ABSTRACT
AIM: This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine. METHODS: This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed. RESULTS: A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15-102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5645 patients (49.4%) were given an in-person appointment. For the remaining 5789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (pâ¯<â¯0.0001), visited the emergency department more times (one month: pâ¯=â¯0.04; three months: pâ¯=â¯0.001), were admitted to the hospital more times (one month: pâ¯=â¯0.0001; three months: pâ¯=â¯0.0001), and had higher mortality at one year (12.7% vs. 9.8% pâ¯=â¯0.0001). In the Cox analysis, only in-person appointments (RRâ¯=â¯1.11; pâ¯=â¯0.04)) and age (RRâ¯=â¯1.09; pâ¯<â¯0.01) were independent factors of mortality. No complaints or claims of any kind were registered. CONCLUSIONS: These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.
Subject(s)
Colonic Neoplasms , Lymphoma, B-Cell , Age Factors , Aged , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colonic Neoplasms/diagnosis , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/drug therapy , Colonic Neoplasms/mortality , Colonoscopy , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Female , Humans , Lymphoma, B-Cell/diagnosis , Lymphoma, B-Cell/diagnostic imaging , Lymphoma, B-Cell/drug therapy , Lymphoma, B-Cell/epidemiology , Lymphoma, B-Cell/mortality , Male , Middle Aged , Prednisone/therapeutic use , Prognosis , Radiography, Abdominal , Rituximab , Sex Factors , Tomography, X-Ray Computed , Vincristine/therapeutic useABSTRACT
No disponible
Subject(s)
Female , Middle Aged , Humans , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Colonoscopy/methods , Colonography, Computed Tomographic/methods , Tomography, Emission-Computed/methods , Antibodies, Monoclonal , Colonic Neoplasms/complications , Colonic Neoplasms/diagnosis , Prognosis , Radiography, Thoracic/methods , Cyclophosphamide/therapeutic use , Vincristine/therapeutic use , Prednisone/therapeutic use , Doxorubicin/therapeutic useABSTRACT
No disponible
Subject(s)
Female , Adult , Middle Aged , Humans , Lung Abscess/complications , Lung Abscess/diagnosis , Myositis/diagnosis , Staphylococcus aureus/isolation & purification , Immunosuppression Therapy , Pleural Effusion/complications , Bronchoscopy/methods , Anti-Bacterial Agents/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Cloxacillin/therapeutic use , Bacteria/pathogenicity , Myositis/complications , Comorbidity , Staphylococcus aureus/pathogenicity , Radiography, Thoracic/methods , Tomography, Emission-Computed/methods , Echocardiography/methodsABSTRACT
No disponible
No disponible
Subject(s)
Male , Adult , Humans , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Myocarditis/chemically inducedSubject(s)
Cerebellar Ataxia/virology , Herpes Zoster/complications , Acute Disease , Adult , Humans , MaleABSTRACT
No disponible
Subject(s)
Female , Aged , Humans , Carcinoma, Renal Cell/pathology , Bronchial Neoplasms/secondary , Kidney Neoplasms/pathology , Neoplasm Metastasis/pathologyABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Thrombophlebitis/complications , Mesenteric Veins/physiopathology , Factor V Deficiency/complications , Anti-Bacterial Agents/therapeutic useSubject(s)
Community-Acquired Infections/microbiology , Pneumonia, Bacterial/microbiology , Proteus Infections/diagnosis , Proteus mirabilis/isolation & purification , Aged, 80 and over , Community-Acquired Infections/diagnosis , Community-Acquired Infections/diagnostic imaging , Diverticulum/complications , Humans , Male , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/diagnostic imaging , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/therapy , Proteus Infections/diagnostic imaging , Radiography , Urinary Bladder Diseases/complications , Urinary Catheterization/adverse effects , Urinary Tract Infections/complications , Urinary Tract Infections/microbiologyABSTRACT
No disponible
No disponible
Subject(s)
Male , Adult , Humans , Cerebellar Ataxia/diagnosis , Cerebellar Ataxia/therapy , Chickenpox/diagnosis , Acetaminophen/therapeutic use , Hydroxyzine/therapeutic use , Tomography, Emission-Computed/methods , Metoclopramide/therapeutic use , Exanthema/complications , Exanthema/diagnosis , Acyclovir/therapeutic use , Chickenpox/complications , Chickenpox , Cerebellar Ataxia/complications , Antiviral Agents/pharmacology , Antiviral Agents/pharmacokinetics , Antiviral Agents/therapeutic useABSTRACT
No disponible
Subject(s)
Male , Aged, 80 and over , Humans , Community-Acquired Infections/microbiology , Pneumonia, Bacterial/microbiology , Proteus Infections/diagnosis , Proteus mirabilis/isolation & purification , Community-Acquired Infections/diagnosis , Community-Acquired Infections , Diverticulum/complications , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/therapy , Proteus Infections , Urinary Tract Infections/complications , Urinary Tract Infections/microbiology , Urinary Catheterization/adverse effects , Urinary Bladder Diseases/complicationsSubject(s)
Brucellosis , Epididymitis/microbiology , Orchitis/microbiology , Adult , Brucellosis/diagnosis , Epididymitis/diagnosis , Humans , Male , Orchitis/diagnosisSubject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hypothyroidism/complications , Lovastatin/adverse effects , Myositis/chemically induced , Aged , Diabetes Mellitus, Type 2/complications , Disease Susceptibility , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypercholesterolemia/complications , Hypercholesterolemia/drug therapy , Hypothyroidism/diagnosis , Lovastatin/therapeutic useABSTRACT
No disponible
Subject(s)
Male , Adult , Humans , Brucellosis/complications , Brucellosis/diagnosis , Epididymitis/complications , Epididymitis/diagnosis , Fever of Unknown Origin/diagnosis , Doxycycline/therapeutic use , Streptomycin/therapeutic use , Orchitis/drug therapy , Epididymitis/drug therapy , Brucella/isolation & purification , Orchitis/complications , Testis , Fever of Unknown Origin/etiology , Epididymitis/epidemiology , Orchiectomy/trends , OrchiectomyABSTRACT
Hypertension is a frequent cardiovascular risk factor in liver transplant recipients. The usefulness of ambulatory blood pressure monitoring (ABPM) in these patients is unknown. This study was aimed at evaluating the circadian rhythms of blood pressure in liver allograft recipients. In 53 liver transplant patients blood pressure was measured with the Spacelabs device program. No patient received antihypertensive therapy for at least 15 days beforehand. Clinical blood pressure measurement showed 26 patients to be hypertensive. Of these, ABPM verified the diagnosis in 23. Overall, 72% of the patients were hypertensive, and 39.5% showed a nondipper pattern. Diastolic hypertension was more frequent than systolic hypertension. No differences were found in renal function, immunosuppressive therapy, or corticosteroids.
