Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

[Validation of a questionnaire for the analysis of digital competence in patients with type 1 diabetes mellitus]. / Validación de un cuestionario para analizar la capacidad digital de pacientes con diabetes mellitus tipo 1.

OBJECTIVE: Validation of a questionnaire designed to stratify the level of digital competence in chronic patients. METHOD: Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency. RESULTS: The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77. CONCLUSIONS: The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools.

[Evaluation of contingency plans in the care of patients in intensive care units in the COVID-19 pandemic]. / Evaluación de los planes de contingencia en la atención a pacientes en Unidades de Cuidados Intensivos en la pandemia por COVID-19.

BACKGROUND: The expansion of intensive care areas has been one of the most significant measures in this forced adaptation to the evolution of the different phases of the COVID-19 pandemic. The objective is to evaluate the deployment of contingency plans in the care of patients admitted to intensive care units during the period from March 19 to April 20, 2020, in a public hospital, reference for 300,000 inhabitants belonging to the Galician Health Service. MATERIALS AND METHODS: Qualitative research from focus groups, with systematic sampling. Based on the adaptation to the health environment of the 10 measures recommended by Deloitte to face a pandemic, an evaluation was carried out by the quality unit of the Health Area. As outcome indicators, the number of COVID-19 patients, % of patients admitted to hospital, % patients admitted to intensive care units, as well as the number of deaths from COVID-19, were evaluated in seven health areas in the period March 19 to April 20, 2020. RESULTS: The qualitative evaluation identified 2 areas for improvement (communication and risk assessment) of the 10 recommended measures. The Health Area has the lowest relative (2.6%) and absolute (16) rate of deceased patients, as well as the lowest relative (7.9%) and absolute (24) rate of patients admitted to intensive services for COVID-19. The infection rate in professionals has been 4.4%. CONCLUSIONS: The simplicity and identification of areas for improvement added to the low consumption of resources are strengths of this proposal. This self-assessment can be helpful in identifying areas for improvement.

Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine.

This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.

Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine. / Recomendaciones sobre la valoración integral y multidimensional del anciano hospitalizado. Posicionamiento de la Sociedad Española de Medicina Interna.

This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.