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

Objetivos: Conocer las características de la atención inicial y el seguimiento telefónico de pacientes con sospecha de COVID-19 en la primera ola de la pandemia. Diseño: Observacional retrospectivo (auditoría de historias clínicas).Emplazamiento: Centro de salud urbano. Participantes: Casos probables de SARS-CoV-2 (15/03/2020 a 15/06/2020). Mediciones principales Ámbito de atención inicial y seguimiento telefónico (número de llamadas y duración). Variables sociodemográficas (incluyendo estructura familiar). Curso clínico (sintomatología, vulnerabilidad, pruebas, ingreso hospitalario y desenlace). Resultados Trescientos uno pacientes (51,5 [±17,8] años, 23% vulnerables, 17% estructura familiar no nuclear). Valoración inicial en el centro de salud (59,8%: telefónica; 25,2%: presencial). En urgencias hospitalarias (11%) presentaron síntomas similares que en atención primaria, predominan estructuras familiares no nucleares (p<0,05; test χ2), realizando más pruebas (p<0,05; test χ2). En domicilio (3,9%) son pacientes ancianos vulnerables (p<0,01, test ANOVA). El seguimiento telefónico duró 17,1 [±10,3] días con 8,2 [±4,4] llamadas, superior si provenían de urgencias o domicilio (p<0,03; test ANOVA). Se incrementa tras ≥2 consultas presenciales (OR: 4,8), la presencia de síntomas de alarma (OR: 2,3) y la edad ≥45 años (OR: 2,0). Se realizaron pocas pruebas de confirmación (19,3% antigénicas, 13% serologías). El 15,3% ingresos hospitalarios (todos valorados en centros de salud), con 6,3% casos severos y 2,3% exitus. Conclusión Durante la primera ola de la pandemia, la población optó por ser atendida de forma telemática en su centro de salud. Las valoraciones iniciales en urgencias del hospital se relacionan con la falta de apoyo social, pero no con mayor gravedad clínica. El seguimiento telefónico fue aceptado por la población y permitió seleccionar a los pacientes con peor curso clínico.

ObjectiveTo 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.

Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19 / Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery

La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria. El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes. Son objetivos operativos: proponer un plan de consultas, conocer cómo limita la asistencia a las consultas, definir qué patologías se benefician más con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5.619 consultas con una falta de respuesta telefónica del 19%. El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo más probable la respuesta telefónica para las consultas de unidad, OR = 0,60 o de traumatología general, OR = 0,67 y menos para los derivados desde urgencias. El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0,34, control postoperatorio, OR = 0,49, y unidades, OR = 0,40, cumplieron mejor este requisito. De los pacientes restantes, las consultas de traumatología general, OR = 0,50, y las derivadas a unidades, OR = 0,54 fueron las que más se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que más precisan de ser realizadas de forma presencial

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most

Consultoría telefónica en COT durante la pandemia por COVID-19. ¿Ha venido para quedarse? / Telephone consultation service in orthopedics during COVID-19 pandemic

ANTECEDENTES Y OBJETIVO: Durante la pandemia COVID-19, la actividad de los servicios quirúrgicos se ha visto obligada a adaptarse y transformarse. La telemedicina se está implantando como nunca antes en esta nueva situación, en la que los pacientes están confinados y los profesionales sanitarios presentan riesgo de infectarse. El objetivo es mostrar que una reestructuración combinada telemática y presencial de las visitas, permite asegurar la asistencia médica, garantizando la protección del personal sanitario y de los pacientes. MATERIAL Y MÉTODO: Estudio descriptivo observacional sobre el seguimiento de pacientes durante la pandemia por COVID-19, combinando la consulta telefónica con la presencial. RESULTADOS: Se realizaron un total de 5.031 llamadas telefónicas, diferenciando entre derivaciones, visitas de atención primaria especializada y consulta externa hospitalaria. Se registraron como: efectivas, tributarias de visita presencial y no se logra contacto telefónico. Y las dividimos en dos grupos: resueltas y no resueltas. Del total de visitas no presenciales telefónicas fueron efectivas un 53%. CONCLUSIONES: La medicina telemática es una opción factible en un servicio de traumatología, y de manera adecuada será una opción interesante de mantener tras la pandemia. Futuras líneas de investigación deberían ser abiertas para mejorar la capacidad de resolución de este sistema, analizar su relación coste-efectividad y subsanar los conflictos legales que pudieran existir

BACKGROUND AND AIM: The current COVID-19 pandemic scenario has driven surgical departments to a transformation. The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. MATERIAL AND METHOD: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. RESULTS: A total of 5031 telephone calls were made, differentiating between medical referrals, specialized primary care visits, and outpatient consultation. They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved. 53% of all telematic visits were successful. CONCLUSIONS: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist

Acessibilidade ao pré- natal e fatores de risco nas parturientes do HSPM / Prenatal accessibility and risk factors in HSPM parturients

Foi realizado análise de prontuários das parturientes a termo do Hospital do Servidor Público Municipal de São Paulo (HSPM) durante o ano de 2017, contabilizado e avaliado o número de consultas de pré-natal durante toda a gestação baseado no consenso estabelecido pela Organização Mundial de Saúde (OMS) de no mínimo oito encontros de pré-natal ao qual reduz o risco de morbidade materna e perinatal. A partir do número de consultas, as parturientes foram subdivididas por idade, raça, quantidade gestacional e se a assistência ao pré-natal foi feita no Hospital do Servidor e descentralizados (Funcionárias) ou externamente (Munícipes/SUS). O número total de parturientes foi de 997, destas 331 apresentaram menos de oito consultas de pré-natal no momento do parto, o que corresponde a 33,1% de todos os partos a termo do HSPM. A partir destes dados obteve-se a conclusão de que as pacientes provenientes do Sistema Único de Saúde (SUS), multigestas, maiores de 18 anos, amarelas e indígenas apresentam riscos maiores à não acessibilidade ao pré-natal e portanto, necessitam de intervenções para a melhoria à acessibilidade.

A regulação do acesso às consultas especializadas: dificuldades e desafios / The regulative access to specialized consultations: difficulties and challenges

A Central de Regulação é o local onde são registradas todas as solicitações de atendimento. Participam do sistema de regulação ambulatorial as Unidades Básicas de Saúde (UBS), as Estratégias de Saúde Família (ESF), a Central de Regulação e as Unidades de Referência. Objetivo: Buscou identificar os principais motivos de devolução das solicitações de consultas especializadas inseridas no Sistema de Regulação (SISREG) do município de Dourados/MS pelas unidades de saúde solicitantes (UBS e ESF) no período de fevereiro de 2015 a julho de 2015. Materiais e Métodos: Trata-se de um estudo descritivo de abordagem quantitativa. A coleta de dados foi realizada através de acesso ao SISREG utilizando-se de um questionário. De forma aleatória, optou-se pela região norte dentre as cinco regiões existentes. Resultados: De um total de 6.657 solicitações de consultas especializadas inseridas no SISREG no período estudado, 253 (3,8%) foram devolvidas. As principais justificativas de devolução da solicitação à unidade de origem foram: ficha incompleta (35,2%) devido à falta de registros clínicos e necessidade de atualização de dados pessoais (18,6%). A maioria dos usuários eram mulheres (61%). As especialidades que tiveram mais solicitações devolvidas foram: cirurgia geral (14,6%), otorrinolaringologia (12,3%) e oftalmologia (11,9%). Quanto à classificação de risco para atendimento: azul (69,2%) e amarelo (21,7%). Conclusão: Conclui-se que o principal motivo de devolução das solicitações foi o preenchimento inadequado das fichas dos pacientes quanto a dados clínicos e pessoais. Ressalta-se a importância que todos os envolvidos no atendimento orientem o paciente a atualizar os dados pessoais antes e durante a consulta, e ao entregar a solicitação para inclusão no sistema. A utilização do protocolo de exames e consultas especializadas pode diminuir o tempo de espera do paciente e otimizar o trabalho dos reguladores.

Introduction: The Regulation Central is the place where all treatment requests are registered. Take part in the outpatient regulation system the Basic Units of Health (UBS) and Family Health Strategies (ESF), Regulation Central and the Reference Units. Objective: This study aimed at identifying the main reasons for the returning of specialist consultations implemented by the requesting health units (UBS and ESF) in the Regulation System (SISREG) in Dourados/MS from February 2015 to July 2015.Materials and Methods:This is a descriptive study, quantitative approach. Data collection was carried out through access to SISREG using a questionnaire made to obtain them. The northern region was randomly chosen among the five existing regions. This region has nine health units (UBS/ESF). Results: From a total of 6,657 scheduled appointments, 253 (3.8%) were returned. The main reasons found for returning the requests to the source drive were: incomplete form (35, 2 %) due to lack of clinical records, waiting vacancy (20,2%) and need to update personal data (18,6%). Most users were women (61%). The specialties that have returned more requests were: general surgery (14.6%), otolaryngology (12.3%) and ophthalmology (11.9%). As for the risk rating for care: blue (69,2%) and yellow (21,7%). Conclusion: Therefore, the main reason for the return of specialist consultation was the inadequate completion of patient records, in both clinical and personal data. It is important to stress that all those involved in the care guide the patient to update the personal data before and during the consultation, and to deliver the request for inclusion in the system. If the test and outpatient visits protocol written by the Dourados Municipal Health Office were more carefully followed there could be a reduction of discards and of the waiting time for the patients, and an optimization of the work of regulators.