Gender differences on healthcare accessibility and outcomes of a electronic inter-clinician consultation program at the cardiology department in a Galician Health Area

Aims To assess the longer-term results (hospital admissions and mortality) in women versus men referred to a cardiology department from primary care using an e-consultation in our outpatient care programme. Methods We selected 61,306 patients (30,312 women and 30,994 men) who visited the cardiology service at least once between 2010 and 2021: 69.1% (19,997 women and 20,462 men) were attended in e-consultation (from 2013 to 2021) and 30.9% (8920 women and 9136 men) in in-person consultations (from 2010 to 2012) without gender differences in the proportion of patients attended in each period. Using an interrupted time series regression model, we analysed the impact of incorporating e-consultation into the healthcare model and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all-cause hospital admissions and mortality during the one-year after cardiology consultation. Results The introduction of e-consultation substantially decreased waiting times to cardiology care; during the in-person consultation period, the mean delay for cardiology care was 57.9 (24.8) days in men and 55.8 (22.8) days in women. During the e-consultation period, the waiting time to cardiology care was markedly reduced to 9.41 (4.02) days in men and 9.46 (4.18) in women. After e-consultation implantation, there was a significant reduction in the 1-year rate of hospital admissions and mortality, both in women and men iRR [IC 95%]: 0.95 [0.93–0.96] for HF, 0.90 [0.89–0.91] for CV and 0.70 [0.69–0.71] for all-cause hospitalization; and 0.93 [0.92–0.95] for HF, 0.86 [0.86–0.87] for CV and 0.88 [0.87–0.89] for all-cause mortality in women; and 0.91 [0.89–0.92] for HF, 0.90 [0.89–0.91] for CV and 0.72 [0.71–0.73] for all-cause hospitalization; and 0.96 [0.93–0.97] for HF, 0.87 [95% CI: 0.86–0.87] for CV and 0.87 [0.86–0.87] for all-cause mortality, in men. Conclusion Compared with the in-person consultation period, an outpatient care programme that includes an e-consultation significantly reduced waiting time to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year, without significative gender differencesS

Un mundo escrito: Construcción de un espacio virtual-institucional para archivos de escritores de Misiones. 16H346

Este proyecto es continuación de proyectos de crítica genética que se llevaron a cabo, o están en marcha en la Secretaría de Investigación de la Facultad de Humanidades de la UNaM, que tienen como objeto manuscritos de la literatura provincial. La labor de este proyecto implica una red de acuerdos teóricos, críticos y metodológicos iniciales, un rastreo e identificación de documentos en la región y la tramitación de préstamos ante poseedores actuales de los manuscritos a la que se suma lo interdisciplinario con el diálogo entre la crítica genética y la ciencia de la computación. A la luz de este diálogo el proyecto se propone en esta primera etapa promover tres acciones: a) desarrollar un sitio virtual-institucional que facilite el acceso en línea a archivos de escritores regionales que se vienen estudiando en la UNaM. b) hacer un relevamiento de los archivos de manuscritos que en la actualidad se encuentran diseminados, invisibles a las investigaciones para, en ese gesto, recuperarlos e incentivar su estudio. c) diseñar y construir una base de datos y un repositorio digital de manuscritos, utilizando para esta tarea software Open Source. d) sentar las bases para un estudio sobre la factibilidad de implementar un proceso de Text Mining que automatice la recuperación de información relevante, categorice los documentos y los agrupe de acuerdo a características comunes. e) Afianzar lazos institucionales con otros proyectos existentes en Argentina (UNLP), Francia (CRLA-Archivos), Bélgica (UCLovaina), España ( Universidad de Castilla La Mancha) y con UNNE y la UNLa con quien ya tenemos un convenio de colaboración en Minería de datos

The impact of inter-clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care

Background An early diagnosis and early initiation of oral anticoagulants (OAC) are main determinants for outcomes in patients with atrial fibrillation (AF). Inter-clinician electronic consultations (e-consultations) program for the general practitioner referrals to cardiologist may improve health care access by reducing the elapsed time for cardiology care. Objective To evaluate the effect of a reduced elapsed time to care after a inter-clinician e-consultations program implementation (2013–2019) in comparison with previous in-person consultation (2010–2012) in the outpatient health care management in a Cardiology Department. Methodology We included 10,488 patients with AF 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 program (2013–2019) for all primary care referrals to cardiologists that preceded patient's in-person consultation when considered. The shared electronic patient dossier (EPD) was available between GP and cardiologist, and any change in therapy advice from cardiologist was directly implemented in this EPD. Results During the e-consultation period (2013–2019) were referred 6627 patients by GPs to cardiology versus 3861 during the in-person consultation (2010–2012). The e-consultation implementation was associated with a reduction in the elapsed time to anticoagulation prescription (177.6 ± 8.9 vs. 22.5 ± 8.1 days, p < .001), and an increase of OAC use (61% [95% IC: 19.6%–102.4%], p < .001). The e-consult program implementation was associated with a reduction in the 1-year CV mortality (.48 [95% CI: .30–.75]) and all-cause mortality (.42 [95% CI: .29–.62]). The OAC reduces the stroke mortality (.15 [95% CI: .06–.39]) and CV mortality (.43 [95% CI: .29–.62]) and all-cause mortality (.23 [95% CI: .17–.31]). Conclusion A shared EPD-based inter-clinician e-consultation program significantly reduced the elapsed time for cardiology consultation and initiation of OAC. The implementation of this program was associated with a lower risk of stroke and cardiovascular/all-cause mortalityS

Factors influencing erythrocyte sedimentation rate in adults New evidence for an old test

The erythrocyte sedimentation rate (ESR) is a routine test for inflammation. Few studies have investigated the potential influence of lifestyle factors and common metabolic abnormalities on the ESR. This study investigates the influence of demographic factors, alcohol consumption, smoking, physical activity, obesity, and metabolic syndrome on the ESR in adults.This cross-sectional study covered 1472 individuals (44.5% males; age range, 18-91 years) randomly selected from the population of a Spanish municipality. The ESR was measured using a standardized method. We assessed habitual alcohol consumption in standard drinking units, along with tobacco smoking, regular physical exercise (by questionnaire), body mass index, and variables defining metabolic syndrome. Multivariate analyses were performed, including mean corpuscular volume and hemoglobin concentration in the models.The ESR was higher in females than in males, and increased steadily with age. Median ESR of females was 2-fold higher than that of males, and median ESR of individuals aged >65 years was 2-fold higher than that of individuals in the youngest category (ages 18-35 years). Body mass index, presence of metabolic syndrome, and smoking were independently and positively associated with higher ESR values. Light alcohol drinkers and individuals with high regular physical activity displayed lower ESR values than did alcohol abstainers and individuals with low physical activity, respectively.ESR varies greatly with age and sex, and corresponding reference values are proposed. Lifestyle factors (physical activity, smoking, and alcohol consumption) and common metabolic abnormalities (obesity and related metabolic syndrome) may also influence ESR values

Un mundo escrito: Construcción de un espacio virtual-institucional para archivos de escritores de Misiones. 16H346

Este proyecto es continuación de proyectos de crítica genética que se llevaron a cabo, o están en marcha en la Secretaría de Investigación de la Facultad de Humanidades de la UNaM, que tienen como objeto manuscritos de la literatura provincial. La labor de este proyecto implica una red de acuerdos teóricos, críticos y metodológicos iniciales, un rastreo e identificación de documentos en la región y la tramitación de préstamos ante poseedores actuales de los manuscritos a la que se suma lo interdisciplinario con el diálogo entre la crítica genética y la ciencia de la computación. El proyecto se propone en esta primera etapa promover tres acciones: a) desarrollar un sitio virtual -institucional que facilite el acceso en línea a archivos de escritores regionales que se vienen estudiando en la UNaM. b) hacer un relevamiento de los archivos de manuscritos que en la actualidad se encuentran diseminados, invisibles a las investigaciones para, en ese gesto, recuperarlos e incentivar su estudio. c) diseñar y construir una base de datos y un repositorio digital de manuscritos, utilizando para esta tarea software Open Source. d) sentar las bases para un estudio sobre la factibilidad de implementar un proceso de Text Mining que automatice la recuperación de información relevante, categorice los documentos y los agrupe de acuerdo a características comunes. e) Afianzar lazos institucionales con otros proyectos existentes en Argentina (UNLP) y con UNNE y la UNLa con quien ya tenemos un convenio de colaboración en Minería de datos, con Francia (CRLA-Archivos), Bélgica (UCLovaina), España (Universidad de Castilla La Mancha)

Galician multidisciplinary consensus about the use of lipid-lowering drugs

Se desarrolla un consenso multidisciplinar sobre el uso de hipolipemiantes, pues las cifras de consumo de hipolipemiantes han aumentado considerablemente en los ultimos años, Las últimas guías publicadas han levantado bastante polémica y se considera necesario la realización de este consenso e identificar los niveles de riesgo de los pacientes, para tratar las dislipemias y normalizar el uso de hipolipemientes. Se realiza una mención especial al tratamiento de la dislipemia en la enfermedad renal crónica

Cost and potential savings of electronic consultation and its relationship with reduction in atmospheric pollution

Background: Telemedicine has been incorporated into daily clinical practice. The purpose of this paper is to evaluate the economic impact of electronic consultation as a means of referring patients between Primary Care (PC) services and the referral Cardiology Service (CS) of a tertiary hospital, in particular, the cost of reduced air pollution. Methods: The direct and indirect costs associated with all the interconsultations between PC and a CS of a tertiary hospital were analyzed under a universal single act model versus a prior e-consultation model that selected patients who would later attend the single-act consultation. The cost of pollution from private motor vehicle travel by road has been analyzed with a Cobb–Douglas cost function. Results: The total cost per patient, including the costs associated with death, represented a saving in the model with e-consultation of 25.6%. The economic value for the reduction of contamination would be EUR 12.86 per patient. Conclusions: The introduction of e-consultation in the outpatient management of patients referred from PC to a CS, helps to reduce direct and indirect costs for the patient and the Health Care System. The cost of pollution associated with the trips explains the total cost to a greater extent, except for the first face-to-face consultation

Longer-term results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area

Background: Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are not described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility and hospital admissions) of an electronic consultation (e-consultation) outpatient care management program. Methods: Epidemiological and clinical data were obtained from the 41,258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person-consultation (2010-2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients’ in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation program on i) delay time (days) in care and ii) hospital admissions. We also analyzed iii) total number and referral rate (population adjusted referred rate) in both periods (in-person consultation and e-consultation); and iv) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital center. Results: During the e-consultation period, the demand for cardiology care increased (7.2 ±2.4% vs. 10.1 ±4.8% per 1,000 inhabitants, p<0.001) and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (-0.96, 95%CI [-0.951, -0.966], p<0.001) was maintained with e-consultations (-0.064, 95%CI [0.043, 0.085], p<0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (IRR: 1,011;95% CI [1,003-1,018]), was stabilized (IRR:1,000; 95% CI [0.985, 1.015]; p=0.874). Conclusions: Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend