Campanella Nando, Morosini Pierpaolo, Sampaolo Guido, Catozzo Vania, Caso Andrea, Ferretti Maurizio, Giovagnoli Moreno, Torniai Mariangela, Antico Ettore
Telemedicine Unit of the University of the State of Amazonas, Brazil.
Internal Medicine Department of Ascoli Piceno, Marche Region Health District, Italy.
Eur J Intern Med. 2015 Nov;26(9):675-9. doi: 10.1016/j.ejim.2015.08.010. Epub 2015 Aug 30.
e-Health strategies are supposed to improve the performance of national health systems. Medical teleconsultation (MT) is an important component of such e-Health strategies.
The outcome of MT was evaluated with regard to the impact on the medical error vulnerability (MEV) of internal medicine patients.
A team of internal medicine doctors plus a network of forty specialists was set-up in one health district belonging to a unified and universal national health system of a country of Western Europe, in order to provide free-of-charge MT to support general practitioners in solving internal medicine cases. In this observational study, the case series of 2013 is reviewed.
a) Only 21% of the MT fell short to the general practitioner's expectations about the case solving focus; b) throughout the medical care process of the patient, 49% of the cases met with one or more of the five MEVs, namely: 1) clinical test mishandling; 2) inaccurate differential diagnosis; 3) inadequate information flow between health providers at different levels of care (transition care); 4) poor coordination between health providers; and 5) poor reconciliation of medications or hazardous therapies. c) MT canceled or prevented MEVs in 56% and mitigate MEVs in 15% of the cases; d) MT canceled or prevented 85% of MEV caused by poor information exchange in transition care, therefore improving patient referral and counter-referral.
MT reduces MEV and therefore, whenever implemented to a large extent, may improve the quality of health care delivery and the performance of national health systems.
电子健康战略旨在提高国家卫生系统的绩效。医学远程会诊（MT）是此类电子健康战略的重要组成部分。
评估医学远程会诊对内科患者医疗差错易发性（MEV）的影响。
在西欧一个国家统一且通用的国家卫生系统所属的一个健康区，组建了一个内科医生团队以及一个由40名专家组成的网络，以便提供免费的医学远程会诊，以支持全科医生解决内科病例。在这项观察性研究中，回顾了2013年的病例系列。
a）只有21%的医学远程会诊未达到全科医生对病例解决重点的期望；b）在患者的整个医疗过程中，49%的病例出现了五种医疗差错易发性情况中的一种或多种，即：1）临床试验处理不当；2）鉴别诊断不准确；3）不同护理级别医疗服务提供者之间的信息流不足（过渡护理）；4）医疗服务提供者之间协调不佳；5）药物或危险疗法的核对不佳。c）医学远程会诊在56%的病例中消除或预防了医疗差错易发性情况，在15%的病例中减轻了医疗差错易发性情况；d）医学远程会诊消除或预防了85%由过渡护理中信息交换不畅导致的医疗差错易发性情况，从而改善了患者的转诊和反向转诊。
医学远程会诊降低了医疗差错易发性，因此，只要广泛实施，可能会提高医疗服务质量和国家卫生系统的绩效。
