ABSTRACT
Introduction: There are successful reports of the use of telemedicine in nephrology (TN), which would facilitate the access of patients with chronic kidney diseases (CKD) from the primary health centers (PHCs) to the nephrologist. Since 2019, TN has been implemented in Chile as a public health policy with national coverage. The process and outcome indicators associated with the Chilean National TN Program among PHCs and reference nephrologists are described. Methods: Descriptive study of asynchronous telemedicine care performed from urban and rural PHCs (574) (municipal health centers) to 17 nephrologists from Hospital Digital, between January 01, 2019 and June 30, 2021. The percentage of the rural population in Chile is 12.1%. Teleconsultations are sent by the PHCs doctor through a digital platform that contains clinical information, laboratory tests and treatments. The nephrologist in a deferred time, responds in the same way and decides between the options: 1) Counter-refer the patient to PHCs requesting more information or with treatment recommendations;2) Refer to a hospital for more complex studies or treatments. The following were analyzed: 1. Distribution by age, sex and comorbidities;2. Response times;3. Prevalence of CKD by stages;4. Destination post evaluation TN;5. Level of relevance of PHCs consultations. Results: In total, 12.705 asynchronous telemedicine visits were performed (2019: 50.8 %;2020: 31.9 %;2021:17.3%. During the Covid-19 pandemic, attention for TN was maintained although restricted by the health crisis in the public health network. The mean age was 65.9 (SD: 13.2) years;80% were older than 60 years;57%% women. CKD stages: S1 (8.5%%);S2 (16.2%);S3 (53.6%);S4 (17.9%) and S5 (3.7%). Comorbidities: diabetes 56%, hypertension 90.7%, dyslipidemia 65%, overweight 29.2% and obesity 38.7%. The average response time was 91 hrs. (range 1- 173). In total, 7.954 patients (62.6%) were referred to PHCs with recommendations, without requiring transfers to another center. In turn, 4.751 patients (37.4%) required face-to-face nephrological evaluation (58.1% high priority for CKD in stages 4-5). The relevance of the consultations according to the nephrologist's evaluation was considered high 23.1% and median 49.3%. Conclusions: The implementation of TN as a public policy has made it possible to facilitate expeditious access, evaluation and timely treatment of patients with CKD from urban and rural PHCs and prioritize face-to-face care by a nephrologist for those with greater risk or severity. Most of the patients evaluated (62.8%) were referred to PHCs, optimizing the limited space and high demand of face-to-face care per specialist. During the Covid-19 pandemic period, the use of TN was restricted but allowed continuity of control of patients with CKD and decongest PHCs and emergency care centers. Future studies should evaluate the impact of TN in the follow-up of patients screened with CKD, especially in stages 3-5, the decrease in travel-related CO2 emissions due to reduced displacement, the level of patient´s satisfaction/PHCs teams, and the evaluation effective cost of this care modality. No conflict of interest