José Antonio Martin U.- La pandemia de covid-19 está generando una serie de cambios sociales y humanos, así como avances insospechados en muchas áreas de la salud. Estos no se producen solamente en el desarrollo de fármacos, protocolos o vacunas, los cuales quizás sean los más presentes en la información diaria, sino también (y no menos importante) en el modo de interrelación con los pacientes.
Telemedicina y telesalud
Hace muchos años, en 1997, la Organización Mundial de la Salud desarrolló el concepto de “telemedicina”. Esta disciplina hace referencia al suministro de servicios de atención sanitaria llevado a cabo por profesionales sanitarios que utilizan tecnologías de la información y la comunicación en el intercambio de información válida para establecer diagnósticos, prevención y tratamiento de enfermedades. También abarca la formación continua de profesionales en atención a la salud y actividades de investigación y evaluación, con el fin de mejorar la salud de las personas y de sus comunidades. Esta referencia fue el inicio de iniciativas diversas que pretenden acercar los cuidados al paciente y que luego se englobarían en otro concepto, la “telesalud”. Es decir, actividades, servicios y sistemas relacionados con la salud que se llevan a cabo a distancia, mediante las tecnologías de la información y las comunicaciones, con el propósito de promover la salud global, el control de enfermedades y la asistencia sanitaria, así como la educación, gestión e investigación para la salud. Este término incluye a la telemedicina pero también involucra actividades como la capacitación para profesionales de la salud, reuniones administrativas de atención médica y servicios proporcionados por farmacéuticos, trabajadores sociales o fisioterapeutas.
Telefisioterapia
En este último caso, el término “telefisioterapia”, como parte de la telesalud, caracteriza no sólo el desarrollo técnico, sino también un estado mental, una forma de pensar, una actitud y un compromiso para mejorar la atención sanitaria de forma local, regional o mundial empleando las tecnologías de la información y las comunicaciones. Cada vez hay más evidencia científica sobre la aplicación de la telefisioterapia. Los trastornos musculo-esqueléticos son los que tienen un gran impacto en la prestación de asistencia fisioterápica. La telefisioterapia fue válida para muchos trastornos, excepto para alteraciones posturales, donde la puntuación final no fue concluyente con puntuaciones de eficacia de bajas a moderadas.
Ventajas e inconvenientes de la telefisioterapia
Entre las numerosas ventajas que destacan en la telefisioterapia, destacan las siguientes:
- Amplía la capacidad de conectarse con profesionales, independientemente de la distancia o las ubicaciones remotas.
- Disminuye las barreras físicas, los tiempos de espera y los tiempos de trasporte de los usuarios.
- Aumenta la seguridad en personas con problemas de movilidad.
- Aumenta el uso eficiente de los recursos de Salud.
- Mejora la autogestión, con una sociedad menos dependiente de la atención directa en salud.
- Mejora información y autonomía con respecto a la salud personal.
- Reduce ausencias laborales y mejora la eficiencia de las entidades que prestan servicios.
También existen ciertos inconvenientes que deben considerarse en una actividad profesional donde la relación entre el paciente y el fisioterapeuta es muy estrecha. Entre ellos, destacan las siguientes:
- Reduce el contacto humano.
- Convierta al paciente en un usuario.
- Existe una brecha digital en algunos sectores de población y pacientes que dificulta el acceso a la telefisioterapia a ciertos grupos.
- Muchas barreras culturales siguen presentes, sobre todo en sectores más desfavorecidos de la población.
- Las intervenciones se limitan a evaluaciones básicas, recomendaciones y seguimientos.
- La seguridad de los datos, como todo medio electrónico, es discutible.
- Los costes de instalación en términos hardware y software pueden ser elevados.
Al estudiar el balance entre las ventajas y los inconvenientes de la telefisioterapia, se pueden detectar algunas limitaciones en el desarrollo de la misma. Por ejemplo, la tecnología y la falta de soporte pueden limitar la capacidad de proporcionar servicios de forma remota. Por otro lado, existe la incapacidad de proporcionar una gama completa de atención de fisioterapia de forma remota. Por ejemplo, dificultaría técnicas manuales, neurológicas y tecnológicas. Además, la financiación y pago de los servicios prestados de forma remota no está regulada.
Retos de la telefisioterapia
Con todo lo anterior, podemos afirmar que la telefisioterapia tiene todavía muchos retos por delante a los que enfrentarse. Sería importante establecer una regulación de la practica digital, ya que hasta ahora no está desarrollada en términos legales. Para ello, podríamos fijarnos en los países de referencia, que hoy en día son Canadá, Australia o Inglaterra. Estos países tienen modelos de salud muy específicos y competencias muy diversas respecto al modelo español, pero deben ser considerados todavía los modelos mas avanzados en lo que se refiere a la telefisioterapia. Asimismo, es importante recordar la existencia de estándares educativos nacionales de práctica digital dentro del plan de estudios de grado de las carreras de salud, incluida en la fisioterapia. Sabemos que una de cada tres personas en el mundo necesita rehabilitación y, por tanto, fisioterapia en algún momento del curso de su enfermedad o lesión. En definitiva, la telefisioterapia ofrece la posibilidad de prestar servicios evitando riesgos para los fisioterapeutas. Una vez amortizada la inversión tecnológica necesaria, la telefisioterapia supondría un plus de sostenibilidad económica al sistema sanitario y médico, al reducir la presencia en consultas y agilizar las listas de espera, uno de los principales problemas de la sanidad española. Fuente: ElTelemedicina.
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