Search

Introduction Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. Aim We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. Methods We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and

With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers-especially technological, human and social, psychosocial, anthropological, economic, and governance-related-have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.

Since Argentina's government declared a national emergency to combat the COVID-19 pandemic with a lockdown status, it has produced consequences on the healthcare system. We aimed to quantify the effect on the Emergency Department (ED) visits at Hospital Italiano de Buenos Aires. Our electronic health data showed that ED in-person visits declined 46% during the COVID-19 pandemic, from an overall of 176,370 visits during 2019 to 95,421 visits during 2020. Simultaneously, there was a telehealth visits boom when mandatory quarantine began (March 20, 2020): from a median of 12 daily in February 2020 to a median of 338 daily in April 2020; reaching a maximum daily peak of 1,132 on March 26 2020. For a while, teleconsultations replaced ED visits. Then, when face-to-face visits began to increase, teleconsultations began to decrease slowly, as the phenomenon reversed.

Atopic dermatitis is a common chronic dermatological disease in childhood that can affect people's quality of life. The aim of this study was to inquire about the difficulties, needs and interests related to the disease that people with eczema and their caregivers have; in order to develop a tool that is useful for the follow-up of the illness. Electronic surveys were sent to potential users and interviews were conducted with professionals who are specialized on the subject. The main findings allowed us to understand the challenges and situations they face on a daily basis, such as the difficulties related to the family support, the queries on the eczema flare-ups, the struggles with the adherence to treatment and the needs of optimizing their quality of life. These results helped us design a tool that allows patients and their companions to better monitor their disease while optimizing communication with their health professionals.

This study presents an online psoriasis community developed with dermatologists in a PHR. We describe the interaction of users with this platform and the relationship between the use of self-report questionnaires, their results and users' subsequent contact with the healthcare system. Out of 2175 users that interacted with the platform, 477 visited the forums. 60% of those who completed questionnaires presented at least one abnormal result that prompted a recommendation for an outpatient visit. Although our data suggest a trend, we failed to find a statistically significant association between questionnaire severity and visits scheduling. To our knowledge, this is the first study that analyses the relationship between patient self-reported disease severity and the subsequent contact with the healthcare system.

Due to the COVID-19 pandemic, changes and improvements regarding the organization have been made to adapt quickly at the Emergency Department (ED) of the Hospital Italiano de Buenos Aires, Argentina. This article describes the design, implementation, and use of an electronic dashboard which provided monitoring of patients discharged home, during follow-up with telehealth. It was useful to access essential information to organize and coordinate professional work and patients' surveillance, providing highly relevant data in real-time as proxy variables for quality and safety during home isolation. The implemented tool innovated in the integration of technologies within a real context. The information management was crucial to optimize services and decision-making, as well to guarantee safety for healthcare workers and patients.

This study presents an online psoriasis community developed with dermatologists in a PHR. We describe the interaction of users with this platform and the relationship between the use of self-report questionnaires, their results and users’ subsequent contact with the healthcare system. Out of 2175 users that interacted with the platform, 477 visited the forums. 60% of those who completed questionnaires presented at least one abnormal result that prompted a recommendation for an outpatient visit. Although our data suggest a trend, we failed to find a statistically significant association between questionnaire severity and visits scheduling. To our knowledge, this is the first study that analyses the relationship between patient self-reported disease severity and the subsequent contact with the healthcare system.

Due to the COVID-19 pandemic, changes and improvements regarding the organization have been made to adapt quickly at the Emergency Department (ED) of the Hospital Italiano de Buenos Aires, Argentina. This article describes the design, implementation, and use of an electronic dashboard which provided monitoring of patients discharged home, during follow-up with telehealth. It was useful to access essential information to organize and coordinate professional work and patients’ surveillance, providing highly relevant data in real-time as proxy variables for quality and safety during home isolation. The implemented tool innovated in the integration of technologies within a real context. The information management was crucial to optimize services and decision-making, as well to guarantee safety for healthcare workers and patients.

Since Argentina’s government declared a national emergency to combat the COVID-19 pandemic with a lockdown status, it has produced consequences on the healthcare system. We aimed to quantify the effect on the Emergency Department (ED) visits at Hospital Italiano de Buenos Aires. Our electronic health data showed that ED in-person visits declined 46% during the COVID-19 pandemic, from an overall of 176,370 visits during 2019 to 95,421 visits during 2020. Simultaneously, there was a telehealth visits boom when mandatory quarantine began (March 20, 2020): from a median of 12 daily in February 2020 to a median of 338 daily in April 2020; reaching a maximum daily peak of 1,132 on March 26 2020. For a while, teleconsultations replaced ED visits. Then, when face-to-face visits began to increase, teleconsultations began to decrease slowly, as the phenomenon reversed.

The digital divide can hinder the ability of elderly patients to fully benefit from PHRs. They are "digital immigrants", not having the life-long exposure to technology as younger generations, as well as physical and cognitive disabilities. The aim of this study was to explore the digital divide as a barrier for the use of a PHR in older adults (69 years of age) and describe the use of a PHR in an elderly population in Argentina. We conducted a cross sectional study which included older adults who attended the Coronavirus vaccination campaign in 2021. Data were collected through a survey encompassing digital divide factors and use of the PHR. A total of 128 participants agreed to complete the survey, 60.15% reported using the PHR. We found a statistically significant correlation of education level, having a personal computer and internet access with PHR use. Concerning PHR users, 45.45% reported needing assistance to use it. Although the elderly population represents a large portion of patients, there is not enough research done on their use experience using eHealth solutions. There is pending work in the eHealth field to integrate these elders into current PHRs and help them enjoy their benefits.

Telemedicine is the provision of services by health professionals through the use of information and communication technologies. Its implementation is usually carried out through systems of va riable usability. In 2016, Parmanto et al, developed and validated a questionnaire in English that measures its usability and allows to evaluate all factors that influence it. In 2019, we translated, adapted cross-culturally, and published this questionnaire in Spanish. With the aim of transforming it into a reliable and accessible tool, the utility of which is indisputable in the current context, we carried out a research work that allowed its validation and simplification.

Telemedicine is the provision of services by health professionals, through the use of information and communication technologies. Its implementation helps to shorten distances, facilitate access to the health system, improve the effectiveness of care and reduce costs. In 2016, Bambang Parmanto et al, developed and validated a questionnaire in English that measures its usability and allows to evaluate all the factors that influence it. Since similar tools do not exist in the Spanish language to date, a research work was carried out for transcultural translation and adaptation that included seven steps. The questionnaire obtained after this process provides a valuable tool to objectify information that is vital to contribute to the cycle of continuous improvement of the care process of these characteristics, in which patients, health professionals and funders are involved.

This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems.Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an initial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question.A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indicators documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results.The instrument obtained has adequate psychometric properties and will contribute to the objective evaluation of the experience of health professionals who perform telemedicine.Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina.Com base na versão abreviada em espanhol – e validada localmente – do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliou-se a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo.Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados.O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a avaliação objetiva da experiência dos profissionais que realizam telemedicina.

Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until EDreadmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31- 3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety. Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces. Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística. Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes reconsultaron a CEA, con una tasa de incidencia global a los 14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009). Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente. Introdução: Descrever as características dos pacientes com COVID-19 com sintomas leves e alta do Centro de Emergência de Adultos (CEA) e acompanhados ambulatorialmente por telemedicina. Estime as taxas de nova consulta ao CEA e de hospitalização e explore os fatores associados a esses resultados. Métodos: Coorte retrospectiva de junho a agosto de 2020 no Hospital Italiano de Buenos Aires, que incluiu COVID-19 com sintomas leves. Eles foram acompanhados por 14 dias até a ocorrência de nova consulta no CEA e / ou internação. Modelos de Kaplan-Meier e regressão logística foram usados. Resultados: De um total de 1.239 pacientes, com mediana de 41 anos e 53,82% homens, 167 pacientes consultaram novamente o CEA, com uma taxa de incidência global em 14 dias de 13,08% (IC95% 11,32 a 15,08). Destes, 83 necessitaram de hospitalização (média de 4,98 dias), 6% não estavam relacionados com COVID-19 e 5 pacientes morreram. Após o ajuste para fatores de confusão (idade ≥65, sexo, diabetes, hipertensão, ex-tabagismo, tabagismo ativo, febre, diarreia e saturação de oxigênio), encontramos associações significativas: tabagismo prévio (ORa 2,09, IC 95% 1,31-3,34, p0 = 0,002), febre (ORa 1,56, IC 95% 1,07-2,28, p = 0,002) e saturação de oxigênio (ORa 0,82, IC 95% 0,71-0,95, p = 0,009). Conclusão: A taxa de 13% de re-consulta ao CEA durante 14 dias de seguimento foi muito significativa para a gestão hospitalar, qualidade do desempenho e segurança do paciente. Fil: Pedretti, Ana. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Márquez Fosser, Santiago. McGill University; Canadá. Hospital Italiano; Argentina Fil: Pasquinelli, Rosario. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Vallone, Marcelo. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Plazzotta, Fernando. Hospital Italiano; Argentina Fil: Luna, Daniel Roberto. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; Argentina Fil: Martínez, Bernardo. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Rodriguez, Paz. Hospital Italiano; Argentina Fil: Grande Ratti, María Florencia. Hospital Italiano; Argentina

Objetivo. El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina. Métodos. A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen. Resultados. Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discriminante fueron apropiadas. La validez de criterio externo mostró resultados óptimos. Conclusiones. El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.

The objective of this study was to investigate the difficulties and information needs that both patients and their companions have in the context of a scheduled surgery. Observations in the operating room waiting zone and semi-structured interviews were conducted to patients with scheduled surgeries, their companions, administrative staff members and surgeons. We developed a journey map to explain the patient’s experience through the perioperative process. The emerging categories were Fragmented communication, Understanding the surgical process and Waiting times. Knowing the information needs of patients and companions was important to identify problems and opportunities for improvement in our institution’s Personal Health Records.