Patients’ perceptions of remote care in municipal primary health care

Abstract

Introduction: Remote care consists in the model health professionals and patients exchange information through electronic devices on health-related issues. This form of care has considerably increased, mainly because it was an attempt to prevent the spread of the new coronavirus (COVID-19). Objective: To understand the perception of users from different population groups about remote care provided in primary health care in the city of Florianópolis (state of Santa Catarina, Brazil). Methods: Qualitative research, in which patients remotely contacted by researchers themselves were invited to participate in an in-depth interview about previous remote care, according to groups that could, from the researchers’ perspective, present different opinions. The interviews were recorded after obtaining patient’s consent, with subsequent transcription and conventional content analysis. Results: Remote consultations and virtual interactions with the primary care service were well received, with quality comparable to face-to-face appointments, without limiting technical problems. This tool seems to be long-lasting and promising, but not for any condition or demand, and it is up to the health professional, in the patients’ opinion, to decide between face-to-face or remote care at the time of care. Patients tend to prefer remote modalities for more specific issues and face-to-face modalities for complex issues that require physical examination. Medical inspection, made possible by video, was not considered a physical examination. We noticed there is a conventional consultation process, consisting of a trigger (problem or a complaint) and followed by: 1) dialogue between physician and patient; 2) physical examination; 3) complementary examination; and 4) conduct. When all items are present, and in that order, there is a unanimous interpretation that a consultation took place. When one of these items is absent, the interaction is not always seen as a consultation and the conduct informed to the patient has often been interpreted as isolated guidance or screening. Conclusions: Despite being a useful tool in expanding the forms of access to health care, the interpretation of consultation in remote care may be discordant between health professionals and patients. This can be related both to the virtual format and to the necessary lack of physical touch inherent in all modalities. We did not gather the opinion of users who do not have access to the Internet or other devices. Fortunately, for patients who do not have access to this tool, spontaneous demand and face-to-face care continue to be part of the services provided in Florianópolis.