Letter to the Editor
New Outpatient Management Based on a Respiratory Virtual Clinic. An Effective Measure in Times of Austerity
Una nueva gestión ambulatoria basada en la consulta virtual de neumología. Una medida efectiva en tiempos de «austeridad»
Juan Marco Figueira Gonçalves
, M. Carmen Hernández Gracia, José Julián Batista Martín
Corresponding author
Servicio de Neumología, Hospital Universitario Nuestra Señora de la Candelaria (HUNSC), Santa Cruz de Tenerife, Spain
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "279" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumotórax tras lavado broncoalveolar realizado para diagnóstico de infección por micobacterias no tuberculosas. ¿Una complicación «atípica» de la broncoscopia?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1194 "Ancho" => 1901 "Tamanyo" => 391597 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Upper panel: computed tomography (CT) images of the chest obtained at the time of presentation with pneumothorax and pleural effusion. 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Una medida efectiva en tiempos de «austeridad»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Specialized care outpatient clinics tend to be inundated by high numbers of patients referred from primary care centers (PCC).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> This overload seriously undermines the management of waiting lists and delays the evaluation of patients with severe diseases.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2,3</span></a> Long waiting lists are the result of a shortage of human resources, work systems, and interdependency between PCC and specialized care facilities. In the Canary Islands, these problems are compounded by geographical obstacles and the remote location of communities. Tenerife has a surface area of 2034.38<span class="elsevierStyleHsp" style=""></span>km<span class="elsevierStyleSup">2</span> and an estimated population of 906,854 inhabitants, making it the most heavily populated island in Spain. Most of the population is concentrated in 3 areas: Santa Cruz de Tenerife, San Cristobal de la Laguna and the municipalities of Arona and Adeje. The latter 2, located in the south of the island, have a resident population of 200,000 inhabitants, and the nearest tertiary hospital is at least 80<span class="elsevierStyleHsp" style=""></span>km away.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The disperse population in the south of the island and their ensuing transport difficulties led to the implementation in June 2012 of the Respiratory Virtual Clinic, the aim of which was to manage and prioritize pulmonology referrals from PCC. The Respiratory Virtual Clinic takes place 2 days a week, and up to 15 cases are discussed in each session. The consultant pulmonologist prioritizes cases by examining the data provided online by the PCC (clinical history, physical examination, complementary tests) and performs a triage, by either indicating to the treating physician the procedure to follow, or by personally evaluating the patient. In the latter case, the tests required for the first appointment are performed on the same day in the outpatient clinic (chest X-ray, spirometry or blood gases), and the patient is referred directly to the right clinic: either the general pulmonology clinic held 4 days a week or else the dedicated COPD clinic, which takes place once a week. Patients already monitored in the pulmonology clinic whose respiratory disease worsens can immediately access either of the 2 clinics without the need for a referral from the PCC.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In less than 3 years, this formula has reduced the overall number of PCC consultations by 14%, and the number of first appointments by 56%. The reduction in workload meant that chronic patients can be more closely monitored, leading to a 61% reduction in the number of hospital admissions to the pulmonology department, while follow-up appointments rose by 15% (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, the Respiratory Virtual Clinic increased the number of consultations that could be resolved by the PCC by 19%, underscoring the efficiency of this type of management.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Figueira JM, Hernández Gracia MC, Batista Martín JJ. Una nueva gestión ambulatoria basada en la consulta virtual de neumología. Una medida efectiva en tiempos de «austeridad». Arch Bronconeumol. 2016;52:279–280.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">June 2011 – May 2012 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">June 2012 – May 2013 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">June 2013 – May 2014 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinic visits in person \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4099 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3948 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3558 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First appointments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">893 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Follow-up appointments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2093 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2674 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2142 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Virtual visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1470 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1427 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dedicated COPD clinic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">258 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">523 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of hospital admissions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Year 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Year 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Year 2014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">501 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">417 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">195 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035953.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of Visits and Patients Seen in the Pulmonology Department.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idoneidad de las derivaciones de Atención Primaria a especialidades médicas hospitalarias" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. 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| 2023 December | 1 | 2 | 3 |
| 2023 March | 6 | 4 | 10 |
| 2023 February | 34 | 15 | 49 |
| 2023 January | 20 | 30 | 50 |
| 2022 December | 38 | 28 | 66 |
| 2022 November | 38 | 24 | 62 |
| 2022 October | 34 | 35 | 69 |
| 2022 September | 33 | 30 | 63 |
| 2022 August | 34 | 37 | 71 |
| 2022 July | 30 | 40 | 70 |
| 2022 June | 24 | 34 | 58 |
| 2022 May | 40 | 42 | 82 |
| 2022 April | 33 | 29 | 62 |
| 2022 March | 35 | 45 | 80 |
| 2022 February | 27 | 36 | 63 |
| 2022 January | 30 | 37 | 67 |
| 2021 December | 17 | 41 | 58 |
| 2021 November | 43 | 38 | 81 |
| 2021 October | 40 | 48 | 88 |
| 2021 September | 15 | 36 | 51 |
| 2021 August | 24 | 29 | 53 |
| 2021 July | 26 | 34 | 60 |
| 2021 June | 26 | 41 | 67 |
| 2021 May | 32 | 31 | 63 |
| 2021 April | 62 | 89 | 151 |
| 2021 March | 34 | 25 | 59 |
| 2021 February | 39 | 30 | 69 |
| 2021 January | 17 | 12 | 29 |
| 2020 December | 31 | 18 | 49 |
| 2020 November | 26 | 14 | 40 |
| 2020 October | 31 | 15 | 46 |
| 2020 September | 19 | 13 | 32 |
| 2020 August | 22 | 13 | 35 |
| 2020 July | 23 | 18 | 41 |
| 2020 June | 18 | 7 | 25 |
| 2020 May | 23 | 11 | 34 |
| 2020 April | 36 | 26 | 62 |
| 2020 March | 34 | 12 | 46 |
| 2020 February | 30 | 16 | 46 |
| 2020 January | 26 | 15 | 41 |
| 2019 December | 24 | 14 | 38 |
| 2019 November | 35 | 20 | 55 |
| 2019 October | 20 | 15 | 35 |
| 2019 September | 8 | 14 | 22 |
| 2019 August | 20 | 13 | 33 |
| 2019 July | 28 | 26 | 54 |
| 2019 June | 17 | 13 | 30 |
| 2019 May | 25 | 24 | 49 |
| 2019 April | 39 | 26 | 65 |
| 2019 March | 31 | 23 | 54 |
| 2019 February | 30 | 12 | 42 |
| 2019 January | 29 | 8 | 37 |
| 2018 December | 25 | 16 | 41 |
| 2018 November | 47 | 14 | 61 |
| 2018 October | 59 | 16 | 75 |
| 2018 September | 24 | 13 | 37 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 15 | 0 | 15 |
| 2018 April | 31 | 8 | 39 |
| 2018 March | 36 | 4 | 40 |
| 2018 February | 26 | 8 | 34 |
| 2018 January | 63 | 5 | 68 |
| 2017 December | 49 | 6 | 55 |
| 2017 November | 26 | 4 | 30 |
| 2017 October | 23 | 9 | 32 |
| 2017 September | 18 | 5 | 23 |
| 2017 August | 19 | 12 | 31 |
| 2017 July | 20 | 7 | 27 |
| 2017 June | 34 | 9 | 43 |
| 2017 May | 22 | 10 | 32 |
| 2017 April | 13 | 21 | 34 |
| 2017 March | 10 | 7 | 17 |
| 2017 February | 16 | 3 | 19 |
| 2017 January | 7 | 3 | 10 |
| 2016 December | 29 | 14 | 43 |
| 2016 November | 26 | 13 | 39 |
| 2016 October | 55 | 16 | 71 |
| 2016 September | 37 | 5 | 42 |
| 2016 August | 50 | 2 | 52 |
| 2016 July | 3 | 1 | 4 |
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