Expanding Primary Care Access: A Telehealth Success Story

Abstract

Our challenge was to structure a telemedicine framework that is capable of expanding access to services and testing while increasing the quality of the services provided. In this report, we describe the development of a telemedicine project in Brazil and its impact on increasing access to specialist consultations, diagnostic testing, and specialized medical advice to physicians. WHO & WHEREIn early By December, 2016, more than 83,000 hotline teleconsultations had been provided, with user satisfaction rates close to 95%. Specialist consultation was rendered unnecessary in 2 out of every 3 cases discussed.The state of Rio Grande do Sul struggles with large waiting lists in various medical specialties. The wait time can in many cases exceed 3 years. We worked with the Rio Grande do Sul State Department of Health to improve the quality of specialist referrals through development of referral protocols and clinical discussion of waitlisted patients. This has been implemented for 13 medical specialties, with protocols developed for 147 health conditions. As a result, the backlog of specialty appointments was reduced from 190,000 to 68,000 in just 2 years (July 2014 to Dec 2016). We had no problem adding specialists because we created a new field of work for them within the project.We have also expanded our portfolio with telediagnosis and tele-education initiatives. Tele-education actions include the provision of health apps (230,000 downloads so far), distance learning (15,000 students), a YouTube channel, (more than 1 million views) and a website where all our services are centralized. In 2013, we added a telespirometry service, which has already provided 13,000 tests using 9 spirometers distributed across the state of Rio Grande do Sul, enough to cover 100% of the state population of 11 million. This alone has sharply reduced wait times for pulmonary medicine consults (See the Supplemental Appendix).Brazil's medical residency programs are expected to encourage residents to use our tools, which are also promoted through contact with coordinators and presentations at national congresses. In our university, all 140 medical students in their final year are required to make at least 2 teleconsultations in the 3 months of internship. LEARNINGThrough this project, we have learned that effective information and communication technologies can be extremely valuable in health care. Telehealth represents the future of primary health care, and there is no way back.

Avaliação Econômica de um Serviço de Telemedicina para ampliação da Atenção Primária à Saúde no Rio Grande do Sul: o microcusteio do Projeto TeleOftalmo

“…It is estimated that waiting for an appointment to receive a prescription for corrective len-ses is more than one year in southern Brazil 16 . The lack of rational criteria in the ophthalmological appointment scheduling protocol, which causes an excessive delay in providing medical services, has the most severe consequence of irreparable loss of vision, in cases of glaucoma, dia-betic retinopathy, among other pathologies.…”

“…The Telehealth Center of the Federal University of Rio Grande do Sul (TelessaúdeRS-UFRGS) was selected as the telemedicine's study object 15,16 , because combating eye diseases is a priority for the World Health Organization (WHO) 33 and because it demands greater interest among managers in knowing the real cost of the procedure. TeleOftalmo is a telemedicine research and service offering project that has been underway since July 2017 in the state of Rio Grande do Sul (RS), Brazil, which receives primary funding from the Ministry of Health, through the Program to Support the Institutional Development of the Unified Health System (PROADI-SUS).…”

“…Brazil is a country with unique opportunities for the development and applications of telemedicine, given its geographical distribution and inability to meet the demand for face-to-face care 2,15,16 . Data from the management system of specialized outpatient appointments provided by the State Health Secretariat of Rio Grande do Sul reveal that, at the end of 2016, the number of people waiting for a specialized ophthalmology visit in the capital was about 10 times higher than the monthly offer of visits, translating into a maximum 19-month waiting period 17 .…”

“…Existing economic assessments of the subject are still recent and do not allow an assertive con-clusion about the economic feasibility of the implementation in the Brazilian Health System 19 . It is known that the scientific and financial investments required to introduce these technologies into the system are high 20 , enhancing the importance of conducting accurate economic analyses to guide decisions regarding the implementation of telemedicine services 16,20 .…”

Atenção básica ou atenção primária à saúde?

“…Based on local studies, this research has identified strategies that promote coordination of care, highlighting the expansion of caseresolution capacity in basic care. The objective is for basic health care to effectively become the service that the population uses regularly, expanding the scope of actions, arrangements for communication and exchange of information between services, direct communication between general practitioners and specialists, clinical dialogue and continuing training with participation by professionals from basic care and specialized care, shared electronic patient files, Telehealth with second opinions, and drafting of standard protocols with participation by professionals from basic care and specialized care 14,15,16,17,18,19 .…”