Economic studies and randomized-control studies are reportedly of poor practicability for evaluating the performance of medical teleconsultation systems, particularly in areas with large rural indigenous populations. Thus, this is an observational case study, focusing on a retrospective audit of the performance of a teleconsultation system by establishing and estimating measurable quality indicators (QI). The inhabitants of the rainforest of the state of Amazonas, partly indigenous, have poor access to the health system facilities, despite government guarantees, due to both cultural and geographical considerations. Nevertheless, the Telemedicine and Telehealth Centre (TTC) provide the Primary Health Care Doctors (PCD) of 22 municipalities with teleconsultation. Whenever the complexity of the health problem of a patient exceeds the PCD’s capacities, the PCD can apply for teleconsultation via satellite antenna Internet connection and the TTC expectedly returns e-mail based (asynchronous) counseling within 72 h through its network of teleconsultants. A board, composed of 5 international TTC-external experts, audited the proceedings, analyzed the series of cases submitted from January to September 2016, established QI, and proposed desirable standards. The results of some QI are that: a) the anamnesis, physical examination, and attached documentation from the PCD are still of poor quality and require improvements through PCD training; b) the TTC provides teleconsultation within 32 h in ordinary cases and twentyone hours in urgent cases; c) the database of teleconsultants (mostly internationals) available covers thirty-nine specialties; d) additional synchronous communication was used in 14%, mostly in traumatology; e) the referral advising ratio is at 16%; f) In the referral process, the flow of clinical data between health providers is unsatisfactory; g) cold cases are at 4% and h) definitive response in counseling is at 44%. Observational case series studies, based on external audit, are supportive in outlining performance and pointing out actions aimed at improvement.
Nando Campanella, Harold Martin Wright, Pierpaolo Morosini, Guido Sampaolo and Gianluca Serafini