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Using asynchronous telemedicine in rural primary care settings in the Catalonian Central Region


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WONCA 21st World Conference – Brazil 2016

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Using asynchronous telemedicine in rural primary care settings in the Catalonian Central Region

  1. 1. Using asynchronous telemedicine in rural primary care settings in the Catalonian Central Region Dr Josep Vidal-Alaball. Primary Care Physician. MPH
  2. 2. Two types of telemedicine can be distinguished: real- time and not real-time teledermatology. Asynchronous, not real-time or store-and-forward telemedicine is type of telemedicine where clinical data is collected, stored, and then forwarded to be interpreted later on. There is no need for the patient and the clinician to be available at the same time or place
  3. 3. Provides better access to users - RURAL Van Der Heijden, J.P. et al., 2011. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. British Journal of Dermatology, 165(Table 1), pp.1058–1065 Is both effective and efficient Hersh, W.R. et al., 2002. A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. Journal of Telemedicine and Telecare, 8(4), pp.197–209 Ekeland, A.G., Bowes, A. & Flottorp, S., 2010. Effectiveness of telemedicine: a systematic review of reviews. International journal of medical informatics, 79(11), pp.736–71 Enjoy a high acceptance among users Devine, J., 2009. User satisfaction and experience with antelemedicine service for diabetic footndisease in an Australian rural community. Available at: Telemedicine …
  4. 4. In the Catalonian Central Region, dermatology waiting lists had increased significantly during the years 2010-2011 To try to reverse this trend in early 2011 we began a teledermatology project Since the start of the project, the median (confidence interval 95%) of the days on the waiting list has reduced from 30 (29; 32) to 16 (15; 17) days * *Vidal-Alaball, J. et al., 2014. Evaluación del impacto de la teledermatología en la disminución de la lista de espera en la comarca del Bages (2009-2012). Aten Primaria, pp.9–10. Reduces waiting lists
  5. 5. Teledermatology. Pathway: HC 1. We take a picture of the lesion (Digital Camera - iPad) 2. We include the picture in the e-clinical history 3. We write the clinical history for the Dermatologist in the e-notes 4. The dermatologist has access to the e-history 5. The dermatologist looks at the pictures, writes a diagnosis and suggest treatment or ask for a referral
  6. 6. Teleulcers Inspired by the good results of teledermatology, in November 2012 Teleulcers was introduced Teleulcers is a project aiming to improve the care of patient with chronic wounds. Expert vascular advice is available for primary care nurses. Three main features define this service: • its transversality (primary care – hospital) • a virtual teleconsultation system • nursing leadership in the care of patients with chronic wounds Teleulcers has not sought to attend a high number of patients but has strived for quality of care
  7. 7. Teleophthalmology Used for screening diabetic retinopathy 1. Photographs of the retina are taken by a nurse and included in the e-clinical history 2. The ophthalmologist access the e-notes 3. The ophthalmologist looks at the photographs, writes a diagnosis and suggest follow up
  8. 8. Teleaudiometry 1. The primary care doctor takes the history (job) and performs a ear examination (otoscopy) 2. An audiometry is performed by a nurse, scanned and included in the e-clinical history 3. The ENT doctor access the e-notes 4. The ENT doctor looks at the audiometry, writes a diagnosis and suggest follow up 5. The primary care doctor calls the patient and explains the diagnosis
  9. 9. Josep Vidal-Alaball Twitter: @jvalaball