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Valoración de usuarios y profesionales sanitarios sobre la teleconsulta en Atención Primaria: estudio transversal
Evaluation of users and health professionals on teleconsultation in primary care: A cross-sectional study
Sofia Gamucci Jiménez de Pargaa, Agnès Garriga Casanovasb,
Autor para correspondencia
agarrigacasanovas@gmail.com

Autor para correspondencia.
, Judith Gómez Sansc, Javier Aramendía Macuad, Anna Guardiola Salae, Francesc Orfila Pernasf
a Centre d’Atenció Primària Guineueta, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
b Centre d’Atenció Primària El Carmel, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
c Centre d’Atenció Primària Prosperitat-Verdum, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
d CUAP Casernes, Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
e Centre d’Atenció Primària Sarrià de Ter, Atenció Primària Girona, Institut Català de la Salut, Girona, España
f Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La telemedicina&#44; entendida como una forma de prestaci&#243;n de servicios sanitarios a distancia&#44; se impuso como herramienta indispensable para hacer frente a la demanda sanitaria durante los primeros meses de la pandemia de enfermedad por coronavirus de 2019 &#40;COVID-19&#41;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Si bien la teleconsulta &#40;TC&#41; &#40;consulta telem&#225;tica por tel&#233;fono&#44; chat o videollamada&#41; ya se usaba&#44; la pandemia precipit&#243; su aplicaci&#243;n tanto en el seguimiento de los pacientes con infecci&#243;n por SARS-CoV-2 como de sus enfermedades agudas y cr&#243;nicas&#44; involucrando a todo el personal sanitario asistencial&#46; La TC permiti&#243; un acceso m&#225;s seguro a la atenci&#243;n primaria mediante la disminuci&#243;n del riesgo de contagio respecto a la asistencia presencial<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En &#233;poca prepand&#233;mica&#44; la investigaci&#243;n en telemedicina se centraba en mejorar los sistemas de informaci&#243;n&#44; seguridad del paciente y protecci&#243;n de datos<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a>&#46; Tambi&#233;n permit&#237;a evaluar el manejo de enfermedad cr&#243;nica&#44; mayoritariamente en el &#225;mbito de la consulta externa&#46; Los datos de satisfacci&#243;n por parte de los usuarios son buenos&#44; especialmente en aquellos casos en los que ya exist&#237;a una relaci&#243;n previa entre el paciente y el profesional asistencial<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;5</span></a>&#46; La bibliograf&#237;a revisada sugiere que la telemedicina mejora el acceso a la asistencia sanitaria en &#225;reas rurales en las que los servicios sanitarios disponibles son m&#225;s reducidos<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A grandes rasgos se observa que la valoraci&#243;n de la TC en Atenci&#243;n Primaria es mayoritariamente positiva<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>&#46; No obstante&#44; esta nueva realidad asistencial merece un an&#225;lisis m&#225;s detallado de todos los &#225;mbitos que abarca&#58; sanitario&#44; social&#44; organizativo&#44; econ&#243;mico&#44; legal y &#233;tico&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La principal barrera que presenta la telemedicina es la problem&#225;tica relacionada con la conectividad &#40;acceso a dispositivos&#44; conocimiento en telecomunicaciones&#44; calidad de conexi&#243;n&#44; etc&#46;&#41;&#44; tanto por parte de los pacientes como de los profesionales<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a>&#46; Tiene dificultades en la relaci&#243;n entre profesional y paciente por la ausencia de contacto f&#237;sico&#44; que desaf&#237;a tanto la capacidad comunicativa del profesional en cuanto a la interpretaci&#243;n adecuada de la demanda asistencial<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a>&#44; como la transmisi&#243;n de la informaci&#243;n m&#233;dica de forma comprensible y tranquilizadora para el paciente<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En cuanto al aspecto econ&#243;mico&#44; no hay evidencia del coste-efectividad de la TC en Atenci&#243;n Primaria respecto a la visita presencial<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;10</span></a>&#46; Sin embargo&#44; para el paciente s&#237; implica un ahorro en cuanto a desplazamientos y organizaci&#243;n laboral que influye en su valoraci&#243;n positiva de la TC<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;7&#44;10&#44;11</span></a>&#46; Resulta interesante destacar que&#44; pese a que la TC suele demorarse menos que la atenci&#243;n presencial&#44; se pone en duda que el tiempo total invertido sea menor debido a posibles problemas t&#233;cnicos o un mayor n&#250;mero de visitas de seguimiento o de urgencias posteriores<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a la accesibilidad&#44; se ha puesto de manifiesto la paradoja de que la introducci&#243;n de la atenci&#243;n telem&#225;tica en la atenci&#243;n primaria no ha supuesto una mejor&#237;a en la eficiencia de la asistencia dado que el aumento de accesibilidad ha provocado un aumento de demanda y&#44; por lo tanto&#44; no ha disminuido el tiempo de demora para ser atendido ni el volumen de trabajo de los profesionales sanitarios<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La telemedicina abre un nuevo escenario de inequidad social en la accesibilidad a la asistencia sanitaria en lo que respecta al acceso a la formaci&#243;n tecnol&#243;gica necesaria para llevarla a cabo o al poder econ&#243;mico necesario para la adquisici&#243;n del material&#46; Una prueba que ilustra dicha desigualdad es el hecho de que la poblaci&#243;n joven realiza un mayor uso de la TC<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tambi&#233;n aparecen nuevos retos en cuanto a la confidencialidad y la seguridad del paciente en lo que se refiere a la transmisi&#243;n de informaci&#243;n&#44; tanto por escrito &#40;protecci&#243;n de datos&#41; como oral<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7&#44;10</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En la revisi&#243;n bibliogr&#225;fica se observa que la TC tiene un papel leg&#237;timo en la Atenci&#243;n Primaria siempre y cuando sea complementaria a la atenci&#243;n presencial<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">4&#44;13&#44;14</span></a>&#46; Una vez normalizada la situaci&#243;n epidemiol&#243;gica&#44; el objetivo de la Atenci&#243;n Primaria no deber&#237;a ser frenar el uso de la TC por las dificultades planteadas&#44; sino identificar qu&#233; aspectos se deben trabajar para garantizar su uso &#243;ptimo<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Por todo esto&#44; nos planteamos conocer la valoraci&#243;n de usuarios y profesionales sanitarios sobre la TC en el &#225;mbito de la Atenci&#243;n Primaria&#44; incluyendo la atenci&#243;n a trav&#233;s de consulta telef&#243;nica y la e-consulta&#44; chat accesible a trav&#233;s de la aplicaci&#243;n de La Meva Salut del Servei Catal&#224; de la Salut&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio es describir&#44; mediante una encuesta&#44; el grado de satisfacci&#243;n global con la TC seg&#250;n el motivo de consulta&#44; la satisfacci&#243;n con las diversas caracter&#237;sticas inherentes a la TC y las preferencias de uso de la TC en el futuro&#44; por parte tanto de usuarios como de profesionales&#46; Asimismo&#44; analizar si existen diferencias en la valoraci&#243;n y preferencias entre usuarios y profesionales&#44; y seg&#250;n diferentes caracter&#237;sticas sociodemogr&#225;ficas de los usuarios&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Material y m&#233;todos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se trata de un estudio transversal mediante administraci&#243;n de un cuestionario ad hoc durante el &#250;ltimo trimestre de 2021 en el &#225;mbito de la Atenci&#243;n Primaria&#46; Se obtuvo informaci&#243;n de 2<span class="elsevierStyleHsp" style=""></span>poblaciones&#58; los usuarios asignados a los equipos de Atenci&#243;n Primaria de El Carmel y Bon Pastor&#44; del Instituto Catal&#225;n de la Salud de Barcelona ciudad&#44; que atienden una poblaci&#243;n de 31&#46;974 personas&#44; y los profesionales de Medicina de Familia y Enfermer&#237;a de dichos equipos&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se estim&#243; el tama&#241;o de la muestra de usuarios en 300 pacientes&#44; tomando como referencia una proporci&#243;n esperada del 75&#37; o superior de satisfacci&#243;n con la TC&#44; atendiendo a la bibliograf&#237;a revisada<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a>&#46; Se incluy&#243; a aquellos que hab&#237;an tenido alguna consulta telef&#243;nica o e-consulta en el &#250;ltimo a&#241;o a partir de datos de la historia cl&#237;nica informatizada&#44; excluyendo a los menores de 18 a&#241;os&#44; aquellos con deterioro cognitivo diagnosticado o hipoacusia severa&#46; Se aleatoriz&#243; la poblaci&#243;n resultante&#44; estratificada por edad y sexo&#44; y se realiz&#243; la entrevista telef&#243;nica a los usuarios de la lista de forma consecutiva&#44; respetando el orden aleatorio&#44; hasta conseguir el tama&#241;o de muestra final&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Respecto a los profesionales de medicina y Enfermer&#237;a&#44; se facilit&#243; la encuesta a todos los que trabajaban en los centros participantes&#46; De un total de 64 profesionales se obtuvieron 48 respuestas &#40;tasa de respuesta del 75&#37;&#41;&#44; siendo las p&#233;rdidas por ausencia debida a incapacidad temporal o vacaciones&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A los usuarios se les administr&#243; el cuestionario por v&#237;a telef&#243;nica&#44; solicitando su consentimiento oral&#44; y a los profesionales sanitarios&#44; presencialmente&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El cuestionario fue dise&#241;ado ad hoc&#44; bas&#225;ndonos en la literatura y adapt&#225;ndolo a los objetivos&#44; y &#250;nicamente en lengua espa&#241;ola&#46; Se realiz&#243; un pilotaje inicial donde se evalu&#243; la validez de contenido por parte de diversos profesionales sanitarios y usuarios no sanitarios&#44; valorando el contenido y la comprensi&#243;n&#44; si las preguntas estaban redactadas de forma clara y la facilidad de cumplimentaci&#243;n&#46; Los entrevistadores&#44; que fueron los propios investigadores&#44; consensuaron y estandarizaron la forma de pasar la entrevista y las explicaciones que se daban&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El cuestionario ten&#237;a una parte com&#250;n de valoraci&#243;n de la TC seg&#250;n motivos de consulta y perspectivas de futuro&#44; y preguntas espec&#237;ficas seg&#250;n fueran usuarios o profesionales&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Las principales variables comunes fueron&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Valoraci&#243;n global de la TC &#40;escala Likert&#44; de 1 a 5&#58; muy negativamente&#44; negativamente&#44; neutral&#44; positivamente&#44; muy positivamente&#41; seg&#250;n el motivo de consulta &#40;incapacidad temporal &#91;IT&#93;&#44; receta electr&#243;nica &#91;RE&#93;&#44; patolog&#237;a cr&#243;nica &#91;PC&#93;&#44; patolog&#237;a aguda &#91;PA&#93; y COVID-19&#41;&#46; Para el an&#225;lisis se agrupan las categor&#237;as de muy negativo y negativo&#44; y las de muy positivo y positivo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Preferencias de atenci&#243;n de cara al futuro&#58; visita presencial o TC &#40;telef&#243;nica o e-consulta&#41; seg&#250;n los motivos de consulta antes citados&#46;</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">Se contextualizaron los conceptos de enfermedad aguda y cr&#243;nica durante la encuesta mediante ejemplos de situaciones cl&#237;nicas habituales&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Tambi&#233;n se incluyeron variables sobre las caracter&#237;sticas de la TC&#58; la valoraci&#243;n de la relaci&#243;n entre profesional y paciente&#44; y la valoraci&#243;n de los aspectos &#233;tico-legales y de gesti&#243;n&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Se recogieron a su vez variables sociodemogr&#225;ficas&#58; edad&#44; sexo&#44; nivel de dominio de tecnolog&#237;as seg&#250;n el uso habitual de dispositivos electr&#243;nicos&#44; pa&#237;s de origen&#44; nivel de estudios y salud percibida en usuarios y especialidad en profesionales&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0120" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo y de comparaci&#243;n de proporciones mediante la prueba de la chi al cuadrado entre grupos &#40;profesional&#47;usuario&#44; edad&#44; sexo&#41;&#44; teniendo en cuenta todas las partes de la encuesta&#46; Las variables de tipo Likert de valoraci&#243;n global de TC seg&#250;n motivos fueron tratadas tambi&#233;n como variables num&#233;ricas&#46; Para la comparaci&#243;n de medias en las escalas Likert se utiliz&#243; la prueba no param&#233;trica de U de Mann-Whitney&#46; Se estableci&#243; un nivel de significaci&#243;n de 5&#37;&#46; Todos los an&#225;lisis estad&#237;sticos se realizaron con el programa estad&#237;stico IBM SPSS versi&#243;n 23&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; EE&#46; UU&#46;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Aspectos &#233;ticos</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se obtuvo la aprobaci&#243;n del comit&#233; &#233;tico del IDIAP Jordi Gol &#40;c&#243;digo 21&#47;191-P&#41; y el consentimiento informado de los participantes&#46;<elsevierMultimedia ident="fig0005"></elsevierMultimedia></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0130" class="elsevierStylePara elsevierViewall">Respondieron a la encuesta 300 usuarios &#40;52&#37; mujeres&#41; y 48 profesionales&#44; 25 de Enfermer&#237;a y 23 de Medicina &#40;71&#37; mujeres&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El recurso de TC m&#225;s utilizado por los usuarios durante el a&#241;o previo fue el telef&#243;nico &#40;83&#37;&#41;&#46; Las caracter&#237;sticas sociodemogr&#225;ficas de las 2<span class="elsevierStyleHsp" style=""></span>muestras pueden verse en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Tal y como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; pacientes y profesionales valoraron positivamente la TC para gestionar la RE &#40;el 83 y el 82&#37;&#44; respectivamente&#41;&#44; la IT &#40;el 80 y el 64&#37;&#41; y cuestiones relacionadas con la COVID-19 &#40;el 71 y el 58&#37;&#41;&#46; La valoraron con menos frecuencia de forma positiva para tratar las enfermedades agudas &#40;el 47 y el 25&#37;&#41; y cr&#243;nicas &#40;el 49 y el 33&#37;&#41;&#46; Globalmente los profesionales valoraron peor la TC que los usuarios&#44; excepto para la RE&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra las diferencias en la valoraci&#243;n de la TC seg&#250;n caracter&#237;sticas sociodemogr&#225;ficas&#46; Los usuarios menores de 70 a&#241;os valoraron mejor la TC respecto a los mayores &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; sin diferencias entre sexos&#46; Expresar un buen nivel de dominio de tecnolog&#237;as tambi&#233;n se asoci&#243; a una mejor valoraci&#243;n&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra las preferencias de cara al futuro&#46; Profesionales y usuarios prefieren una visita presencial de entrada para el manejo de enfermedades cr&#243;nicas &#40;el 83 y el 82&#37;&#41; y agudas &#40;el 94 y el 82&#37;&#41;&#46; Para la RE&#44; profesionales y pacientes prefieren la TC&#44; y para la IT un 52&#37; de usuarios prefieren presencial respecto al 29&#37; de los profesionales&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Analizando las preferencias de futuro de los usuarios seg&#250;n caracter&#237;sticas sociodemogr&#225;ficas &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#44; los m&#225;s j&#243;venes y con mejor manejo de la tecnolog&#237;a optan por la TC respecto a los mayores o con menor dominio de tecnolog&#237;as&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Finalmente&#44; la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a> muestra la valoraci&#243;n de algunas caracter&#237;sticas del proceso de la TC&#46; Los usuarios valoran mejor que los profesionales la intimidad y confianza generados en la TC y globalmente se considera una herramienta eficiente que ahorra tiempo&#46; Los profesionales expresan la necesidad de m&#225;s formaci&#243;n en competencias comunicativas&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los resultados del estudio ponen de manifiesto 2<span class="elsevierStyleHsp" style=""></span>realidades contrapuestas que conviven en los centros de Atenci&#243;n Primaria estudiados&#46; Por un lado&#44; la TC se ha implementado con una buena valoraci&#243;n general&#44; tanto por parte de los usuarios como de los profesionales en el per&#237;odo que abarca estudio y&#44; por el otro&#44; muestran que de cara al futuro la visita presencial es la preferida para la enfermedad cr&#243;nica y aguda&#44; especialmente en los usuarios mayores de 70 a&#241;os&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En l&#237;nea con lo descrito por Solans et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&#44; el perfil de usuario que valor&#243; mejor la TC corresponde a una persona joven&#44; laboralmente activa&#44; con buen dominio tecnol&#243;gico y con poca complejidad asistencial&#46; En cambio&#44; a mayor edad y mayor complejidad asistencial&#44; mayor preferencia por la presencialidad&#46; En ese mismo sentido&#44; los resultados de un estudio transversal a 253 personas mediante cuestionario de satisfacci&#243;n con escala Likert del &#225;mbito de la Atenci&#243;n Primaria en Portugal realizado por Gomes-de Almeida<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> sugiere que&#44; a m&#225;s edad&#44; menos satisfacci&#243;n e inter&#233;s en nuevas TC&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No obstante&#44; tal y como apuntan Molt&#243;-Puigmart&#237; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> y Carrillo de Albornoz<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> en sendas revisiones sistem&#225;ticas&#44; cuando se cumplen las condiciones &#243;ptimas en cuanto al perfil de usuario y a la tarea asistencial&#44; la TC puede suponer la v&#237;a m&#225;s eficiente&#44; justificando as&#237; que se impulse como nueva v&#237;a asistencial&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En este estudio&#44; para la renovaci&#243;n de la receta electr&#243;nica o la revisi&#243;n de una incapacidad temporal&#44; la TC es la preferida en la actualidad y de cara al futuro&#44; sobre todo entre los m&#225;s j&#243;venes&#46; El nivel de dominio de las nuevas tecnolog&#237;as es claramente un factor determinante en las valoraciones y est&#225; estrechamente relacionado con la edad de los usuarios estudiados&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Se puede deducir que la TC&#44; que present&#243; un auge exponencial como v&#237;a asistencial en respuesta a la situaci&#243;n de pandemia&#44; se puede considerar como herramienta &#250;til y eficiente tambi&#233;n en situaci&#243;n de normalidad epidemiol&#243;gica siempre y cuando no suponga una amenaza para la precisi&#243;n diagn&#243;stica&#44; la elecci&#243;n del tratamiento&#44; la buena comunicaci&#243;n entre profesional y usuario&#47;a o la confidencialidad&#44; tal y como mencionan Jim&#233;nez Carrillo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> en un estudio cualitativo basado en entrevistas a 62 personas de Navarra y Euskadi&#44; subrayando la importancia de que la no presencialidad puede repercutir en la calidad asistencial&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Por tanto&#44; nuestros datos corroboran que la aplicaci&#243;n de la TC no debe ser indiscriminada y prevalece establecer en cada centro de Atenci&#243;n Primaria&#44; seg&#250;n las caracter&#237;sticas de la poblaci&#243;n&#44; en qu&#233; escenarios cl&#237;nicos se considera la herramienta asistencial m&#225;s adecuada<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8&#44;10&#44;13</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En el mismo sentido&#44; en el &#225;mbito hospitalario tambi&#233;n hay estudios que han evaluado la satisfacci&#243;n de la TC del usuario con resultados similares a los nuestros en cuanto a las gestiones asistenciales mejor valoradas &#40;citando el art&#237;culo&#58; &#171;para realizar un seguimiento&#44; dar un resultado&#44; gestionar citas&#44; siempre que no se requiere explorar al paciente o hacer alguna prueba renovar el tratamiento en casos leves y para recetar&#187;&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Una clara limitaci&#243;n de nuestro estudio ata&#241;e a un posible sesgo de selecci&#243;n&#44; dado que solo se interrog&#243; a qui&#233;n pudo atender y llevar a cabo una conversaci&#243;n telef&#243;nica en el momento de la recogida de datos&#46; Asimismo&#44; fueron excluidos los usuarios sin TC en el a&#241;o previo&#44; para obtener opiniones basadas en experiencias reales&#44; La mayor&#237;a de los usuarios atendidos en ese periodo&#44; sin embargo&#44; tuvieron contacto con la TC&#44; afectando poco a la representatividad del estudio&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">La poblaci&#243;n con dificultades en la comunicaci&#243;n est&#225; infrarrepresentada en este estudio&#44; siendo una limitaci&#243;n habitual en encuestas por v&#237;a telef&#243;nica&#46; La hipoacusia&#44; frecuente en las personas de edad m&#225;s avanzada&#44; supone un criterio de exclusi&#243;n&#46; Conviene puntualizar que se utiliz&#243; la estratificaci&#243;n por edad para asegurar un m&#237;nimo de respuestas de todos los grupos etarios&#44; incluyendo los mayores de 70 a&#241;os&#44; que podr&#237;an de otra manera quedar infrarrepresentados por problemas de comunicaci&#243;n&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En la misma l&#237;nea&#44; la poblaci&#243;n migrante con barrera idiom&#225;tica puede presentar mayores dificultades de comprensi&#243;n ling&#252;&#237;stica para responder la encuesta por v&#237;a telef&#243;nica&#46; Cabe decir que no hubo ninguna exclusi&#243;n por este motivo&#44; ya que la poblaci&#243;n migrante sin conocimiento de la lengua espa&#241;ola tiene poca representaci&#243;n en la poblaci&#243;n de ambos barrios&#46; Ser&#237;an necesarios dise&#241;os m&#225;s espec&#237;ficos para abordar el estudio de estas situaciones de barrera idiom&#225;tica y cultural en las interacciones sanitario-paciente&#44; tanto en contextos presenciales como de telemedicina&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Por otra parte&#44; el sesgo de memoria tambi&#233;n pudo haber condicionado las respuestas relacionadas con TC realizadas en el &#250;ltimo a&#241;o&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Tampoco podemos olvidar que las encuestas se realizaron en un momento influido por la pandemia por COVID-19&#44; en el &#250;ltimo trimestre de 2021&#44; en el que la consulta presencial segu&#237;a estando limitada&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; la muestra analizada procede de un &#225;rea demogr&#225;fica urbana de Barcelona con un nivel socioecon&#243;mico medio-bajo&#44; pudiendo afectar la validez externa del estudio&#46; Sin embargo&#44; al haber seleccionado la muestra estratificada por grupos de edad y sexo&#44; hay representaci&#243;n suficiente de participantes con diferentes niveles de estudios y conocimientos tecnol&#243;gicos&#44; lo que hace la extrapolaci&#243;n m&#225;s factible&#46; En otros entornos m&#225;s rurales y dispersos geogr&#225;ficamente&#44; por otro lado&#44; la TC puede ofrecer ventajas que en este estudio no se pueden valorar&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">As&#237; pues&#44; se deber&#237;an llevar a cabo estudios con una muestra m&#225;s amplia y heterog&#233;nea permitiendo la extrapolaci&#243;n de los resultados a la poblaci&#243;n general&#46; Esto ser&#237;a especialmente &#250;til de cara a establecer protocolos sanitarios aplicables al territorio&#44; siempre y cuando se obtuvieran resultados concluyentes que pudieran transformarse en ajustes favorables para una mejor gesti&#243;n del d&#237;a a d&#237;a de la Atenci&#243;n Primaria&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Consideraciones &#233;ticas</span><p id="par0235" class="elsevierStylePara elsevierViewall">Este estudio fue aprobado el 28 de julio de 2021 por el CEI IDIAP Jordi Gol con el c&#243;digo 21&#47;191-P&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0285" class="elsevierStylePara elsevierViewall">La investigaci&#243;n no recibi&#243; ning&#250;n tipo de apoyo financiero&#46; Se ha recibido una ayuda de la Gerencia de Atenci&#243;n Primaria y la Comunidad de Barcelona Ciudad del Institut Catal&#224; de la Salut para financiar los gastos de publicaci&#243;n&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicto de intereses</span><p id="par0290" class="elsevierStylePara elsevierViewall">Los autores no refieren ning&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conocer la valoraci&#243;n y preferencias de usuarios y profesionales sanitarios sobre la teleconsulta en Atenci&#243;n Primaria&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal mediante encuesta&#44; telef&#243;nica a usuarios y presencial a profesionales&#44; en 2021&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Emplazamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Atenci&#243;n Primara urbana&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Sujetos</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Muestra aleatoria de usuarios con teleconsultas en el &#250;ltimo a&#241;o&#44; estratificados por sexo y edad&#44; y m&#233;dicos y enfermeros de los centros participantes&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Mediciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Variables Likert valorando la teleconsulta seg&#250;n motivos de consulta&#44; preferencias y aspectos relacionados&#46; An&#225;lisis descriptivo y comparaci&#243;n de proporciones y medias&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Responden 300 pacientes y 48 profesionales&#46; Ambos valoran positivamente la teleconsulta para gestionar la receta electr&#243;nica &#40;RE&#41; &#40;el 83 y el 83&#37;&#44; respectivamente&#41;&#44; la incapacidad temporal &#40;IT&#41; &#40;el 80 y el 64&#37;&#41; y cuestiones relacionadas con la COVID-19 &#40;el 71 y el 58&#37;&#41;&#46; La valoraci&#243;n positiva de la teleconsulta disminuye para el tratamiento de las enfermedades agudas &#40;el 47 y el 25&#37;&#41; y cr&#243;nicas &#40;el 49 y el 33&#37;&#41;&#46; Globalmente las personas &#60;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os valoran mejor la teleconsulta &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; sin diferencias entre sexos&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Usuarios y profesionales prefieren la presencialidad para enfermedades cr&#243;nicas &#40;el 82 y el 83&#37;&#41; y agudas &#40;el 82 y el 94&#37;&#41;&#44; y teleconsulta para RE &#40;el 68&#44;7&#37; y el 88&#44;6&#37;&#41;&#46; El 52&#37; de los usuarios prefieren visita presencial para IT frente al 29&#37; de los profesionales &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La teleconsulta se ha implementado con una buena valoraci&#243;n tanto de pacientes como profesionales&#46; La visita presencial es la preferida para la enfermedad cr&#243;nica y aguda&#44; especialmente en personas mayores&#46; Habr&#225; que definir en qu&#233; casos la teleconsulta es la mejor herramienta seg&#250;n las caracter&#237;sticas de cada poblaci&#243;n&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To evaluate the perceptions and preferences of users and health professionals on teleconsultation in primary care&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study with a telephone survey of users and a face-to-face survey of professionals carried out at 2021&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Urban primary health care&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Participants</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Random sample of users with teleconsultations in the last year&#44; stratified by sex and age&#44; and doctors and nurses from participating centres&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Measurements</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Likert variables assessing teleconsultation according to consultation motives&#44; preferences and related aspects&#46; Descriptive analysis and comparison of proportions and means&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Three hundred patients and 48 professionals answered the questionnaire&#46; Both groups value positively the teleconsultation for the management of the electronic prescription &#40;EP&#41; &#40;83&#37; and 83&#37;&#44; respectively&#41;&#44; sick leave &#40;SL&#41; &#40;80&#37; and 64&#37;&#41; and issues related to COVID-19 &#40;71&#37; and 58&#37;&#41;&#46; The positive assessment of teleconsultation decreases for the treatment of acute pathologies &#40;47&#37; and 25&#37;&#41; and chronic diseases &#40;49&#37; and 33&#37;&#41;&#46; Globally&#44; people &#60;70 years value teleconsultation more highly <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;001&#41;&#44; without differences between sexes&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Users and professionals prefer face-to-face consultation for chronic diseases &#40;82&#37; and 83&#37;&#41; and acute pathologies &#40;82&#37; and 94&#37;&#41;&#44; and teleconsultation for EP &#40;68&#46;7&#37; and 88&#46;6&#37;&#41;&#46; 52&#37; of users prefer face-to-face visits for SL compared to 29&#37; of professionals <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Teleconsultation implementation has been well valued by both patients and professionals&#46; The face-to-face visit is preferred for chronic and acute pathologies&#44; especially in the elderly&#46; It will be necessary to define in which cases teleconsultation is the best tool according to the characteristics of each population&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Usuarios&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">155 &#40;51&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#44;4 &#40;20&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45&#44;5 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>18-39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92 &#40;30&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;29&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40-69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;35&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;70&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>70&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">103 &#40;34&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel de estudios</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">123 &#40;41&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secundarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">116 &#40;38&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superiores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Espa&#241;ola&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Europea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Am&#233;rica latina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel dominio tecnolog&#237;as</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muy bajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Situaci&#243;n laboral</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabaja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pensionista&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Profesi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medicina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;52&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Salud percibida</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;12&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87 &#40;29&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Buena&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">148 &#40;49&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muy buena&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recurso m&#225;s utilizado en el &#250;ltimo a&#241;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Telef&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;83&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>E-consulta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;17&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            "detalle" => "Tabla "
            "rol" => "short"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Usuarios&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Profesionales&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Incapacidad temporal</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;11&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neutral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;8&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;31&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141 &#40;79&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;63&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Receta electr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;11&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neutral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;13&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">224 &#40;82&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;82&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Patolog&#237;a cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;32&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;31&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;35&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">117 &#40;49&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;33&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neutral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10 &#40;20&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Positivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>255&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5 &#40;10&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neutral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">15 &#40;31&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Positivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">181 &#40;71&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">28 &#40;58&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COVID-19Media &#40;DE&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;16 &#40;1&#44;09&#41;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;65 &#40;1&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel de estudios</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Secundarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Superiores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Profesionales</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ha sido f&#225;cil contactar con el paciente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">39&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Representa una herramienta eficiente en tiempo y recursos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Permite realizar las distintas fases de una entrevista cl&#237;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Permite comunicar correctamente el plan de tratamiento y el seguimiento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">45&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Permite un buen manejo de la incertidumbre&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#191;Consideras que tienes suficientes habilidades comunicativas para llevar a cabo una teleconsulta &#40;visita telef&#243;nica&#47;e-consulta&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">66&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#191;Te gustar&#237;a recibir m&#225;s formaci&#243;n para mejorar tus competencias comunicativas en el &#225;mbito de la teleconsulta&#63;&nbsp;\t\t\t\t\t\t\n
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Lo conocido sobre el tema</span><p id="par0240" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0245" class="elsevierStylePara elsevierViewall">En &#233;poca prepand&#233;mica&#44; la investigaci&#243;n en telemedicina ten&#237;a como misi&#243;n optimizar los sistemas de informaci&#243;n&#44; seguridad del paciente y protecci&#243;n de datos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0250" class="elsevierStylePara elsevierViewall">No existen evidencias robustas sobre el coste-efectividad de la teleconsulta en Atenci&#243;n Primaria respecto a la visita presencial&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0255" class="elsevierStylePara elsevierViewall">La teleconsulta permite mejorar el acceso a la asistencia sanitaria en &#225;reas rurales&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Qu&#233; aporta este estudio</span><p id="par0260" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0265" class="elsevierStylePara elsevierViewall">La teleconsulta tiene una valoraci&#243;n globalmente positiva por parte de los usuarios y de los profesionales sanitarios encuestados&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0270" class="elsevierStylePara elsevierViewall">Seg&#250;n los usuarios&#44; la teleconsulta permite respetar la intimidad del usuario&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0275" class="elsevierStylePara elsevierViewall">Los profesionales consideran que no permite realizar una entrevista cl&#237;nica &#243;ptima&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0280" class="elsevierStylePara elsevierViewall">Independientemente de la edad&#44; tanto usuarios como profesionales prefieren la visita presencial para el manejo de la enfermedad cr&#243;nica y aguda&#46;</p></li></ul></p></span></span>"
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                            2 => "F&#46; Santos Guerra"
                            3 => "R&#46; Ares-Rico"
                            4 => "R&#46; Su&#225;rez-Gil"
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                          "etal" => true
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                            2 => "L&#46; Middleton"
                            3 => "J&#46; Kennedy"
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                            5 => "L&#46; Russell"
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                    0 => array:1 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Effectiveness of interventions based on telemedicine on health outcomes in patients with multimorbidity in Primary Care&#58; A systematic review"
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                            0 => "B&#46; Pascual-de la Pisa"
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                      "doi" => "10.1016/j.aprim.2019.08.004"
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                            4 => "G&#46; Battineni"
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es en pt

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