Telehealth for Supporting Referrals to Specialized Care During COVID-19.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic led to the suspension or postponement of care for non-urgent conditions worldwide. Regula Mais Brasil is an initiative of the Unified Health System (SUS) in Brazil to optimize the management of referrals to specialized care by using telehealth. Objectives: To report the expansion of telehealth activities of Regula Mais Brasil in response to COVID-19 and to assess qualification of referrals in primary health care (PHC) units as well as the added value of teleconsultation in qualifying referral cases. Methods: Descriptive study of the teleconsultations carried out as an additional strategy to the remotely operated referral management system, responsible for navigating cases from PHC units to specialized care in Recife, Brazil, between May 6, 2020 and September 30, 2020. Teleconsultation was implemented as a tool for reducing delays in the access to health care due to COVID-19 and ultimately allowed for reclassification of the referral adequacy and priority. Changes in referral priority ratings and referral decisions after teleconsultation were analyzed. Results: A total of 622 referral cases were analyzed. Approved referrals represented 51.9% of cases. The main reason for approved referrals was the need for diagnostic resources. There was a reduction in priority ratings in 449 cases (72.2%) after teleconsultation. There was a statistically significant association between the change of priority ratings and the decision on referral (Pearson's χ2, p-value <0.0001). Results show that telemedicine had an impact on the prioritization and qualification of cases referred to specialized services. Conclusions: A need was detected to rapidly adapt tools available for telemedicine in Brazil. Our results demonstrate that teleconsultation as an additional strategy to the remotely operated referral management system has contributed toward improving equitable access to specialized services.

Is there a relationship between spirituality/religiosity and resilience? A systematic review and meta-analysis of observational studies.

Resilience is the ability to recover or cope with adverse situations. Spiritual and religious beliefs may be associated with important "resilience resources." To investigate whether there is a relationship between spirituality/religiosity (S/R) and resilience. This is a systematic review (observational studies) with meta-analysis following the PRISMA guidelines. From a total of 2468 articles, 34 observational studies were included. We identified a moderate positive correlation between S/R and resilience (r = 0.40 (95% CI, 0.32-0.48], p < 0.01). When only high-quality articles were included, the results were maintained. Conclusion: A moderate positive correlation was found between S/R and resilience.

[Development of standards for education and training in family and community medicine - contributions by WONCA IberoAmerica (CIMF)]. / Desarrollo de estándares para la educación y formación en medicina familiar y comunitaria - contribuciones de la WONCA IberoAmérica (CIMF).

The WONCA Education Working Party (WEP) is developing a set of standards for medical student education, postgraduate training in family medicine / general practice and continuing professional development for family doctors. At this point the contributions by WONCA world regions are very important, and for this reason the main objective of this report is to present the standards developed by the Iberoamerican WONCA Region (CIMF). To be comprehensive and effective, standards should reflect regional realities and so the contributions from CIMF may reinforce and strengthen the key initiative of WEP and the implementation of the standards throughout the world.

Telenursing in primary health care: report of experience in southern Brazil.

The Rio Grande do Sul Telematics and Telehealth kernel in Brazil, aims to enhance the quality of the Unified Health System (UHS) in support of primary health care (PHC) services, most of them engaged in the Family Health Program (FHP). Among the initiatives of the TeleHealth Rio Grande do Sul, there is consulting via e-mail and videoconference. They are requested and answered using specific forms available on TeleHealth's intranet. This study registers the experience on supporting and answering demands using clinical evidence, and presents professional characteristics and some results reached until now. Data related to professional characteristics were extracted from a questionnaire prepared by the program execution team, and applied during training sessions in 2007 and 2008. Consults sent by nurses, technicians and community health agents were analyzed considering its number and content. The analyzed sample of nurses showed that 89.1% were female, 40% younger than 30 years old and the majority graduated within the past 5 years. Most of them (97) work for the FHP and 51.61% have a pos graduate degree. Most of the interviewed nurses use e-mail to communicate and the internet at least once a week. So far, the program TeleHealth Rio Grande do Sul have received 498 consult requests, 111 related to the nursing field. The nurses answer nursing related doubts, sent by nursing technicians and community health agents. The consults involve several different subjects, mainly on wounds, woman health, drugs and medicines. Considering the consults demanded, the group decided to create health care protocols, starting with the most requested subjects, such as the wounds, which is about to be released on the Rio Grande do Sul TeleHealth website.