Is telemedicine prepared to overcome the barriers to access of health services in Brazil?
TeleNordeste’s experience report
DOI:
https://doi.org/10.5712/rbmfc19(46)4010Keywords:
Telemedicine, Primary health care, Barriers to access of health services.Abstract
Problem: In Brazil, there is evidence that certain disadvantaged groups have lower survival rates and a higher probability of premature death. Health inequities are favored by the poor distribution of healthcare professionals, especially doctors, across the country. Telehealth has the potential to support the resolution of issues related to the population’s health. This article described the implementation of a teleconsultation service for Primary Health Care (PHC) with secondary services through telemedicine. It includes challenges and barriers to implementation not commonly described in the literature. Methods: This is an experiential report on the implementation of TeleNordeste in Rio Grande do Norte. The project was developed in collaboration with the Brazilian Ministry of Health through the Support Program for Sustainable Development of the Unified Health System (PROADI-SUS) and built with the assistance of local professionals and managers based on the PASA model, linking teleconsultant doctors to Family Health Teams in the territory. Results: Several stages were necessary for implementation, such as situational diagnosis, approach visits, and collaboration contracts between municipalities and Moinhos de Vento Hospital Association (Associação Hospitalar Moinhos de Vento – AHMV). During implementation, barriers and challenges related to technological, human, and social aspects of the healthcare network, psychosocial and anthropological factors, as well as governmental and economic factors, were identified. Conclusions: Despite all the barriers and challenges encountered in the implementation process, it was possible to verify that teleconsultations have many advantages and also function as a strategy for continued education. The teleconsultation model implemented in Rio Grande do Norte has demonstrated a reduction in waiting time and resolved the majority of cases attended, reducing in-person referrals.
Downloads
Metrics
References
Brasil. Ministério da Saúde. Sistema Único de Saúde – SUS [Internet]. [acessado em 18 maio 2024]. Disponível em: https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/s/sus
Macedo AS, Ferreira MAM. O programa mais médicos e alocação equitativa de médicos na atenção primária à saúde (2013-2017). REAd Rev Eletrôn Adm (Porto Alegre) 2020;26(2):381-408. https://doi.org/10.1590/1413-2311.288.97551 DOI: https://doi.org/10.1590/1413-2311.288.97551
Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429-45. https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN DOI: https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN
Constante HM, Marinho GL, Bastos JL. The door is open, but not everyone may enter: racial inequities in healthcare access across three Brazilian surveys. Cien Saude Colet 2021;26(9):3981-90. https://doi.org/10.1590/1413-81232021269.47412020 DOI: https://doi.org/10.1590/1413-81232021269.47412020
Guilloux AGA, Miotto BA, Almeida CJ, Guerra A, Cassenote A, Matijasevich A, et al. Demografia médica no BRASIL 2023 [Internet]. São Paulo: FMUSP; 2023. [acessado em 19 maio 2024]. Disponível em: https://amb.org.br/wp-content/uploads/2023/02/DemografiaMedica2023_8fev-1.pdf
Alves MEM, Santi CAN, Ramos MCPS, Matos PBL, Lopes ALN, Nascimento LS. Telessaúde na atenção primária à saúde no Brasil: uma análise com base no 3o ciclo do PMAQ-AB. RECISATEC-Revista Científica Saúde e Tecnologia 2022;2(1):2-15. DOI: https://doi.org/10.53612/recisatec.v2i1.86
Moreira TC, Constant HM, Faria AG, Matzenbacher AMF, Balardin GU, Matturro L, et al. Tradução, adaptação transcultural e validação de questionário de satisfação em telemedicina. Rev Bras Med Fam Comunidade 2022;17(44):2837. https://doi.org/10.5712/rbmfc17(44)2837 DOI: https://doi.org/10.5712/rbmfc17(44)2837
Chagas MEV, Constant HMRM, Jacovas VC, Rocha JC, Steimetz CGC, Matte MCC, et al. The use of telemedicine in the PICU: a systematic review and meta-analysis. PLoS One 2021;16(5):e0252409. https://doi.org/10.1371/journal.pone.0252409 DOI: https://doi.org/10.1371/journal.pone.0252409
Araujo AL, Moreira TC, Rados RDV, Gross PB, Molina-Bastos CG, Katz N, et al. The use of telemedicine to support Brazilian primary care physicians in managing eye conditions: the TeleOftalmo Project PLoS One 2020;15(4):e0231034. https://doi.org/10.1371/journal.pone.0231034 DOI: https://doi.org/10.1371/journal.pone.0231034
Brasil. Presidência da República. Secretaria-Geral. Subchefia para Assuntos Jurídicos. Lei no 14.510, de 27 de dezembro de 2022. Altera a Lei no 8.080, de 19 de setembro de 1990, para autorizar e disciplinar a prática da telessaúde em todo o território nacional, e a Lei no 13.146, de 6 de julho de 2015; e revoga a Lei no 13.989, de 15 de abril de 2020 [Internet]. 2022 [acessado em 19 maio 2024]. Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2022/lei/L14510.htm
Conselho Federal de Medicina. Resolução CFM no 2.314/2022. Define e regulamenta a telemedicina, como forma de serviços médicos mediados por tecnologias de comunicação [Internet]. Brasília: Conselho Federal de Medicina; 2022 [acessado em 31 ago. 2023]. Disponível em: https://sistemas.cfm.org.br/normas/arquivos/resolucoes/BR/2022/2314_2022.pdf
Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. J Nurse Pract 2021;17(2):218-21. https://doi.org/10.1016/j.nurpra.2020.09.013 DOI: https://doi.org/10.1016/j.nurpra.2020.09.013
Goodman D, Ogrinc G, Davies L, Baker GR, Barnsteiner J, Foster TC, et al. Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: Examples of SQUIRE elements in the healthcare improvement literature. BMJ Qual Saf 2016;25(12):e7. https://doi.org/10.1136/bmjqs-2015-004480 DOI: https://doi.org/10.1136/bmjqs-2015-004480
Mendes EV. As redes de atenção à saúde. Ciên Saúde Coletiva 2010;15(5):2297-305. https://doi.org/10.1590/S1413-81232010000500005 DOI: https://doi.org/10.1590/S1413-81232010000500005
Instituto Brasileiro de Geografia e Estatística. Cidades e Estados. Rio Grande do Norte [Internet]. Brasília: IBGE, 2014 [acessado em 31 ago. 2023]. Disponível em: https://www.ibge.gov.br/cidades-e-estados/rn.html
Lameiras MAP, Moraes ML. Análise e projeções de inflação [Internet]. Carta de Conjuntura 2023;58 [acessado em 25 maio 2023]. Disponível em: https://www.ipea.gov.br/cartadeconjuntura/index.php/2023/03/
Chen AH, Kushel MB, Grumbach K, Yee Jr HF. Practice profile. A safety-net system gains efficiencies through ‘eReferrals’ to specialists. Health Aff (Millwood) 2010;29(5):969-71. https://doi.org/101377/hlthaff20100027 DOI: https://doi.org/10.1377/hlthaff.2010.0027
Saiso SG, Marti MC, Pascha VM, Pacheco A, Luna D, Plazzotta F, et al Implementation of telemedicine in the Americas: barriers and facilitators. Rev Panam Salud Publica 2021;45:e131. https://doi.org/10.26633/RPSP.2021.131 DOI: https://doi.org/10.26633/RPSP.2021.131
Sarti TD, Almeida APSC. Incorporation of telehealth in primary healthcare and associated factors in Brazil. Cad Saude Publica 2022;38(4):PT252221. https://doi.org/10.1590/0102-311XPT252221 DOI: https://doi.org/10.1590/0102-311xpt252221
Leddy A, Ggita J, Berger CA, Kityamuwesi A, Sanyu AN, Tinka LK, et al. Barriers and facilitators to implementing a digital adherence technology for tuberculosis treatment supervision in Uganda: qualitative study. J Med Internet Res 2023;25:e38828. https://doi.org/10.2196/38828 DOI: https://doi.org/10.2196/38828
Schreiweis B, Pobiruchin M, Strotbaum V, Suleder J, Wiesner M, Bergh B. Barriers and facilitators to the implementation of eHealth services: systematic literature analysis. J Med Internet Res 2019;21(11):e14197. https://doi.org/10.2196/14197 DOI: https://doi.org/10.2196/14197
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Maria Eulália Vinadé Chagas, Gabriela Tizianel Aguilar, Tiago Sigal Linhares, Taís de Campos Moreira, Andressa Dutra Dode, Gabriel Ricardo Fernandes, Guilherme Carey Frohlich, Deysi Heck Fernandes, Hilda Maria Rodrigues Moleda Constant, Felipe Cezar Cabral
This work is licensed under a Creative Commons Attribution 4.0 International License.
By submitting a manuscript to the RBMFC, authors retain ownership of the copyright in the article, and authorize RBMFC to publish that manuscript under the Creative Commons Attribution 4.0 license and identify itself as the vehicle of its original publication.
