Una nueva forma de comunicación entre reumatología y atención primaria: la consulta virtual / A new form of communication between rheumatology and primary care: the virtual consultation

La prevalencia de las enfermedades reumáticas ha aumentado en los últimos años y la consulta virtual de reumatología puede ser útil para reducir el número de visitas innecesarias y priorizar aquellas que requieran una atención precoz. La consulta virtual asocia la telemedicina y las telecomunicaciones. En este estudio se describen las características de las consultas virtuales realizadas a un Servicio de Reumatología en el periodo de un año, objetivándose que más de la mitad se pueden resolver sin necesidad de citar al paciente. Con la consulta virtual se ha conseguido: 1) tener un contacto cercano con el médico de atención primaria, 2) solucionar con rapidez las dudas sobre la enfermedad reumática de sus pacientes, 3) mejorar su formación en las enfermedades reumáticas y 4) priorizar a aquellos pacientes que requieran una valoración precoz por parte de un reumatólogo (AU)

In recent years, the prevalence of rheumatic diseases has increased. The virtual consultation of rheumatology could help to avoid unnecessary visits and attend those who need an early visit. The virtual consultation is associated with telemedicine and telecommunication. The objective of this study is to describe the characteristics of all virtual consultations performed in the Rheumatology Service during a one year period. More than a 50% were resolved without giving the patients an appointment. With virtual consultation we have achieved: 1) a closer contact with primary care, 2) rapid resolution of doubts about rheumatic disease in patients, 3) improvement of training in rheumatic disorders and 4) prioritizing those patients requiring early assessment by a rheumatologist (AU)

Principios generales de la interconsulta médica en enfermos hospitalizados / General principles of medical interconsultation for hospitalised patients

La interconsulta médica en pacientes hospitalizados constituye una actividad habitual entre los especialistas en medicina interna. Sin embargo, a pesar de su impacto e importancia crecientes, no se ha establecido un modelo que defina sus características, sus objetivos o la información que debe contener. En este trabajo, desde el Grupo de Asistencia Compartida e Interconsultas de la Sociedad Española de Medicina Interna, se proponen unas recomendaciones generales respecto a la forma de solicitar y de responder una interconsulta médica hospitalaria, así como un formato para la misma (AU)

Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations (AU)

Eficacia de un sistema de consultas de alta resolución en gastroenterología en un centro hospitalario andaluz / Efficacy of a high-resolution consultation system in gastroenterology at an Andalusian hospital center

Antecedentes: la consulta alta resolución o única es aquel proceso asistencial ambulatorio en el que queda establecido un diagnóstico junto con su correspondiente tratamiento y reflejados ambos en un informe clínico, siendo realizadas estas actividades en una sola jornada. Objetivos: conocer en qué grado los pacientes con patología digestiva pueden beneficiarse del sistema de consultas en acto único. Material: estudio descriptivo de 179 episodios de primeras vistas seleccionadas aleatoriamente de una consulta de alta resolución de gastroenterología. Analizamos el porcentaje de pacientes que se beneficiaron de una consulta en acto único así como de las pruebas complementarias realizadas. Resultados: las patologías más frecuentes atendidas fueron la dispepsia (16%), los antecedentes familiares de cáncer de colon (16%) y enfermedad por reflujo gastroesofágico (16%). Setenta y nueve (44%) de las primeras visitas se resolvieron en consulta única y 80 (45%) de una prueba diagnóstica (100% ecografía abdominal) y revisión tras esta en el mismo día. La realización de una prueba en el día incrementaba significativamente el porcentaje de consulta única frente a los que no se les realizaba (57% frente a 34%, p < 0,002). Los pacientes con enfermedad por reflujo gastroesofágico, dispepsia, colelitiasis y hepatopatía crónica eran las patologías que terminaban en mayor porcentaje en consulta única. Conclusiones: las consultas de gastroenterología pueden beneficiarse en gran medida de un sistema de consulta de alta resolución solo con cambios organizativos y sin costes adicionales especiales (AU)

Background: By high resolution consultation (HRC) we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established and recorded. Objective: To assess to which extent patients with digestive conditions may benefit from a single consultation system. Material: A descriptive study of 179 first visit events, randomly selected as high-resolution consultations in gastroenterology. We discuss the percentage of patients who benefited from HRC and the complementary tests performed. Results: Most common conditions included dyspepsia (16%), a family history of colon cancer (16%) and gastroesophageal reflux disease (GERD) (16%). Seventy-nine (44%) of all first visits became HRCs and 80 (45%) required a diagnostic test (100% abdominal ultrasound) that was reviewed on the same day. Performing a test on the same day significantly increased the percentage of HRCs (57% vs. 34%, p < 0.002). GERD, dyspepsia, cholelithiasis and chronic liver disease were the subjects most commonly leading to HRC. Conclusions: Gastroenterology consultations may largely benefit from an HRC system with only organizational changes and no additional costs (AU)

National Ambulatory Medical Care Survey: 2000 summary.

OBJECTIVE: This report describes ambulatory care visits made to physician offices within the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Highlights of trends in physician office visit utilization from 1997 through 2000 are also presented. METHOD: The data presented in this report were collected from the 2000 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Trends are based on NAMCS data from 1997 through 2000. RESULTS: During 2000, an estimated 823.5 million visits were made to physician offices in the United States, an overall rate of 300.4 visits per 100 persons. Approximately half of the visits were made to the patient's primary care physician. The proportion of office visits where a physician or physician group was the owner of the practice has steadily increased since 1997 (74.3 percent in 1997 versus 88.1 percent in 2000). Of all visits made to these offices in 2000, approximately 57 percent listed private insurance as the primary expected source of payment, and 29 percent were made by patients belonging to a health maintenance organization. There were an estimated 89.9 million injury-related visits during 2000, or 32.8 visits per 100 persons. Blood pressure check was the leading diagnostic screening test (45.3 percent) and males were more likely than females to have no diagnostic or screening services mentioned. The proportion of visits with at least one prescription for cardiovascular-renal drugs, hormones, or metabolic/nutrient drugs has increased since 1997.

Ambulatory surgery outcomes: a survey of office-based delivery.

Due to a few well-publicized stories about patient injury and death, office-based ambulatory surgery has recently been thrust upon the forefront of current discussions about clinical outcomes. This has stimulated interest among ambulatory surgery stakeholders, including physicians, patients, and elected officials. An analysis of medical office-based surgical facilities in Florida indicates that office-based surgeons tend to work independently, with limited peer oversight, although as a whole, they professionally subscribe to a high level of ethical standards and offer patients an expected high quality level of clinical expertise. The results did not definitively indicate a relationship between unaccredited medical offices and unacceptable surgical procedures. The paper concludes by offering fifteen medical office standards that can aid in developing office surgery oversight policies.