Implementation of the teleconsultation service with an emphasis on gastroenterology in the San Pablo Clinic Network (Peru) during the COVID-19 pandemic

Objective: To describe the assistance provided by the teleconsultation service in the San Pablo Clinic Network (RCSP) during the COVID-19 pandemic, with an emphasis on the specialty of gastroenterology. The study: Descriptive study. Data from the Electronic Medical Records System and the RCSP administrative system were reviewed. Results: The RCSP includes 8 locations (5 in Lima). Between April 2020 and December 2021, 1,156,253 visits were made (6.6% of these by teleconsultation). The specialties with the most teleconsultations were internal medicine and endocrinology, and the specialties with the most face-to-face consultations were gynecology-obstetrics and traumatology. Gastroenterology was the ninth most frequent specialty in teleconsultation and the fifth in face-to-face consultation. The most frequent diagnoses of this specialty, both for face-to-face consultation and teleconsultation, were dyspepsia and gastroesophageal reflux disease Conclusion: The implementation of the teleconsultation service in the RCSP is reported. In addition, lessons learned in this process are provided.

Impact of the COVID-19 pandemic on outpatient endocrinology consultation and teleconsultation in a Peruvian hospital

Background: The COVID-19 pandemic affected the continuity of face-to-face medical consultations, so strategies, such as teleconsultations, were implemented to close the gaps in care. The objective of this study was to describe the impact of the pandemic in the traditional endocrinology consultation at Hospital Nacional Alberto Sabogal Sologuren (Callao, Peru). Materials and methods: We carried out a descriptive study of analysis of secondary data, that was obtained from the Sistema de Salud Inteligente of the Social Security of Peru. Data from outpatient consultations between May 2019 and November 2021 were analyzed. Results: Due to the pandemic, the proportion of face-to-face consultations decreased from 100% (pre-pandemic period) to 29,4% (during the pandemic), while teleconsultations predominated after its implementation. More than 68% of patients were women, in face-to-face consultations the median age before and during the pandemic was 59 and 56 years, respectively, while in teleconsultations it was 58 years. Diabetes mellitus was the main reason for consultation (between 32,6% and 34,4% of all consultations), followed by hypothyroidism and nodular thyroid disease. During the pandemic, the proportion of consultations for hypothyroidism was higher in teleconsultations vs. face-to-face consultations (25,3% vs. 18%). Conclusions: During the pandemic, teleconsultations predominated over face-to-face consultation. There were no relevant differences in median age or predominant gender among patients before or during the pandemic. Diabetes mellitus was the main reason for consultation in general and during the pandemic consultations for hypothyroidism were higher in teleconsultation. © 2022 Thieme Medical Publishers, Inc.. All rights reserved.

Clinical Practice Guideline for the treatment of COVID-19 in the Social Security of Peru (EsSalud)

Introduction: Since the beginning of the COVID-19 pandemic, different drugs and medications have been used for the prevention and treatment of COVID-19 infection. Likewise, various investigations have been carried out to evaluate the efficacy and safety of these interventions, many of which have been shown to generate more harm than benefit for the patient, for this reason it is necessary to standardize the management of adult patients with COVID-19 in our context. Objective: To provide evidence-based clinical recommendations for the management of adults with COVID-19. Methods: A guideline development group (GEG) was formed that included medical specialists and methodologists. For its elaboration, GEG decided to carry out a rapid adaptation of the Guide for the care of critical adult patients with COVID-19 in the Americas of the Pan American Health Organization (PAHO) as well as to carry out searches for novo questions. For the formulation of the recommendations, the evidence frameworks for the decision (EtD) of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology were developed. Results: This CPG addressed 28 clinical questions, divided into three topics: prevention, diagnosis and management. Based on these questions, 33 recommendations (16 strong and 17 conditional), 26 good clinical practices (GCP) and 2 flowcharts were formulated. This CPG was published in its third version in December 2021 Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the management of adults with COVID 19 in EsSalud. © 2022 Publicado por Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.

[Peruvian Physical Medicine and Rehabilitation residents' perception about their medical residency during the COVID-19 pandemic]. / Percepción de residentes de Medicina Física y Rehabilitación del Perú sobre su residencia médica durante la pandemia por COVID-19.

INTRODUCTION AND OBJECTIVES: The COVID-19 pandemic has affected medical residency (MR) programs worldwide. However, few reports have focused on the MR of Physical Medicine and Rehabilitation (PM&R). Therefore, our objective was to describe the perceptions of PM&R residents in Peru about their MR during the COVID-19 pandemic. MATERIALS AND METHODS: Cross-sectional study. During June 2021, we sought to address all PM&R residents in Peru, using a virtual, anonymous and voluntary survey of 13 questions elaborated in Google Forms, which addressed their perception of RM. RESULTS: Of 142 PM&R residents in Peru, 60 (42.3%) responded to the survey. Among these, 21.7% considered that their residency training site (RTS) met little or nothing with the minimum requirements to be one, 50% that their RTS cared little or notthing for him/her since the start of the COVID-19 pandemic, 35% that the physicians attending their RTS cared little or nothing about academics, and 71.7% that the lack of subspecialist physicians in PM&R greatly affects their training. In addition, 71.7% and 81.7% reported having learned little or nothing about musculoskeletal ultrasound and electrodiagnostic studies, respectively. Finally, 18.3% reported regretting to have chosen the specialty. CONCLUSIONS: We found an important negative perception about MR and a low self-perception of having learned about musculoskeletal ultrasound and electrodiagnostic studies. It is important to delve into the causes and look for alternatives to improve the training of PM&R residents.

Evidence-based clinical decision making during the COVID-19 pandemic

The COVID-19 pandemic is a difficult scenario for clinical decision making. Therefore, this paper aims to explain healthcare practitioners some basic concepts about evidence-based decision making with respect on doing or not doing a given intervention. For this, firstly we will discuss in which cases an evidence-based decision making process in necessary. Then, some previous concepts will be clarified (decision making based on pathophysiological plausibility, observations made during clinical practice, clinical evidence, as well as the influence from the pharmaceutical industry). Afterwards steps for evidence-based decision making will be described: Asking a question, looking for references answering this question, critically assess such references, understand the underlying logic for decision making, prepare for decision-making, make a balance (benefit, harm, and cost), perform a shared decision making process and reassess the evidence.