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Does the teleconsultation reduce face to face visits?

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General Practitioners’ perceptions in the Catalan public primary care system.
eConsulta is a asynchronous teleconsultation service between general practitioners and citizens connected to the electronic medical history systems of public primary healthcare

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Does the teleconsultation reduce face to face visits?

  1. 1. gencat.cat/ics Does the teleconsultation between professionals and patients reduce face to face visits? General Practitioners’ perceptions in the Catalan public primary care system Josep Vidal-Alaball Primary Care Physician Health Promotion in Rural Areas Research Group Catalonia
  2. 2. gencat.cat/ics eConsulta 203/11/2019 eConsulta is a asynchronous teleconsultation service between general practitioners and citizens connected to the electronic medical history systems of public primary healthcare It has been in operation since the end of 2015 as a complement to the face-to-face consultations offered by the territory’s Primary Care Teams (PCTs) From the patient’s point of view, eConsulta is one of the services available in their personal health folder, a personal digital space which provides access to personal health information.
  3. 3. gencat.cat/ics eConsulta 303/11/2019
  4. 4. gencat.cat/ics eConsulta 403/11/2019
  5. 5. gencat.cat/ics Study 503/11/2019 The aim of this study is to evaluate the impact of the use of eConsulta in reducing the number of face-to- face visits to PCTs In the Catalan central region, the 20 GPs who most frequently used eConsulta (performed nearly 70% of the total amount of teleconsultations) were offered to participate in the study. 18 were able to participate.
  6. 6. gencat.cat/ics Study 603/11/2019 Each GP recorded three pieces of information for each of the interactions they carried out: 1. Type of interaction according to the 13 types proposed by the authors 2. Whether, in their opinion, a face-to-face visit was avoided (defined as the absence of the need for a face-to-face visit following the consultation) 3. Whether, in their opinion, the patient would have requested a face-to-face visit had eConsulta not been available.
  7. 7. gencat.cat/ics Results 703/11/2019 • A total of 3,559 messages corresponding to 2,268 teleconsultations (1.57 messages per teleconsultation) were analysed • The majority of teleconsultations were initiated by the patient (60%) and that a significant proportion consist of a single message that did not generate any response • Regarding the format, the messages we composed of a title and a text body which are on average 17 and 250 characters long, respectively. The texts of messages written by the GPs were slightly longer than those from patients (280 vs. 190 characters on average).
  8. 8. gencat.cat/ics Results. Type of Consultation 803/11/2019 Type of consultation N % 1 Management of test results 758 34.77 2 Sick leave management 113 5.18 3 Arranging an appointment 160 7.34 4 Requesting a clinical report/certificate 37 1.70 5 Repeat prescription 262 12.02 6 Vaccination 21 0.96 7 Other administrative issues 67 3.07 8 Clinical doubts 345 15.83 9 Pharmacological issues 79 3.62 10 Queries related to anticoagulants 1 0.05 11 Error in sending the message 45 2.06 12 Other 144 6.61 13 Technical tests 124 5.69
  9. 9. gencat.cat/ics Results 903/11/2019 Has this eConsulta avoided a face-to-face visit? • GP answered YES in 88% of the econsultations analyzed • The ability to decrease the number of face-to-face visits is quite uniform in terms of each type of consultation (the least decisive teleconsultations are those which fall into the category "Other")
  10. 10. gencat.cat/ics Results 1003/11/2019 In the absence of a service like eConsulta, would the patient have made a face-to-face visit? • GP answered YES in 72% of the econsultations analyzed • This suggest that eConsulta implies a demand induction of 28%. It is observed that the ease of contact that facilitates the tool occurs mainly in type 12 consultations "others"
  11. 11. gencat.cat/ics Results 1103/11/2019 • econsultations which consisted of a single message primarily relate to the type defined as "management of test results” • Who initiates a teleconsultation does not determine its degree of resolution as the % of resolution of the teleconsultations is not statistically different regardless of whether it is initiated by the patient or the GP (p=0.045) • Message length is statistically related to the case being resolved, as sending longer messages increased the likelihood of the consultation being satisfactorily concluded [OR=1,66 (1,32-2,07) p<0,001]
  12. 12. gencat.cat/ics Discussion 1203/11/2019 • This study suggests that eConsulta is a tool which can reduce the number of face-to-face consultations in the context of primary care • The study also shows what types of visits eConsulta is likely to be used by patients and GPs • It is worth noting that the second most frequent reason for sending a message was to ask a medical question, demonstrating that there is demand for a non-face-to- face interaction means to resolve health issues. López Seguí F, Vidal Alaball J, Sagarra Castro M, García Altés A, García Cuyàs F Does teleconsultation reduce face to face visits? Evidence from the Catalan public primary care system JMIR Preprints. 25/04/2019:14478 DOI: 10.2196/preprints.14478 URL: https://preprints.jmir.org/preprint/14478
  13. 13. gencat.cat/ics 13
  14. 14. gencat.cat/ics gencat.cat/ics Information/contact: jvidal.cc.ics@gencat.cat http://icscatalunyacentral.cat/recerca http://www.slideshare.net/jvalaball Twitter/Instagram: @jvalaball

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