Impacto de las consultas y triajes telefónicos pediátricos en el uso del servicio de urgencias hospitalario / Pediatric televisits and telephone triage: impact on use of a hospital emergency department

Objetivos: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. Método: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. Resultados: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. Conclusiones: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres

Objectives: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. Methods: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. Results: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. Conclusions: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit

A feasible method to study the Danish out-of-hours primary care service.

INTRODUCTION: The primary care out-of-hours (OOH) service is of considerable importance; it is the main provider of freely accessible medical advice outside daytime hours, and it covers 75% of the active time in the health-care system. Although the OOH handles three million contacts annually, only little is known about the reasons for encounter, the performed clinical work and the patient perspectives. MATERIAL AND METHODS: During a one-year period (2010-2011), data on patient contacts were collected using pop-up questionnaires integrated into the existing IT system. The questions explored the contents and characteristics of patient contacts. A paper-based questionnaire was sent to the included patients. RESULTS: Of all 700 general practitioners (GP) on duty, 383 (54.7%) participated at least once, and the participating GPs were representative of all GPs. In total, 21,457 contacts were registered; and the distribution of patient, contact and GP characteristics in OOH contacts was similar to the background contacts. Telephone consultations were most often offered to children and home visits primarily to elderly patients. The patient response rate was 51.2%. Females comprised the majority of the included contacts and of the respondents in the patient survey. CONCLUSION: The method was highly feasible for generating a representative sample of contacts to OOH services. The project has formed a substantial and valid basis for further studies and future research in the OOH service. FUNDING: Financed by the Region of Central Jutland, the Danish National Research Foundation for Primary Care and the Health Foundation. TRIAL REGISTRATION: not relevant.

Representing second opinion requests from primary care within the Brazilian tele-health program: international classification of primary care, second edition.

Standardization of second opinion question-answer pairs with a classification system can be used to facilitate data sharing and reuse. The Brazilian telehealth program faces the problem of representing biomedical knowledge from the primary care second opinion demands generated by rural health care teams. The objective is to determine if one of the medical classification systems has a superior ability to standardize Portuguese-language second opinion question-answer pairs. Data from 2,638 second opinions from 2010 were randomly reduced to a 264 question-answer pair data set. The semantic meaning of the question-answer pairs was manually assigned to an International Classification of Primary Care, Second edition (ICPC2) code. Eight question-answer pairs did not contain sufficient medical semantic meaning to allow for mapping to an ICPC2 code; 53 question-answer pairs did contain sufficient medical semantic meaning for mapping, however an appropriate ICPC2 code did not exist; and 203 question-answer pairs did contain sufficient medical semantic meaning for mapping to an ICPC2 code. A review of the literature indicates that there is no baseline to compare the 77% success rate against.

[Importance of the Teratogen Information Service in Bahia, Brazil, for prevention of congenital malformations: an initial four-year review]. / A importância do Serviço de Informações sobre Agentes Teratogênicos, Bahia, Brasil, na prevenção de malformações congênitas: análise dos quatro primeiros anos de funcionamento.

Teratogenic agents are defined as physical, chemical, or biological agents or nutrient deficiencies that lead to fetal structural or functional alterations. Information on the effects of exposure to teratogens during pregnancy is of the utmost importance. In order to achieve this goal, in 2001, the Bahia State Teratogen Information Service was created in the Medical Genetics Department at the University Hospital of the Federal University in Bahia. The current paper aimed to describe the first four years of operation in the service. From March 2001 to May 2005, the service was consulted by telephone, fax, and e-mail. During this period, 408 queries were made, for a total of 1,091 different reasons. Most queries were made by pregnant women and health care professionals. Hair products, herbal teas, and misoprostol were the most widely investigated agents. The low number of queries (average 1/day) shows the need for more awareness-raising on the risks posed by the various agents.

A importância do Serviço de Informações sobre Agentes Teratogênicos, Bahia, Brasil, na prevenção de malformações congênitas: análise dos quatro primeiros anos de funcionamento / Importance of the Teratogen Information Service in Bahia, Brazil, for prevention of congenital malformations: an initial four-year review

Agente teratogênico é definido como o agente físico, químico, biológico ou estado de deficiência que, durante a vida embrionária, leva a alteração na estrutura ou função do concepto. Informações sobre a conduta a ser tomada no caso de exposições a teratogênicos durante a gestação são imprescindíveis. Com essa finalidade, em 2001, foi implantado o Serviço de Informações sobre Agentes Teratogênicos da Bahia (SIAT-BA), localizado no Serviço de Genética Médica do Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia. O objetivo é descrever as características do atendimento do SIAT-BA nos seus primeiros quatro anos de funcionamento. As consultas foram realizadas através do contato via telefone, fax ou e-mail, entre março de 2001 e maio de 2005. Nesse período, o SIAT-BA recebeu 408 consultas, totalizando 1.091 motivos. A maioria das consultas foi realizada por gestantes e profissionais de saúde. Produtos para cabelo, chás e misoprostol foram os agentes mais investigados. O pequeno número de consultas (1/dia) indica a necessidade de maior divulgação do serviço e da conscientização da população sobre os riscos oferecidos pelos diversos agentes.

Teratogenic agents are defined as physical, chemical, or biological agents or nutrient deficiencies that lead to fetal structural or functional alterations. Information on the effects of exposure to teratogens during pregnancy is of the utmost importance. In order to achieve this goal, in 2001, the Bahia State Teratogen Information Service was created in the Medical Genetics Department at the University Hospital of the Federal University in Bahia. The current paper aimed to describe the first four years of operation in the service. From March 2001 to May 2005, the service was consulted by telephone, fax, and e-mail. During this period, 408 queries were made, for a total of 1,091 different reasons. Most queries were made by pregnant women and health care professionals. Hair products, herbal teas, and misoprostol were the most widely investigated agents. The low number of queries (average 1/day) shows the need for more awareness-raising on the risks posed by the various agents.

Videoconferencing: what are the benefits for dental practice?

For more than 3 years members of the TeleDent team from Bristol University have been looking at the potential of videoconferencing technology for dentistry. Here they explain what videoconferencing is and how it can help the GDP. They discuss examples of its most promising uses for the profession, which include professional updating and providing diagnostic support at a distance. They describe the equipment that is needed, the different types of system available and give an indication of costs. A suggested procedure for using the technology for remote referrals is outlined. 'Store and forward' techniques are also discussed. These do not involve a live video but involve the sending of static electronic files. This approach is compared with videoconferencing, and the article looks at the question of which will be best suited to the GDP, and for what purposes.