Aspectos medicolegales de la práctica de la teledermatología en España / Medical and Legal Aspects of the Practice of Teledermatology in Spain

El ejercicio de la teledermatología ya se encuentra plenamente incorporado a nuestra práctica clínica. Sin embargo, tras revisar aspectos legislativos y éticos sobre confidencialidad, calidad asistencial, autonomía del paciente, privacidad, responsabilidad profesional y seguros en relación con la teledermatología constatamos que aún carece de regulación específica, y sus aspectos legales están poco desarrollados. Garantizar la confidencialidad, la autonomía del paciente y la seguridad en el almacenamiento y envío de los datos son cuestiones imprescindibles para su práctica. La responsabilidad de los facultativos que intervienen en el proceso es uno de los principales motivos de controversia, y la figura del médico responsable es determinante para decidir sobre la atribución de la misma. Es necesario el desarrollo de una regulación concreta para ejercer la teledermatología de forma segura para los profesionales y los pacientes

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients

Medical and Legal Aspects of the Practice of Teledermatology in Spain. / Aspectos medicolegales de la práctica de la teledermatología en España.

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.

Utilidad y eficiencia de la teledermatoscopia en el manejo del cáncer de piel en atención primaria / Usefulness and efficiency of teledermoscopy in skin cancer management in primary care

OBJETIVO: Evaluar la utilidad de la teledermatoscopia como método de diagnóstico y de triaje de las lesiones sospechosas de cáncer cutáneo entre atención primaria y dermatología. Analizar la reducción en el número de derivaciones y estimar el ahorro conseguido. MATERIALES Y MÉTODOS: Estudio de concordancia sobre una serie de casos no aleatorizada. Estudio observacional descriptivo. Teleconsultas remitidas desde 2 centros de salud (urbano y rural) al servicio de dermatología de referencia en Córdoba (España) entre enero de 2017 y abril de 2019. Se recogieron los diagnósticos propuestos por atención primaria antes y después de utilizar dermatoscopia y el diagnóstico del/la dermatólogo/a y otras variables epidemiológicas. Se realizaron análisis descriptivo y estudio de concordancia. RESULTADOS: Se efectuaron 395 teleconsultas. El coeficiente de concordancia κ entre los diagnósticos de ambos especialistas sin utilizar dermatoscopia fue de 0,486. Si se emplea esta técnica la concordancia fue de 0,641. Se produjo una reducción del 58% de derivaciones, un ahorro de 2.475€ en transporte en ambulancia y una reducción del absentismo laboral de 550h de trabajo. Los diagnósticos más comunes fueron queratosis seborreica (20%; n=79) y carcinoma basocelular (15,2%; n=60). CONCLUSIONES: La incorporación de la dermatoscopia aumenta la concordancia diagnóstica, siendo un sistema útil para priorizar pacientes y liberar la demanda de atención hospitalaria con el consecuente ahorro de recursos, y evitando desplazamientos innecesarios a nuestros pacientes

OBJECTIVE: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving

[Usefulness and efficiency of teledermoscopy in skin cancer management in primary care]. / Utilidad y eficiencia de la teledermatoscopia en el manejo del cáncer de piel en atención primaria.

OBJECTIVE: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving.

Analisis de la prescripción farmacológica en pacientes institucionalizados / Analysis of the medical prescription in institutionalised patients

Objetivos. Valorar la concordancia terapéutica de fármacos prescritos con sus diagnósticos en pacientes institucionalizados en 2 periodos de tiempo, así como las características de esta prescripción. Material y métodos. Estudio observacional, descriptivo y cuasiexperimental. Se analiza la prescripción y diagnósticos clínicos de pacientes institucionalizados y al cuidado de un mismo profesional médico en 2 periodos de tiempo y con un intervalo de un año (2010-2011), ofreciendo en ese intervalo información sobre la prescripción. Resultados. Se estudió a 81 pacientes (78% mujeres), con edad media de 84 ± 7 años y con 5 ± 2 diagnósticos por paciente. El número de fármacos distintos por paciente fue más de 8 en los 2 periodos, siendo superior en el 2011 frente al 2010. De todos los fármacos prescritos, nos encontramos que en el año 2010 el 8,88% y en el 2011 el 9,38% están incluidos en el grupo de fármacos de utilidad terapéutica baja. En el año 2010 se aprecia una concordancia del 86,71 ± 13,75 frente a 87,17 ± 14,58 en el año 2011, es decir, el 87% de los pacientes tienen fármacos acordes a sus diagnósticos, lo que supone una mejora del 0,47 de un periodo con respecto al otro. No existen diferencias estadísticamente significativas entre ambos años. Conclusiones. La prescripción en pacientes institucionalizados es muy elevada y el número de fármacos por paciente aumentó tras la información. Cuando analizamos los fármacos prescritos destaca un alto porcentaje de medicamentos incluidos en el grupo de utilidad terapéutica baja (citicolina). Un porcentaje significativo de prescripciones no se corresponden con los diagnósticos presentes en su historia clínica (AU)

Objectives. To evaluate/assess the therapeutic concordance/agreement with prescribed medication in patients institutionalized diagnoses in two periods of time as well as the characteristics of this prescription. Material and methods. Observational and descriptive study. Prescribing and clinical diagnoses of institutionalized patients were analyzed. These patients were treated by the same physicians during the period of time with a one-year interval (2010-2011), offering prescribing information in this period. Results. A total of 81 patients (78% women), mean age 84 ± 7 years, and 5 ± 2 diagnoses per patient. The number of drugs per patient was more than 8 in the 2 periods, being higher in 2011 compared to 2010. From all the prescription, we found that 8.88% in 2010 and 9.3% in 2011 are included as “limited clinical value” drugs. In 2010, it sees a concordance of 86.71 ± 13.75 against 87.17 ± 14.58 in 2011, it means, 87% of patients are treated with drugs in agreement with their diagnoses, representing an increase of 0.47 in 2011 regarding 2010. No statistically significant differences between the 2 years. Conclusions. The prescriptions in institutionalized patients are very high and the number of drugs per patient increased after information. When we analyzed prescriptions we underline a high percentage of drugs included in the group of limited clinical value (citicoline). A significant percentage of prescriptions don’t correspond with diagnoses avaiable in their clinical history (AU)

[Analysis of the medical prescription in institutionalised patients]. / Analisis de la prescripción farmacológica en pacientes institucionalizados.

OBJECTIVES: To evaluate/assess the therapeutic concordance/agreement with prescribed medication in patients institutionalized diagnoses in two periods of time as well as the characteristics of this prescription. MATERIAL AND METHODS: Observational and descriptive study. Prescribing and clinical diagnoses of institutionalized patients were analyzed. These patients were treated by the same physicians during the period of time with a one-year interval (2010-2011), offering prescribing information in this period. RESULTS: A total of 81 patients (78% women), mean age 84±7 years, and 5±2 diagnoses per patient. The number of drugs per patient was more than 8 in the 2 periods, being higher in 2011 compared to 2010. From all the prescription, we found that 8.88% in 2010 and 9.3% in 2011 are included as "limited clinical value" drugs. In 2010, it sees a concordance of 86.71±13.75 against 87.17±14.58 in 2011, it means, 87% of patients are treated with drugs in agreement with their diagnoses, representing an increase of 0.47 in 2011 regarding 2010. No statistically significant differences between the 2 years. CONCLUSIONS: The prescriptions in institutionalized patients are very high and the number of drugs per patient increased after information. When we analyzed prescriptions we underline a high percentage of drugs included in the group of limited clinical value (citicoline). A significant percentage of prescriptions don't correspond with diagnoses avaiable in their clinical history.

Hepatitis C: es hora de actuar / Hepatitis C: it´s time to act

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Uso racional de antibióticos en Atención Primaria: una necesidad inaplazable / Rational antibiotics use in primary health care: a no postponable need

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[Evolution in consumption of and attitude towards tobacco towards physicians at the regional hospital "Reina Sofía," Córdoba]. / Evolución del consumo y actitud ante el tabaco de los médicos del hospital regional "Reina Sofía, Córdoba.

OBJECTIVES: to study the evolution of the smoking prevalence and the personal attitudes about smoking among doctors of a university hospital. MATERIAL & METHODS: cross-sectional study. A survey. Study population was all physicians working in "Reina Sofía" University Hospital of Cordoba (N=738). By systematic sampling we select a random sample of 250 especialist physicians. We designed a self-administered questionnaire with items measuring the prevalence of smoking, the brand they used, the degree of smoking dependence, and their opinion about the new anti-smoking law. We also study the measures for smoking cessation that doctors considered most useful. We compared our data with other similar study carried out in 1987. RESULTS: the prevalence of tobacco use was 42% (CI:95%: 35.5-48.9), below the figure we obtained in 1987 (56.3%; p < 0.001). Doctors between 36-45 years had the highest rates of tobacco consumption (p < 0.01). 86.9% of smokers thought that smoking was unhealthy and among these 83.3% accepted the risk derived of smoking. 86.7% of smokers used to smoke inside the hospital. 86.8% of doctors thought that the new public places restrictive smoking law must be implemented. Doctors smoke more often (68.5%) when they are on call and 26.4% of them recognize to smoke when they inform the patient's family. CONCLUSIONS: we highlight a reduction of the prevalence of smoking among this kind of physicians. We still consider important the high number of physicians which smoke inside the hospital, although this figure have significantly decreased.