Background: Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation service between primary care professionals and citizens in the public health care system, has already reached 1 million cases. Before the COVID-19 pandemic, the use of eConsulta was growing at a monthly rate of 7%, and the growth has been exponential from March 15, 2020 to the present day. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. Objective: The aim of this study was to annotate a random sample of teleconsultations from eConsulta, and to evaluate the level of agreement between health care professionals with respect to the annotation. Methods: Twenty general practitioners retrospectively annotated a random sample of 5382 cases managed by eConsulta according to three aspects: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. A total of 1217 cases were classified three times by three different professionals to assess the degree of consensus among them. Results: The general practitioners considered that 79.60% (4284/5382) of the teleconsultations resulted in avoiding a face-to-face visit, and considered that 64.96% (3496/5382) of the time, the patient would have made a face-to-face visit in the absence of a service like eConsulta. The most frequent uses were for management of test results (26.77%, 1433/5354), management of repeat prescriptions (24.30%, 1301/5354), and medical enquiries (14.23%, 762/5354). The degree of agreement among professionals as to the annotations was mixed, with the highest consensus demonstrated for the question “Has the online consultation avoided a face-to-face visit?” (3/3 professionals agreed 67.95% of the time, 827/1217), and the lowest consensus for the type of use of the teleconsultation (3/3 professionals agreed 57.60% of the time, 701/1217). Conclusions: This study shows the ability of eConsulta to reduce the number of face-to-face visits for 55% (79% × 65%) to 79% of cases. In comparison to previous research, these results are slightly more pessimistic, although the rates are still high and in line with administrative data proxies, showing that 84% of patients using teleconsultations do not make an in-person appointment in the following 3 months. With respect to the type of consultation performed, our results are similar to the existing literature, thus providing robust support for eConsulta’s usage. The mixed degree of consensus among professionals implies that results derived from artificial intelligence tools such as message classification algorithms should be interpreted in light of these shortcomings.

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中文翻译：

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加泰罗尼亚语初级保健服务中的患者和医护人员之间的远程咨询：回顾性跨部门研究中的消息注释分析。

背景：在过去的十年中，几个工业化国家的公共医疗保健系统中都引入了远程医疗服务。在加泰罗尼亚，使用eConsulta（一种初级保健专业人员和公共卫生保健系统中的公民之间的异步远程咨询服务）的使用已经达到100万例。在COVID-19大流行之前，eConsulta的使用量每月以7％的速度增长，从2020年3月15日到今天，这种增长呈指数级增长。尽管已广泛使用该工具，但很少有定性证据说明如何使用此工具。目的：本研究的目的是对来自eConsulta的远程会诊进行随机注释，并评估医疗保健专业人员之间关于注释的一致程度。方法：20名全科医生从以下三个方面对eConsulta管理的5382例病例进行了回顾性注释：根据6个作者建议类别的互动类型，从业者是否认为避免了面对面拜访以及是否相信如果没有eConsulta，则患者将要求面对面访问。由三名不同的专业人士对1217例病例进行了三次分类，以评估他们之间的共识程度。结果：全科医生认为，有79.60％（4284/5382）的远程会诊避免了面对面的就诊，并认为64.96％（3496/5382）的患者会进行面对面的就诊。在没有像eConsulta这样的服务的情况下进行面对面访问。最频繁的用途是管理测试结果（26。77％，1433/5354），重复处方管理（24.30％，1301/5354）和医疗咨询（14.23％，762/5354）。专家对注释的同意程度参差不齐，其中“在线咨询是否避免了面对面访问？”这一问题显示出最高的共识。（3/3专业人士同意67.95％的时间，即827/1217），以及对远程会诊使用类型的最低共识（3/3专业人士同意57.60％的时间，是701/1217）。结论：该研究表明，eConsulta能够将面对面访问的次数从55％（79％×65％）减少到79％。与以前的研究相比，这些结果有些悲观，尽管其发生率仍然很高，并且与行政数据代理一致，表明84％的使用远程会诊的患者在接下来的3个月内没有亲自预约。关于咨询的类型，我们的结果与现有文献相似，因此为eConsulta的使用提供了有力的支持。专业人士之间的共识程度参差不齐，这意味着应该根据这些缺点来解释从人工智能工具（例如消息分类算法）获得的结果。

这仅仅是抽象的。阅读JMIR网站上的全文。JMIR是互联网时代电子健康和医疗保健领域领先的开放获取期刊。