Medical Journal – You’ve got mail!

You have an email! – when increased accessibility does not mean improved accessibility

In 2021, there were 36 million medical consultations in primary health care, which is 10.7% more than in 2020 and 14.2% more than in 2019. about every second there was a consulting doctor.

This increase in consultations is accompanied, concomitantly, by an increase in users without a family doctor – from 2020 to 2021, approximately 300,000 people found themselves without a family doctor, i.e. more than 400,000 people if we compare 2019. to a record number of consultations while, since 2014, there have not been as many users without a family doctor. Much of this growth is in remote consultations.

These contacts have more than doubled compared to the years preceding the pandemic and corresponded in 2021 to 55.9% of medical consultations in CSP. In 2021, out of 10 consultations, 6 were remote and 4 face-to-face, whereas before the pandemic, every 10 consultations were 3 remote for 7 face-to-face.

Trying to analyze the reason for this new reality, we can find several explanations. On the one hand, teleconsultations have increased with the pandemic and, although they are already fewer in number compared to the periods of pandemic waves, they contribute to this increase in remote consultations. On the other hand, bureaucratic creativity for new reporting and reporting needs continues and continues to contribute to a high workload for all family physicians.

As for the refills of chronic drugs, despite the recent possibility of issuing a prescription valid for one year, allowing a reduction in the workload related to this renewal, the fact that it is based on electronic platforms, sms and e-mail with which chronic patients are unable to interact, conditions a new task for the FP: printing prescriptions that have not yet been delivered to the pharmacy. There is a rare day when it is not necessary to print a prescription already issued (often prescribed elsewhere in the health system) because the user has deleted the message, lost the treatment card or not.
find the email.

But in my personal experience, the main reason for this increase in remote contacts is email. Available 24 hours a day, regardless of public holidays, weekends, holidays or absences and without any moderation, email is a resource increasingly used by users. It is a job that, currently, it is not possible to account for accurately, being hidden in the statistics of all consultations without the presence of the user.

However, what initially would serve to facilitate and bring users closer to health professionals ends up conditioning inequalities in access to care. Inequality, because we know that a large part of our users do not use the Internet or e-mail, and are generally the weakest, with the fewest resources who have the most difficulty in accessing these means. Second, because users who use this means of communication often use it for situations that are not clinically necessary or that should be resolved through personal or face-to-face care.

Or ask for multiple prescription refills, or send test results separately as results become available, even with an appointment scheduled for the following week, or insist on a response within hours of sending of the e-mail, or ask for clarification on the doubts that should be placed on the SNS24. These are the over-users of email. This overuse without any criteria or regulation leads to a saturation of the doctor’s agenda, strongly conditioning the access of users who really need it.

On the other hand, the tool itself (e-mail) does not correspond to our needs. The fact that it does not allow communication by typification of the subject, means that the management is done only by order of arrival of the e-mail, which makes it difficult to answer within the appropriate deadlines for each subject or makes it impossible an automatic response directed to the subject in question. On the other hand, since there are no mandatory fields, it is often not possible to unambiguously identify the user, forcing the exchange of several electronic messages with the user, to the detriment of both parties. .

The lack of regulation in the use of electronic mail and the lack of integration with the real capacity of our agenda has led to a loss of accessibility to the real needs of our users.

Thus, it is concluded that an increase in accessibility does not mean an improvement in accessibility, since what began with the good intention of increasing it now seriously risks translating into a deterioration of accessibility due to to overuse.

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