Using asynchronous telemedicine in rural primary

care settings in the Catalonian Central Region

Dr Josep Vidal-Alaball. Primary Care Physician. MPH

Two types of telemedicine can be distinguished: real-time and not real-time teledermatology.

Asynchronous, not real-time or store-and-forward telemedicine is type of telemedicine where clinical data is collected, stored, and then forwarded to be interpreted later on. There is no need for the patient and the clinician to be available at the same time or place

Provides better access to users - RURALVan Der Heijden, J.P. et al., 2011. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. British Journal of Dermatology, 165(Table 1), pp.1058–1065

Is both effective and efficient Hersh, W.R. et al., 2002. A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. Journal of Telemedicine and Telecare, 8(4), pp.197–209

Ekeland, A.G., Bowes, A. & Flottorp, S., 2010. Effectiveness of telemedicine: a systematic review of reviews. International journal of medical informatics, 79(11), pp.736–71

Enjoy a high acceptance among users Devine, J., 2009. User satisfaction and experience with a\ntelemedicine service for diabetic foot\ndisease in an Australian rural community. Available at: http://www.ircst.health.nsw.gov.au/__data/assets/pdf_file/0009/98397/Jenni_Devine_report.pdf.

Telemedicine …

In the Catalonian Central Region, dermatology waiting lists had increased significantly during the years 2010-2011

To try to reverse this trend in early 2011 we began a teledermatology project

Since the start of the project, the median (confidence interval 95%) of the days on the waiting list has reduced from 30 (29; 32) to 16 (15; 17) days **Vidal-Alaball, J. et al., 2014. Evaluacion del impacto de la teledermatologia en la disminucion de la lista de espera en la comarca del Bages (2009-2012). Aten Primaria, pp.9–10.

Reduces waiting lists

Teledermatology. Pathway:

HC

1. We take a picture of the lesion (Digital Camera - iPad)

2. We include the picture in the e-clinical history

3. We write the clinical history for the Dermatologist in the e-notes

4. The dermatologist has access to the e-history

5. The dermatologist looks at the pictures, writes a diagnosis and suggest treatment or ask for a referral

TeleulcersInspired by the good results of teledermatology, in November 2012 Teleulcers was introduced

Teleulcers is a project aiming to improve the care of patient with chronic wounds. Expert vascular advice is available for primary care nurses.

Three main features define this service: • its transversality (primary care – hospital)• a virtual teleconsultation system• nursing leadership in the care of patients with

chronic wounds

Teleulcers has not sought to attend a high number of patients but has strived for quality of care

Teleophthalmology Used for screening diabetic retinopathy

1. Photographs of the retina are taken by a nurse and included in the e-clinical history

2. The ophthalmologist access the e-notes

3. The ophthalmologist looks at the photographs, writes a diagnosis and suggest follow up

Teleaudiometry 1. The primary care doctor takes the history (job) and

performs a ear examination (otoscopy)

2. An audiometry is performed by a nurse, scanned and included in the e-clinical history

3. The ENT doctor access the e-notes

4. The ENT doctor looks at the audiometry, writes a diagnosis and suggest follow up

5. The primary care doctor calls the patient and explains the diagnosis

Josep Vidal-Alaball josep.vidal@

gmail.com

Twitter: @jvalaball http://www.slideshare.net/jvalaball