DNOOM Kongress, Zagreb

1. 10 years of Telemedicine
Services in Catalonia:
from desperation to
success
Josep Vidal-Alaball, MD, PhD, MPH
Head of the Central Catalonia Primary Care Research Unit

2. Telemedicine in Central Catalonia
2

3. Telemedicine in Central Catalonia
3

4. Telemedicine in Central Catalonia
4
In the Catalonian central region, three counties, have
developed several telemedicine programs, which
have had considerable success in reducing waiting
lists while having wide acceptance among users
Among the programs of telemedicine, the most
successful is teledermatology and the most
innovative are teleulcers and teleaudiometries
Teledermatology was first introduced in the in 2010,
since them, this programme has evolved and has
consolidated.

5. Telemedicine in Central Catalonia
5
All telemedicine programs work in the same way; the
primary care physician or nurse take a photograph
of the lesion or the injury and attaches it to the
electronic medical records of the patient along with
an explanation of the injury
The use of electronic medical records guaranties
confidentiality of images, since it avoids potentially
insecure electronic storage and e-mail
The specialists of the hospital access the electronic
medical records, review the images and propose a
treatment or action plan.

6. Telemedicine in Central Catalonia
6
The primary care physician or nurse review these
instructions and makes a telephone call to the
patient to explain the results of the consultation
All of this can usually be done in less than 5-7
working days
If the specialist of the hospital has any doubts, ask
the primary care professional to refer the patient
for a face-to-face visit.

7. Telemedicine in Central Catalonia
7
Inspired by the good results of teledermatology, in
November 2012 Teleulcers was introduced
Teleulcers is a project aiming
to improve the care of patient
with chronic wounds or ulcers.
Expert vascular advice is
available for primary care
nurses.

8. Telemedicine in Central Catalonia
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Latest telemedicine service being introduced is Teleaudiology
(2013). It has some similarities with teledermatology
&Teleulcers but no photographs are taken
Patients are referred to a Primary Care Centre where an
audiometry is performed
Audiometry, together with some clinical information is
scanned and inserted in the electronic medical records
Otorhinolaryngologist access electronic medical records,
review the audiometry and propose an action plan
Primary care physician reviews these instructions and makes
a telephone call to the patient to explain results
This service also used to follow up patients with hearing loss.

9. Telemedicine in Central Catalonia
9

10. Evaluation
10
The Teledermatology program had considerable
success in reducing dermatology waiting lists, from a
mean of 30 days (95% CI: 29-32) to a mean of 16 days
(95% CI: 15-17) after its implementation (2013)

11. Evaluation
11
Cost-Minimization Analysis
For the period between 2011 and 2019, a total of 52,198
visits were recorded. Telemedicine saved € 780,397.
A differential cost favorable to telemedicine of about € 15 per
visit was observed, with the patient being the largest
beneficiary of this saving (by 85%) in terms of shorter waiting
times and travel costs (RURAL).
In social terms and in our semi-rural context, telemedicine is
more efficient than usual care.

12. Evaluation
12
Face-to-face visits and visits prevented through telemedicine
(January 2018 and June 2019)
The telemedicine service was considered to have replaced a face-to-face
consultation when no face-to-face visit occurred in relation to the same type of
specialist in the 3 months following the telemedicine consultation

13. Evaluation
13

14. Evaluation
14
Both in the urban environment and in rural areas there is an
increase in referrals to the teledermatology service in
2016 compared to the previous year.
The teledermatology consultation rate per thousand
inhabitants assigned was greater in rural teams than in the
urban ones.
However, the number of referrals to the face-to-face
dermatology service after a teledermatology consultation
also decreased significantly and this effect was more
pronounced in RURAL centers.
Vidal-Alaball J, Mendioroz Peña J, Sauch Valmaña G.
Rural-Urban Differences in the Pattern of Referrals to
an Asynchronous Teledermatology Service. Int Arch
Med. 2018;11(30):1–5.

15. Risks with telemedicine
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Can induce consultations for banal reasons, as easier
access is provided (through a mobile application, for
example).
Can cause inequalities in the use of the service, with
access differences for specific groups of patients
according to their resources or digital skills (elderly).
These inequalities could also occur among
professionals less familiar with technological
environments (out of the loop).
Telemedicine can be seen as a cheap alternative by
governments.

16. Conclusions
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• Telemedicine has shown great potential to help improve patient care,
especially in rural settings.
• Telemedicine is a medical act, and as such, must be accepted by
the patient. Patients need to be involved.
• Telemedicine must guarantee the patient's right to autonomy,
professional secrecy, protection of personal data, privacy and
confidentiality.
• Telemedicine is not a replacement to face-to-face visits, it is an
adjunct
• The professional and the patient should decide which model of visit is
appropriate in each case (face-to-face, telephone, telemedicine,
house visit) and how to reverse a face-to-face visit to a telemedicine
one and vice versa depending on its suitability.
• Telemedicine should not be an excuse for inferior health care and
should not be used to cut health care services, specially in rural
areas.

17. ics.gencat.cat
Josep Vidal-Alaball
jvidal.cc.ics@gencat.cat
@jvalaball