Sistema de consultoría virtual entre la Atención Endocrinológica Especializada y la Atención Primaria / Virtual referral system between specialized endocrinological care and primary care

Mejorar la resolución de las enfermedades endocrinológicas en Atención Primaria utilizando las nuevas tecnologías de la información (TI). Disminuir las visitas inadecuadas en Atención Especializada. Establecer un sistema de comunicación directo y asesorar a los médicos de familia de forma rápida y efectiva. Material y métodos Mediante una agenda especial, el médico de familia programa a los pacientes que quieren consultar al endocrinólogo sin presencia física. Las consultas son contestadas en la historia clínica compartida. Si el paciente consultado precisa una visita, el especialista lo cita en su agenda. Descripción de las consultas virtuales realizadas durante los años 2008, 2009 y 2010 utilizando la historia clínica informatizada por los médicos de familia de 6 centros. Comparación de la adecuación de las primeras visitas derivadas al especialista (según protocolos pactados) del año 2007 con el 2009.ResultadosTotal de consultas virtuales: 1.705. Tipo de enfermedades: tiroides un 35%, diabetes un 50%, obesidad un 4% y otras un 11%. En el año 2008 las consultas más frecuentes eran enfermedad tiroidea y en el año 2010 diabetes, que pasó del 25,5 al 66%. En el año 2007 había un 25% de primeras visitas inadecuadas y en el año 2009 un 10%. El 88% de las consultas fueron resueltas virtualmente. Conclusiones Aumento de la resolución de los casos en Atención Primaria. Disminución de las primeras visitas derivadas inadecuadamente en Atención Especializada. Incentivación del trabajo en equipo entre Atención Primaria y Atención Especializada favoreciendo la continuidad asistencial. Asignación más racional de los recursos existentes. Mejora en el acceso a la formación en anatomía patológica endocrina entre los médicos de familia (AU)

The resolution improvement of endocrine diseases in Primary Care using communication and information technology (IT). Reduce number of inappropriate appointments to specialist care visits. Direct line establishment of communication between Primary Care and Specialist Care and provide quick and useful advices to GPs. Methods and materials: The GP establishes appointments for patients who need a visit with the specialist of endocrinology without physical presence. The queries are recorded in the medical share history of each patient. If a person requires a visit, the Specialist Care makes an appointment himself. A descriptive analysis was made based on virtual visits during 2008-2010,using the electronic medical history of patients from 6 GP centers. Compare of adequacy of first visits (according to agreed protocols) between 2007 and 2009.Results: Total number of online queries: 1705. Pathology: thyroid 35%, diabetes 50%, obesity 4%and others 11%. The most common virtual queries were the thyroid dysfunctions in 2008 and diabetes in 2010. Diabetes increased from 25,5% to 66%. In 2007 there were a 25% of inappropriate first visit which were reduced to 10% in 2009. 88% of queries were resolved virtually. Conclusions: Increase in the capacity of case resolution in Primary Care. Decrease of inappropriate first visits from Primary Care to Specialist Care. Encourage teamwork between Hospital and primary care. Improve the access of training in endocrine pathology among GP (AU)

Virtual referral system between specialized endocrinological care and primary care.

PURPOSES: To study the resolution improvement of endocrine diseases in primary care using communication and information technology (IT). Reduce number of inappropriate appointments to specialist care visits. Direct line establishment of communication between primary care and specialist care and provide quick and useful advices to GPs. MATERIALS AND METHODS: The GP establishes appointments for patients who need a visit with the specialist of endocrinology without physical presence. The queries are recorded in the medical share history of each patient. If a person requires a visit, the specialist care makes an appointment himself. A descriptive analysis was made based on virtual visits during 2008-2010, using the electronic medical history of patients from 6 GP centers. Adequacy of first visits (according to agreed protocols) between 2007 and 2009 was compared. RESULTS: Total number of online queries: 1705. Pathology: thyroid 35%, diabetes 50%, obesity 4% and others 11%. The most common virtual queries were the thyroid dysfunctions in 2008 and diabetes in 2010. Diabetes increased from 25.5% to 66%. In 2007 there were 25% of inappropriate first visit which were reduced to 10% in 2009. 88% of queries were resolved virtually. CONCLUSIONS: There was an increase in the capacity of case resolution in primary care with decrease of inappropriate first visits from primary care to specialist care. Teamwork between hospital and primary care was encouraged. The access of training in endocrine pathology among GP was improved.

Frequent attendance in primary care: comparison and implications of different definitions.

BACKGROUND: The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. AIM: To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. DESIGN OF STUDY: One-phase cross-sectional study. SETTING: Seventy-seven primary care centres in Catalonia, Spain. METHOD: A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. RESULTS: The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. CONCLUSION: The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).