Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study

Solans, Oscar; Seguí, Francesc López; Vidal-Alaball, Josep; Simó, Josep M.; Vian, Oscar Hernandez; Cabo, Pascual Roig; Hernández, Marta Carrasco; Domínguez, Carmen Olmos; Reig, Xavier Alzaga; Díaz, Yesika; Medina, Manuel; Hermosilla, Eduardo; Leon, Nelson; Guimferrer, Nuria; González, Mercedes Abizanda; Cuyàs, Francesc García; Sust, Pol Pérez

doi:10.2196/16484

Cited by 13 publications

(19 citation statements)

References 17 publications

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“…However, the 108 participants can be seen as a representative sample of the professionals who use telemedicine in this area, since it is not expected that many more professionals use it, although the exact number has not been recorded. Considering that nurses make up almost half of the sample, the socio-demographic profile of the participants is quite similar to that shown by analyses of primary care professionals in Catalonia [32].…”

Section: Limitationssupporting

confidence: 60%

Primary Care Professionals’ Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey

Vidal-Alaball

Seguí

Garcia-Domingo

et al. 2020

IJERPH

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While telemedicine services enjoy a high acceptance among the public, evidence regarding clinician’s acceptance, a key factor for sustainable telemedicine services, is mixed. However, telemedicine is generally better accepted by both patients and professionals who live in rural areas, as it can save them significant time. The objective of this study is to assess the acceptance of medical record-based, store and forward provider-to-provider telemedicine among primary care professionals and to describe the factors which may determine their future use. This is an observational cross-sectional study using the Catalan version of the Health Optimum questionnaire; a technology acceptance model-based validated survey comprised of eight short questions. The online, voluntary response poll was sent to all 661 primary care professionals in 17 primary care teams that had potentially used the telemedicine services of the main primary care provider in Catalonia, in the Central Catalan Region. The majority of respondents rated the quality of telemedicine consultations as “Excellent” or “Good” (83%). However, nearly 60% stated that they sometimes had technical, organizational or other difficulties, which might affect the quality of care delivered. These negatively predicted their declared future use (p = 0.001). The quality of telemedicine services is perceived as good overall for all the parameters studied, especially among nurses. It is important that policymakers examine and provide solutions for the technical and organizational difficulties detected (e.g., by providing training), in order to ensure the use of these services in the future.

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Section: Limitationssupporting

confidence: 60%

Primary Care Professionals’ Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey

Vidal-Alaball

Seguí

Garcia-Domingo

et al. 2020

IJERPH

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“…In addition, 84.88% (187,569/220,981) of the conversations had a general practitioner as the clinical interlocutor, with the others being nurses (14.31%, 31,622/220,981) or other professionals such as pediatricians and gynecologists. The characteristics of professionals that use eConsulta were previously reported, demonstrating an age range of the general practitioners of 45-54 years, who scored higher than the 80th percentile on the quality of care index, had a high degree of accessibility, involved in teaching, and work on a health team in a high socioeconomic urban setting [ 3 ]. Messages and their respective subject lines had an average length of 231 and 18 characters, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, eConsulta is an asynchronous teleconsultation service that has been integrated into the program of computerized medical records of primary care of the public health system [ 3 ]. The service was introduced in 2015 and was gradually phased in until 2017, when it became established as a service available to all primary care teams as a complement to face-to-face care.…”

Section: Introductionmentioning

confidence: 99%

Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study

Seguí¹,

Walsh²,

Solans³

et al. 2020

J Med Internet Res

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Background Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation service between primary care professionals and citizens in the public health care system, has already reached 1 million cases. Before the COVID-19 pandemic, the use of eConsulta was growing at a monthly rate of 7%, and the growth has been exponential from March 15, 2020 to the present day. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. Objective The aim of this study was to annotate a random sample of teleconsultations from eConsulta, and to evaluate the level of agreement between health care professionals with respect to the annotation. Methods Twenty general practitioners retrospectively annotated a random sample of 5382 cases managed by eConsulta according to three aspects: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. A total of 1217 cases were classified three times by three different professionals to assess the degree of consensus among them. Results The general practitioners considered that 79.60% (4284/5382) of the teleconsultations resulted in avoiding a face-to-face visit, and considered that 64.96% (3496/5382) of the time, the patient would have made a face-to-face visit in the absence of a service like eConsulta. The most frequent uses were for management of test results (26.77%, 1433/5354), management of repeat prescriptions (24.30%, 1301/5354), and medical enquiries (14.23%, 762/5354). The degree of agreement among professionals as to the annotations was mixed, with the highest consensus demonstrated for the question “Has the online consultation avoided a face-to-face visit?” (3/3 professionals agreed 67.95% of the time, 827/1217), and the lowest consensus for the type of use of the teleconsultation (3/3 professionals agreed 57.60% of the time, 701/1217). Conclusions This study shows the ability of eConsulta to reduce the number of face-to-face visits for 55% (79% × 65%) to 79% of cases. In comparison to previous research, these results are slightly more pessimistic, although the rates are still high and in line with administrative data proxies, showing that 84% of patients using teleconsultations do not make an in-person appointment in the following 3 months. With respect to the type of consultation performed, our results are similar to the existing literature, thus providing robust support for eConsulta’s usage. The mixed degree of consensus among professionals implies that results derived from artificial intelligence tools such as message classification algorithms should be interpreted in light of these shortcomings.

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“…Despite the fact that some studies question the efficiency of teleconsultations between primary care professionals and citizens [ 7 ], several studies suggest that the eConsulta tool helps to reduce the number of face-to-face visits [ 4 , 6 ], which may be one of the drivers of its growing use among users. With regard to the health care professionals that use eConsulta, a previous analysis found that doctors who use eConsulta are typically in the 45-64 years age group, score higher than the 80th percentile on the Quality of Care Index, have a high degree of accessibility, are involved in teaching, and work as part of a health team in a high socioeconomic urban setting [ 15 ]. With regard to eConsulta users, it is vital to analyze their characteristics in order to provide a service that is appropriate and adjusted to their needs and to also understand who is being covered by this service (and who is not) during the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study

Solans¹,

Vidal-Alaball²,

Cabo³

et al. 2021

J Med Internet Res

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Background eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.

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Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study

Cited by 13 publications

References 17 publications

Primary Care Professionals’ Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey

Primary Care Professionals’ Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey

Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study

Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study

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