Analysis of the quality of e-Consultations in chronic obstructive pulmonary disease

• Published in: Respiratory medicine 2024-02, Vol.222, p.107514, Article 107514
• Main Authors: Álvarez-Dobaño, José M., Rodríguez-García, Carlota, Atienza, Gerardo, Toubes, María E., Rodríguez-Núñez, Nuria, Zamarrón, Carlos, Novo-Platas, José Ángel, Soto-Feijóo, Roi, Landín, Elisa, Carreiras-Cuiña, María, Martínez-Martínez, Honorio J., Carbajales, María Cruz, Otero, Borja, Valdés, Luis
• Format: Article
• Language: English
• Subjects: Capacity of resolution; Chronic obstructive pulmonary disease; e-consultations; Overdiagnosis; Quality
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2023.107514

The quality of e-Consultations in the COPD is unknown. The objectives of this study were (i) to evaluate the quality of referrals; (ii) to define the characteristics of patients referred from Primary Care (PC) to the Unit of Pulmonology; and (iii) to describe differences between accepted and rejected patients. A retrospective, observational study of e-Consultations requested by PC for suspected COPD throughout 2022. To quantify the quality of the e-Consultations, an arbitrary scale of 12 variables (score 0–10) was created. In total, 384 e-Consultations were reviewed, of which 167 (43.5 %) resulted in a face-to-face visit, and 217 (56.5 %) were rejected. No differences were observed between the two types of patients, except for confirmations of diagnostic suspicion of COPD [significantly higher in accepted patients (p = 0.042)]; physical examination data of rejected patients (more data provided; p = 0.015); and lung function (significantly better in rejected patients). The mean quality of referrals was acceptable (5.6 ± 2.1 score): 121 (31.3 %) had insufficient quality; 118 (30.5 %) acceptable; 75 (19.4 %) good, and 30 (7.8 %) excellent. Quality was low in half of the variables analyzed (6/12); acceptable in 3, and good in another 3. The capacity of resolution of referrals was good (one e-Consultation) in 199 requests (66.1 %); deficient (two e-Consultations) in 72 (23.9 %), and poor (≥3 e-Consultations) in 30 (10 %). Overdiagnosis was 40.2 % (86/214 e-Consultations). The risk could be classified in 247 patients (64.3 %; 135 low-risk; 90 high-risk). When adequate information is provided, e-Consultations help identify different levels of severity. However, the quality and capacity of resolution of referrals were suboptimal, with a high percentage of overdiagnoses. •E-Consultation is a safe electronic application available on the electronic medical history of patients, but since its implementation in pulmonology, an evaluation has not yet been performed to assess the quality of the information provided by general practitioners for a correct decision-making, in patients with suspected COPD.•4232 e-Consultations were reviewed, of which 3077 were sent from primary care: 387 were made for suspicion of COPD.•Suspected cases of COPD referred for an e-Consultation are heterogeneous, ranging from mild to high-risk cases, which can be differentiated via e-Consultation, when relevant information is available.•The overall quality of referrals and capacity of resolution