Telemedicine in healthcare access during the covid-19 pandemic: a scoping review / Telemedicina no acesso à saúde durante a pandemia de covid-19: uma revisão de escopo

ABSTRACT OBJECTIVE Mapping the role of telemedicine in the health access of patients with chronic diseases in continuous care actions (except for covid-19) during the pandemic. METHODS This is a scoping review, with an adapted version of the Prisma-Scr methodology and using the Population (patients with chronic diseases), Concept (telemedicine as a health access tool) and Context (covid-19 pandemic) strategy. We searched through the following databases: PubMed, Scopus, Embase, Web of Science, Lilacs and SciELO, resulting in 18 articles at the end of the review. We used the technological, sociocultural and assistance analysis dimensions. RESULTS Eighty-eight percent of the analyzed papers posited that telemedicine use to provide care increased during the pandemic. We identified that this use was positively related to the reduction of complications and the absence of physical displacement for care, expanding it to rural areas. Important barriers were presented, most importantly the digital exclusion, language sociocultural barriers, and inaccessibility to technological instruments for disabled people. CONCLUSIONS Innovation in care arrangements calls attention to how living labor is important to produce healthcare, using various technologies, and reveals tensions caused by the forces acting on healthcare micro politics. We conclude that, despite important barriers, telemedicine contributed to the care of chronic patients during the covid-19 pandemic.

RESUMO OBJETIVO Mapear a contribuição da telemedicina para o acesso à saúde dos pacientes portadores de doenças crônicas em ações de cuidados continuados (exceto para covid-19) no contexto da pandemia. MÉTODOS Trata de revisão de escopo, com adaptação da metodologia Prisma-Scr e utilizou a estratégia População (Pacientes portadores de doenças crônicas), Conceito (Telemedicina como ferramenta de acesso à saúde) e Contexto (Pandemia de covid-19). Foram realizadas buscas nas bases de dados PubMed, Scopus, Embase, Web of Science, Lilacs e SciELO, que resultou em um total de 18 artigos ao final da revisão. As dimensões de análise utilizadas foram tecnológica, sociocultural e assistencial. RESULTADOS Entre os artigos analisados, 88% demonstraram o aumento do uso da telemedicina para realização do cuidado durante a pandemia. Identificamos que a utilização da telemedicina esteve relacionada positivamente com a diminuição de complicações e a falta de necessidade de deslocamento físico para o atendimento com ampliação da assistência para áreas rurais. Barreiras importantes foram apresentadas, sendo a exclusão digital e barreiras socioculturais de idioma e falta de acessibilidade dos instrumentos tecnológicos para portadores de deficiência as principais. CONCLUSÕES A inovação nos arranjos assistenciais ressalta a importância do trabalho vivo no processo de produção do cuidado, com o emprego de tipos de tecnologias diversos, e expressa tensionamentos em decorrência das forças atuantes na micropolítica do cuidado. Concluímos que, apesar de barreiras importantes, a telemedicina contribuiu para o cuidado dos pacientes crônicos durante a pandemia de covid-19.

Prestation des interventions de santé mentale et de soutien psychosocial à distance

La pandémie mondiale de COVID-19 nous a forcés à explorer des options pour fournir des interventions de santé mentale et de soutien psychosocial à distance (numériques ou en ligne), en raison des mesures de santé publique nécessaires pour maintenir la distanciation physique. Dans ce contexte, et si les services de santé mentale nécessitent des professionnels spécialisés ou d’autres prestataires de soins de santé formés en santé mentale, les agents communautaires peuvent fournir des interventions psychosociales telles que les premiers secours psychologiques et le soutien mutuel.

Manual de registro y codificación de las atenciones de emergencias y urgencias en el primer nivel de atención / Registration and coding manual for emergency and urgent care at the first level of care

El documento describe los estándares necesarios, que permitan optimizar el proceso de la recolección de la data, y así obtener finalmente información de manera oportuna, consistente, confiable y de calidad de las atenciones de emergencias y urgencias

Utilidad de la telemedicina en la atención pediátrica urgente durante la pandemia por COVID-19 / Usefulness of telemedicine in urgent pediatric care during the COVID-19 pandemic

Introducción: nuestro sistema sanitario ha sufrido una reorganización sin precedentes priorizando la atención de los pacientes con sintomatología COVID-19. El uso de telemedicina se presenta como una alternativa útil en la era pos-COVID. El objetivo del estudio fue valorar la utilidad del servicio de mensajería de Twitter como herramienta de telemedicina para el cribado de patología urgente. Material y métodos: estudio descriptivo, retrospectivo y transversal de un programa de telemedicina desarrollado por un equipo de especialistas en Pediatría y sus Áreas Específicas durante el estado de alarma. Se recogieron datos demográficos, número y motivos de consultas según signos, síntomas y su forma de presentación (texto, foto o vídeo). Se analizó el número de consultas resueltas, derivaciones y el grado de satisfacción. Resultados: se atendió un total de 182 consultas realizadas en su mayoría por mujeres (71%), durante las primeras semanas del confinamiento (70%). El 100% fueron mensajes de texto, acompañados casi en un tercio de los casos de material audiovisual (27,2% fotos, 4,6% vídeos). La edad media de los pacientes atendidos fue de 2,72 ± 2,74 y los principales motivos de consulta: fiebre, exantemas y dificultad respiratoria. El 18,13% tuvo relación con la COVID-19, y solamente el 8,24% fue derivado. Conclusiones: aunque la telemedicina no puede reemplazar la valoración presencial y todavía existen limitaciones técnicas y legales, nuestros resultados sugieren que podría ser una alternativa prometedora para mejorar el acceso, reducir los tiempos de triaje, coordinar los recursos disponibles, y disminuir el riesgo de contagio y saturación de las instalaciones sanitarias (AU)

Introduction: our healthcare system has undergone an unprecedented reorganization, prioritizing the care of patients with COVID-19 symptoms. Telemedicine has emerged as a useful alternative in the post-COVID era. The aim of the study was to assess the usefulness of the Twitter® messaging service as a telemedicine tool for the screening of urgent pathology.Material and methods: cross-sectional, retrospective and descriptive study of a telemedicine programme developed by a team of specialists in paediatrics and its subspecialities during the state of alarm. We collected demographic data and the number and reasons for consultations based on the presenting signs and symptoms and how they were conveyed (text, photo and/or video). We analysed the number of resolved concerns, referrals and the degree of user satisfaction.Results: the service managed a total of 182 consultations, mostly made by women (71%) and during the first weeks of the survey (70%). All consultations included text, accompanied in almost 1/3 of the cases by audiovisual content (27.2% photo, 4.6% video). The average age of the managed patients was 2.72 ± 2.74 years and the main reasons for consultation were fever, exanthema and respiratory difficulty. Of all consultations, 18.13% were related to COVID-19, and only 8.24% led to referral.Conclusions: although telemedicine cannot replace face-to-face assessment and there are still technical and legal limitations, our results suggest that it could be a promising alternative to improve access, reduce triage times, coordinate available resources, and decrease the risk of contagion and the saturation of health care facilities. (AU)

Principales consultas urológicas a la guardia de un hospital de alta complejidad / Main urological consultations on duty at a highly complex hospital

Introducción: En Argentina nuestrainstitución cuenta con un residente de guardia activa deurología que se ocupa de las llamadas al radio únicodurante la noche. Existen pocos trabajos que tratan estetema que resulta importante, ya que brinda informaciónútil para promover educación y optimizar la dinámicahospitalaria.Onjetivo: Describir las características de las llamadasal radio de urología durante la guardia.Materiales y métodos: Durante la guardia activa,se registraron llamadas al radio durante el período comprendido en junio y julio de 2019. Determinamos: hora,fuente, sexo y edad del paciente, motivo de la llamaday los clasificamos según: llamadas para guardia inmediata (que necesitó intervención instrumental urológicacomo sonda, talla o lavado vesical, etc.), llamadas innecesarias (número equivocado) y número de urgenciasque requieren llamar a médico urólogo de pasiva paraguardia quirúrgica inmediata.Resultados: Se recopilaron un total de 325 llamadas,la mayoría de pacientes de sexo masculino. El principalmotivo de la llamada fue para colocación, recambio olavado de sonda vesical y/o talla vesical. Obtuvimos139 llamadas que requirieron intervención urológica. Elmayor número de llamadas fue de la Guardia externa(119), seguidos de Clínica Médica (47). La mayoría delas llamadas (242) no fueron ingresos. El total de llamadas innecesarias fueron 3 que corresponden al númeroequivocado.Conclusión: Este trabajo permitió detallar las llamadas al radio de Urología provenientes de otros serviciosy guardia externa, pudiendo identificar las problemáticas más comunes y educar en base a esto.(AU)

Introduction: In Argentina, our institution has a urology resident on call who handles requests to the single radio during nighttime. Few studiesaddress this important issue that provides useful information to promote education and optimize hospital dynamics.Objetive: To describe the characteristics of the callsreceived in the urology radio during night shifts. Materials ans methdos: During the night shifts,all calls to the radio were recorded during the periodbetween June and July 2019. We determined: time,source, sex, and age of the patient, reason for the calland classified the calls according to: calls for immediate resolution (which required urological instrumentalintervention, bladder catheterization or lavage, etc.),unnecessary calls (wrong number), and the number ofemergencies that require calling a superior for immediate surgical resolution.Results: We registered a total of 325 calls, most ofthem male patients. The main reason for calling wasfor placement, replacement, or washing of the urinarycatheter or suprapubic catheter. We obtained 139 callsthat required urological intervention. The highest number of calls was from the emergency department (119),followed by the Internal Medicine staff (47). Most ofthem (242) did not require patient admission. The totalof unnecessary calls was three, corresponding to wrongnumber.Conclusion: This study helped us to characterizethe calls to the Urology radio from other services andemergency department, allowing us to identify the mostcommon problems and educate based on this.(AU)

Herramientas tecnológicas para el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno / Technological tools for the control and follow-up of patients with respiratory diseases and oxygen support

El uso de las herramientas tecnológicas en salud permite llegar a puntos geográficos donde la medicina tradicional traza una brecha entre las instituciones de salud y los pacientes. Estas tecnologías pueden llegar a reducir las tasas de inasistencia médica, aumentar la adherencia al tratamiento y ayudar a garantizar la frecuencia apropiada de las visitas médicas. El presente trabajo se propuso realizar una revisión de la literatura sobre el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno, a través de herramientas tecnológicas. Se realizó una búsqueda en las bases de datos Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, con descriptores tipo Medical Subject Headings (MeSH) y Descriptores en Ciencias de la Salud (DeCS). El análisis de la literatura se realizó por medio de los elementos Strobe, Amstar. A partir de los estudios incluidos en el análisis final se puede evidenciar que la tecnología móvil en salud se ha convertido en una herramienta de gran importancia en el seguimiento y control de pacientes con enfermedades respiratorias, lo cual proporciona en tiempo real datos que pueden ser usados para minimizar complicaciones y ampliar la oportunidad de atención con calidad en pacientes con problemas respiratorios. No obstante, es necesaria la realización de ensayos clínicos que determinen los beneficios clínicos, al utilizar las herramientas tecnológicas en esta área(AU)

The use of technological tools in health allows reaching geographical points where traditional medicine draws a gap between health institutions and patients. These technologies can reduce medical absence rates, increase adherence to treatment, and help ensure the appropriate frequency of medical visits. In the present work it was proposed to carry out a review of the literature on the control and follow-up in patients with oxygen and respiratory diseases through technological tools. A search was carried out in the databases Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, with descriptors such as Medical Subject Headings (MeSH) and Descriptors in Health Sciences (DeCS). The analysis of the literature was carried out using the elements Strobe, Amstar. From the studies included in the final analysis, it can be evidenced that mobile health technology has become a very important tool in the monitoring and control of patients with respiratory diseases, which provides data in real time that They can be used to minimize complications and expand the opportunity for quality care in patients with respiratory problems, however, it is necessary to carry out clinical trials to determine the clinical benefits, when using technological tools in this area(SU)

Remote Delivery of MHPSS (Mental Health and Psychosocial) Interventions

The global COVID-19 pandemic has forced very different types of interventions to explore options for providing remote (digital, tele, or online) Mental Health and Psychosocial Support (MHPSS), mainly due to the public health need to maintain physical distancing. This fact-sheet provides general guidance to implement MHPSS remote interventions, aligned with the PAHO and WHO e-Health considerations. Considering physical distancing as the key public health measure to prevent COVID-19, new remote strategies are needed to ensure the continuity of treatment for mental health interventions. Remote modalities need specific adjustments for MHPSS, this document provides general guidance in this regard, in an easy and quick format to read.

Digital Health: A Strategy to Maintain Health Care for People Living with Noncommunicable Diseases during COVID-19

Noncommunicable diseases (NCDs) are the main cause of death and disability worldwide. Effective management of these chronic conditions depends largely on continuous, responsive, accessible, and quality services and successful patient engagement and self-management. Digital health, and in particular telemedicine visits, electronic records, and electronic prescriptions, have already demonstrated having advantages in successfully ensuring continuity of care, especially when services are disrupted, as well as monitoring and evaluating interventions for NCDs.

Telecardiología en tiempos de la pandemia de COVID-19 / Telecardiology in times of the COVID-19 pandemic

No disponible

Psychiatry in the aftermath of COVID-19 / La psiquiatría post-COVID-19

The COVID-19 pandemic has forced mental health professionals to substantially change the way they work and may have a delayed impact on patients. The aftermath of COVID-19 will shine a light on certain aspects of psychiatry addressed in this article: psychiatry as a medical specialty, the psychological aspects of medical practice, liaison and consultative psychiatry, home hospitalization, and virtual or telemedicine outpatient care. The consequences of population lockdown, complicated grief over solitary deaths, and the impact of the health crisis on mental health professionals - from hospitals to community services, rehabilitation facilities, and primary care - will be the focus of our efforts during the period of lockdown easing and in the medium term. There will be a foreseeable increase in demand for psychiatric care in the medium and long term along with an impact on mental health education and research

La pandemia por COVID-19 ha obligado a modificar sustancialmente la forma de trabajar de los profesionales de la salud mental, y puede tener un impacto diferido sobre los pacientes. La psiquiatría post-COVID-19 pondrá en valor la especialidad como parte de la medicina, los aspectos psicológicos de la práctica médica, la psiquiatría de enlace e interconsulta hospitalaria, la atención domiciliaria y la atención ambulatoria virtual o telemática. Las consecuencias del confinamiento poblacional, el duelo por las muertes solitarias y el impacto de la crisis sanitaria sobre los profesionales de la salud mental, desde los dispositivos hospitalarios hasta los comunitarios, de rehabilitación y la atención primaria, centrarán nuestros esfuerzos durante el desescalado y el medio plazo. Es previsible un aumento de la demanda de atención psiquiátrica a medio y largo plazo, y un impacto en la docencia e investigación en salud mental

COVID-19 and the role of information systems and technologies at the first level of care

Care centered on the response to COVID-19: Identify, report, contain, manage, and refer. Information systems for health—through timely access to correctly disaggregated data, proper integration of national and local systems, digital health, and the application of widely used information and communication technologies (ICTs)—facilitate the effective identification, reporting, and analysis of cases and contacts; early search for and detection of cases; and identification and monitoring of at-risk populations, cases, and contacts. Containment is strengthened through platforms for follow-up and monitoring of cases, contacts, quarantine, and social isolation. These systems, in turn, enable mass dissemination of information on preventive measures to all of society. Platforms for telemedicine visits, remote monitoring of patients, and remote communication enable health workers at the first level of care to manage medical care and facilitate home monitoring of people with COVID-19. These same mechanisms, together with electronic health records and local and national information systems, facilitate hospital referrals of patients with severe signs and symptoms or risk factors.

Teleconsulta de reumatología infantil en tiempo de COVID-19 / Teleconsultation of infant rheumatology in Covid-19 Time

No disponible

Telerreumatología en tiempos de crisis durante la pandemia por COVID-19 / Tele-rheumatology during the COVID-19 pandemic

INTRODUCCIÓN: Durante la pandemia por COVID-19 las necesidades de prevención de transmisión de la infección viral nos obligaron a potenciar las consultas virtuales. OBJETIVO: El objetivo de estudio es describir los resultados obtenidos con la anterior estrategia y definir el perfil de paciente más idóneo para aplicarla. MATERIAL Y MÉTODOS: Durante el período comprendido entre el 16 de marzo y y el 10 de mayo del 2020 todas las consultas sucesivas de nuestro servicio fueron realizadas en formato de teleconsulta reumatológica (TCR). Se recogieron las características sociodemográficas, geofuncionales y clínicas de los pacientes; se evalúo mediante escala numérica verbal (0-10, donde 0 = muy insatisfecho hasta 10 = completamente satisfecho) el grado de satisfacción del paciente/médico con la TC. RESULTADOS: La mayoría de los pacientes atendidos en las 469 TCR realizadas fueron mujeres, con una edad media de 60,83 años. Solo el 16% había realizado estudios universitarios. La distancia media recorrida para acudir a una consulta presencial era de 33km, con una inversión de tiempo total promedio de 2 h. La mayoría de los sujetos estaban diagnosticados de artrosis/reumatismos de partes blandas u osteoporosis; el 21% eran presentaban artritis reumatoide. La duración media de la TCR fue de 9,64 min. Encontramos una mayor satisfacción con la TCR por parte del paciente, cuando el nivel de estudios era más alto (OR = 4,33) y por parte del médico cuando el individuo manejaba mejor Internet (OR = 3,22). CONCLUSIÓN: Es posible transferir actividad asistencial reumatológica hacia la TCR con un grado importante de satisfacción para el paciente y el médico

INTRODUCTION: During the COVID-19 pandemic strategies to prevent transmission of the viral infection obliged our hospital to promote virtual consultations. OBJECTIVE: The objective of this study is to describe the results obtained with the previous strategy of transferring activity to teleconsultation during the period of maximum impact of the pandemic. MATERIAL AND METHODS: Between 16/03 and 10/05/2020 all successive consultations in our unit were performed in virtual rheumatology teleconference (RTC) format. The socio-demographic, geo-functional and clinical characteristics of all patients were collected; a numeric verbal scale (NVS) (where 0=very dissatisfied to 10=fully satisfied) was applied to assess the degree of satisfaction of the doctor/patient with the RTC. RESULTS: 469 TC were included. Most patients seen by RTC were women, mean age: 60,83 years. Only 16% had university education. The mean distance travelled for face-to face consultation is 33 Km with a mean total time of 2hours. Most individuals were diagnosed with osteoarthritis/soft tissue rheumatic diseases and/or osteoporosis; 21% had rheumatoid arthritis. The mean length of the TC was 9.64minutes. We find more patient satisfaction with the TC when their level of education is higher (OR=4.12); doctor satisfaction was higher when the individual was better able to manage the Internet (OR=3.01). CONCLUSION: It is possible to transfer rheumatological care activity to TC with a considerable degree of satisfaction for both the patient and the doctor

Drones: uso sanitario en situaciones de emergencia / Drones: sanitary use in emergency situations

Los drones, aparatos en auge en nuestra sociedad, se quieren introducir en las emergencias sanitarias. Este trabajo quiere explorar las opiniones al respecto de personal sanitario y de especialistas en ingeniería aeroespacial. Para ello se realiza un estudio con enfoque cualitativo utilizando entre-vistas en profundidad. La muestra to-tal es de 8 entrevistas, las cuales se distribuyen en 6 expertos en gestión de crisis y 2 expertos en ingeniería aeroespacial. Las categorías que se han analizado han sido TIC (tecnologías de in-formación y comunicación) en emergencias, inspección en la zona, el dron como elemento del gabinete de crisis, el dron en el triage, la capacidad de carga de pago de un dron para el transporte de recursos y la relación de las características de los drones. Del análisis se han obtenido resulta-dos claramente a favor de la integración de los drones como apoyo a los órganos de decisión. Para concluir con este trabajo, se anima a la integración de drones en los simulacros de gestión de crisis para comprobar, asegurar y mejorar su aplicación en este ámbito

Drones, devices booming in our society, are to be introduced in health emergencies. This work explores the views of health personnel and aerospace engineering specialists. This study is a qualitative approach performed using in-depth interviews. The total sample is 8 interviews which are decomposed into 6 experts in crisis management and 2 experts in aerospace engineering. The categories used were TIC (In-formation and Communication Technologies) in emergencies, inspection of the area, the drone as an element of the cabinet crisis, the drone in the triage, the payload capacity of a drone for the transportation of resources and the relationship of the characteristics of the drones. The analysis results obtained go clearly in favor of the integration of drones to support decision makers. To conclude this work, we encourages the integration of drones in crisis management drills to test, ensuring and improving their application in this area