Structure and work process for implementing medical teleconsultation in the Brazilian National Health System, a cross-sectional study using 2017-2018 data

Catapan, Soraia de Camargo; Willemann, Maria Cristina Antunes; Calvo, Maria Cristina Marino

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (1) • 2021 • https://doi.org/10.1590/S1679-49742021000100015 copy

Structure and work process for implementing medical teleconsultation in the Brazilian National Health System, a cross-sectional study using 2017-2018 data^* * Article derived from the Ph.D. thesis entitled ‘Teleconsulta Médica para Atenção Especializada no Sistema Único de Saúde: Possibilidades e Limitações’ [‘Medical Teleconsultation for Specialized Care in the Brazilian National Health System: Possibilities and Limitations’], to be defended by Soraia de Camargo Catapan, under the supervision of Professor Maria Cristina Marino Calvo, at the Federal University of Santa Catarina Postgraduate Program in Public Health. This research was conducted with the support of the Coordination for the Improvement of Higher Education Personnel, a foundation linked to the Brazilian Ministry of Education: Process No. 001/2017.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the structure and the work process in Primary Care for implementing medical teleconsultation in municipalities in different regions and with different population sizes (<25,000; 25,000-100,000; >100,000 inhabitants).

Methods

Cross-sectional study, with descriptive and bivariate analysis, using data from 2017-2018 to assess the availability of computers with internet access, webcam, microphone, speaker, as well as to assess the work processes (use of Telehealth, service supply and demand control center, and communication flow).

Results

30,346 primary health centers and 38,865 teams were evaluated. Presence of teleconsultation equipment in the health centers ranged from 1.2% in large northern municipalities to 26.7% in small southern municipalities. Established work process ranged from 10.7% in small northern municipalities to 39.5% in large southern municipalities. Compared to the South, medium-sized municipalities in the North (OR=0.14 - 95%CI 0.11;0.17) and Northeast (OR=0.21 - 95%CI 0.18;0.25) regions were less likely to have the necessary equipment.

Conclusion

Significant regional inequalities call for investments in Digital Health.

Keywords:
Telemedicine; Remote Consultation; Information Technology; Policy Making; Cross-Sectional Studies

Region	Population size	Computer with internet access^a		Continuous internet		Camera^b		Speaker^b		Microphone^b		UBS^c with desirable structure		UBS^c with minimal structure
Region	Population size	n	%	n	%	n	%	n	%	n	%	n	%	n	%
North	Large (n=741)	479	64.6	337	45.5	114	15.4	195	26.3	51	6.9	9	1.2	336	45.3
	Medium (n=867)	397	45.8	295	34.0	82	9.5	166	19.1	58	6.7	17	2.0	288	33.2
	Small (n=776)	435	56.1	334	43	143	18.4	263	33.9	77	9.9	29	3.7	328	42.3
Northeast	Large (n=2,244)	1,275	56.8	1,113	49.6	404	18.0	577	25.7	211	9.4	99	4.4	1,076	48.0
	Medium (n=4,786)	2,285	47.7	2,238	46.8	1,030	21.5	1,706	35.6	652	13.6	339	7.1	2,072	43.3
	Small (n=5,566)	3,006	54.0	2,938	52.8	1,274	22.9	2,039	36.6	737	13.2	323	5.8	2,707	48.6
Midwest	Large (n=568)	410	72.2	297	52.3	80	14.1	175	30.8	62	10.9	39	6.9	297	52.3
	Medium (n=625)	527	84.3	402	64.3	174	27.8	345	55.2	107	17.1	71	11.4	399	63.8
	Small (n=1,037)	938	90.5	772	74.4	342	33.0	682	65.8	244	23.5	170	16.4	766	73.9
Southeast	Large (n=3,267)	2,493	76.3	2,164	66.2	716	21.9	1,288	39.4	495	15.2	272	8.3	2,135	65.4
	Medium (n=2,433)	1,932	79.4	1,621	66.6	448	18.4	998	41.0	249	10.2	155	6.4	1,612	66.3
	Small (n=3,095)	2,614	84.5	2,380	76.9	775	25.0	1,791	57.9	448	14.5	290	9.4	2,360	76.3
South	Large (n=1,261)	1,162	92.1	989	78.4	425	33.7	669	53.1	243	19.3	165	13.1	988	78.4
	Medium (n=1,134)	1,040	91.7	887	78.2	466	41.1	776	68.4	305	26.9	231	20.4	887	78.2
	Small (n=1,946)	1,782	91.6	1,587	81.6	958	49.2	1,527	78.5	630	32.4	519	26.7	1,582	81.3
Brazil	Large (n=8,081)	5,819	72.0	4,900	60.6	1,739	21.5	2,904	35.9	1,062	13.1	584	7.2	4,832	59.8
	Medium (n=9,845)	6,181	62.8	5,443	55.3	2,200	22.3	3,991	40.5	1,371	13.9	813	8.3	5,258	53.4
	Small (n=12,420)	8,775	70.7	8,011	64.5	3,492	28.1	6,302	50.7	2,136	17.2	1,331	10.7	7,743	62.3

Region	Population size	Uses Telehealth		Specialized consultation supply and demand control center		Institutionalized communication flow (from Primary to Specialized Care)		Teams with minimal work process
Region	Population size	n	%	n	%	n	%	n	%
North	Large (n=1,141)	312	27.3	1,024	89.7	362	31.7	147	12.9
	Medium (n=1,094)	445	40.7	977	89.3	318	29.1	148	13.5
	Small (n=964)	411	42.6	757	78.5	221	22.9	103	10.7
Northeast	Large (n=3,629)	1,555	42.8	3,055	84.2	1,298	35.8	801	22.1
	Medium (n=5,075)	2,847	56.1	4,765	93.9	2,222	43.8	1,437	28.3
	Small (n=5,785)	3,092	53.4	4,941	85.4	2,003	34.6	1,139	19.7
Midwest	Large (n=920)	358	38.9	865	94.0	295	32.1	153	16.6
	Medium (n=672)	422	62.8	585	87.1	258	38.4	186	27.7
	Small (n=1,077)	660	61.3	867	80.5	289	26.8	188	17.5
Southeast	Large (n=6,761)	3,277	48.5	6,116	90.5	3,592	53.1	2,072	30.6
	Medium (n=2,738)	1,232	45.0	2,578	94.2	1,234	45.1	645	23.6
	Small (n=3,355)	2,002	59.7	2,940	87.6	1,051	31.3	607	18.1
South	Large (n=2,130)	1,510	70.9	1,970	92.5	1,024	48.1	842	39.5
	Medium (n=1,294)	855	66.1	1,235	95.4	601	46.4	452	34.9
	Small (n=2,230)	1,412	63.3	2,060	92.4	715	32.1	494	22.2
Brazil	Large (n=14,581)	7,012	48.1	13,030	89.4	6,571	45.1	4,015	27.5
	Medium (n=10,873)	5,849	53.8	10,229	94.1	4,678	43.0	2,895	26.6
	Small (n=13,411)	7,577	56.5	11,565	86.2	4,279	31.9	2,531	18.9

Population size	Region	Minimal structure		p-value^c	Minimal work process		p-value^c
Population size	Region	OR^a	95%CI^b		OR^a	95%CI^b
Large	North	0.23	0.19;0.28	<0.001	0.23	0.19;0.27	<0.001
	Northeast	0.25	0.22;0.30	<0.001	0.43	0.38;0.49	<0.001
	Midwest	0.30	0.24;0.37	<0.001	0.30	0.25;0.37	<0.001
	Southeast	0.52	0.44;0.61	<0.001	0.68	0.61;0.75	<0.001
	South	1.00	-		1.00	-
Medium	North	0.14	0.11;0.17	<0.001	0.29	0.24;0.36	<0.001
	Northeast	0.21	0.18;0.25	<0.001	0.74	0.65;0.84	<0.001
	Midwest	0.49	0.40;0.61	<0.001	0.71	0.58;0.87	0.001
	Southeast	0.55	0.46;0.64	<0.001	0.57	0.50;0.66	<0.001
	South	1.00	-		1.00	-
Small	North	0.17	0.14;0.20	<0.001	0.42	0.33;0.53	<0.001
	Northeast	0.22	0.19;0.25	<0.001	0.86	0.76;0.97	<0.001
	Midwest	0.65	0.54;0.78	<0.001	0.74	0.62;0.89	0.004
	Southeast	0.74	0.64;0.85	<0.001	0.78	0.68;0.89	0.001
	South	1.00	-		1.00	-

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Soraia de Camargo Catapan - Campus Reitor João David Ferreira Lima, Rua Delfino Conti, s/n, Bloco H, Trindade, Florianópolis, SC, Brazil. Postcode: 88040-900. E-mail: scatapan@gmail.com