A clinician-to-clinician universal electronic consultation programme at the cardiology department of a Galician healthcare area improves healthcare accessibility and outcomes in elderly patients

Mazón‐Ramos, Pilar; Cinza‐Sanjurjo, Sergio; Garcia‐Vega, David; Portela‐Romero, Manuel; Sanmartin-Pena, Juan C; Rey-Aldana, Daniel; Monzonís, A. Martínez; Espasandín-Domínguez, Jenifer; Gude‐Sampedro, Francisco; González-Juanàtey, José Ramón

doi:10.1093/ehjdh/ztad004

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Our study has demonstrated that this programme is associated with a reduction in waiting lists and better health outcomes, for all patients 4,14 including those with a previous diagnosis of cardiac disease such as HF 23 and AF 24 . In addition, this programme has significantly improved the accessibility of the CD for patients who live far from the hospital, particularly those over 80 years old 25 . Our study has also highlighted that clinician‐to‐clinician programmes, such as e‐consultation, can enhance healthcare equity and quality, which is especially important for vulnerable patients, including women.…”

Section: Discussionmentioning

confidence: 68%

“…24 In addition, this programme has significantly improved the accessibility of the CD for patients who live far from the hospital, particularly those over 80 years old. 25 Our study has also highlighted that clinician-to-clinician programmes, such as e-consultation, can enhance healthcare equity and quality, which is especially important for vulnerable patients, including women. We have previously reported inequalities in the care of women and believe that our findings address this issue.…”

Section: Allmentioning

confidence: 79%

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Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Mazón‐Ramos

Aldana

Garcia‐Vega

et al. 2023

Eur J Clin Investigation

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AimsTo assess the longer‐term results (hospital admissions and mortality) in women versus men referred to a cardiology department from primary care using an e‐consultation in our outpatient care programme.MethodsWe selected 61,306 patients (30,312 women and 30,994 men) who visited the cardiology service at least once between 2010 and 2021: 69.1% (19,997 women and 20,462 men) were attended in e‐consultation (from 2013 to 2021) and 30.9% (8920 women and 9136 men) in in‐person consultations (from 2010 to 2012) without gender differences in the proportion of patients attended in each period. Using an interrupted time series regression model, we analysed the impact of incorporating e‐consultation into the healthcare model and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all‐cause hospital admissions and mortality during the one‐year after cardiology consultation.ResultsThe introduction of e‐consultation substantially decreased waiting times to cardiology care; during the in‐person consultation period, the mean delay for cardiology care was 57.9 (24.8) days in men and 55.8 (22.8) days in women. During the e‐consultation period, the waiting time to cardiology care was markedly reduced to 9.41 (4.02) days in men and 9.46 (4.18) in women. After e‐consultation implantation, there was a significant reduction in the 1‐year rate of hospital admissions and mortality, both in women and men iRR [IC 95%]: 0.95 [0.93–0.96] for HF, 0.90 [0.89–0.91] for CV and 0.70 [0.69–0.71] for all‐cause hospitalization; and 0.93 [0.92–0.95] for HF, 0.86 [0.86–0.87] for CV and 0.88 [0.87–0.89] for all‐cause mortality in women; and 0.91 [0.89–0.92] for HF, 0.90 [0.89–0.91] for CV and 0.72 [0.71–0.73] for all‐cause hospitalization; and 0.96 [0.93–0.97] for HF, 0.87 [95% CI: 0.86–0.87] for CV and 0.87 [0.86–0.87] for all‐cause mortality, in men.ConclusionCompared with the in‐person consultation period, an outpatient care programme that includes an e‐consultation significantly reduced waiting time to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year, without significative gender differences.

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Section: Discussionmentioning

confidence: 68%

Section: Allmentioning

confidence: 79%

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Mazón‐Ramos

Aldana

Garcia‐Vega

et al. 2023

Eur J Clin Investigation

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“…They can also significantly reduce the need for face-to-face consultations, with reductions ranging from 8.9% to 51%, depending on the clinical setting and specialty. 28 Our group has previously reported the benefits of implementing an e-consultation program as the first step for all PCP referrals to our CD. This initiative improved 1-year outcomes compared to a previous period of in-person consultation for all referrals.…”

Section: Discussionmentioning

confidence: 99%

Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients

Cinza‐Sanjurjo,

Mazón‐Ramos,

Rey‐Aldana

et al. 2024

Eur J Clin Investigation

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BackgroundThe prevalence of cancer patients with concomitant cardiovascular (CV) disease is on the rise due to improved cancer prognoses. The aim of this study is to evaluate the long‐term outcomes of cancer patients referred to a cardiology department (CD) via primary care using e‐consultation.MethodsWe analysed data from cancer patients with prior referrals to a CD between 2010 and 2021 (n = 6889) and compared two care models: traditional in‐person consultations and e‐consultations. In e‐consultation model, cardiologists reviewed electronic health records (e‐consultation) to determine whether the demand could be addressed remotely or necessitated an in‐person consultation. We used an interrupted time series regression model to assess outcomes during the two periods: (1) time to cardiology consultation, (2) rates of all‐cause and CV related hospital admissions and (3) rates of all‐cause and CV‐related mortality within the first year after the initial consultation or e‐consultation at the CD.ResultsIntroduction of e‐consultation for cancer patients referred to cardiology care led to a 51.8% reduction (95%CI: 51.7%–51.9%) in waiting times. Furthermore, we observed decreased 1‐year incidence rates, with incidence rate ratios (iRRs) [IC95%] of .75 [.73–.77] for CV‐related hospitalizations, .43 [.42–.44] for all‐cause hospitalizations, and .87 [.86–.88] for all‐cause mortality.ConclusionsCompared to traditional in‐person consultations, an outpatient care program incorporating e‐consultation for cancer patients significantly reduced waiting times for cardiology care and demonstrated safety, associated with lower rates of hospital admissions.

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“…The development of integrated health records can make clinician-to-clinician communication more fluent and contain all the necessary information to optimize the resolution of the HF patient clinical problem, 21 and also our publications about our experience. 23–25 …”

Section: Discussionmentioning

confidence: 99%

Impact of a clinician-to-clinician electronic consultation in heart failure patients with previous hospital admissions

Garcia-Vega,

Mazón-Ramos,

Portela-Romero

et al. 2023

European Heart Journal - Digital Health

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Aims To evaluate the impact of an outpatient care management programme that includes a clinician-to-clinician e-consultation on delay time in care, hospital admissions, and mortality in a high-risk group of patients with heart failure (HF) and previous episodes of HF hospitalization (HFH). Methods and results We selected 6444 HF patients who visited the cardiology service at least once between 2010 and 2021. Of these, 4851 were attended in e-consult, and 2230 had previous HFH. Using an interrupted time series regression model, we analysed the impact of incorporating e-consult into the healthcare model in the group of patients with HFH and evaluated the elapsed time to cardiology care, HF, cardiovascular (CV), and all-cause hospital admissions and mortality, calculating the incidence relative risk (iRR). In the group of patients with HFH, the introduction of e-consult substantially decreased waiting times to cardiology care (8.6 [8.7] vs. 55.4 [79.9] days, P < 0.001). In that group of patients, after e-consult implantation, hospital admissions for HF were reduced (iRR [95%CI]: 0.837 [0.840–0.833]), 0.900 [0.862–0.949] for CV and 0.699 [0.678–0.726] for all-cause hospitalizations. There was also lower mortality (iRR [95%CI]: 0.715 [0.657–0.798] due to HF, 0.737 [0.764–0.706] for CV and 0.687 [0.652–0.718] for all-cause). The improved outcomes after e-consultation implementation were significantly higher in the group of patients with previous HFH. Conclusion In patients with HFH, an outpatient care programme that includes an e-consult significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year.

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A clinician-to-clinician universal electronic consultation programme at the cardiology department of a Galician healthcare area improves healthcare accessibility and outcomes in elderly patients

Cited by 7 publications

References 21 publications

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients

Impact of a clinician-to-clinician electronic consultation in heart failure patients with previous hospital admissions

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