RESUMO
BACKGROUND: In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil. PURPOSE: To describe the successful experience of the TNMG in 10 years of activities. METHODS: The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff. RESULTS: Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction. CONCLUSIONS: The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the quality of the PHC.
Assuntos
Atenção Primária à Saúde/organização & administração , Consulta Remota/organização & administração , Atitude do Pessoal de Saúde , Brasil , Comportamento do Consumidor , Análise Custo-Benefício , Apoio Financeiro , Humanos , Monitorização Ambulatorial/economia , Monitorização Ambulatorial/métodos , Atenção Primária à Saúde/economia , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde/organização & administração , Consulta Remota/economia , Telemedicina/organização & administraçãoRESUMO
This observational restrospective study was designed to assess teleconsultations performed by a public telehealth service in Brazil. A satisfaction survey was used to assess the impact on clinical practice. A total of 63,975 teleconsultations were performed, from April 2007 to November 2014. Family physicians (33%) and dermatologists (19%) answered most queries. From January to February 2014 (n=895), the most frequent queries were about etiology (30%) and pharmacological treatment (25%). The satisfaction survey in 2014 (n=571) showed that teleconsultations avoided patient referal in 78%. This study aims to shows the potential of telehealth to provide support to primary care practitioners in remote cities.