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. 2023 Jan 20;4(2):90-98.
doi: 10.1093/ehjdh/ztad004. eCollection 2023 Mar.

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

Pilar Mazón-Ramos  1   2   3 , Sergio Cinza-Sanjurjo  2   3   4 , David Garcia-Vega  1   2   3 , Manuel Portela-Romero  2   3   5 , Juan C Sanmartin-Pena  1   2   3 , Daniel Rey-Aldana  2   3   6 , Amparo Martinez-Monzonis  1   2   3 , Jenifer Espasandín-Domínguez  2   7 , Francisco Gude-Sampedro  2   7 , José R González-Juanatey  1   2   3
Affiliations

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

Pilar Mazón-Ramos et al. Eur Heart J Digit Health. .

Abstract

Aims: We aimed to assess longer-term results (accessibility, hospital admissions, and mortality) in elderly patients referred to a cardiology department (CD) from primary care using e-consultation in outpatient care.

Methods and results: We included 9963 patients >80 years from 1 January 2010 to 31 December 2019. Until 2012, all patients attended an in-person consultation (2010-2012). In 2013, we instituted an e-consult programme (2013-2019) for all primary care referrals to cardiologists that preceded a patient's in-person consultation when considered. We used an interrupted time series (ITS) regression approach to investigate the impact of e-consultation on (i) cardiovascular hospital admissions and mortality. We also analysed (ii) the total number and referral rate (population-adjusted referred rate) in both periods, and (iii) the accessibility was measured as the number of consultations and variation according to the distance from the municipality and reference hospital. During e-consultation, the demand for care increased (12.8 ± 4.3% vs. 25.5 ± 11.1% per 1000 inhabitants, P < 0.001) and referrals from different areas were equalized. After the implementation of e-consultation, we observed that the increase in hospital admissions and mortality were stabilized [incidence rate ratio (iRR): 1.351 (95% CI, 0.787, 2.317), P = 0.874] and [iRR: 1.925 (95% CI: 0.889, 4.168), P = 0.096], respectively. The geographic variabilities in hospital admissions and mortality seen during the in-person consultation were stabilized after e-consultation implementation.

Conclusions: Implementation of a clinician-to-clinician e-consultation programme in outpatient care was associated with improved accessibility to cardiology healthcare in elderly patients. After e-consultations were implemented, hospital admissions and mortality were stabilized.

Keywords: Elderly; Electronic consultation; Healthcare; Outcomes health.

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Conflict of interest statement

Conflict of interest: The authors declare no conflicts of interest in relation to this article.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Analysis of the interrupted temporal trend of cardiovascular hospital admissions in the first year after consultation and summary of estimated linear effects of the ITS model for hospital admissions (left). Analysis of the interrupted temporal trend of cardiovascular mortality in the first year after consultation and summary of estimated linear effects of the ITS model for mortality (right).
Figure 2
Figure 2
Estimated spatial effects of the cardiovascular hospital admission rate (panels A and B) and pointwise 95% significance map (panels c and d) for the in-person consultation and e-consultation periods. In the right panels (B) and (D), it is showed the districts with strictly negative and positive credible intervals in contrast with the districts without changes in both periods.
Figure 3
Figure 3
Estimated spatial effects of the cardiovascular mortality rate (panels A and B) and pointwise 95% significance map (panels c and d) for the in-person consultation and e-consultation periods. In the right panels (B) and (D), it is showed the districts with strictly negative and positive credible intervals in contrast with the districts without changes in both periods.
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