Factors Associated with the Use of a Teleconsultation System in Brazilian Primary Care

[Assessment of the implementation of an care teleregulation project in a Brazilian capital city]

This study evaluates the degree of implementation (DI) of the Regulates+ Brazil project and analyzes to what extent the variations in implementation influence the results observed in access to specialized appointments in Recife, Pernambuco, Brazil. This is an evaluative research of implementation analysis. A logic model and an analysis and judgment matrix with indicators for evaluating the degree of implementation and the results of the Project were developed and submitted to expert consensus. The data collection was conducted via a semi-structured questionnaire applied to key informants and secondary data extracted from the official documents from Regulates+ Brazil and Brazilian National Regulation System (SISREG), referring to the period from May/2020 to May/2021, which were consolidated and compared with values defined in the matrix. The degree of implementation of the Regulates+ Brazil project in Recife was considered to be implemented (83.7%), as well as the Structure (81.7%) and Methods (84.6%) dimensions. However, most effect indicators underperformed, which, when confronted, were consistent with bottlenecks observed in some components and subcomponents of the Project, such as the performance of professionals in basic health units, which was indicated as incipient, especially regarding follow-up of returned requests. The results suggest that any intervention in Telehealth requires, for its proper implementation, the adequacy of teams and work processes, practices of Continuing Education, as well as a continuous evaluation process, to achieve the expected results, or else it will become another bureaucratization and barrier to access.

Perfil dos teleatendimentos realizados pelo núcleo telessaúde-Pará de 2018 a 2019

Introdução: O Programa Telessaúde desempenha seu papel na assistência à saúde, especialmente nas regiões que não possuem estrutura ou atendimento médico especializado no Brasil No Pará esse núcleo presta assistência aos 144 municípios do estado. Objetivo: Delinear o perfil dos atendimentos realizados no estado do Pará. Métodos: O desenho do estudo foi observacional, retrospectivo e quantitativo, com análise da base de dados do programa. A fonte consultada foi a plataforma do Telessaúde-Pará com as consultorias realizadas entre 2018 e 2019. Resultados: Verificou-se que, nesse período, 208 teleconsultorias foram realizadas. Médicos foram os profissionais que mais as solicitaram. Os especialistas que responderam às solicitações com maior frequência foram médicos de família e comunidade, neurologistas e dermatologistas. As dúvidas mais frequentes foram as relacionadas a tratamento farmacológico e diagnóstico. A utilização de teleconsultorias evitou potenciais encaminhamentos em 76,9% dos casos. Entre os profissionais que utilizaram a plataforma, mais de 90% afirmaram satisfação com o serviço. Conclusões: Os dados demonstram a importância do programa na resolubilidade da Atenção Primária à Saúde, muito embora ainda haja pouca adesão e subutilização pelos usuários.

Uso de tecnologias de telessaúde por médicos do Programa Mais Médicos e fatores associados — Espírito Santo, 2016

Introdução: A telessaúde é uma das estratégias de qualificação da atenção primária. Não há trabalho que analise sua utilização no Programa Mais Médicos. Logo, buscou-se analisar a utilização das ferramentas de telessaúde no Mais Médicos do estado do Espírito Santo, em 2016. Objetivo: Analisar a utilização das ferramentas de telessaúde no Mais Médicos do estado do Espírito Santo em 2016. Métodos: Trata-se de um estudo transversal, com aplicação de questionário estruturado ao total de médicos presente em seminários regionais em telessaúde. A análise incluiu frequência absoluta e relativa e análise bivariada com teste exato de Fisher. Resultados: Como resultado, 211 médicos (48,6% do total de profissionais do Mais Médicos) participaram, na maioria cubanos que atuavam em grande centro urbano com especialização em Medicina de Família e Comunidade. A maior parte (n=130, 61,9%) já havia utilizado algum serviço de telessaúde, mas de forma descontínua, sendo a teleducação o mais utilizado (n=101; 77,7%). Conhecer o Programa Telessaúde Brasil Redes e suas ferramentas e vê-las como relevantes para a melhoria do serviço associou-se a maior uso das tecnologias. A facilidade e o tipo de dispositivo utilizado para acessar a internet não influenciam a utilização do programa. Conclusões: Conclui-se que o conhecimento das ferramentas de telessaúde e a relevância dada a elas pelos profissionais e seu entorno estão mais associados a seu uso que as condições estruturais de trabalho.

National analysis of dental teleconsulting of the Brazilian Telehealth Program

This cross-sectional study nationally evaluated asynchronous dental teleconsulting services offered by the Telehealth Brazil Networks Program, using the 2019 Telehealth Results Monitoring and Evaluation System database and considering Brazilian regional differences. The following teleconsulting variables were collected: dentist's sex and specialty, date/time of question and answer, response time; dental specialty, professional satisfaction, and patient referral. Five Brazilian regions were socioeconomically characterized according to the Human Development Index, estimated population, Gini coefficient, coverage of dental specialty centers, oral health teams in Family Health Strategy, and oral health teams in primary health care (PHC). In total, 2,703 teleconsulting sessions occurred in Brazil in the analyzed period. The Southeast exhibited the highest demand (49.1%). Most dentists were female (60.6%) and were dental surgeons from the Family Health Strategy (61.3%). Most teleconsulting sessions occurred during working hours (85.5%) and questions were answered within 72 hours (66.7%). Level of satisfaction and avoidance of referral yielded rates of 90.9% and 66.8%, respectively, among dentists who answered about these topics. Semiology was the most frequently demanded area in teleconsulting (33.9%). The different demands from the regions reflected regional differences. The most frequently demanded specialties represent the Brazilian PHC scenario. Professionals incorporated teleconsulting into their work routine and most teleconsultants responded within the stipulated timeframe. Professional feedback should be encouraged.

[Incorporation of telehealth in primary healthcare and associated factors in Brazil]

The study aimed to analyze the Brazil Networks Telehealth Program in the context of primary healthcare (PHC) in Brazil and to identify related factors. This cross-sectional study used data from the second cycle of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB). The sample consisted of 29,756 healthcare teams who joined the program voluntarily. Independent variables included contextual characteristics (region and population size), healthcare unit (type, telephone access, broadband, number of physicians and nurses, consultation offices, community health workers' room, meeting room, existence of telehealth) and health team characteristics (institutional support). Crude and Poisson regression-adjusted analyses assessed which variables are associated with greater use of telehealth. Prevalence of use of telehealth was 32.7% in the total sample and 73.3% among teams with the Program implemented. Tele-education was the most frequently used modality. Higher rates of prevalence of use were found in the South and Southeast of Brazil, in municipalities with up to 30,000 inhabitants, with telehealth implemented in the unit, with presence of at least one physician, and with at least one telephone available in the service. Institutional support had a 40% positive impact on prevalence of use of telehealth. Infrastructure variables such as Internet and availability of rooms with different purposes appeared not to significantly impact the use of these technologies, indicating that institutional support and the implementation of telehealth itself in the unit are more important for increasing adherence to the Program.

Orthopedic Asynchronous Teleconsultation for Primary Care Patients by a Large-Scale Telemedicine Service in Minas Gerais, Brazil

Background: Telemedicine was implemented in Brazil as a way to support primary health care (PHC). Orthopedic complaints are common in PHC, and, because musculoskeletal diseases are the most frequent causes of chronic pain, it is important to explore knowledge gaps of PHC as well as to understand the teleconsultations' impact on reducing referrals to secondary care. Materials and Methods: Observational, retrospective study that analyzed consecutive orthopedic asynchronous teleconsultations from the Telehealth Network of Minas Gerais, a large-scale public telehealth service, performed from September 17, 2013 to June 18, 2020. Teleconsultations were analyzed based on the type of query. Results: Throughout the study, 1,174 teleconsultations from 254 municipalities were analyzed. Most requests for teleconsultations were from nurses (37.8%) and physicians (48.7%). In 58.3%, challenges could be solved by a general practitioner, meanwhile 38.4% needed referral to an orthopedic specialist. Most queries related to a specific case (assistencial teleconsultation, 66.0%), and the others were classified as educational (34%). With regard to the motivation for the assistencial teleconsultations, 72% approached treatment options, 49.5% surrounded possible diagnosis, and 20.1% discussed patient's rehabilitation. In addition, 95.5% of requests could be solved by teleconsultation, without the need for referral to in-person consultation with the specialist. Conclusions: Teleconsultations can help investigate the most frequent queries in PHC. Most of them were solved without the need for referral, showing the potential of teleconsultations in daily practice as a way to manage patients and guarantee better access to first-rate health care. As for the public health system, teleconsultations represent a way to overcome the distance barrier to health care access.

Assessing the telemedicine acceptance for adults in Brazil

PURPOSE

This study aimed to find factors influencing the acceptance of telemedicine for adults in Brazil. Moreover, it investigates the moderating role of disease complexity and the generational digital divide phenomenon on the intention to use the telemedicine service.

DESIGN/METHODOLOGY/APPROACH

A quasi-experiment was employed. Primary data were collected using a survey research method considering two different scenarios based on disease complexity and symptom severity. A total of 248 responses were collected using a structured questionnaire. The authors also tested these two scenarios in three generations (X, Y and Z) of adults. Partial least squares structural equation modeling (PLS-SEM) was used to analyze the collected data and test the research hypotheses.

FINDINGS

The results indicated that performance expectancy and perceived security and reliability are two predictors of the behavioral intention to use telemedicine, whereas effort expectancy and social influence showed no statistical significance. Furthermore, the results demonstrated that adults tend to adopt telemedicine regardless of the level of disease complexity. Finally, this study does not support the existence of a digital divide in the three generations.

ORIGINALITY/VALUE

The study applies the UTAUT model to assess the telemedicine acceptance for younger generations. It examines patient risk perception (security and reliability) as one antecedent of telemedicine acceptance.

Investigating Patients' Intention to Continue Using Teleconsultation to Anticipate Postcrisis Momentum: Survey Study

Background

The COVID-19 crisis has drastically changed care delivery with teleconsultation platforms experiencing substantial spikes in demand, helping patients and care providers avoid infections and maintain health care services. Beyond the current pandemic, teleconsultation is considered a significant opportunity to address persistent health system challenges, including accessibility, continuity, and cost of care, while ensuring quality.

Objective

This study aims at identifying the determinants of patients’ intention to continue using a teleconsultation platform. It extends prior research on information technology use continuance intention and teleconsultation services.

Methods

Data was collected in November 2018 and May 2019 with Canadian patients who had access to a teleconsultation platform. Measures included patients’ intention to continue their use; teleconsultation usefulness; teleconsultation quality; patients’ trust toward the digital platform, its provider. and health care professionals; and confirmation of patients’ expectations toward teleconsultation. We used structural equation modeling employing the partial least squares component-based technique to test our research model and hypotheses.

Results

We analyzed a sample of 178 participants who had used teleconsultation services. Our findings revealed that confirmation of expectations had the greatest influence on continuance intention (total effects=0.722; P<.001), followed by usefulness (total effects=0.587; P<.001) and quality (total effects=0.511; P<.001). Usefulness (β=.60; P<.001) and quality (β=.34; P=.01) had direct effects on the dependent variable. The confirmation of expectations had direct effects both on usefulness (β=.56; P<.001) and quality (β=.75; P<.001) in addition to having an indirect effect on usefulness (indirect effects=0.282; P<.001). Last, quality directly influenced usefulness (β=.34; P=.002) and trust (β=.88; P<.001). Trust does not play a role in the context under study.

Conclusions

Teleconsultation is central to care going forward, and it represents a significant lever for an improved, digital delivery of health care in the future. We believe that our findings will help drive long-term teleconsultation adoption and use, including in the aftermath of the current COVID-19 crisis, so that general care improvement and greater preparedness for exceptional situations can be achieved.

A systematic scoping review of change management practices used for telemedicine service implementations

BACKGROUND

Telemedicine improves access to health care services enabling remote care diagnosis and treatment of patients at a distance. However, the implementation of telemedicine services often pose challenges stemming from the lack of attention to change management (CM). Health care practitioners and researchers agree that successful telemedicine services require significant organizational and practice change. Despite recognizing the importance of the "people-side" of implementation, research on what constitutes best practice CM strategies for telemedicine implementations remains fragmented, offering little cohesive insight into the specific practices involved in the change process. We conducted a systematic scoping review of the literature to examine what and how CM practices have been applied to telemedicine service implementation, spanning a variety of health care areas and countries.

METHODS

Three bibliographic databases (CINAHL, PubMed, and ISI Web of Science) and four specialist telehealth journals were searched. To keep the review manageable and relevant to contemporary telemedicine technologies and contexts, the search was limited to articles published from 2008 to 2019. Forty-eight articles were selected for inclusion.

RESULTS

From the 48 articles, 16 CM practices were identified relating to either strategic or operational aspects of telemedicine implementations. We identify the key CM practices that are recognized in the broader CM literature as essential for successful and sustained change but are not commonly reported in telemedicine implementation studies. We draw on the CM literature to provide a comprehensive process-based, researched-informed, organizing framework to guide future telemedicine service implementations and research.

CONCLUSIONS

Our findings suggest that the slow rate of adoption of telemedicine may be due to a piecemeal approach to the change process, and a lack of understanding of how to plan, manage and reinforce change when implementing telemedicine services.

O serviço de teleconsultoria assíncrona na APS: avaliação de uso e fatores associados do Programa Telessaúde Espírito Santo entre 2012 e 2015

Introdução: As poucas avaliações de implementação de programas de telessaúde no Brasil mostram uma pequena utilização de seus serviços, devendo-se conhecer as razões disto. Objetivou-se analisar as taxas de utilização do serviço de teleconsultoria do Programa Telessaúde Espírito Santo no período de 2012 a 2015, verificando a influência de estratégias de fomento à sua utilização. Métodos: Estudo descritivo com base em dados secundários de perfil dos profissionais cadastrados e produção de teleconsultorias e webconferências. Resultados: No período analisado, foram 3076 profissionais cadastrados, sendo que 381 (12,4%) realizaram 2182 consultorias (41,4% solicitadas por enfermeiros), configurando uma utilização do serviço inferior ao seu potencial. Os dados sugerem que a utilização do serviço de teleconsultoria está associada à participação em seminários regionais (aumento de 15,5% no número de profissionais atuantes; p=0,037); que a gestão de cadastros dos profissionais tem impacto limitado; que há correlação positiva forte (r=0,73; p=0,016) entre uso de teleconsultoria e de teleducação; e que a monitoria de campo pode influenciar positivamente. Conclusão: O uso dos serviços de Telessaúde é pequeno, sendo que o foco de suas ações deva ser seu usuário final com vias a sua sustentabilidade.

Development and Implementation of a Methodology for Quality Assessment of Asynchronous Teleconsultations

Background: There is a lack of evidence regarding audits or quality analysis of telehealth strategies in clinical practice. Our aim is to develop and implement a methodology for quality assessment of asynchronous teleconsultations. Materials and Methods: A random sample of asynchronous teleconsultations performed by the specialists from the Telehealth Network of Minas Gerais (TNMG), a public telehealth service in Brazil, was selected. The responses were evaluated regarding size, objectivity, quality, ethics, courtesy, and grammar, and received a score for each category: 1 = fair, 2 = moderate, and 3 = good. As each domain has a different importance in rating the overall quality of teleconsultation, each one was assigned a different weight, and a final score was calculated. Results: A total of 576 teleconsultations were assessed. Overall, the scores were good or moderate for all items. Only a few cases were classified as fair. Among medical specialties, pediatrics was the one that proportionally received the highest number of fair classifications, and the item "quality of the answers" was the one with highest number of worse classifications for this specialty. Corrective actions were implemented. With regard to the nonmedical specialties, the majority of the items were classified as good or moderate, and in rare cases some items received the fair rating. Conclusion: The methodology showed to be useful to evaluate the teleconsultation service. We established six domains that we considered important components to be assessed. This assessment was essential to identify the priority areas to receive correct actions. It may be easily replicated in other services worldwide.

[Factors associated with the non-use of telehealth consultancy by physicians of the Family Health Strategy]

This study sought to evaluate the frequency and factors associated with non-use of telehealth consultancy by physicians who work in the Family Health Strategy (FHS) in the North of the State of Minas Gerais. It is a cross-sectional study that used a previously-tested self-administered questionnaire. Poisson regression analysis with robust variance was used after bivariate analysis to identify the factors associated with non-use of telehealth consultancy. A total of 385 physicians from 73 municipalities participated in the study. The frequency of non-use of telehealth consultancy by physicians in the FHS was 55.8%. After multiple analysis, the following variables were identified: the lack of availability of computers and Internet access in the Basic Health Units (BHU) for medical professionals (p = 0.001; PR = 1.10; 95% CI: 1.04-1.17), the lack of information about telehealth consultancy (p< 0.001; PR = 1.47; 95% CI: 1.38-1.56) and lack of training in telehealth consultancy (p < 0.001; PR = 1.15; 95% CI: 1.08-1.24). The results support that the informatics infrastructure of the BHU, the dissemination of the service and the training should orient the strategies for implementation, diffusion and improvement of the quality of telehealth consultancy services in primary health care.

[Use of telehealth as a tool to support continuing health educationUtilización del Programa de Telesalud en el estado de Maranhão como herramienta para apoyar la educación permanente sobre la salud]

OBJECTIVE

To assess the usage of services provided by the State of Maranhão Telehealth Program, Brazil, as a tool to support continuing health education for primary care workers.

METHOD

This quantitative, descriptive study used data from the Brazilian National Telehealth Platform for the years 2015 and 2016. To assess teleconsultations requested by municipalities and health care units in the state of Maranhão, the monthly system usage rate and the mean monthly request rate per municipality and primary health care unit were calculated. Teleconsultations were described regarding the requester's profession, most frequent topics, satisfaction with the response provided, and resolvability of responses. Tele-education activities were classified according to the number of computers and users logged into the activity.

RESULTS

From January 2015 to December 2016, 13 976 teleconsultations were provided, requested by 47 municipalities. Most municipalities were small (up to 40 thousand residents) and had low municipal human development index (0.512 to 0.768). The mean overall usage rate and the monthly usage rate by municipality and unit were higher than those reported in the literature. Nurses and community health agents were the most active requesters. Of the users who completed the optional evaluation, over 80% stated that their question was answered.

CONCLUSIONS

The usage indicators for the state of Maranhão Telehealth Program were more positive than those reported by other telehealth services in Brazil and abroad. This indicates that the Program is sustainable, with good potential to support primary care and be used as a tool for continuing health education.

Primary health care and the coordination of care in health regions: managers' and users' perspective

This paper aims to analyze the healthcare coordination by Primary Health Care (PHC), with the backdrop of building a Health Care Network (RAS) in a region in the state of São Paulo, Brazil. We conducted a case study with qualitative and quantitative approaches, proceeding to the triangulation of data between the perception of managers and experience of users. We drew analysis realms and variables from the three pillars of healthcare coordination - informational, clinical and administrative/organizational. Stroke was the tracer event chosen and therapeutic itineraries were conducted with users and questionnaires applied to the managers. The central feature of the construction of the Health Care Network in the studied area is the prominence of a philanthropic organization. The results suggest fragility of PHC in healthcare coordination in all analyzed realms. Furthermore, we identified a public-private mix, in addition to services contracted from the Unified Health System (SUS), with out-of-pocket payments for specialist consultation, tests and rehabilitation. Much in the same way that there is no RAS without a robust PHC capable of coordinating care, PHC is unable to play its role without a solid regional arrangement and a virtuous articulation between the three federative levels.

Wearable-Based Human Activity Recognition Using an IoT Approach

This paper presents a novel system based on the Internet of Things (IoT) to Human Activity Recognition (HAR) by monitoring vital signs remotely. We use machine learning algorithms to determine the activity done within four pre-established categories (lie, sit, walk and jog). Meanwhile, it is able to give feedback during and after the activity is performed, using a remote monitoring component with remote visualization and programmable alarms. This system was successfully implemented with a 95.83% success ratio.

[Structural typology of Brazilian primary healthcare units: the 5 Rs]

The structural typology of Brazil's 38,812 primary healthcare units (UBS) was elaborated on the basis of the results from a survey in cycle 1 of the National Program for Improvement in Access and Quality of Primary Care. Type of team, range of professionals, shifts open to the public, available services, and installations and inputs were the sub-dimensions used. For each sub-dimension, a reference standard was defined and a standardized score was calculated, with 1 as the best. The final score was calculated by factor analysis. The final mean score of Brazilian UBS was 0.732. The sub-dimension with the worst score was "installations and inputs" and the best was "shifts open to the public". The primary healthcare units were classified according to their final score in five groups, from best to worst: A, B, C, D, and E. Only 4.8% of the Brazilian UBS attained the maximum score. The typology showed specific characteristics and a regional distribution pattern: units D and/or E accounted for nearly one-third of the units in the North, and two-thirds of units A were situated in the South and Southeast of Brazil. Based on the typology, primary healthcare units were classified according to their infrastructure conditions and possible strategies for intervention, as follows: failed, rudimentary, limited, fair, and reference (benchmark). The lack of equipment and inputs in all the units except for type A limits their scope of action and case-resolution capacity, thus restricting their ability to respond to health problems. The typology presented here can be a useful tool for temporal and spatial monitoring of the quality of infrastructure in UBS in Brazil.

Coordenação do cuidado na atenção primária à saúde: estudo avaliativo em município sede de macrorregião do nordeste brasileiro

Resumo Estudos internacionais e nacionais têm destacado a importância da coordenação do cuidado para a organização de sistemas locais de saúde. Este estudo avaliou a coordenação do cuidado pela Atenção Primária à Saúde (APS) em um sistema local de saúde do Estado da Bahia. Trata-se de um estudo de caso em município sede de macrorregião, com dois níveis de análise: equipe e gestão municipal. Adotou-se condições traçadoras (hipertensão arterial e diabetes mellitus) e elaborou-se uma imagem-objetivo correspondente à coordenação do cuidado, a partir da revisão atualizada da literatura nacional e internacional. Foram realizadas entrevistas semiestruturadas com profissionais, gestores da APS e utilizadas outras fontes documentais. Evidenciou-se que a coordenação do cuidado não tem sido alcançada no município, onde apenas 14 dos 22 critérios propostos foram atendidos, destacando-se como principais dificuldades a ausência de protocolos assistenciais, de sistemas informatizados e de outras tecnologias de informação e comunicação. As evidências e a operacionalização conceitual de um modelo para avaliar a coordenação do cuidado são contribuições relevantes deste estudo, que podem ser aplicadas a outros contextos com características similares.

The Experience of a Sustainable Large Scale Brazilian Telehealth Network

BACKGROUND

In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil.

PURPOSE

To describe the successful experience of the TNMG in 10 years of activities.

METHODS

The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff.

RESULTS

Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction.

CONCLUSIONS

The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the quality of the PHC.

Telehealth in Rio Grande do Sul, Brazil: Bridging the Gaps

INTRODUCTION

In 1988, Brazil adopted a universal healthcare model in which access is mediated by the primary care level. However, difficulties have emerged in the coordination of care between the primary and specialized levels. Telehealth was thus proposed as a means to overcome this challenge. This article describes initiatives developed by a large Brazilian program, TelessaúdeRS/UFRGS, in the fields of teleconsultation, telediagnosis, tele-education, and information technology development to support the public healthcare system.

MATERIALS AND METHODS

TelessaúdeRS/UFRGS was established in 2010 to develop a telehealth platform and a support system for primary care teams with a special focus on optimizing the flow between primary and specialized levels of care. To define priorities, TelessaúdeRS analyzes the health needs of the Brazilian population and the most common inquiries it receives from primary care health professionals. This information is then combined with the best available scientific evidence for development of services.

RESULTS

Since 2010, over 50,000 clinical consultations have been provided. More than 15,000 healthcare professionals have benefited from teleconsultations and from telediagnosis and tele-education activities. All services were provided using information technology solutions developed by the Telessaúde team, including smartphone apps and a Web-based National Telehealth Platform.

CONCLUSIONS

The case of TelessaúdeRS/UFRGS shows that even in the presence of structural limitations, telemedicine is potentially useful to improve the quality of care and streamline the flow between different levels of care.

Providing Telehealth Services to a Public Primary Care Network: The Experience of RedeNUTES in Pernambuco, Brazil

BACKGROUND

Information technologies have been applied in primary care domains to improve the delivery of health services. This article reports the telehealth network experience in Pernambuco, Brazil.

MATERIALS AND METHODS

Five different data sets were used, one by each service and the structural aspects of the network, collected from 2008 until August 2015. The data include solicited themes for educational activities, users' evaluation of services, numbers of sites, municipalities participating, participants in tele-education activities, teleconsultations, telediagnosis, and remote screenings. The analysis was done in absolute and percentage values using Microsoft Excel (version 2007).

RESULTS

The indicators show high utilization of tele-education resources, followed by the teleconsultation service. The synchronous modality was the most used and the general clinical question was the most frequent type of question. Nurses are the professional category that most used the teleconsultation services (36%). Telediagnosis of electrocardiography has growth utilization, overcoming teleconsulting more recently. The satisfaction rate was 89%, and 68.5% of professionals changed their planning to patients' referrals to specialists.

CONCLUSIONS

Telehealth has been considered effective since it avoids inappropriate referrals of the patient and provides continuous actualization to health professionals. Our results provide evidence of the feasibility and importance of using telehealth as a tool to ensure the universality, equality, and completeness in the health system.