RESUMO
INTRODUCTION: The availability of interdisciplinary groups trained in morbidly adherent placenta (MAP) is limited. Telemedicine can be a useful strategy to bring patients affected by MAP to institutions specialized in its management. We sought to assess how useful an informal teleconsultation is for MAP cases among users who contacted a reference center for this pathology in a low middle-income country. METHODOLOGY: Likert-type surveys were conducted among specialist physicians who carried out teleconsultation with a MAP experienced institution, for assessing how useful the remote assistance was. RESULTS: In 15-month period, 21 teleconsultations associated with MAP were recorded. Teleconsultation was considered "very useful" by 100% of obstetricians. Among the physicians, 90.5% said they would "definitely use the service again" if they had a new case of MAP and 85.7% said that they would "always recommend" the service to other groups of specialists. CONCLUSION: Teleconsultation in MAP cases is perceived by service users as a useful tool in the management of affected patients. In a context with few specialized centers in the management of this condition, telemedicine must be taken into account when designing comprehensive care strategies for this rare and highly morbid disease.
Assuntos
Médicos , Placenta Acreta , Consulta Remota , Telemedicina , Feminino , Humanos , Placenta Acreta/diagnóstico , Placenta Acreta/terapia , Gravidez , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The World Health Organization's World Health Assembly WHA58.28/2005 Resolution recommends the adoption of e-health by health systems of State Members. The Brazilian Telehealth Program integrates the national policy of education for health that combines many strategies with complementary foci, including technical-level workers, undergraduate students of the 14 health professions, residency, postgraduate courses, support, and continuing health education at work. The Brazilian Unified Health System has approximately 1.5 million workers. The objectives of this work areas are as follows: to define a new concept, the so-called "formative second opinion" (FSO); to describe the methodology for its construction; and to show its structure as well as the number of FSOs already available, classified according to the field of knowledge. MATERIALS AND METHODS: The Brazilian Telehealth Program was created in 2007 and has already offered around 41,000 teleconsultations. Based on their relevance and pertinence, 710 questions asked through teleconsulting by health professionals were selected. The questions were handled so that each question should not contain any specific information about patients, preserving professional confidentiality. For each question, a bibliographic review was performed and used to build a structured and standardized answer, based on the best available scientific and clinical evidence. RESULTS: This question-and-answer combination, originated thru teleconsulting, created by the Brazilian Telehealth Program, was termed the FSO and has been made available, with open access for all health professionals, at the Web site of the Program. Among the total number of 710 FSOs, diagnosis and treatment support corresponded to 238 questions (33.5%), followed by primary healthcare (90 questions) and then by subjects concerning oral health (68 questions) and nursery (39 questions). The structure and design of the FSO are also shown. CONCLUSIONS: The FSO helps professionals and health workers to use the already produced best evidence and scientific knowledge to solve their daily practice questions, improving, qualifying, and increasing the resolution of primary healthcare by the Unified Health System in Brazil. Oral health is frequently asked about by professionals, matching the high prevalence of oral disease in primary healthcare.