RESUMO
INTRODUCTION: Colombia has 50,912,429 inhabitants, but only 50-70% of the population can effectively access health care services. The emergency room (ER) is a main contributor to the in-hospital care system since up to half of the admissions come through it. Telemedicine has become a tool to facilitate effective access to health care services, improve the timeliness of care, reduce diagnostic variability, and reduce costs associated with health. The aim of this study is to describe the experience of a Distance Emergency Care Program through Telemedicine (TelEmergency) to improve specialist access for patients at the Emergency Room (ER) in low- and medium-level care hospitals in Colombia. METHODS: An observational descriptive study of a cohort including 1,544 patients during the program's first two years was conducted. Descriptive statistics were used to analyze the available data. The data are presented with summarized statistics of sociodemographic, clinical, and patient-care variables. RESULTS: The study included a total of 1,544 patients, and the majority were adults between 60 and 79 years of age (n = 491, 32%). More than half were men (n = 832, 54%), and 68% (n = 1,057) belonged to the contributory health care regime. The service was requested from 346 municipalities, 70% (n = 1,076) from intermediate and rural settings. The most common diagnoses were related to COVID-19 (n = 356, 22%), respiratory diseases (n = 217, 14%), and cardiovascular diseases (n = 162, 10%). We observed 44% (n = 681) of local admissions either under observation (n = 53, 3%) or hospitalization (n = 380, 24%), limiting the need for hospital transfers. Program operation data revealed that 50% (n = 799) of requests were answered within two hours by the medical staff. The initial diagnosis was modified in 7% (n = 119) of the patients after being evaluated by specialists at the TelEmergency program. CONCLUSIONS: This study shows the operational data collected during the first two years after the implementation of the TelEmergency program in Colombia, the first of its kind in the country. Its implementation offered specialized timely management of patients at the ER in low- and medium-level care hospitals, where there is no availability of specialized doctors.
Assuntos
COVID-19 , Telemedicina , Masculino , Adulto , Humanos , Feminino , Colômbia/epidemiologia , COVID-19/epidemiologia , Hospitalização , América do SulRESUMO
Resumen Objetivo: Proponer una ruta integral de atención en salud a través de la telesalud para el manejo del síndrome coronario agudo. Método: La construcción de la ruta se basa en la revisión de la literatura y la información obtenida en grupos focales con expertos. Resultados: Se construyó una ruta integral de atención en salud para el manejo del paciente con síndrome coronario agudo. Se diagrama en notación gráfica que describe la lógica de pasos, teniendo en cuenta los siguientes actores: pacientes y familias, sistemas de atención de emergencias, telesalud, hospitales de primer y segundo nivel de complejidad, terceros niveles de complejidad con capacidad resolutiva de los casos de síndrome coronario agudo, y entes de inspección, vigilancia y control. Conclusiones: La ruta integral de atención en salud soportada en la telesalud es una apuesta innovadora para optimizar procesos en salud. Puede entenderse como alternativa ante la crisis que afronta el sistema en términos de financiamiento, resultados y legitimidad, teniendo en cuenta el efecto positivo de la telesalud sobre la oferta y el acceso a servicios, diagnósticos y tratamientos oportunos, la superación de distancias geográficas, el mejoramiento de la calidad y la contribución con el despliegue de las guías de práctica clínica.
Abstract Objective: To propose a comprehensive route of health care through telemedicine for the management of acute coronary syndrome. Method: The construction of the route is based on the literature review and the information obtained in focus groups with experts. Results: A comprehensive route of health care has been built for the management of patients with acute coronary syndrome. This comprehensive route of health care is diagrammed in a graphic notation that describes the logic of the steps, taking into account the following actors: the patient and their families, emergency care systems, telemedicine, first and second level of care hospitals, third levels of care with resolution capacity of acute coronary syndrome cases, and inspection surveillance and control authorities. Conclusions: The comprehensive route of health care supported in telemedicine, is an innovative bet to improve processes in health care services. It can be understood as an alternative to the crisis faced by the sector in terms of financing, results and legitimacy, taking into account the positive effect of telemedicine on the provision and access to services, diagnostic and timely treatment, to overcome geographic distances, improve quality and contribute to the deployment of clinical practice guidelines.