Gatekeeping Through Remote Family Physician Consultations in Tertiary University Hospital During the COVID-19 Pandemic: A Cross-Sectional Study.

Abstract

Objective: To explore the potential of gatekeeping for specialized consultations and patient care via remote interactions with family physicians. Methods: This cross-sectional study was conducted at a tertiary hospital between November 2020 and December 2021, when specialized consultations were canceled due to the COVID-19 pandemic. Patients who were evaluated for remote consultation with family physicians were included. Remote consultations were done by a family physician team facilitated through the TelessaúdeRS-UFRGS service. The primary outcome was potential patients eligible for discharge from specialty ambulatory to primary care. Data Sources and Analytic Sample: Data were collected from hospital records. Candidates for remote consult included stable health conditions, indicating the absence of acute or decompensated symptoms as reported in the consult request via the online platform, absence of necessity for any medical procedures or scheduled surgeries, and absence of time-sensitive situations. The prevalence of the outcome was estimated at a corresponding 95% confidence interval. The chi-square test compared the outcome according to COVID-19 mortality waves and specialty groups. Results: At the outset, 2,429 consultations were assessed against the study's eligibility criteria. Among these, 2,160 consultations were included, of whom 776 were candidates for family physician team consultation. Subsequently, the remote family physicians team conducted 557 (23% of the original sample) consultations. Overall, 10% (95% CI: 9-11) had the potential to be discharged from specialty care. Patients' age was linked to discharged likelihood. Prevalence rates varied across specialty groups (highest in surgical patients) and COVID-19 waves (highest in the second wave). Conclusions: This study, conducted within a tertiary hospital's specialty outpatient clinic, highlights the potential of remote consultations with a family physician team in identifying cases suitable for management in primary care settings. Our findings demonstrate that 10% of cases assessed through remote consultations exhibited potential for primary care management.