Impact of a universal electronic consultation program at the cardiology service of a galician health area on hospital admissions and on the accessibility and equity of healthcare services

Abstract

Background: The implementation of integrated electronic medical record projects between healthcare levels allows all healthcare professionals access to all the clinical information of patients, which is a key factor in optimizing the management of healthcare resources, facilitating the communication between professionals and avoiding medical acts that do not add value, always from the premise of safety and quality for patients [1]. The benefits that telemedicine models can bring in reducing waiting times and the role they can play in organizing the growing demand for care have been described [2,3]. A matter of concern is the lack of accessibility for patients who live further away from their reference hospital centers, not only from a management point of view but also from a clinical point of view, since they are patients who are usually admitted with more complications and therefore could have a worse prognosis. Purpose: To assess the impact on accessibility to healthcare provision and hospital admissions of an outpatient care management program that includes an e-consultation through an integrated medical record. Patients and methods: It was registered the epidemiological and clinical data available from the 41,258 patients referred from January 1, 2010 to December 31, 2019, from Primary Care to the Cardiology Service of a health area, in which all doctors share the same electronic medical record. The municipality where the patients live and the admissions for cardiovascular causes in any hospital service during the first year after consultation in the Cardiology Service was recorded. Results: After the e-consultation was implemented, the demand for care increased in all municipalities (7.2±2.4 vs 10.1±4.8 rates per 1,000 habitants-year, p<0.001). In general, higher delay times were recorded in the regional hospital area, the furthest patients; the spatial effects also were similar in both periods; however, these differences were lower in the e-consultation period than in the in-person consultation period, Figure 1. Also, during the single act consultation period, we observed a progressive reduction in the delay to cardiology consultation which was markedly reduced after the implementation of the e-consultation. The interrupted time series analysis showed that the number of hospital admissions during the period of the Single Act Consultation has increased at approximately 1.1% per month (RR: 1,011 [IC95%: 1.003-1.018]), and after the implementation of the E-Consultation, this upward trend is stabilized in mean with a constant trend (RR: 1.011∗0.989 ∼ 1), Figure 2. Conclusions: The implementation of an e-consultation in the outpatient management model increases the demand for care and improves accessibility to health care for patients furthest from the referral hospital. After the implementation of the e-consultation, the upward trend of hospital admissions observed during the single act period, was stabilized with a slight downward trend. (Figure Presented).