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Zhang W, Yang P, Wang H, Pan X, Wang Y. The effectiveness of a mHealth-based integrated hospital-community-home program for people with type 2 diabetes in transitional care: a protocol for a multicenter pragmatic randomized controlled trial. BMC PRIMARY CARE 2022; 23:196. [PMID: 35931991 PMCID: PMC9356450 DOI: 10.1186/s12875-022-01814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022]
Abstract
Background Diabetes is a progressive condition requiring long-term medical care and self-management. The ineffective transition from hospital to community or home health care may result in poor glycemic control and increase the risk of serious diabetes-related complications. In China, the most common transitional care model is home visits or telephone interventions led by a single healthcare setting, with a lack of cooperation between specialists and primary care, which leads to inadequate service and discontinuous care. Thus, an integrated hospital-community-home (i-HCH) transitional care program was developed to promote hospital and community cooperation and provide comprehensive and continuous medical care for type 2 diabetes mellitus (T2DM) via mobile health (mHealth) technology. Methods This protocol is for a multicenter randomized controlled trial in T2DM patients. Hospitalized patients diagnosed with T2DM who meet the eligibility criteria will be recruited. The patients will be randomly allocated to either the intervention or the control group and receive the i-HCH transitional care or usual transitional care intervention. The change in glycated hemoglobin is the primary outcome. Secondary outcome measures are blood pressure, lipids (total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein), body mass index, self-management skills, quality of life, diabetes knowledge, transitional care satisfaction and the rate of readmission. The follow-up period of this study is six months. Discussion The study will enhance the cooperation between local hospitals and communities for diabetes transitional care. Research on the effectiveness of diabetes outcomes will have potentially significant implications for chronic disease patients, family members, health caregivers and policymakers. Trial registration Chinese Clinical Trial Registry ChiCTR1900023861: June 15, 2019.
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Silva AFRD, Moura KRD, Moura TVC, Oliveira ASSD, Moreira TMM, Silva ARVD. Telephone intervention in self-care practices with the feet of patients with diabetes: a randomized clinical trial. Rev Esc Enferm USP 2021; 55:e03737. [PMID: 34190883 DOI: 10.1590/s1980-220x2020047203737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the effect of a telephone intervention for self-care practices with the feet of people with type 2 diabetes mellitus. METHOD This is a randomized clinical trial with two groups, control and intervention, carried out with 102 users with type 2 diabetes mellitus linked to four Basic Health Units in a municipality in the state of Piauí. For the intervention group, six telephone interventions were carried out in three months; and the control group received only conventional follow-up. For assessment, a form was applied before and after the intervention period. RESULTS In the intragroup analysis, when comparing self-care practices with the feet in the control group in the pre- and post-tests, there was no significant difference (p > 0.05); in the intervention group, there was an increase in self-care practices in 70% of the items, with p < 0.001 to 0.03. When analyzing the practice of intergroup self-care after the telephone intervention, the positive effect of the intervention was evidenced, obtaining statistically significant differences in 60% of the items, with a value of p < 0.001 to 0.031. CONCLUSION The telephone intervention promoted greater adherence to self-care practices with the feet of patients with type 2 diabetes mellitus. Brazilian Clinical Trials Registry: RBR-3pq5th.
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Roxo-Gonçalves M, Stüermer VM, dos Santos LF, Kinalski DDF, de Oliveira EB, Roman R, Carrard VC. Synchronous Telephone-Based Consultations in Teledentistry: Preliminary Experience of the Telehealth Brazil Platform. TELEMEDICINE REPORTS 2021; 2:1-5. [PMID: 35720762 PMCID: PMC9049800 DOI: 10.1089/tmr.2020.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Brazilian National Health System (NHS) has incorporated telehealth to improve the quality of care in recent decades. Among the actions taken, teleconsultations have been offered to support diagnosis and decision-making for health professionals. METHODS This cross-sectional study aimed to summarize the preliminary experience of a telephone-first consultation for oral health issues available for dentists and physicians from primary health care (PHC). RESULTS The study sample was 385 teleconsultations with oral health questions requested from all Brazil sent from May 2018 to July 2019, majority by dentists 83.2% (n = 332). Oral medicine was the main reason for teleconsultation (50.9%). Resolution in PHC was considered possible in 57.1% of cases (n = 220). CONCLUSIONS It was concluded that a telephone-first consultation may be useful to improve the resolvability and the quality of care in the PHC on oral health issues. The teledentistry allows the resolution of oral issues in PHC, avoiding the displacement of patients to more distant specialized centers. Teledentistry could be more useful in the actual coronavirus disease (Covid-19) pandemic.
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Affiliation(s)
- Michelle Roxo-Gonçalves
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- TelessaudeRS-UFRGS, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vanessa Müller Stüermer
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Postgraduate Programme in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Ferraz dos Santos
- TelessaudeRS-UFRGS, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniela dal Forno Kinalski
- TelessaudeRS-UFRGS, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Rudi Roman
- TelessaudeRS-UFRGS, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinicius Coelho Carrard
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- TelessaudeRS-UFRGS, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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Silva AB, da Silva RM, Ribeiro GDR, Guedes ACCM, Santos DL, Nepomuceno CC, Caetano R. Three decades of telemedicine in Brazil: Mapping the regulatory framework from 1990 to 2018. PLoS One 2020; 15:e0242869. [PMID: 33237947 PMCID: PMC7688174 DOI: 10.1371/journal.pone.0242869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
This study characterized the evolution of Brazilian public telemedicine policy in the Brazilian Unified Health System for 30 years from 1988 to 2019 by analyzing its legal framework. We identified 79 telemedicine-related legislations from the federal government (laws, decrees, and ordinances) and 31 regulations of federal councils of health professionals. Three historical phases were established according to the public policy cycle, and material was classified according to the purpose of the normative documents. The content analysis was based on the advocacy coalition framework model. Of the federal legislations, 8.9% were for the Formulation/Decision-Making phase, 43% for the Organization/Implementation phase, and 48.1% for the Expansion/Maturation phase of telemedicine policy in Brazil. The Federal Council of Medicine was the most active in standardizing telemedicine and was responsible for 21 (67.7%) regulations. The first legislations were passed in 2000; however, the coalitions discussed topics related to telemedicine and created their belief systems from the 1990's. The time cycle which included formulation and decision making for Brazilian telemedicine policy, extended until 2007 with the creation of several technical working groups. The expansion and maturation of telemedicine services began in 2011 with the decentralization of telemedicine policy actions across the country. Telemedicine centers which performed telediagnosis influenced the computerization of primary health care units. We conclude that Brazilian telemedicine field has greatly grown and changed in recent years. However, despite the proliferation of legislations and regulations in the period studied, there is still no fully consolidated process for setting up a wholly defined regulatory framework for telemedicine in Brazil.
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Affiliation(s)
- Angélica Baptista Silva
- Department of Human Rights, Health and Cultural Diversity, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Medicines and Pharmaceutical Services Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Rondineli Mendes da Silva
- Department of Human Rights, Health and Cultural Diversity, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Medicines and Pharmaceutical Services Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gizele da Rocha Ribeiro
- Department of Human Rights, Health and Cultural Diversity, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Medicines and Pharmaceutical Services Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Daniela Lacerda Santos
- Department of Collective Health, Medical School of Petrópolis, Faculdade Arthur Sá Earp Neto, Petrópolis, Rio de Janeiro, Brazil
| | - Carla Cardi Nepomuceno
- Department of Health Policy, Planning and Administration, Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosângela Caetano
- Department of Health Policy, Planning and Administration, Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Harzheim E, Chueiri PS, Umpierre RN, Gonçalves MR, Siqueira ACDS, D’Avila OP, Molina Bastos CG, Katz N, Dal Moro RG, Telles LF, Schmitz CAA. Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)1881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Novos desafios epidemiológicos e demográficos demandam novas formas de organizar os sistemas de saúde. O presente ensaio propõe a telessaúde como ferramenta organizativa, capaz de suavizar o triângulo de ferro da atenção à saúde e de facilitar a busca pelo triple aim, pelo seu potencial de aumento do acesso e qualidade com redução de custo. A integração da telessaúde ao processo de referência e transição entre serviços assistenciais aumenta a resolutividade da Atenção Primária à Saúde (APS), favorece a coordenação do cuidado, promove adesão terapêutica, diminui reinternações e estimula a prevenção quaternária. Este ensaio propõe a telessaúde como metasserviço que confere densidade tecnológica à APS e permite que ela se torne coordenadora efetiva do cuidado, passando a organizar o fluxo de informações, pessoas e insumos. Frente às inovações propostas, é essencial avaliar o impacto de ações já existentes de telessaúde para viabilizar a sua aplicação como metasserviço de saúde.
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