina para facilitar la asistencia sanitaria. En noviembre de 2020 iniciamos un programa de e-interconsulta entre Atención Primaria (AP)-Neurología, de respuesta asíncrona, a través de una plataforma integrada en la estación clínica corporativa del Sistema Sanitario Público de Andalucía. Presentamos los resultados de su primer año de funcionamiento. Métodos Estudio descriptivo de las e-interconsultas recibidas durante 2021 desde un área sanitaria de aproximadamente 300.000 habitantes ≥14 años. Se establecieron como motivos de consulta: "Cefalea primaria” (CEF), "Deterioro cognitivo de novo” (DC), "Complicaciones de la demencia” (DEM) y "Epilepsia” (EPI), definiéndose unos criterios preestablecidos y la información clínica/pruebas que se debían aportar. Los médicos/as de familia podían elegir entre e-interconsultar o derivar directamente para cita presencial. Resultados Se recibieron 1.806 e-interconsultas (≈6/1.000 hab./año). Por motivos de consulta: DC 34′3%, CEF 32%, DEM 14′4%, EPI 11′7%, no especificado 7′6%. Las respuestas se demoraron una media de 2′25 días y se clasificaron en: "precisa cita presencial” (47′12%), "alta” (39´98%), "no cumple criterios” (12′57%) o "seguimiento por e-interconsulta” (0′33%). Como era previsible, para el DC una alta proporción precisó cita presencial (73′46%);su mayor utilidad fue priorizar las citas y modalidad de asistencia. Para el resto de motivos, la proporción de "alta” alcanzó el 52′61%. Conclusiones La e-interconsulta asíncrona entre AP-Neurología es una herramienta útil en las condiciones indicadas, permitiendo resolver en un "acto único” y con escasa demora una significativa proporción de dudas clínicas o terapéuticas, así como optimizar las citas presenciales.

The cognitive and psychiatric subacute impairment in severe Covid-19.

Neurologic impairment persisting months after acute severe SARS-CoV-2 infection has been described because of several pathogenic mechanisms, including persistent systemic inflammation. The objective of this study is to analyze the selective involvement of the different cognitive domains and the existence of related biomarkers. Cross-sectional multicentric study of patients who survived severe infection with SARS-CoV-2 consecutively recruited between 90 and 120 days after hospital discharge. All patients underwent an exhaustive study of cognitive functions as well as plasma determination of pro-inflammatory, neurotrophic factors and light-chain neurofilaments. A principal component analysis extracted the main independent characteristics of the syndrome. 152 patients were recruited. The results of our study preferential involvement of episodic and working memory, executive functions, and attention and relatively less affectation of other cortical functions. In addition, anxiety and depression pictures are constant in our cohort. Several plasma chemokines concentrations were elevated compared with both, a non-SARS-Cov2 infected cohort of neurological outpatients or a control healthy general population. Severe Covid-19 patients can develop an amnesic and dysexecutive syndrome with neuropsychiatric manifestations. We do not know if the deficits detected can persist in the long term and if this can trigger or accelerate the onset of neurodegenerative diseases.