Telehealth Actions to Address COVID-19 in Latin American Countries.

Introduction: This study set out to examine the use of telehealth resources to tackle the coronavirus disease 2019 (COVID-19) pandemic in Latin America within the scope of national telehealth projects (NTPs). Methods: A qualitative study developed using ethnomethodology for appropriate understanding of how telehealth actions were carried out in practice during the COVID-19 pandemic within the scope of NTPs, in the following countries: Argentina, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Peru, and Uruguay. The study was carried out from October to 2020 to March 2021. The number of participations in the discussion groups, formed by coordinating teams of NTPs, totaled 90. Results were described in the worksheet completed according to the script. Each country reviewed its respective data, three times on average, in an effort to clarify actions developed. Results: Three groups of countries were identified: (1) Countries with a telehealth background that used these resources to tackle COVID-19 and thereby refined telehealth activities. Countries with greater experience in NTP design, such as Mexico, Colombia, Peru, and Argentina, were able to use a wide range of telehealth activities to tackle the pandemic, with offers of teleconsultation, teleguidance, telemonitoring to patients, and training of health professionals; (2) Countries with some telehealth activities to address COVID-19. Uruguay, Ecuador, El Salvador, and Costa Rica; and (3) Countries with no evidence of telehealth resource use during the pandemic. Honduras and Guatemala. Discussion: Most NTPs in Latin America have improved their telehealth activities, contributing to address the COVID-19 pandemic in Latin America.

Implementation of Telehealth Resources in Primary Care in Brazil and Its Association with Quality of Care.

Background:Although several reviews on the relation between telemedicine and health care outcomes have pointed out some evidence, they have also underscored the need for further investigation.Introduction:Brazil has a national telehealth program implemented in 2007, involving teleconsulting and distance education actions in primary care.Objective:This study aims to describe the implementation of telehealth in primary care in Brazil and to identify if there is an association between telehealth and quality of care.Methods:A cross-sectional study analyzing data from interviews with 29,778 primary care team professionals in Brazil in 2014, which represents 92.5% of existing health care teams, on aspects of information technology, telehealth, and care was carried out. A multiple binary regression analysis was performed to study the associations between the extent of health care actions and using telehealth.Results:Of the 24,055 primary care units in Brazil where teams worked, only 50.1% (n: 12,055) had internet access, and 32.71% of teams claimed to be involved in telehealth actions in 2014. Between 2012 and 2014 there was an expansion in the use of telehealth resources in all regions of Brazil. The highest magnitude was observed for the association between employment of telehealth and improvement in child care (odds ratio [OR] = 2.09), followed by diabetes mellitus care (OR = 1.91), hypertension (OR = 1.89), and finally, women's health (OR = 1.86).

Belo Horizonte Telehealth: Incorporation of Teleconsultations in a Health Primary Care System.

INTRODUCTION: The Belo Horizonte Telehealth program, a pioneer in telemedicine within the Brazilian National Health System (Sistema Único de Sauùde in Portuguese), was implemented by the Belo Horizonte City Health Department (SMSA-BH) in 2004. The purpose of the present study is to analyze opinions on the obstacles, difficulties, and suggestions on the use of teleconsultations. METHODS: Semi-structured interviews were conducted among primary healthcare professionals and health managers. Content analysis for the latter was carried out using NVIVO® software to categorize responses. Simple descriptive quantitative aspects were analyzed to verify the use of the system over the years by the primary care unit (PCU) professionals. RESULTS: The difficulties encountered were related to the use of the system, inadequate response to teleconsultation requests, infrastructure problems, lack of practicality for the use of the program, difficulty in incorporating the program into the organizational culture, and lack of managerial support. Changes in management organization over the years have interfered with the use of the teleconsultation system. The most requested specialties were neurology, cardiology, endocrinology, and angiology. DISCUSSION: The main suggestions for increasing the number of teleconsultations requests included dissemination of information and prioritization by the management; improvement of the infrastructure; organization of the time and the agenda of the PCU professional; training the professionals for its use; and preconditioning the referrals to secondary level care to a previous teleconsultation. CONCLUSION: Teleconsultations need to be incorporated in the daily routine of PCUs by both managers and health professionals to assure its usage and improve the quality of care.

Is the Use of Information and Communication Technology Associated With Aspects of Women's Primary Health Care in Brazil?

The use of information and communication technology (ICT) is on the increase in the health systems, representing a means of improving the quality of health care. This study analyzed the ICT incorporation in primary care in Brazil and identified the different aspects that may be associated with better quality in the care provided, in relation to certain aspects of women's care. We noted an unevenness regarding ICT incorporation in Brazil. However, the findings indicate an association between ICT and certain aspects of the quality provided in women's health care, which reinforces the need for further studies on this type of evaluation.

Institutional and matrix support and its relationship with primary healthcare.

OBJECTIVE: To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams. METHODS: In this cross-sectional study, we evaluated two kinds of primary healthcare support - 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was "level of support" (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test. RESULTS: The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23). CONCLUSIONS: In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

[An overview of telehealth initiatives in Latin America]. / Uma visão panorâmica das ações de telessaúde na América Latina.

This article aimed to systematize the views on telehealth in Latin America and to present the experience of building an instrument for monitoring the development of telehealth initiatives based on the reality of this region. A group was structured to coordinate telehealth efforts in Latin America, with members appointed by the ministries of health of 16 countries. Five thematic groups were also set up. Based on international experiences and focusing on the reality of telehealth in the continent, an instrument was created to monitor the development of telehealth in Latin America. Several countries have national telehealth projects: Brazil, Colombia, Ecuador, Mexico, Panama. Others are in the process of development and early deployment: Bolivia, Costa Rica, Cuba, El Salvador, Guatemala, Peru, Venezuela. The instrument described in the article, which is still being tested, proposes a characterization of countries according to their telehealth development stage: nonexistent, nascent, intermediate, advanced, and exemplary. Currently, important telehealth initiatives are already underway in Latin America.

Telehealth distance education course in Latin America: analysis of an experience involving 15 countries.

BACKGROUND: Telehealth activities are already going on in many Latin American countries. This article aims to present and evaluate a distance learning telehealth training course in the region. MATERIALS AND METHODS: This was a cross-sectional descriptive study. A coordinating committee was formed, composed of medical school faculty from 15 countries, which defined the course's syllabus, teaching model, and mentoring structure. A questionnaire was prepared, using a Likert scale, in order to verify if the parameters of gender, age, professional category, postgraduate degree, and experience in distance education indicated any difference in relation to the course evaluation. The responses were analyzed by chi-squared test, considering as significant a value of p<0.05. RESULTS: Of the 353 enrolled participants, 251 (71.10%) did the basic modules, and 96 (43.91%) completed the full training. In relation to the overall course assessment, it was considered excellent or good by 80.92% of participants, the mentors received positive evaluations by 72.83% of students, the course content was evaluated as excellent or good by 87.4% of students, and 94.40% of participants would recommend it. As for the parameters assessed, only experience in distance education was statistically significant for the evaluation of the tutors. CONCLUSIONS: The results presented indicate an important concern on the part of the Latin American countries participating on the course in relation to telehealth training activities. Regarding course assessment, high approval rates in relation to tutoring, educational model, course content, and goals were noted, corroborating literature data. The experience of conducting a Latin American shared telehealth training course was indeed positive, contributing to the development of telehealth actions.

Teleconsultations in public primary care units of the city of belo horizonte, Brazil: profile of patients and physicians.

OBJECTIVE: The aim of this study is to report patient and physician profiles of those who used the teleconsultation system in the primary care health units of a health district in the city of Belo Horizonte, MG, Brazil. MATERIALS AND METHODS: Data were collected from the telehealth attendance records of nine Primary Health Units (Unidade Básica de Saúde [UBS] in Portuguese) and from interviews carried out with the referring physicians. The criteria for inclusion required that data come from users seen by means of telehealth in the period between December 2004 and August 2010 and from the practitioners who saw them. The following were excluded: physicians who were not working in the UBS when the data were collected and a physician who did not agree to take part in the study. RESULTS: Two hundred sixty-three teleconsultations were analyzed, and 20 referring physicians were interviewed. The offline method was the most common. The physicians were predominantly female and had graduated over 11 years ago. The patients were predominantly adult women. After teleconsultation, a prescription was not necessary for 9.8% of patients. When required, 83.2% of the medication was available in the UBS. In 68.3% of cases, additional tests were required. The incorporation of these technologies prevented the physical referral of patients in 64.2% of cases. CONCLUSIONS: Telehealth resources can help to improve the provision of primary healthcare, reducing the number of physically referred patients. The number of teleconsultations is still small, and there is a need to encourage physicians to use the system.

Evaluating the experience of training through videoconferences in primary care.

INTRODUCTION: The technological innovations that are a part of organizational realities allow for new possibilities in social processes. In Belo Horizonte, Brazil, the municipality established a system of training through videoconferences in primary care connecting professors and professionals from primary care units to discuss assistance problems in medicine, nursing, and dentistry. OBJECTIVE: An evaluation of the professionals' perception regarding the system of training through videoconferences in primary care. METHODS: The study involved 148 basic health units in the city of Belo Horizonte. A structured survey was applied to a sample of 373 people who used the system in 2008. RESULTS: According to the survey data, 58.6% of the professionals participated in more than three videoconferences in 6 months, whereas 30.3% did not participate in any type of face-to-face training activity; 98% considered the topics interesting and 70% affirmed that the topics discussed helped them when performing assistance tasks. Other aspects that were evaluated as excellent or good include: 36.6% approved the sound quality of the videoconferences, 46.4% approved the image quality, and 43.9% approved the system stability. These results highlight some problems. Nevertheless, 90.2% evaluated the telehealth project as being excellent or good and 96.7% would recommend the implementation of the project in other units. CONCLUSIONS: The system of educational training videoconferences can contribute to improving the competence of primary healthcare attention.

[Using information resources management to set up the area of health information: a case analysis]. / Estruturação da área de informação em saúde a partir da gerência de recursos informacionais: análise de experiência.

OBJECTIVE: To report the experience of the City Department of Health in Belo Horizonte (SMSA/BH), state of Minas Gerais, Brazil, with the use of information resources management (IRM) to develop a health information system. METHODS: In this case study we reviewed documents describing initiatives in the area of information, the mechanisms used to enable these initiatives, and the results achieved with a management system focused on the implementation of an electronic medical records system in the period from 2003 to 2008. This process is described and analyzed from the perspective of IRM. RESULTS: The system contributed to a change in the health care model, resulting from the electronic integration of 103 basic health units, 9 specialized units, and 503 family health teams, with emphasis on information that was relevant for the family health program. CONCLUSIONS: The following IRM components were effectively implemented as part of the electronic system: creation of a single locus for the areas of information technology and information, potential leveraging of information technology, and establishment of a strategic forum for information-related decision-making. One limitation refers to the use of strategic information for long-term decision-making.

Telehealth in primary healthcare: an analysis of Belo Horizonte's experience.

BACKGROUND: Telehealth resources were implemented in the city of Belo Horizonte, providing tools for the medical assistance model as well as strengthening the quality of primary healthcare attention. OBJECTIVE: The objective of this study was to analyze the characteristics of the incorporation of telehealth resources in Belo Horizonte, Brazil, and its contribution to the structuring of primary healthcare. MATERIALS AND METHODS: This study focused on a description of the telehealth projects related to primary healthcare in the city and the results of the implementation process. The sources for this analysis include documents presented to financing institutions, reports from the Belo Horizonte City Department of Health, and articles and technical reports related to the evaluations of the project. RESULTS: The BHTelehealth Project has been established in 148 basic health units in Belo Horizonte. It develops assistance and educational activities by using 3D modeling, interactive videos, and animations. The analysis of this implementation process identified both positive and negative aspects. Telehealth has strengthened the role of primary healthcare as the coordinator of attention. It has reinforced primary care units by widening the scope of attention offered at this level and has provided primary care staff with a powerful arsenal of up-to-date information and tools. CONCLUSION: BHTelehealth served as a model for implementing the National Telehealth Program, in course in Brazil, involving 900 cities. This is attributed to its positive impact on the training of primary care unit professionals.