The pandemic has accelerated telemedicine.Getty Images
Minimizing patient exposure to the virus has been one of the basic principles of primary care during these pandemic months. With health centers doing PCR tests every day, consultations have turned to telephone lines. Patients are only asked to come to the center when an auscultation or some other physical examination is required. It can be said that the pandemic has forced the adoption of telemedicine or telecare. But it has been a lacking adoption. In Spain, public health professionals complain of a lack of resources, not only human, but also technical. There is a lack of effective communication channels, such as a platform that allows videoconferences or something as everyday as sending photos or videos via mobile.
“Many patients say 'can I send you a photo of what has come out of my hand? ' Well, no, because we don't have tools ”, laments Amparo Naranjo, a family doctor at the Las Matas office, belonging to the Monterrozas health center, in the Community of Madrid. Naranjo offers an approximate calculation: “Now 80% of the consultations are by phone. A majority of the queries are resolved like this. ”
The phenomenon is not exclusively Spanish. In a study focused on the United States, the consulting firm Arizton estimated an 80% growth in the telemedicine market in this country during 2020. At the same time, the director of the Center for Health and Technology at the University of Rochester Medical Center ( United States), Roy Dorsey, wrote in The Lancet that the use of remote medicine had multiplied by 10 in the first weeks of the pandemic. According to the Spanish Society of Family and Community Medicine (Semfyc), in times of covid-19 a family doctor performs an average of 32 medical acts through telecare (five hours and 20 minutes of his day) and attends a dozen patients face-to-face
Don't go out, we take care of them at home
Videoconferencing is considered an advance in telemedicine. "A telephone conversation with a patient is not the same as seeing his face, seeing how the patient looks," emphasizes Juan José Rodríguez Sendín, president of the Central Ethics Commission of the Colegio Médica Organization. Although he points out that for the assistance to be more complete, equipment would also be needed to measure certain constants, make an electro or check oxygen saturation
The basic level of telemedicine, however, goes through technologies that are simpler to acquire and to modify protocols of performance. "We would need tools with video calls, enable a specific program to send photographs," highlights the family doctor, who adds to the list of requests the possibility of sending sick leave by email. "When a person is confined, he has to ask a neighbor or a friend to come to the center for physical leave, because we cannot send it to him by e-mail," he explains.
Saturated telephone lines
Among the questions that he has to Addressing telecare there is another basic problem. It is the saturation of the telephone lines. “There are not enough lines. And then people call the health center and no one picks up the phone ”, says Rodríguez Sendín. Some patients claim a way to be able to leave a message to be called later, but it is not possible. “All of this is unforeseen. I am not saying that it is the same in all of Spain, but it is not generally foreseen ”, deepens the spokesperson for the Colegio Médica Organization.
Naranjo tells what happens with an example: “If there are four lines in the health center and the doctors and nurses are on the phone, because the consultations are by phone, there is no possibility of anyone picking up the phone. The lines are busy. " It can happen – and it happens, according to Naranjo – that there are more doctors than telephone lines. In this way, all doctors cannot be treating patients at the same time. Thus, the bottleneck of primary care is further strangled. The family doctor comments that in her center it was like that in the first weeks of the pandemic. She only got on the line when another doctor hung up the phone. They now have mobile phones. But it has been the city council of his area who has distributed them among the doctors to free the telephone lines. The Ministry of Health of the Community of Madrid, for its part, claims to have implemented measures to alleviate primary care, reorganization and aimed at the care of covid-19 patients
Today, for Naranjo the main problem It is the fatigue of the day to day. The optimal number of patients that a doctor should see on his day, estimated by the Community of Madrid, is from 31 to 33. She starts at 8.00 with 40 patients on the list. During the morning more are added and at 3:00 pm it may have passed consultation to about 60. With the added difficulty of telephone assistance: “Telephone calls imply more concentration than seeing the patient. Because when you have it in front of you, the patient tells you that a rash has appeared and you see it. On the phone he has to tell you and you have to think what that could be without seeing it. ”
This accumulation of patients could be alleviated in part if there were the means to telework from home in primary care. "There are many people who are on sick leave because, either because of their pathology or because of their age, they cannot run the risk of seeing covid patients," explains the family doctor. "These workers, if teleworking is enabled at home, which is a safe environment, they can continue working and can make phone calls like we do the rest."
In communities like Murcia and Andalusia this already happens, according to Naranjo. But not in other communities. In hospital care in Madrid, teleworking does exist, but not in primary care. In December, there were 443 workers on leave in the Community of Madrid, according to the Central Health and Safety Committee, made up of trade union organizations and the Administration. A part of them, those who belong to a group at risk for covid, could work if the corresponding resources and permits are enabled. The Ministry of Health highlights an effort to expand the staff of health centers. Since the beginning of the pandemic, 73 family doctors have been hired out of a total of 1,500 new hires.
Beyond the pandemic situation, Naranjo believes that not investing in telemedicine can take a toll on public health. These types of services can become a way to expand medical care to older people or take them to remote areas. But also to improve the observation of patients with chronic diseases or under certain treatments. She advocates for the creation of a nationwide telemedicine plan. Currently the document that best fits this denomination is the Insalud Telemedicine Plan , published by the Ministry of Health and Consumer Affairs and dated January 2000.
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