Medical justifications for telecardiology in primary health care in Joinville, Brazil
DOI:
https://doi.org/10.5712/rbmfc19(46)3722Keywords:
Telecardiology, Primary Health Care, Referral and Consultation, Cardiovascular diseases.Abstract
Introduction: It is essential to properly understand the main signs and symptoms, complementary tests, and therapy most commonly used in cardiology by physicians who work in the gateway to the healthcare system to ensure problem-solving care in most cases, thus avoiding unnecessary referrals to secondary health care and, consequently, overloading the healthcare system. In cardiology, some situations demand rapid diagnosis and treatment, in order to avoid damages that include serious sequelae and death of the patient, which justify care in emergency room. In other cases, the specialist’s evaluation can contribute to diagnosis, indication of the most appropriate complementary tests, a differentiated therapy and, mainly, the confirmation of the measures taken by primary health care physicians. However, for various reasons, including insecurity, there is an excess of referrals to specialists. Objective: In this study we aim to identify the main gaps related to cardiology in primary health care that contribute to or result in unnecessary referrals to cardiologists. Methods: This is a descriptive research on the database of 588 telecardiology sessions of Health Centers of primary health care in Joinville (state of Santa Catarina), Brazil, carried out from January 2020 to March 2021. The need for specialized face-to-face care for patients was evaluated by analyzing the cases. Results: A total of 74.15% cases could be resolved in primary health care. In addition, we identified that the main doubts of the primary health care physicians were related to alterations in signs and symptoms, followed by doubts about heart diseases and results of complementary tests. Other consulting sessions addressed questions about noncardiac diseases, medications, and inquiries that did not fit into any of the previous categories. Conclusions: Teleconsulting can avoid a significant number of unnecessary referrals, preventing specialist’s overload. Likewise, it can contribute to guidance to other professionals that enable the solution of these and future cases in primary health care.
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Lopes MACQ, Oliveira GMM de, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, et al. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2019;113:1006-56. https://doi.org/10.5935/abc.20190205 DOI: https://doi.org/10.5935/abc.20190205
Aquino ER da S, Domingues RB, Mantese CE, Fantini FGMM, Nitrini R, Prado GF do. Telemedicine use among neurologists before and during COVID-19 pandemic. Arq Neuro-Psiquiatr 2021;79:658-64. https://doi.org/10.1590/0004-282X-ANP-2020-0488 DOI: https://doi.org/10.1590/0004-282x-anp-2020-0488
Wang J, Cheng L, Liu J, Zhang B, Wang W, Zhu W, et al. Laparoscopy vs. laparotomy for the management of abdominal trauma: a systematic review and meta-analysis. Front Surg 2022;9:817134. https://doi.org/10.3389/fsurg.2022.817134 DOI: https://doi.org/10.3389/fsurg.2022.817134
Brasil. Ministério da Saúde. Portaria nº 2.546, de 27 de outubro de 2011. Redefine e amplia o Programa Telessaúde Brasil, que passa a ser denominado Programa Nacional Telessaúde Brasil Redes (Telessaúde Brasil Redes). [Internet]. 2011 [acessado em 20 fev. 2023]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2546_27_10_2011.html
Maeyama MA, Calvo MCM. A Integração do Telessaúde nas Centrais de Regulação: a teleconsultoria como mediadora entre a Atenção Básica e a Atenção Especializada. Rev Bras Educ Med 2018;42:63-72. https://doi.org/10.1590/1981-52712015v42n2RB20170125 DOI: https://doi.org/10.1590/1981-52712015v42n2rb20170125
Maldonado JMS de V, Marques AB, Cruz A. Telemedicine: challenges to dissemination in Brazil. Cad Saúde Pública 2016;32. https://doi.org/10.1590/0102-311X00155615 DOI: https://doi.org/10.1590/0102-311X00155615
Silva EA da. A telessaúde e seus impactos na formação continuada dos profissionais de saúde em rede. EmRede 2017;4:116-29. ISSN 2359-6082
Catapan S de C, Calvo MCM. Teleconsulta: uma Revisão Integrativa da Interação Médico-Paciente Mediada pela Tecnologia. Rev Bras Educ Med 2020;44. https://doi.org/10.1590/1981-5271v44.1-20190224 DOI: https://doi.org/10.1590/1981-5271v44.1-20190224
Harzheim E, Chueiri PS, Umpierre RN, Gonçalves MR, Siqueira AC da S, D’Avila OP, et al. Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI. Rev Bras Med Fam Comunidade 2019;14:1881. https://doi.org/10.5712/rbmfc14(41)1881 DOI: https://doi.org/10.5712/rbmfc14(41)1881
Soobiah C, Cooper M, Kishimoto V, Bhatia RS, Scott T, Maloney S, et al. Identifying optimal frameworks to implement or evaluate digital health interventions: a scoping review protocol. BMJ Open 2020;10:e037643. https://doi.org/10.1136/bmjopen-2020-037643 DOI: https://doi.org/10.1136/bmjopen-2020-037643
Brasil. Ministério da Saúde. Universidade Federal do Rio Grande do Sul. Protocolos de encaminhamento da atenção básica para a atenção especializada: Cardiologia. v. 2. Brasília: Ministério da Saúde/Universidade Federal do Rio Grande do Sul; 2016. p. 23.
Aredo JV, Ding JB, Lai CH, Trimble R, Bromley-Dulfano RA, Popat RA, et al. Implementation and evaluation of an elective quality improvement curriculum for preclinical students: a prospective controlled study. BMC Med Educ 2023;23:66. https://doi.org/10.1186/s12909-023-04047-0 DOI: https://doi.org/10.1186/s12909-023-04047-0
Mathura P, Marini S, Spalding K, Duhn L, Kassam N, Medves J. Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering. BMJ Open Qual 2023;12:e001965. https://doi.org/10.1136/bmjoq-2022-001965 DOI: https://doi.org/10.1136/bmjoq-2022-001965
Sypes EE, de Grood C, Clement FM, Parsons Leigh J, Whalen-Browne L, Stelfox HT, et al. Understanding the public’s role in reducing low-value care: a scoping review. Implement Sci 2020;15:20. https://doi.org/10.1186/s13012-020-00986-0 DOI: https://doi.org/10.1186/s13012-020-00986-0
Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, et al. Estatística Cardiovascular – Brasil 2021. Arq Bras Cardiol 2022;118:115-373. https://doi.org/10.36660/abc.20211012 DOI: https://doi.org/10.36660/abc.20211012
Vodička S, Naji HF, Zelko E. The Role of Telecardiology in Dealing with Patients with Cardiac Rhythm Disorders in Family Medicine – Systematic Review. Zdr Varst 2020;59:108-16. https://doi.org/10.2478/sjph-2020-0014 DOI: https://doi.org/10.2478/sjph-2020-0014
Costa IBSDS, Bittar CS, Rizk SI, Araújo AED, Santos KAQ, Machado TIV, et al. O Coração e a COVID-19: O que o Cardiologista Precisa Saber. Arq Bras Cardiol 2020;114:805-16. https://doi.org/10.36660/abc.20200279 DOI: https://doi.org/10.36660/abc.20200279
Mélo CB, Farias GD, Ramalho HVB, Santos JMG dos, Rocha TT da, Gonçalves EJG, et al. Teleconsulta no SUS durante a pandemia da COVID-19 no Brasil. Res Soc Dev 2021;10(8):e54010817675. https://doi.org/10.33448/rsd-v10i8.17675 DOI: https://doi.org/10.33448/rsd-v10i8.17675
Prefeitura Municipal de Joinville. Secretaria da Saúde. Relatório Anual de Gestão (RAG) 2021. Joinville: Secretaria da Saúde; 2022.
Prefeitura Municipal de Joinville. Secretaria da Saúde. Relatório Anual de Gestão (RAG) 2020. Joinville: Secretaria da Saúde; 2021.
Maeyama MA, Calvo MCM, Nilson LG, Dolny LL. Obligatoriedad de la teleconsulta: una herramienta de gestión para la regulación en salud. Latin Am J Telehealth 2020;7(2):108-13. https://doi.org/10.32443/2175-2990(2020)365 DOI: https://doi.org/10.32443/2175-2990(2020)365
Marotha RA, Rojas Arroyo S, Rodríguez Bonilla F, Navarro Chavarría C, Mora Orozco WE, Barrios Delgado EA. Análisis del alcance de la telecardiología en sus inicios en Brasil, México y España. Latin Am J Telehealth 2019;6(3):290-4. https://doi.org/10.32443/2175-2990(2019)317 DOI: https://doi.org/10.32443/2175-2990(2019)317
Gehrke MA, Dias PS, Natividade TSS, Magalhães ACC, Braun N, Pessoa MS. Perfil dos teleatendimentos realizados pelo núcleo telessaúde-Pará de 2018 a 2019. Rev Bras Med Fam Comunidade 2023;18(45):3364. https://doi.org/10.5712/rbmfc18(45)3364 DOI: https://doi.org/10.5712/rbmfc18(45)3364
Trento MA. Comparación entre la indicación para encaminamientos del teleconsultor y del médico de salud de la familia: el caso de Betim, Minas Gerais. Latin Am J Telehealth 2018;5(2):166-74. https://doi.org/10.32443/2175-2990(2023)448 DOI: https://doi.org/10.32443/2175-2990(2018)243
Ribeiro EG, Brant L, Rezende LC, Teixeira RA, Parreiras LC, Franco TB, Ribeiro A, et al. Effectiveness of telemedicine in reducing hospitalizations in patients discharged from the hospital due to heart failure: a randomized clinical trial protocol. Int J Cardiovasc Sci 2022;35(5):635-42. https://doi.org/10.36660/ijcs.20210131 DOI: https://doi.org/10.36660/ijcs.20210131
Sarti TD, Andreão RV, Souza CB, Schimidt MQ, Celestrini JR. O serviço de Teleconsultoria assíncrona na APS: avaliação de uso e fatores associados do Programa Telessaúde Espírito Santo entre 2012 e 2015. Rev Bras Med Fam Comunidade 2019;14(41):2068. https://doi.org/10.5712/rbmfc14(41)2068 DOI: https://doi.org/10.5712/rbmfc14(41)2068
Prefeitura de Joinville. Projeto-piloto de teleconsultas amplia acesso aos serviços da Secretaria da Saúde de Joinville [Internet]. 2022 [acessado em 20 out. 2023]. Disponível em: https://www.joinville.sc.gov.br/noticias/projeto-piloto-de-teleconsultas-amplia-acesso-aos-servicos-da-secretaria-da-saude-de-joinville/.
Hoepfner C, Franco SC, Maciel RA, Hoepfner AMDS. Programa de apoio matricial em cardiologia: qualificação e diálogo com profissionais da atenção primária. Saúde Soc 2014;23(3):1091-101. https://doi.org/10.1590/S0104-12902014000300028 DOI: https://doi.org/10.1590/S0104-12902014000300028
Hoepfner C, Longo M, Coiradas ADO, Teixeira LMR. Matricial support and arterial hypertension control. Int J Cardiovasc Sci 2017;30(3):199-206. https://doi.org/10.5935/2359-4802.20170045 DOI: https://doi.org/10.5935/2359-4802.20170045
Serôdio ACF. Estratégias para qualificação da atenção à saúde cardiovascular no SUS Campinas [dissertação de mestrado]. Campinas: Universidade Estadual de Campinas; 2019.
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Copyright (c) 2024 Isabeli Zenato Patruni, Hellen Cristine da Silveira, Stella Regina Percio, Rafaela Luisa Kowalski, Clóvis Hoepfner
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