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Suárez-Dono FJ, Martínez-Rey C, Novo-Platas J, Fernández Peña C, Rodríguez Méndez ML, Pérez Iglesias A, Casariego-Vales E. E-consults between primary care and internal medicine: implementation, accessibility, benefits, and implications. Rev Clin Esp 2024; 224:421-427. [PMID: 38871291 DOI: 10.1016/j.rceng.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024]
Abstract
AIM This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine. METHODS This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed. RESULTS A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15-102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5645 patients (49.4%) were given an in-person appointment. For the remaining 5789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (p < 0.0001), visited the emergency department more times (one month: p = 0.04; three months: p = 0.001), were admitted to the hospital more times (one month: p = 0.0001; three months: p = 0.0001), and had higher mortality at one year (12.7% vs. 9.8% p = 0.0001). In the Cox analysis, only in-person appointments (RR = 1.11; p = 0.04)) and age (RR = 1.09; p < 0.01) were independent factors of mortality. No complaints or claims of any kind were registered. CONCLUSIONS These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.
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Affiliation(s)
- F J Suárez-Dono
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain
| | - C Martínez-Rey
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain
| | - J Novo-Platas
- Control de Gestión, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain
| | - C Fernández Peña
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain
| | - M L Rodríguez Méndez
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain
| | - A Pérez Iglesias
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain
| | - E Casariego-Vales
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Av Choupana s/n, Santiago de Compostela, 15706, Spain.
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Graña Gil J, Moreno Martínez MJ, Carrasco Cubero MDC. Delphi consensus on the use of telemedicine in rheumatology: RESULTAR study. REUMATOLOGIA CLINICA 2024; 20:254-262. [PMID: 38821741 DOI: 10.1016/j.reumae.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/12/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND AND OBJECTIVES There is growing interest in the potential of telemedicine (TM) as an alternative to physical consultation. Although numerous studies prove the benefits of TM in rheumatology, there are no recommendations on its implementation in Spain. The aim of this study was to analyze the application of TM in rheumatology consultations in Spain. MATERIALS AND METHODS Qualitative, cross-sectional, multicenter study with Delphi methodology in two rounds of queries. A structured ad hoc questionnaire was designed that included statements on teleconsultation, nursing teleconsultation, telecare, telerehabilitation, teleradiology, telehealth tele-education, main barriers, advantages and disadvantages of telehealth tele-education and TM in rheumatoid arthritis. The participants were rheumatology specialists practicing in Spain. RESULTS The participating rheumatologists (N = 80) had a mean age of 42.4 (±9.0) years, with 12.6 (±8.4) years of experience. Some of the aspects of TM that obtained the greatest consensus were: TM is useful for follow-up of some patients, to help determine if a face-to-face consultation is necessary, or to assist patients with rheumatoid arthritis if they present low activity or in remission; certain patients, such as those in their first consultation or those who present digital barriers or cognitive deterioration, should be seen face-to-face; TM presents some technical and patient access barriers; TM can be useful in nursing and in continued medical education. CONCLUSIONS TM can be beneficial for the treatment and follow-up of patients with rheumatic diseases, as well as for alleviating the face-to-face care burden in rheumatology.
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Affiliation(s)
- Jenaro Graña Gil
- Servicio de Reumatología, Hospital Universitario de A Coruña, A Coruña, Spain
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de la Torre Rubio N, Pavía Pascual M, Campos Esteban J, Godoy Tundidor H, Fernández Castro M, Andréu Sánchez JL. Usefulness of an electronic consultation system between primary care health centres and the rheumatology department of a tertiary hospital. REUMATOLOGIA CLINICA 2023; 19:512-514. [PMID: 37164881 DOI: 10.1016/j.reumae.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/13/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Rheumatic diseases account for almost 30% of consultations attended in Spanish primary care centres. The main objective was to analyse the demand for rheumatology consultations from Primary Care and their resolution using the electronic consultation system. PATIENTS AND METHODS Retrospective descriptive study of electronic consultations from primary care centres in the health area to the Rheumatology service of a tertiary hospital, between July 2020 and May 2021. RESULTS The last 500 consecutive consultations were collected. Mean age of patients was 59.5 years; 74.2% were women. Main reasons for consultation were osteoporosis and treatment of patients with rheumatoid arthritis and spondyloarthritis under follow-up by the department. Mean response time was 2 days. Fifty-seven per cent of patients required outpatient appointments. DISCUSSION Over 40% of queries were resolved thanks to the electronic consultation system in an average of 2 days, otherwise patients would have been referred to specialized care.
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Affiliation(s)
- Natalia de la Torre Rubio
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
| | - Marina Pavía Pascual
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - José Campos Esteban
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Hilegarda Godoy Tundidor
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Mónica Fernández Castro
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - José Luis Andréu Sánchez
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
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Navarro-Compán V, Ermann J, Poddubnyy D. A glance into the future of diagnosis and treatment of spondyloarthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111611. [PMID: 35898564 PMCID: PMC9310200 DOI: 10.1177/1759720x221111611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
The last two decades have seen major developments in the field of
spondyloarthritis (SpA), but there are still important unmet needs to address.
In the future, we envisage important advances in the diagnosis and treatment of
SpA. In the diagnosis of SpA, the use of online and social media tools will
increase awareness of the disease and facilitate the referral of patients to
rheumatology clinics. In addition, more specific diagnostic tests will be
available, especially advanced imaging methods and new biomarkers. This will
allow most patients to be diagnosed at an early stage of the disease. In the
treatment of SpA, an increasing number of novel treatment targets can be
expected, most of which will be directed against intracellular enzymes. We hope
to see more strategy trials shaping treatment pathways in SpA and accommodating
principals of precision medicine. Approved treatment options will be available
for both axial and peripheral SpA. We also hope to intervene not only at the
inflammation level but also at the level of underlying immunological processes
that might be associated with a higher probability of long-standing remission if
not a cure. Finally, artificial intelligence techniques will allow for the
analysis of large-scale data to answer relevant research questions for the
diagnosis and management of patients with SpA.
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Affiliation(s)
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin 12203, Germany
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Knitza J, Janousek L, Kluge F, von der Decken CB, Kleinert S, Vorbrüggen W, Kleyer A, Simon D, Hueber AJ, Muehlensiepen F, Vuillerme N, Schett G, Eskofier BM, Welcker M, Bartz-Bazzanella P. Machine learning-based improvement of an online rheumatology referral and triage system. Front Med (Lausanne) 2022; 9:954056. [PMID: 35935756 PMCID: PMC9354580 DOI: 10.3389/fmed.2022.954056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Rheport is an online rheumatology referral system allowing automatic appointment triaging of new rheumatology patient referrals according to the respective probability of an inflammatory rheumatic disease (IRD). Previous research reported that Rheport was well accepted among IRD patients. Its accuracy was, however, limited, currently being based on an expert-based weighted sum score. This study aimed to evaluate whether machine learning (ML) models could improve this limited accuracy. Materials and methods Data from a national rheumatology registry (RHADAR) was used to train and test nine different ML models to correctly classify IRD patients. Diagnostic performance was compared of ML models and the current algorithm was compared using the area under the receiver operating curve (AUROC). Feature importance was investigated using shapley additive explanation (SHAP). Results A complete data set of 2265 patients was used to train and test ML models. 30.5% of patients were diagnosed with an IRD, 69.3% were female. The diagnostic accuracy of the current Rheport algorithm (AUROC of 0.534) could be improved with all ML models, (AUROC ranging between 0.630 and 0.737). Targeting a sensitivity of 90%, the logistic regression model could double current specificity (17% vs. 33%). Finger joint pain, inflammatory marker levels, psoriasis, symptom duration and female sex were the five most important features of the best performing logistic regression model for IRD classification. Conclusion In summary, ML could improve the accuracy of a currently used rheumatology online referral system. Including further laboratory parameters and enabling individual feature importance adaption could increase accuracy and lead to broader usage.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Université Grenoble Alpes, AGEIS, Grenoble, France
- *Correspondence: Johannes Knitza,
| | - Lena Janousek
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Cay Benedikt von der Decken
- Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany
- Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
- RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Stefan Kleinert
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
- Medizinische Klinik 3, Rheumatology/Immunology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Wolfgang Vorbrüggen
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Verein zur Förderung der Rheumatologie e.V., Würselen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J. Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Felix Muehlensiepen
- Université Grenoble Alpes, AGEIS, Grenoble, France
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France
- Institut Universitaire de France, Paris, France
- LabCom Telecom4Health, Orange Labs and Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Bjoern M. Eskofier
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martin Welcker
- RheumaDatenRhePort (rhadar), Planegg, Germany
- MVZ für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Peter Bartz-Bazzanella
- Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
- RheumaDatenRhePort (rhadar), Planegg, Germany
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