Intervención de la telemedicina en pacientes peruanos con insuficiencia cardíaca en tiempos de COVID-19 / Telemedicine Intervention in Peruvian Patients with Heart Failure in Times of COVID-19

Introducción: La insuficiencia cardíaca tiene un gran impacto epidemiológico, no solo por su alta morbilidad y mortalidad, sino también por el alto costo en servicios hospitalarios. Las tasas de hospitalización por reagudizaciones y readmisiones luego del alta se han incrementado los últimos años, lo que constituye en la actualidad un problema de salud pública. Objetivo: Evaluar el efecto de la intervención de la telemedicina en pacientes peruanos con insuficiencia cardíaca en tiempos de COVID-19. Métodos: Se utilizó un diseño cuasi experimental con evaluación antes y después de la intervención en 32 pacientes provenientes de Chimbote (Perú), entre los meses de enero a junio del 2021, que aceptaron participar en el estudio y cumplieron con los criterios de inclusión y exclusión. Se utilizó una ficha de recolección de datos que registró las características clínicas de los pacientes, frecuencia de hospitalización y clase funcional, así como el cuestionario de Kansas City que midió la calidad de vida relacionada a salud. En la intervención, se implementaron actividades de telemedicina que comprendió teleconsulta médica de cardiología, telemonitoreo y teleorientación de enfermería, y teleorientación de nutrición. Resultados: Se redujo la frecuencia de hospitalización de 9,4 por ciento a 0 por ciento en los pacientes categorizados en clase funcional III disminuyó de 28,1 por ciento a 15,6 por ciento, y el score general se mejoró de 65,8 a 69,6 puntos. Conclusiones: La intervención de la telemedicina mejoró los resultados sanitarios de los pacientes peruanos con insuficiencia cardíaca(AU)

Introduction: Heart failure has a great epidemiological impact, not only because of its high morbidity and mortality, but also because of the high cost in hospital services. Hospitalization rates for exacerbations and readmissions after discharge have increased in recent years, which is currently a public health problem. Objective: To evaluate the effect of telemedicine intervention in Peruvian patients with heart failure in COVID-19 times. Methods: A quasi-experimental design was used with evaluation before and after the intervention in 32 patients from Chimbote (Peru), between January and June 2021, who agreed to participate in the study and met the inclusion and exclusion criteria. A data collection form was used to record the clinical characteristics of the patients, frequency of hospitalization and functional class, as well as the Kansas City questionnaire that measured health-related quality of life. Telemedicine activities were implemented in the intervention, including cardiology medical teleconsultation, telemonitoring and nursing tele-guidance, and nutrition tele-guidance. Results: The frequency of hospitalization was reduced from 9.4 to 0 percent, while in patients categorized in functional class III it decreased from 28.1 to 15.6 percent. The overall score was improved from 65.8 to 69.6 points. Conclusions: The telemedicine intervention improved health outcomes in Peruvian patients with heart failure(AU)

Usabilidad de la atención de salud virtual en el período de cuarentena en los meses de mayo a julio 2020 por COVID-19 en el Instituto Nacional de Salud del Niño de Perú

Introducción: La pandemia COVID-19 ocasionó que se restrinja la atención por consultorio externo presencial en los establecimientos de salud, el gobierno establece acciones para continuar con la prestación de dichos servicios sanitarios. Objetivo del estudio: Describir la usabilidad de la atención de salud virtual en el período de cuarentena por la COVID-19 en el Instituto Nacional de Salud del Niño (INSN) de Perú. Material y métodos: Estudio transversal. Al INSN ingresaron 7697 pacientes para consulta externa virtual los meses de mayo a julio de 2020. El muestreo fue aleatorio simple y se tuvo una muestra de 374 participantes que cumplieron los criterios de selección. Se empleó el cuestionario de usabilidad de telesalud (TUQ). Se entrevistó telefónicamente a padres de pacientes que se atendieron por consulta virtual. Resultados: La edad promedio de los entrevistados fue de 36,2 años, mayoritariamente mujeres y de Lima. La edad promedio de los pacientes atendidos es 6,7 años, siendo mayormente varones (51,3%). El Smartphone fue el dispositivo más utilizado (97,6%); servicios de medicina los más consultados (84,4%), patologías más recurrentes las relacionadas al aparato respiratorio (10,4%). El 55,2% y 57,4% de los participantes está totalmente de acuerdo sobre la utilidad y facilidad de uso de la atención médica virtual respectivamente. Conclusiones: El uso de la telesalud en el INSN tuvo un impacto positivo, logró que los pacientes estén conectados con su médico a fin de continuar con sus tratamientos y brindar una óptima respuesta de atención médica en tiempo real.

Introduction: The COVID-19 pandemic caused face-to-face outpatient care in health establishments to be restricted, the government establishes actions to continue providing said health services. Objective of the study: To describe the usability of the virtual health care in the COVID-19 quarantine period at the National Institute of Child Health (INSN) of Peru. Material and methods: Cross-sectional study. 7,697 patients were admitted to the INSN for virtual outpatient consultation from May to July 2020. The sampling was simple random and there was a sample of 374 participants who met the selection criteria. The telehealth usability questionnaire (TUQ) was used. Parents of patients who received virtual consultation were interviewed by telephone. Results: The average age of the interviewees was 36.2 years, mostly women and from Lima. The average age of the patients treated is 6.7 years, being mostly male (51.3%). The Smartphone was the most used device (97.6%); medical services the most consulted (84.4%), most recurrent pathologies related to the respiratory system (10.4%). 55.2% and 57.4% of the participants totally agree on the usefulness and ease of use of virtual medical care, respectively. Conclusions: The use of telehealth in the INSN had a positive impact, it managed to connect patients with their doctor in order to continue with their treatments and provide an optimal medical care response in real time.

Using information and communication technologies (ICTs) to solve the repressed demand for primary dental care in the Brazilian Unified Health System due to the COVID-19 pandemic: a randomized controlled study protocol nested with a before-and-after study including economic analysis.

BACKGROUND: With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic. METHODS: Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system.  Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored. DISCUSSION: This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021).

Teleorientación en el servicio de oftalmología de un hospital público de mayo a agosto del 2020 durante la pandemia COVID-19 en el Perú

ABSTRACT Objectives: To identify presumptive diagnoses of patients treated by synchronous teleorientation in the Ophthalmology Service of Cayetano Heredia Hospital (CHH) during the COVID-19 pandemic, describing their demographic characteristics and the percentage of patients referred for a face-to-face evaluation. Methods: A retrospective observational descriptive study with secondary analysis of a database collected from May to August 2020 consisting of patients treated with teleorientation in the Ophthalmology service at CHH. Results: Three hundred and eight patients were included in the analysis. The main presumptive diagnoses were dry eye syndrome (24,68%), glaucoma (18.51%), cataract (17,85%), post-operated (5,84%) and viral/bacterial conjunctivitis (5,52%). Most patients were female (64,29%) and they came from Metropolitan Lima (91,88%). The number of older adults was higher than that of non-older adults (51,29% vs 48,70%). Finally, the patients sent to the Ophthalmology service for a face-to-face appointment were 4,55%. Discussion: During the period of this study, the main presumptive diagnosis was dry eye syndrome. This result obtained is similar to other hospitals. The main presumptive diagnoses that required a face-to-face appointment were acute posterior vitreous detachment, glaucoma, age-related macular degeneration because they needed especial examination, like measuring the intraocular pressure and fundoscopy. Older adults required assistance more frequently compared to the non-older adult group (84.41% vs 59.57%, p< 0,001).

RESUMEN Objetivos: Identificar los diagnósticos presuntivos de pacientes tratados por teleorientación sincrónica en el servicio de oftalmología del Hospital Cayetano Heredia (HCH) durante la pandemia del COVID-19, describiendo sus características demográficas y el porcentaje de pacientes derivados para una evaluación presencial. Métodos: Estudio descriptivo observacional retrospectivo con análisis secundario de una base de datos recopilada de mayo a agosto de 2020 de pacientes tratados por teleorientación en el servicio de Oftalmología en el HCH. Resultados: Un total de 308 pacientes ingresaron para análisis. Los principales diagnósticos presuntivos fueron: síndrome de ojo seco (24,68 %), glaucoma (18,51 %), catarata (17,85 %), posoperado (5,84 %) y conjuntivitis viral/bacteriana (5,52 %). La mayoría fueron mujeres (64,29 %) y de Lima Metropolitana (91,88 %). El porcentaje de adultos mayores fue más alto que los no mayores (51,29 % vs 48,70 %). El porcentaje de pacientes citados en el servicio de oftalmología para cita presencial fue de 4,55 %. Discusión: Durante el período de este estudio, el principal diagnóstico presuntivo fue síndrome de ojo seco. Este resultado es similar al de otros hospitales. Los diagnósticos que requirieron una cita presencial fueron desprendimiento de vítreo posterior agudo, glaucoma y degeneración macular porque necesitaron de un examen especial como la determinación de la presión intraocular y el examen de fondo de ojo. Los adultos de más edad tuvieron mayor necesidad de asistencia familiar versus el grupo de no mayores (84,41 % vs 59,57 %, p< 0,001.

Teleorientación y teleseguimiento en la ingesta alimentaria de pacientes con hipertensión arterial y diabetes mellitus / Teleorientation and telemonitoring of food intake in patients with hypertension and diabetes mellitus

RESUMEN Objetivo: Describir la ingesta alimentaria antes y después de las sesiones de teleorientación y teleseguimiento en pacientes con hipertensión arterial y diabetes mellitus. Materiales y métodos: Estudio de diseño cuasiexperimental en el cual se evaluó la ingesta alimentaria de 80 participantes, con diagnóstico de hipertensión arterial y diabetes mellitus, al inicio de la intervención y al finalizar las sesiones de teleorientación y teleseguimiento programadas. Resultados: Al empezar la intervención solo el 6,25 % obtuvo una valoración de ingesta alimentaria adecuada, la cual aumentó hasta 71,25 % al finalizar las sesiones de teleorientación y teleseguimiento programadas. Conclusiones: La implementación de un sistema de teleorientación y teleseguimiento nutricional en pacientes con hipertensión arterial y diabetes mellitus mejora la ingesta alimentaria, lo que permite confirmar la eficacia del uso de las TIC en las intervenciones sanitarias para el beneficio de la población.

ABSTRACT Objective: To describe the food intake of patients with hypertension and diabetes mellitus before and after teleorientation and telemonitoring sessions. Materials and methods: A quasi-experimental study conducted with 80 participants with a diagnosis of hypertension and diabetes mellitus, whose food intake was evaluated at the beginning of the intervention and at the end of the scheduled teleorientation and telemonitoring sessions. Results: At the beginning of the intervention, only 6.25 % of the participants showed an adequate food intake, which increased to 71.25 % at the end of the scheduled teleorientation and telemonitoring sessions. Conclusions: The implementation of a nutrition teleorientation and telemonitoring system in patients with hypertension and diabetes mellitus improves their food intake, thus confirming the efficacy of using ICTs in health interventions for the benefit of the population.

Teletriaje/teleorientación de enfermería pediátrica en el contexto de la pandemia por Covid-19 / Pediatric Nursing Teletriage/teleorientation in the context of the Covid-19 pandemic

Objetivo principal: Determinar las principales acciones de Teletriaje/teleorientación de enfermería pediátrica durante la pandemia por Covid-19. Metodología: Estudio exploratorio, longitudinal, documental, con 349 fichas de registro, en un instituto especializado de Lima, Perú, durante los meses de mayo a julio del 2020. Resultados principales: 28,4% de los atendidos fueron lactantes; 54,4% de sexo masculino; 47,3% con Seguro Integral de Salud; 89,1% procedentes de la capital; 66,9% se conectaron por llamada telefónica; 20,9% presentó problemas dérmicos. El principal diagnóstico de enfermería identificado fue seguridad y protección (38,1%); 87,4% fueron derivados a especialidades médicas y 100% de usuarios manifestaron su conformidad. Conclusión principal: El Teletriaje/teleorientación de enfermería pediátrica es un eficiente procedimiento asistencial que inicia la consulta externa virtual o presencial, seleccionando especialidades pediátricas y brindando consejería. Este procedimiento alcanzó reconocimiento social.(AU)

Primary Objective: Determine the principal actions of Teletriage /teleorientation of pediatric nursing during the Covid-19 pandemic. Method: Exploratory, longitudinal, documentary study, with 349 registration cards, in a specialized institute from Lima, Peru, during the months of May to July in the year 2020. Principal results: 28.4% of the patients attended were breastfeeding; 54.4% were male; 47.3% with Insurance (Seguro Integral de Salud); 89.1% were from the capital; 66.9% were connected through a phone call; 20.9% presented skin problems. The primary identified diagnostic of nursing was Safety and Protection (38.1%); 87.4% were referred to medical specialties and 100 % of users expressed their agreement. Main conclusion: Pediatric nursing teletriage/teleorientation, efficient assistance procedure that initiates virtual or face-to-face outpatient consultation, selecting pediatric specialties and providing counseling. This procedure achieved social recognition.(AU)

Development and implementation of telehealth for peritoneal dialysis and kidney transplant patients monitoring during the COVID-19 pandemic / Desenvolvimento e implementação do atendimento a distância para acompanhamento de pacientes em diálise peritoneal e tranplantados renais durante a pandemia de covid-19

Abstract The coronavirus (Sars-Cov-2) pandemic raised the need for social distance to reduce its spread. Chronic kidney disease patients on renal replacement therapy are especially susceptible to developing the most severe form of COVID-19, and, at the same time, require regular medical and multidisciplinary periodic follow-up. On an emergency basis, Brazil's professional regulatory bodies authorized telehealth assistance, which made possible to migrate from face-to-face to distance appointments in health services across the country, when necessary. This article's main objective is to describe the process of developing and implementing telehealth for monitoring renal transplant patients and patients on peritoneal dialysis during the COVID-19 pandemic.

Resumo A pandemia do coronavírus (Sars-CoV-2) trouxe a necessidade do isolamento social para a diminuição de sua propagação. Pacientes renais crônicos em terapia renal substitutiva são especialmente suscetíveis a desenvolverem a forma mais grave da covid-19, e, ao mesmo tempo, necessitam de acompanhamento médico e multidisciplinar regular com consultas periódicas. Em caráter emergencial, órgãos regulatórios profissionais brasileiros passaram a autorizar o atendimento da equipe de saúde por meio da teleconsulta, o que tornou possível a migração das consultas presenciais para consultas a distância nos serviços de saúde em todo o país, quando necessário. O principal objetivo deste artigo foi descrever o processo de desenvolvimento e implementação da teleorientação para acompanhamento de pacientes transplantados renais e em diálise peritoneal de um serviço de Joinville, SC, durante a pandemia de covid-19.