[Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement]. / Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora.

OBJECTIVE: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. DESIGN: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. SITE: Physicians with healthcare duties in primary care in Aragon. PARTICIPANTS: Specialist physicians and resident interns in Family and Community Medicine. MEANSUREMENTS: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. RESULTS: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. CONCLUSIONS: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.

Assessing patient satisfaction with telephone-based consultations before, during and after the COVID-19 pandemic in Spain.

OBJECTIVE: To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services. DESIGN: A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted. SETTING: PC. PARTICIPANTS: 405 users of PC services in Zaragoza (Spain). MAIN OUTCOME MEASURE: Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests. RESULTS: The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine. CONCLUSION: This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions.

[Implementation and use of telemedicine in health care during the outbreak of monkeypox in the health area of Ibiza and Formentera]. / Implantación y uso de la telemedicina en la asistencia sanitaria del brote de viruela símica en el Área de Salud de Ibiza y Formentera.

OBJECTIVE: The objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area. DESIGN AND SITE: A descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care. PARTICIPANTS AND METHODS: All patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves. RESULTS AND CONCLUSIONS: The adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring.

[Teleconsultation: finding its place in primary care]. / Teleconsulta: encontrando su lugar en Atención Primaria.

Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation. This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change. To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential. Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.

[Evaluation of users and health professionals on teleconsultation in primary care: A cross-sectional study]. / Valoración de usuarios y profesionales sanitarios sobre la teleconsulta en Atención Primaria: estudio transversal.

OBJECTIVE: To evaluate the perceptions and preferences of users and health professionals on teleconsultation in primary care. DESIGN: Cross-sectional study with a telephone survey of users and a face-to-face survey of professionals carried out at 2021. SETTING: Urban primary health care. PARTICIPANTS: Random sample of users with teleconsultations in the last year, stratified by sex and age, and doctors and nurses from participating centres. MEASUREMENTS: Likert variables assessing teleconsultation according to consultation motives, preferences and related aspects. Descriptive analysis and comparison of proportions and means. RESULTS: Three hundred patients and 48 professionals answered the questionnaire. Both groups value positively the teleconsultation for the management of the electronic prescription (EP) (83% and 83%, respectively), sick leave (SL) (80% and 64%) and issues related to COVID-19 (71% and 58%). The positive assessment of teleconsultation decreases for the treatment of acute pathologies (47% and 25%) and chronic diseases (49% and 33%). Globally, people <70 years value teleconsultation more highly (P<.001), without differences between sexes. Users and professionals prefer face-to-face consultation for chronic diseases (82% and 83%) and acute pathologies (82% and 94%), and teleconsultation for EP (68.7% and 88.6%). 52% of users prefer face-to-face visits for SL compared to 29% of professionals (P<.05). CONCLUSIONS: Teleconsultation implementation has been well valued by both patients and professionals. The face-to-face visit is preferred for chronic and acute pathologies, especially in the elderly. It will be necessary to define in which cases teleconsultation is the best tool according to the characteristics of each population.

Recommendations of the Valencian Society of Digestive Pathology for the use of telemedicine and non-contact consultations. / Recomendaciones de la Sociedad Valenciana de Patología Digestiva sobre uso de consultas no presenciales y telemedicina.

The COVID-19 pandemic has meant a qualitative change in the way patients are treated in outpatient clinics. The need to take measures of social isolation as prevention for contagion by the new coronavirus has forced the use of telematic and telephone consultations in most medical and surgical units. The specialty of digestive medicine, due to the characteristics of its patients and frequent support in complementary techniques for diagnosis, is especially suitable for the use of non-contact consultations. In this document a series of recommendations are proposed that can serve as a guide for the establishment or improvement of non-face-to-face digestive medicine consultations.

Changes in the management of IBD patients since the onset of COVID-19 pandemic. A path toward the implementation of telemedicine in Spain?

BACKGROUND: COVID-19 pandemic increased medical services demand aside from interrupting daily clinical practice for other diseases such as inflammatory bowel disease (IBD). Here we present the results of a survey to gain the perception of IBD specialists in their patient-management using telemedicine in their daily practice. METHODS: This was an observational survey study among physicians focused on IBD (gastroenterologist, surgeons, and pediatricians) members of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU), the Spanish Association of Gastroenterology (AEG), and the Spanish Association of Coloproctology (AECP), regarding changes of management of IBD patients. RESULTS: We received a total of 269 responses to the survey (from May to June 2020). Before the pandemic, nearly all the respondents reported performing very frequently their visits face-to-face (n=251, 93.3%) while, during the pandemic, the telephone visits were the most frequent visits performed (n=138, 51.3%). Regarding communication difficulties, 157 (58.4%) respondents reported the impossibility of performing a proper examination as the most relevant issue. Also, 114 (42.4%) respondents considered remote visits more time-consuming than face-to-face visits. Most gastroenterologists (n=188, 83.2%) considered patients with active perianal disease in special need of face-to-face consultation and more than half of the surgeons (n=35, 50.7%) reported having performed an immediate postoperative follow-up remotely. CONCLUSIONS: Most IBD units have implemented remote visits during the pandemic, but most professionals found them more time-consuming and unsuitable for some disease profiles. Therefore, there is a need for the development of better telemedicine systems that can meet professionals' and patients' requirements.

[Optimizing blood pressure control through telemedicine in Primary Care in Spain (Iniciativa Óptima): Results from a Delphi study]. / Optimización del control telemático de la presión arterial en atención primaria en España (Iniciativa Óptima): resultados de un estudio Delphi.

AIM: Members of the working groups on hypertension or cardiovascular disease of the Spanish Societies of Primary Care Physicians (PCPs) [SEMERGEN], Family and Community Medicine [semFYC] and General and Family Physicians [SEMG], conducted a Delphi study to validate with a panel of PCPs with expertise in hypertension several recommendations to optimize teleconsultation in hypertensive patients. MATERIALS AND METHODS: Delphi study based on an online questionnaire with 59 recommendations based on the available evidence and the clinical experience of the authors. RESULTS: 118 PCPs participated in two rounds of the questionnaire (98.3% of the invited physicians), reaching consensus in 53/62 statements (85%). The Primary Care team must proactively select the hypertensive patients suitable for telematic consultation and contact them to set up an appointment. Telematic consultation must begin explaining the reason and aims pursued, continuing with anamnesis, which must explore signs and symptoms of disease worsening, current treatments and level of adherence. In patients with a home blood pressure measurement (HBPM) ≤135/85mmHg, it is recommended to schedule a new telematic appointment in 3-6months. On the contrary, asymptomatic patients with a HBPM ≥135/85mmHg should undergo ambulatory blood pressure monitoring, treatment modification or, in case of warning signs or symptoms, referral to a face-to-face visit or to emergency department. CONCLUSIONS: Teleconsultation can complement face-to-face consultation, constituting an additional tool for the appropriate follow-up of hypertensive patients.

Current expert opinion and attitudes to optimize telemedicine and achieve control in patients with asthma in post-pandemic era: The COMETA consensus.

OBJECTIVE: To collect perspectives and explore consensus for expert recommendations related to asthma control and the use of telemedicine among professionals who manage patients with asthma. DESIGN: A Delphi-like questionnaire was designed to analyse the level of agreement about several recommendations formulated by an expert scientific committee about asthma control and the use of telemedicine with this purpose. A dedicated scientific committee validated the questionnaire, which included questions about the participants' profile and the use of technological tools at a personal level or in clinical practice. The experts expressed their agreement with a Likert-scale of 9 values: 1-3 was considered no agreement, 4-6 neutral, and 7-9 agreement. A rate ≥70% with the same answer was considered consensus. SITE: The questionnaire was programmed and distributed as an internet-based survey. PARTICIPANTS: A pre-selected sample of 75 experts with experience in telemedicine (pulmonology, allergology, family medicine, nursing and community pharmacy) responded to a Delphi-like questionnaire composed by six questions and 52 items. INTERVENTIONS: Consultation was performed in two consecutive waves: the first wave was carried out from 12th of July to 8th of September of 2021; the second wave, from 25th of October to 12th of November of 2021. MAIN MEASUREMENTS: Three questions about asthma control (actions for achieving or maintaining control of asthma at every visit, current problems that affect asthma control, and potential solutions to offset such problems), and three questions about the impact of telemedicine in asthma control (potential benefits of telemedicine, and potential reticence about telemedicine among both patients and healthcare professionals) were included. RESULTS: From the 52 items inquired, 35 were agreed by consensus. The actions for achieving or maintaining control of asthma, the problems that affect asthma control, and their potential solutions were agreed by consensus. The potential benefits of telemedicine were validated by consensus. None of the potential reservations of patients about telemedicine were validated, while five out of 14 potential reservations of healthcare professionals were agreed by consensus. CONCLUSIONS: The COMETA consensus provides a current picture of the main problems for achieving asthma control, the benefits and the reservations about the use of telemedicine in the Spanish setting, and offers solutions. A wide interest in implementing telemedicine has been observed, although current limitations need to be overcome.

[Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)]. / Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía.

OBJECTIVE: To know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. DESIGN: Observational, retrospective (audit of medical records). LOCATION: Urban Primary Care Center of Andalusia (Spain). PARTICIPANTS: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). PRINCIPAL MEASUREMENTS: Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). RESULTS: Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. CONCLUSION: Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease.

OBJECTIVE: To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. BACKGROUND: The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. DESIGN - METHODS: A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. RESULTS: A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. CONCLUSION: The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.

[Checklist for patients with type 2 diabetes mellitus for remote consultation]. / Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática.

The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.

[Impact of the eConsultation on the primary care agenda]. / Efecto de la consulta virtual (eConsulta) en la frecuentación de visitas en atención primaria.

OBJECTIVE: A «before and after¼ type observational study was carried out to assess the impact of the virtual consultation (eConsulta) on the frequency with which the patient visits their primary care center once they have had their first virtual consultation. SETTING: Assigned population of the primary care center of Masnou-Alella and Ocata-Teià, Catalan Health Institute. PARTICIPANTS: A random sampling was performed and 329 patients who engaged in eConsulta were compared with 329 statistically similar patients in age, sex and medical complexity who did not engage in eConsulta. PRINCIPAL MEDIATIONS: Visits with primary care and nursing in their team are measured, both face-to-face, telephone and eConsulta, over the study period. RESULTS: Patients who performed virtual consultations showed a previous frequent attendance in primary care higher than those who did not perform eConsulta (4.44 medical visits year/versus 3.11). Following the use of the eConsulta, after a year of follow-up, frequency was reduced to levels of the control group (3.16 medical visits/year versus 3.00). After the first virtual visit, patients reduced face-to-face visits by 28.7%. CONCLUSIONS: The eConsulta could be an effective tool to respond to the needs of patients who do not require a face-to-face visit, especially in the most frequent patients.

The imperious need for telemedicine for the care of diabetes during the COVID-19 pandemic. A comprehensive approach study.

INTRODUCTION: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. OBJECTIVE: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. METHODS: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. RESULTS: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. CONCLUSIONS: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.

INTRODUCCIÓN: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. OBJETIVO: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. MÉTODOS: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. RESULTADOS: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. CONCLUSIONES: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.

Expanding Possibilities: Flexibility and Solidarity with Under-resourced Immigrant Families During the COVID-19 Pandemic.

The novel coronavirus has added new anxieties and forms of grieving to the myriad practical and emotional burdens already present in the lives of underserved and uninsured immigrant families and communities. In this article, we relate our experiences since the COVID-19 crisis to the lessons we have learned over time as mental health professionals working with families in no-cost, student-managed community comprehensive health clinics in academic-community partnerships. We compare and contrast the learnings of flexibility of time, space, procedures, or attendance we acquired in this clinical community setting during regular times, with the new challenges families and therapists face, and the adaptations needed to continue to work with our clients in culturally responsive and empowering ways during the COVID-19 pandemic. We describe families, students, professionals, promotoras (community links), and IT support staff joining together in solidarity as the creative problem solvers of new possibilities when families do not have access to Wi-Fi, smartphones, or computers, or suffer overcrowding and lack of privacy. We describe many anxieties related to economic insecurity or fear of facing death alone, but also how to visualize expanding possibilities in styles of parenting or types of emotional support among family members as elements of hope that may endure beyond these unprecedented tragic times of loss and uncertainty.

El novedoso coronavirus ha agregado nuevas ansiedades y formas de duelo a la infinidad de cargas emocionales y prácticas ya presentes en las vidas de las familias y las comunidades de inmigrantes marginados que no tienen seguro. En este artículo, relacionamos nuestras experiencias desde la crisis de la COVID-19 con las lecciones que hemos aprendido en el transcurso del tiempo como profesionales de salud mental que trabajamos con familias en clínicas comunitarias de atención integral de la salud gratuitas y administradas por estudiantes en asociaciones académico-comunitarias. Comparamos y contrastamos los conocimientos de flexibilidad del tiempo, del espacio, de los procedimientos o de la asistencia que adquirimos en este entorno clínico comunitario durante momentos habituales con los nuevos desafíos que enfrentan las familias y los terapeutas, y las adaptaciones necesarias para continuar trabajando con nuestros pacientes de maneras que respondan a sus necesidades culturales y los empoderen durante la pandemia de la COVID-19. Describimos a las familias, a los alumnos, a los profesionales, a las promotoras (vínculos comunitarios) y al personal de asistencia en tecnologías informáticas que se han unido en solidaridad como solucionadores creativos de problemas ofreciendo nuevas posibilidades cuando las familias no tienen acceso a wifi, a teléfonos inteligentes o a computadoras, o sufren el hacinamiento y la falta de privacidad. Describimos muchas ansiedades relacionadas con la inseguridad económica o con el miedo de enfrentar la muerte solos, y también cómo visualizar la ampliación de posibilidades en los estilos de crianza o los tipos de apoyo emocional entre familiares como elementos de esperanza que pueden perdurar luego de estos tiempos trágicos de pérdida e incertidumbre sin precedentes.

Clinical Supervision of Couple and Family Therapy during COVID-19.

This paper addresses the need for a swift transition from in-person clinical supervision to telesupervision during the time of the COVID-19 global pandemic. Five specific areas will be discussed in the effort to enhance the quality of clinical supervision provided to couple and family therapists in training at this time including the following: (1) COVID-19 and the structural changes and technological adaptation of supervision; (2) culturally and contextually sensitive guidelines for clinical supervision during COVID-19; (3) the supervisee's competence and the clinical supervisory process; (4) the new set of boundaries and the supervisory role; (5) and the supervisory alliance and supervisees' vulnerabilities in the face of COVID-19.

En este artículo se aborda la necesidad de una transición rápida de la supervisión clínica en persona a la telesupervisión durante el periodo de la pandemia mundial de la COVID-19. Se tratarán cinco áreas específicas con el fin de mejorar la calidad de la supervisión clínica ofrecida a los terapeutas de pareja y familiares en prácticas durante este periodo, por ejemplo: (1) La COVID-19 y los cambios estructurales y la adaptación tecnológica de la supervisión; (2) pautas que tienen en cuenta las particularidades culturales y contextuales para la supervisión clínica durante la COVID-19; (3) la competencia del supervisado y el proceso de supervisión clínica; (4) el nuevo conjunto de límites y el rol del supervisor; (5) y las vulnerabilidades de la alianza de supervisión y de los supervisados ante la COVID-19.

Telemedicine in the face of the COVID-19 pandemic.

The novel coronavirus SARS-CoV-2 is a positive single-stranded RNA virus that can be immediately translated and integrated into the host cell with its own RNA messenger, facilitating replication inside the cell and infectivity. The rapid progression of the disease presents a real challenge for the whole world. As the usual capacity for citizen care is exceeded, health professionals and governments struggle. One of the most important strategies to reduce and mitigate the advance of the epidemic are social distance measures; this is where telemedicine can help, and provide support to the healthcare systems, especially in the areas of public health, prevention and clinical practices, just as it is doing in others sectors. Telemedicine connects the convenience, low cost, and ready accessibility of health-related information and communication using the Internet and associated technologies. Telemedicine during the coronavirus epidemic has been the doctors' first line of defense to slow the spread of the coronavirus, keeping social distancing and providing services by phone or videoconferencing for mild to focus personal care and limited supplies to the most urgent cases.

[Effectiveness of interventions based on telemedicine on health outcomes in patients with multimorbidity in Primary Care: A systematic review]. / Efectividad de las intervenciones basadas en telemedicina sobre resultados en salud en pacientes con multimorbilidad en atención primaria: revisión sistemática.

OBJECTIVE: To evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care. DESIGN: A systematic review. DATA SOURCES: INAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018. STUDY SELECTION: Inclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located. DATA EXTRACTION: Duplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis. RESULTS: Five articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included. CONCLUSIONS: The relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care.

[Effectiveness of a new model of telephone derivation shared between primary care and hospital care]. / Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria.

AIM: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. DESIGN: No blind randomized controlled clinical trial. SETTING: Northern Huelva Health District. PARTICIPANTS: 154 patients. INTERVENTIONS: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. MEASUREMENTS: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. RESULTS: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered "excessive time and effort consuming". 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. CONCLUSIONS: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an "excessive time and effort consuming" to General Practitioners and was not all that beneficial to complex patients.

[Avances recientes en dermatología comunitaria 2016-2017. Teledermatología, un modelo de enseñanza y asistencia en atención primaria a la salud].

INTRODUCTION: Community dermatology (CD) is integrated by dermatologists, epidemiologists and interested people. It has 27 years of experience at the Guerrero State. Due to unsafety issues, the teaching and medical attention model had to be changed from presential to virtual trough telemedicine. METHOD: Transversal, descriptive, observational and analytic study, in which results from teaching-learning of the health personal that was capacitated throughout the telemedicine network at the Guerrero State were evaluated, during nine courses that reached 35 telemedicine centers. RESULTS: 2465 health workers were capacitated in basic dermatology, which were evaluated in their general knowledge of dermatology before and after every course. The utility of this modality of teaching was statistically evaluated with a random simple in 611 attendees with satisfactory results. DISCUSSION: Teaching through telemedicine network, represents an improvement for CD by reaching a higher number of attendees to several reception centers simultaneously, minimizing transportation expenses and improving the safety of the participants at the activities, with the advantage of allowing continuity of the CD purposes.

INTRODUCCIÓN: La dermatología comunitaria (DC) está integrada por dermatólogos, epidemiólogos y personal afín. Tiene 27 años de existencia en el Estado de Guerrero. Por condiciones de inseguridad se cambió el modelo presencial de enseñanza y atención dermatológica a la forma virtual, a través de teledermatología. OBJETIVO: Determinar la utilidad de la capacitación y enseñanza virtual a través de la telemedicina en DC. MÉTODO: Estudio transversal, descriptivo, observacional y analítico, en el que se evaluaron los resultados de la enseñanza-aprendizaje en el personal de salud capacitado por la red de telemedicina mediante nueve cursos que llegaron a 35 centros de telemedicina en el Estado de Guerrero. RESULTADOS: Se capacitó en dermatología básica a 2465 trabajadores de la salud, evaluando sus conocimientos antes y después de cada curso. Se validó estadísticamente la utilidad de esta modalidad de enseñanza con una muestra al azar de 611 asistentes, con resultados satisfactorios. DISCUSIÓN: La enseñanza a través de la red de telemedicina representa un avance en DC al llegar a un mayor número de asistentes en varios centros de recepción en forma simultánea, minimizando los gastos de transporte y salvaguardando la integridad de los participantes, con la ventaja de dar continuidad a los propósitos de DC.