Brazilian National Service of Telediagnosis in Electrocardiography.

Access to specialized care remains unsolved in Brazil. The National Telediagnosis Project was created to expand successful telediagnosis experiences nationwide. The Telehealth Network of Minas Gerais (TNMG) was selected as a reference for tele-electrocardiogram (ECG). We aim to describe the experience of TNMG of developing and implementing the Brazilian National Service of Telediagnosis in Electrocardiography. Implementation planning includes discussion of workflows, standard procedures, responsibility definition for stakeholders, and adaptation of TNMG telediagnosis system. Tele-ECG has been implemented in 79 municipalities in 5 states. In a survey with 152 health professionals, 57% noted that ECG was not available in the local public health system before, 63% indicated tele-ECG service utilization ≥3 days per week, 96% considered the service very useful and 89% were very satisfied with it. In conclusion, the service fills a gap in specialized care in the public system and can improve access to a basic exam in remote and underserved regions.

Factors associated with the use of a teleconsultation system in Brazilian primary care.

BACKGROUND: The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service that provides support to primary healthcare in Minas Gerais, Brazil, performing teleconsultation and tele-electrocardiography. The aim of this study was to assess teleconsultation requests received by the TNMG and to investigate the factors associated with low teleconsultation utilization in most municipalities. MATERIALS AND METHODS: A cross-sectional study was carried out including 214 municipalities. Indicators were defined to analyze teleconsultation requests. A structured questionnaire was used to investigate factors associated with teleconsultation utilization, which were analyzed by multivariate analysis through a decision tree algorithm (chi-squared automatic interaction detector) to the entire population of the study and logistic regression for municipalities that had used the system during the analyzed period. RESULTS: From May to September 2009, 1,954 teleconsultations were performed. The average number (±standard deviation) of teleconsultations per municipality was 1.71 (±1.50) per month. The majority of the users were located in remote regions with a low Human Development Index. The decision tree showed "conduction of sufficient training" (p=0.0015) as the factor with the greatest positive impact on teleconsultation utilization, followed by "ability to discuss clinical cases outside the teleconsultation system" (p=0.0192). Logistic regression analysis revealed two factors associated with increased use of the system: "complexity of the system" (odds ratio=3.35; 95% confidence interval [CI], 1.58-7.09) and whether they considered that the "service helps to solve everyday problems" (odds ratio=4.37; 95% CI, 1.14-16.69). CONCLUSIONS: The study of factors associated with the low use of the teleconsultation system of the TNMG may help policy makers define strategies to improve the use of teleconsultation services.