Sánchez Peinador Carmen, Torras Borrell Joan, Castillo Moraga María José, Egocheaga Cabello María Isabel, Rodríguez Villalón Xiana, Turégano Yedro Miguel, Gamarra Ortiz Javier, Domínguez Sardiña Manuel, Pallarés Carratalá Vicente
Centro de Salud Cantalejo, Cantalejo, Segovia, España; Grupo de Trabajo de ECV de SEMG, España.
CAP Sant Llàtzer, Terrassa, Barcelona, España; Coordinador del grupo de HTA de la Societat Catalana de Medicina Familiar i Comunitària, CAMFIC, España; Grupo de Trabajo de HTA de SEMFYC, España.
Aten Primaria. 2022 Jul;54(7):102353. doi: 10.1016/j.aprim.2022.102353. Epub 2022 May 16.
Members of the working groups on hypertension or cardiovascular disease of the Spanish Societies of Primary Care Physicians (PCPs) [SEMERGEN], Family and Community Medicine [semFYC] and General and Family Physicians [SEMG], conducted a Delphi study to validate with a panel of PCPs with expertise in hypertension several recommendations to optimize teleconsultation in hypertensive patients.
Delphi study based on an online questionnaire with 59 recommendations based on the available evidence and the clinical experience of the authors.
118 PCPs participated in two rounds of the questionnaire (98.3% of the invited physicians), reaching consensus in 53/62 statements (85%). The Primary Care team must proactively select the hypertensive patients suitable for telematic consultation and contact them to set up an appointment. Telematic consultation must begin explaining the reason and aims pursued, continuing with anamnesis, which must explore signs and symptoms of disease worsening, current treatments and level of adherence. In patients with a home blood pressure measurement (HBPM) ≤135/85mmHg, it is recommended to schedule a new telematic appointment in 3-6months. On the contrary, asymptomatic patients with a HBPM ≥135/85mmHg should undergo ambulatory blood pressure monitoring, treatment modification or, in case of warning signs or symptoms, referral to a face-to-face visit or to emergency department.
Teleconsultation can complement face-to-face consultation, constituting an additional tool for the appropriate follow-up of hypertensive patients.
西班牙基层医疗医生协会（SEMERGEN）、家庭与社区医学协会（semFYC）以及全科与家庭医生协会（SEMG）的高血压或心血管疾病工作组的成员开展了一项德尔菲研究，以让一组在高血压方面具有专业知识的基层医疗医生对多项优化高血压患者远程会诊的建议进行验证。
基于一份在线问卷进行德尔菲研究，该问卷包含基于现有证据和作者临床经验的59条建议。
118名基层医疗医生参与了两轮问卷调查（占受邀医生的98.3%），在62条陈述中的53条（85%）上达成了共识。基层医疗团队必须主动挑选适合远程会诊的高血压患者并与他们联系安排预约。远程会诊必须首先解释原因和目的，接着进行问诊，问诊必须探究疾病恶化的体征和症状、当前治疗情况以及依从性水平。对于家庭血压测量（HBPM）≤135/85mmHg的患者，建议在3 - 6个月后安排新的远程会诊预约。相反，HBPM≥135/85mmHg的无症状患者应进行动态血压监测、调整治疗，或者如果出现警示体征或症状，则转诊至面对面就诊或急诊科。
远程会诊可以补充面对面会诊，成为高血压患者适当随访的一种额外工具。
