Introduction: Remote consultations in general practice can be very useful form of telemedicine, which is basically a way to exchange medical information to improve the clinical health of patients when the patient and their general practitioner (GP) are not on the same place at the same time. This concept was developed in the 1980s to provide health care to patients who lived in remote areas. Methods: We were interested in researching what kind of remote consultations are available in general practice and what is the usage of these methods. We used four keywords – remote consultation and general practice or family medicine or primary care – and we searched in four different scientific databases: Medline–PubMed, Scopus, Web of Science and IEEX Xplore. Results: We used a PRISMA diagram to identify studies and search the four main databases, we investigated 48 full text articles and when we applied our inclusion and exclusion criteria, 12 studies were included in this systematic review. Conclusions: This systematic review covers the topics of remote consultation versus a traditional or classic physical consultation. Studies have shown its importance prior to the COVID-19 pandemic, and its value while in the mist of the pandemic then caring for infected patients. We have found that remote consultation is necessary, but it must be an improvement on the previous system. Teleconsultations can reduce the number of visits, especially during lockdown situations, with both patients and GPs satisfied with the method, but we should not forget that a physical consultation cannot be fully replaced by a remote consultation due to the limitations of the latter.

Purpose: Heart rhythm disorders (HRD) are often present in patients visiting their family physician (FP). Dealing with their problems is not always simple, efficient and cost effective. The aim of this paper is to review the existing literature about the use and experience of telecardiology in patients experiencing HRD. Methods: We conducted a review of literature in PubMed biographical databases (MeSH thesaurus), Web of Science and Cochrane, between 1995 and 2019. We included original articles in English that describe the use of telecardiology at primary and secondary healthcare levels. Exclusion criteria are those publications that discuss heart failure or observation of the activity of pacemakers or defibrillators and the age of patients under 18 years. A total of 19 papers met the inclusion criteria, thirteen of them were original scientific articles and we included them in the analysis. Results: Use of telemedicine can shorten the time from diagnosis to the necessary treatment (2/13), telemedicine can reduce mortality in patients with acute myocardial infarction (4/13), it can shorten the time to diagnose atrial fibrillations (4/13), it can help determine the diagnosis for patients complaining about heart rhythm disorders which were not detected on the standard ECG recording (2/13) and can also help identify cardiac causes for syncope or collapse (2/13). All studies have confirmed that the use of telecardiology significantly reduces the number of unnecessary referrals to a cardiologist or hospitalization, and shortens the time needed to treat patients with life-threatening conditions. Conclusion: The use of telecardiological techniques increases the quality and safety of work in managing patients with cardiovascular disease in FP practice. Usage of telecardiologic devices can also save money and bridge the gap between the primary and secondary healthcare levels.

Introduction: The Jozef Stefan Institute developed a personal portable electrocardiogram (ECG) sensor Savvy that works with a smartphone, and this was used in our study. This study aimed to analyze the usefulness of telecardiology at the primary healthcare level using an ECG personal sensor. Methods: We included 400 patients with a history of suspected rhythm disturbance who visited their family physician at the Healthcare Center Ljubljana and Healthcare Center Murska Sobota from October 2016 to January 2018. Results: The study found that there was no statistically significant difference between the test and control groups in the number of present rhythm disorders and actions taken to treat patients with either observation or administration of a new drug. However, in the test group, there were significantly fewer patients being referred to a cardiologist than in the control group (p < 0.001). Discussion: The use of an ECG sensor helps family physicians to distinguish between patients who need to be referred to a cardiologist and those who can be treated by them. This method is useful for both physicians and patients because it shortens the time taken to start treatment, can be used during pandemics such as COVID-19, and reduces unnecessary cost.

Background: Palpitations are one of most common reasons why a patient visits a general practitioner (GP) and is referred to a cardiologist. Coronavirus disease 2019 (COVID-19) has been associated with new-onset arrhythmias, which are difficult to diagnose at the primary healthcare level during pandemic-related lockdown periods. Methods: A total of 151 patients with a complaint of heart rhythm disorder were included from before and during the COVID-19 pandemic, as well as after the start of vaccination, in this cohort retrospective study. We used a telemedical device—namely, a personal electrocardiographic (ECG) sensor called Savvy—to investigate heart rhythm in patients. The primary outcome of the study was to evaluate the number of actual heart rhythm disorder patients and any differences that infection with or vaccination for COVID-19 had on patients handled in a primary healthcare setting. Results: We found a heart rhythm disorder in 8.6% of patients before the COVID-19 pandemic and in 15.2–17.9% of patients during the COVID-19 pandemic, where the difference was statistically significant (p = 0.002). During the COVID-19 pandemic, we found a heart rhythm disorder in almost 50% of patients that had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) more than one month ago. After the vaccinations started, we also found a heart rhythm disorder in almost 50% of non-vaccinated patients. Conclusions: Using a telemedical approach or remote consultation is a useful method, at the primary healthcare level, for diagnosing and treating patients with palpitations during times of lockdown.

BACKGROUND Heart rhythm disorders affect millions of people annually. The diagnosis usually depends on the electrocardiogram (ECG) record, but a single record does not necessarily reflect the real situation. Continuous methods are rarely accessible at the primary healthcare level. Considering the severity and costs of the diagnostic approach, a cheaper, but reliable, continuous monitoring system for heart rhythm disorders is needed. OBJECTIVE The goal was to analyse the usefulness of telecardiology in the primary health care level. With the help of a patient's history of rhythm disturbance and an ECG scan using an ECG personal sensor (ECG PS), we wanted to evaluate the satisfaction of patients and their physicians with the use of an ECG sensor treatment at the primary level. We also wanted to evaluate the cost-effectiveness of this tool at the primary level and develop a clinical pathway for treating patients with rhythm disorders at the primary health care level. METHODS The Jožef Stefan Institute developed a personal portable ECG sensor that works with a smartphone, which was used in our pilot study. We included patients with a history of suspected rhythm disturbance who visited their family physician at the Healthcare Center Ljubljana and Healthcare Center Murska Sobota from October 2016 to January 2018. RESULTS After the ECG sensor measurement and first checkup at a family physician, the study found that there was no statistical significant difference in the number of present rhythm disorders and actions taken to treat patients with either observation or administration of a new drug. However, there was a statistically significant difference in the number of patients being referred to a cardiologist (p < 0.001). CONCLUSIONS The use of an ECG sensor allows family physicians to confirm an accurate diagnosis and helps them distinguish between patients who need to be referred to a cardiologist as soon as possible and those who can be treated by primary healthcare providers. This method is also readily applicable and useful for both physicians and patients because it shortens the time in starting the treatment and reduces unnecessary cost.

Rationale: Ataxia is defined as an impaired coordination of voluntary muscle movement. In cases of slowly progressing ataxia in young people, we should first consider a genetic origin. Herein, we describe the case of a 25-year-old patient with severe and advanced neurological disease which was diagnosed and treated by a family medicine physician, leading to the discovery of a new form of hereditary ataxia. Patient concerns: In 2016, a 25-year-old professional driver arrived at our family medicine office with a gait disorder that he had been struggling with for the past 5 years. During clinical examination, gait ataxia was evident. In 2018, the patient returned to our family medicine office, with difficulty in speaking and could no longer retain urine. During the examination, he was not oriented in time and space, no longer recognized the staff, and responded only in a few words. Clinically, we observed postural and action tremors, bradykinesia, and increased muscle tone. Diagnoses: The patient was sent to a neurologist for further management. There, a magnetic resonance imaging scan of the head was prescribed, leading to a diagnosis of adrenoleukodystrophy; however, genetic testing and biochemical analysis performed in 2016 did not confirm that. With additional testing in 2018, we confirmed a hereditary mitochondrial leukoencephalopathy (the identified version c.2884C>T in the AARS2 gene has not been previously reported as a pathogen in relation to human diseases). Interventions: Unfortunately, no specific treatment is available, therefore, the reluctance of neurologists to provide treatment is understandable. Family medicine doctors are long-term companions to patients and are sometimes the only support for them and their families when it comes to such an incurable disease. Outcomes: Currently, the patient only needs palliative care. The diagnostic path was completed but no specific therapy is in view. Lessons: Our case shows a 25-year-old patient with severe and advanced neurological disease diagnosed and treated by a family medicine physician. Family doctors play an important role due to their long-term relationship with the patient and the comprehensive care they provide, even in cases where the disease is severe, and the prognosis is unfavorable.