MO241TELEMEDICINE : COVID -19 PANDEMIC AND THE RISE OF THE VIRTUAL CARE IN NEPHROLOGY IN SPAIN
Authors: De Teresa Alguacil Javier , Pereira Pérez Elisa , Osorio Moratalla José Manuel , Osuna Ortega Antonio 
Published: May 2021

Abstract

Background and Aims
The coronavirus disease 2019 (COVID-19) pandemic, has required a rapid and drastic transformation of health systems worldwide, and consequently also of Spanish Nephrology Units, to respond to the critical situation. The adaptation and transformation of nephrology services during the COVID-19 pandemic in Spain was a urgent need. During this period is worth noting that outpatient nephrology consultations were carried out largely virtually. In conclusion, the pandemic has clearly impacted clinical activity in Spanish Nephrology departments including ours at Virgen de las Nieves University hospital (Granada), reducing elective activity.

Method
At the beginning of the pandemic, we quickly adapted by designing an outpatient healthcare model adapted to the situation. With a virtual model we established direct communication via online almost in "real time" between primary care and our Nephrology Service consultation, avoiding unnecessary travel of patients and relatives, risk exposures to interpersonal and reducing the cost and the public crowds in the hospital. Based on inter-consultation criteria adapted to the guidelines and consensus documents of different societies, we established a new intercommunication system between Primary Care Physicians and external nephrology consultations, to FILTER consultations that did not require unnecessary exposures and reducing the cost of healthcare and the waiting time among others.
Between June 2020 and December 2021, we received 372 cases referred from Primary Care for a first virtual assessment in the high-resolution nephrology clinic, clinical recommendations were effectively issued regarding complementary tests, treatment … and the need to refer to our Nephrology outpatient clinic for study and follow-up or not.

Results
Of the 372 patients evaluated VIRTUALLY, 38 were referred by Acute Kidney Injury (AKI) of which 35 were discharged with follow-up by their Primary Care Physician, 37 patients were referred by eGFR &lt;30 ml / min / 1.73m2 being discharged 29, 66 patients were referred by eGFR between 30-60 ml / min / 1.73m2, being discharged 51 , 15 had Albumin / creatinine ratio (ACR ) between 30-300 mg / gr discharging 100%, 22 cases were consulted for ultrasound renal abnormalities and 18 of them were discharged, 5 were referred for apparently non-urological hematuria, not requiring nephrological follow-up in any case, the reason for referral "other causes" had n = 102 of which the main reason was "loss of an appointment in consultation during the pandemic", nephrectomy, kidney transplants with decompensation, family history of hereditary kidney disease (PKD, Alport …) without follow up need in n=95 of cases
In Spain the activity of presential care in outpatient Nephrology consultations was suspended in 47% of the services, carrying out activity through telephone calls in 98.9%, that is, in the majority of Spanish hospitals. In 16.5% of the centers, telemedicine was the only form of external clinical visits. In 57% of the centers, outpatient follow-up tests were stopped during the pandemic.

Conclusion
The actual COVID-19 pandemic has demonstrated that a transformation and adaptation plan based on the optimization of resources, the implementation of telemedicine and the reorganization of our healthcare activity is necessary. The activity of presential care in outpatient Nephrology consultations was suspended in 47% of the Spanish Nephrology services(1).
Humanity has demonstrated once again that it is capable of overcoming adversity, readjusting to change. In our virtual consultation, we attended 372 cases of which 288 (66.6%) were discharged with recommendations to their Primary Care Physician. Avoiding costs, unnecessary exposure of patients, relatives and healthcare personnel, giving an almost "real time” response to the patient and avoiding unnecessary travels. A model of care in external consultations that has come to stay in the future.