Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora / Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement

Objetivo: Conocer la opinión de los médicos de Atención Primaria de Aragón, sobre la interconsulta virtual y su repercusión sobre las distintas dimensiones de la calidad asistencial. Diseño: Estudio transversal, mediante encuesta, de elaboración propia. Se habilitó la recogida de respuestas entre el 14 de abril y el 31 de mayo de 2023. Emplazamiento: Médicos con labor asistencial en atención primaria de Aragón. Participantes: Médicos especialistas e internos residentes en Medicina Familiar y Comunitaria. Mediciones: Características del puesto de trabajo, variables Likert valorando la interconsulta virtual como herramienta y su repercusión en dimensiones de la calidad asistencial, detección de ventajas e inconvenientes y preguntas de respuesta libre planteando líneas de mejora. Resultados: Total de 202 respuestas. El 90,1% de los participantes consideran útil la interconsulta virtual, el 67,8% cree que mejora la calidad de la derivación. Las principales ventajas identificadas son su contribución al enriquecimiento profesional y la visión integral del paciente, y la mejora de la comunicación entre primer y segundo nivel asistencial; el principal inconveniente el papel de Atención Primaria como intermediario en la información al paciente. Las dimensiones de la calidad mejor valoradas fueron eficiencia y equidad, siendo la seguridad la menos valorada. Conclusiones: La interconsulta virtual puede favorecer la comunicación y coordinación asistencial y potenciar la capacidad de resolución de atención primaria. Su éxito radica en formación y tiempo para su uso, consensuar protocolos y homogeneizar la distribución de recursos; no obstante, existen todavía oportunidades de mejora, principalmente en el ámbito de la seguridad.(AU)

Objective: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. Design: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. Site: Physicians with healthcare duties in primary care in Aragon. Participants: Specialist physicians and resident interns in Family and Community Medicine. Meansurements: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. Results: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. Conclusions: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.(AU)

Virtual Consultation in Dermatology: Access Inequalities According to Socioeconomic Characteristics and the Place of Residence.

Virtual consultation has been implemented as a tool to improve the cooperation and coordination between primary care and other specialties. However, in its use in dermatology, inequities have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource. We conducted a cross-sectional study. The study population was individuals living in Aragón, a region in the north-east of Spain, who were users of the Aragon Health Service in 2021. To explore the differences in individual and area characteristics, between patients with virtual and non-virtual dermatology consultation, we performed bivariate analyses. To analyse the use of virtual consultation in dermatology, a multilevel methodology stratified by sex was developed. We analysed 39,174 dermatology visits, with 16,910 being virtual (43.17%). The rates of virtual consultation were higher in urban areas and the most affluent areas, for older persons, chronic complex patients and people with more advantageous socioeconomic positions. The best multilevel model conducted showed inequalities by socioeconomic position and area of residence. There are individual and area inequalities in the use of teledermatology. As this tool should improve equity of access, teledermatology interventions must address and adapt to the needs of the local patient population.

[Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement]. / Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora.

OBJECTIVE: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. DESIGN: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. SITE: Physicians with healthcare duties in primary care in Aragon. PARTICIPANTS: Specialist physicians and resident interns in Family and Community Medicine. MEANSUREMENTS: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. RESULTS: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. CONCLUSIONS: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.

Does virtual consultation between primary and specialised care improve healthcare quality? A scoping review of healthcare quality domains assessment.

BACKGROUND: Virtual consultation has been proposed as a promising tool to improve the coordination and quality of healthcare between primary and specialised care. However, despite its potential facilitators, the evidence on the usefulness of virtual consultation for improving healthcare quality domains is fragmented and unclear. This scoping review aims to assess the impact of virtual consultation on different healthcare quality domains. MATERIAL AND METHODS: We conducted a scoping review with a rigorous search strategy on PubMed, EMBASE and Cochrane Library databases. The inclusion criteria were original articles, reviews, meta-analyses or letters to the editor, published between 1 January 2017 and 24 June 2022, and available in English, Spanish or French. For each of the articles selected, we identified the addressed healthcare quality domains, their facilitators and barriers, areas of improvement and data gaps. We have adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review reporting standards. RESULTS: 1284 manuscripts were retrieved. Finally, 235 papers were included in this review, most of which were original, descriptive studies. The most evaluated quality domain was effectiveness (223 articles). Safety and patient-centred care were the least evaluated. Simultaneous assessment of more than one domain was observed in 117 papers, being effectiveness and timeliness the most frequent combination. Our analysis revealed that virtual consultation is in development and underused. This tool has the potential to improve access to specialised care and enhance coordination between professionals. CONCLUSIONS: Virtual consultation has the potential to provide effective, efficient, equitable and timely attention. However, its contribution to safety and patient-centered care needs further evaluation. Our review emphasises the need for more rigorous research and standardised quality assessment criteria to obtain robust evidence on the usefulness of virtual consultation for improving healthcare quality domains.

An Examination of the Relationship between Visualization Media and Consumer Product Evaluation.

Virtual product presentations that rely on static images and text are often insufficient to communicate all the information that is necessary to accurately evaluate a product. Technologies such as Virtual Reality (VR) or Augmented Reality (AR) have enabled more sophisticated representation methods, but certain product characteristics are difficult to assess and may result in perceptual differences when a product is evaluated in different visual media. In this paper, we report two case studies in which a group of participants evaluated three designs of two product typologies (i.e., a desktop telephone and a coffee maker) as presented in three different visual media (i.e., photorealistic renderings, AR, and VR for the first case study; and photographs, a non-immersive virtual environment, and AR for the second case study) using eight semantic scales. An inferential statistical method using Aligned Rank Transform (ART) proceedings was applied to determine perceptual differences between groups. Our results show that in both cases product attributes in Jordan's physio-pleasure category are the most affected by the presentation media. The socio-pleasure category was also affected for the case of the coffee makers. The level of immersion afforded by the medium significantly affects product evaluation.

Beneficial effect of bilingualism on Alzheimer's disease CSF biomarkers and cognition.

Bilingualism as a component of cognitive reserve has been claimed to delay the onset of Alzheimer's disease (AD). However, its effect on cerebrospinal fluid (CSF) AD-biomarkers has not been investigated. We assessed cognitive performance and CSF AD-biomarkers, and potential moderation effect of bilingualism on the association between age, CSF AD-biomarkers, and cognition. Cognitively healthy middle-aged participants classified as monolinguals (n = 100, nCSF = 59), early (n = 81, nCSF = 55) and late bilinguals (n = 97, nCSF = 52) were evaluated. Models adjusted for confounders showed that bilinguals performed better than monolinguals on digits backwards (early-bilinguals p = 0.003), Judgment of Line Orientation (JLO) (early-bilinguals p = 0.018; late-bilinguals p = 0.004), and Trail Making Test-B (late-bilinguals p = 0.047). Early bilingualism was associated with lower CSF total-tau (p = 0.019) and lower prevalence of preclinical AD (NIA-AA classification) (p = 0.02). Bilingualism showed a moderation effect on the relationship between age and CSF AD-biomarkers and the relationship between age and executive function. We conclude that bilingualism contributes to cognitive reserve enhancing executive and visual-spatial functions. For the first time, this study reveals that early bilingualism is associated with more favorable CSF AD-biomarker profile.