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Araújo MDSD, Albuquerque ACD, Felisberto E, Samico I, Rodrigues ÁS. [Assessment of the implementation of an care teleregulation project in a Brazilian capital city]. CAD SAUDE PUBLICA 2023; 39:e00009623. [PMID: 37466552 PMCID: PMC10494686 DOI: 10.1590/0102-311xpt009623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Isabella Samico
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brasil
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Pachito DV, Etges APBDS, Oliveira PRBPD, Basso J, Bagattini ÂM, Riera R, Gehres LG, Mallmann ÉDB, Rodrigues ÁS, Gadenz SD. Micro-Costing of a Remotely Operated Referral Management System to Secondary Care in the Unified Health System in Brazil. Cien Saude Colet 2022; 27:2035-2043. [PMID: 35544829 DOI: 10.1590/1413-81232022275.07472021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.
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Affiliation(s)
- Daniela Vianna Pachito
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| | - Ana Paula Beck da Silva Etges
- Faculdade de Tecnologia, Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre RS Brasil.,Instituto de Avaliação de Tecnologia em Saúde. Porto Alegre RS Brasil
| | | | - Josué Basso
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| | - Ângela Maria Bagattini
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês. São Paulo SP Brasil
| | - Rachel Riera
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês. São Paulo SP Brasil.,Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | | | | | - Sabrina Dalbosco Gadenz
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
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Moreira TDC, Constant HM, Gomes Faria A, Matzenbacher AMF, Balardin GU, Matturro L, Silva MSD, Umpierre RN, Rodrigues ÁS, Cabral FC, Pagano CGM. Tradução, adaptação transcultural e validação de questionário de satisfação em telemedicina. Rev Bras Med Fam Comunidade 2022. [DOI: 10.5712/rbmfc17(44)2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A telemedicina facilita o acesso ao cuidado para os pacientes. Essa tecnologia tem apresentado bons resultados clínicos e de satisfação dos usuários. A satisfação é um dos principais indicadores de qualidade dos serviços, e sua avaliação permite mudanças na qualidade da prestação de cuidados, identifica problemas e viabiliza a melhor gestão e os melhores comportamentos dos profissionais de saúde. Do aumento do uso da telemedicina no mundo emergiu a necessidade de entendimento da qualidade desse serviço. Objetivo: Traduzir, adaptar culturalmente e validar um questionário para avaliação da satisfação de pacientes atendidos por telemedicina. Métodos: A versão adaptada após a avaliação por um comitê de juízes foi utilizada em pré-teste com 30 pacientes atendidos no projeto TeleOftalmo. Os resultados do pré-teste foram avaliados a fim de se obter uma versão adequada do instrumento. Além disso, o instrumento foi aplicado em uma amostra de 141 pacientes atendidos via telemedicina. Análises de consistência interna e de validação de constructo foram realizadas. Resultados: O coeficiente de validade de conteúdo (CVC) global foi 0,942, demonstrando clareza, pertinência e relevância das questões. O instrumento apresentou consistência interna com alfa de Cronbach estandardizado de 0,6, considerado aceitável. A análise fatorial exploratória apresentou critério de Kaiser-Meyer-Olkin de adequação de amostragem de 0,56 e o teste de esfericidade de Bartlett apresentou valor de 0,001. Conclusões: A versão brasileira do Questionário de Avaliação da Satisfação de Pacientes Atendidos via Telemedicina (QAS-Tele) é um instrumento fácil e viável para a avaliação da satisfação dos pacientes atendidos por telemedicina.
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Gadenz SD, Basso J, de Oliviera PRBP, Sperling S, Zuanazzi MVD, Oliveira GG, da Silva IM, Motta RM, Gehres LG, de Brito Mallmann É, Rodrigues ÁS, Pachito DV, de Faria Leao B. Telehealth to support referral management in a universal health system: a before-and-after study. BMC Health Serv Res 2021; 21:1012. [PMID: 34563176 PMCID: PMC8467186 DOI: 10.1186/s12913-021-07028-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Management of patient flow within a healthcare network, allowing equitable and qualified access to healthcare, is a major challenge for universal health systems. Implementation of telehealth strategies to support referral management has been shown to increase primary care resolution and to promote coordination of care. The objective of this study was to assess the impact of telehealth strategies on waiting lists and waiting times for specialized care in Brazil. METHODS Before-and-after study with measures obtained between January 2019 and February 2020. Baseline measurements of waiting lists were obtained immediately before the implementation of a remotely operated referral management system. Post-interventional measurements were obtained monthly, up to six months after the beginning of operation. Data was extracted from the database of the project. General linear models were applied to assess interaction of locality and time over number of cases on waiting lists and waiting times. RESULTS At baseline, the median number of cases on waiting lists ranged from 2961 to 12,305 cases. Reductions of the number of cases on waiting lists after six months of operation were observed in all localities. The magnitude of the reduction ranged from 54.67 to 88.97 %. Interaction of time measurements was statistically significant from the second month onward. Median waiting times ranged from 159 to 241 days at baseline. After six months, there was a decrease of 100 and 114 waiting days in two localities, respectively, with reduction of waiting times only for high-risk cases in the third locality. CONCLUSIONS Adoption of telehealth strategies resulted in the reduction of number of cases on waiting lists. Results were consistent across localities, suggesting that telehealth interventions are viable in diverse settings.
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Affiliation(s)
- Sabrina Dalbosco Gadenz
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | - Josué Basso
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | | | - Stephan Sperling
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | | | | | - Ivonice Martins da Silva
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | - Raphael Mendes Motta
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | - Luana Gonçalves Gehres
- Ministry of Health, Esplanada dos Ministérios, Bloco G, 3º Andar, 70058-900, Brasília, Distrito Federal, Brazil
| | - Érica de Brito Mallmann
- Ministry of Health, Esplanada dos Ministérios, Bloco G, 3º Andar, 70058-900, Brasília, Distrito Federal, Brazil
| | - Átila Szczecinski Rodrigues
- Ministry of Health, Esplanada dos Ministérios, Bloco G, 3º Andar, 70058-900, Brasília, Distrito Federal, Brazil
| | - Daniela V Pachito
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil.
| | - Beatriz de Faria Leao
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
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Sperling S, Andretta CRDL, Basso J, Batista CEA, Borysow IDC, Cabral FC, de Castro Filho ED, Costa LAV, Gehres LG, Kim KY, Maeyama MA, Mallmann ÉDB, Morbeck RA, Oblonczyk MM, Pachito DV, Rodrigues ÁS, de Souza CF, Toth CPP, Gadenz SD. Telehealth for Supporting Referrals to Specialized Care During COVID-19. Telemed J E Health 2021; 28:544-550. [PMID: 34314637 DOI: 10.1089/tmj.2021.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic led to the suspension or postponement of care for non-urgent conditions worldwide. Regula Mais Brasil is an initiative of the Unified Health System (SUS) in Brazil to optimize the management of referrals to specialized care by using telehealth. Objectives: To report the expansion of telehealth activities of Regula Mais Brasil in response to COVID-19 and to assess qualification of referrals in primary health care (PHC) units as well as the added value of teleconsultation in qualifying referral cases. Methods: Descriptive study of the teleconsultations carried out as an additional strategy to the remotely operated referral management system, responsible for navigating cases from PHC units to specialized care in Recife, Brazil, between May 6, 2020 and September 30, 2020. Teleconsultation was implemented as a tool for reducing delays in the access to health care due to COVID-19 and ultimately allowed for reclassification of the referral adequacy and priority. Changes in referral priority ratings and referral decisions after teleconsultation were analyzed. Results: A total of 622 referral cases were analyzed. Approved referrals represented 51.9% of cases. The main reason for approved referrals was the need for diagnostic resources. There was a reduction in priority ratings in 449 cases (72.2%) after teleconsultation. There was a statistically significant association between the change of priority ratings and the decision on referral (Pearson's χ2, p-value <0.0001). Results show that telemedicine had an impact on the prioritization and qualification of cases referred to specialized services. Conclusions: A need was detected to rapidly adapt tools available for telemedicine in Brazil. Our results demonstrate that teleconsultation as an additional strategy to the remotely operated referral management system has contributed toward improving equitable access to specialized services.
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Affiliation(s)
- Stephan Sperling
- Diretoria de Compromisso Social, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Josue Basso
- Diretoria de Compromisso Social, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Igor da Costa Borysow
- Diretoria Executiva de Responsabilidade Social, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | | | | | | | - Kevin Yun Kim
- Superintendência de Responsabilidade Social, HCor, Sao Paulo, Brazil
| | - Marcos Aurélio Maeyama
- Diretoria Executiva de Responsabilidade Social, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
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Monteiro Grendene G, Szczecinski Rodrigues Á, Katz N, Harzheim E. Referring Quality Assessment of Primary Health Care for Endocrinology in Rio Grande do Sul, Brazil. Stud Health Technol Inform 2015; 216:990. [PMID: 26262292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper presents results of an assessment of the quality research of endocrinology referrals in the public health system in the state of Rio Grande do Sul. From the analysis of 4,458 requests for endocrinology referrals, it was found that 15% of referrals had insufficient information for evaluation and 71% showed no clinical justification for authorization of referencing. The partial results of the study indicated that the lack of information makes it impossible to clinically regulate these requests. The use of referencing protocols associated with telemedicine tools can assist doctors in primary health care in the clinical management and make access to specialized services more equitable and timely.
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Affiliation(s)
| | | | - Natan Katz
- TelessaúdeRS - Programa de Pós Graduação em Epidemiologia, UFRGS, Brazil
| | - Erno Harzheim
- TelessaúdeRS - Programa de Pós Graduação em Epidemiologia, UFRGS, Brazil
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