Evaluación de la usabilidad de la teleconsulta durante la pandemia por COVID-19 en un hospital pediátrico / Assessment of the usability of teleconsultations during the COVID-19 pandemic at a children's hospital

Introducción. La usabilidad en un sistema de teleconsulta afecta directamente la eficiencia y efectividad de la atención médica remota. Objetivo. Evaluar la usabilidad de la teleconsulta durante la pandemia por COVID-19. Población y método. Estudio de corte transversal. Incluimos a los cuidadores de niños/as de 1 mes a 12 años. Evaluamos la usabilidad mediante el Telehealth Usability Questionnaire adaptado en español. Además, evaluamos datos socioeconómicos. Resultados. Tasa de respuesta del 70,2 % (n = 221). La mayoría eran mujeres, edad promedio 33 años, con educación secundaria y cobertura de salud pública. El 87,8 % eligió atención telefónica y el 88,2 % tenía su primera teleconsulta. Alta satisfacción general con puntuaciones menores en facilidad de uso y aprendizaje en videollamadas. Conclusión. La teleconsulta mostró alta usabilidad, independientemente de la modalidad, para cuidadores de niños/as de 1 mes a 12 años.

Introduction. Usability in a telemedicine system directly affects the efficiency and effectiveness of remote health care. Objective. To assess the usability of teleconsultations during the COVID-19 pandemic. Population and method. This was a cross-sectional study. The caregivers of children aged 1 month to 12 years were included. Usability was assessed with the Telehealth Usability Questionnaire, adapted to Spanish. Socioeconomic data were also assessed. Results. The response rate was 70.2% (n = 221). Most responders were women whose average age was 33 years, had completed secondary education and had public health insurance. Of them, 87.8% selected telephone health care and 88.2% had their first teleconsultation. The overall satisfaction was high, with lower scores for ease of use and learning how to use video calls. Conclusion. Regardless of modality, the usability of teleconsultations by caregivers of children aged 1 month to 12 years was adequate.

Mayor uso de teleconsultas programadas y mensajería asincrónica del portal en atención primaria / Increased Use of Scheduled Teleconsultations and Asynchronous Portal Messaging in Primary Care

Introducción: durante la pandemia de COVID-19 hubo un auge sin precedentes de la telemedicina, probablemente por la forzada adopción de tecnología ante las medidas restrictivas. El presente estudio se propuso comparar la interacción y la comunicación entre médicos de cabecera (MC) y pacientes, antes y durante el período de pandemia, en términos de consultas ambulatorias programadas y mensajes del Portal de Salud. Materiales y métodos: corte transversal con muestreo consecutivo de turnos programados y mensajes, ocurridos entre las semanas epidemiológicas (SE) 10 y 23, de 2019 y 2020, respectivamente. Se incluyeron 147 médicos del Servicio de Medicina Familiar y Comunitaria, y una cápita de 73 427 pacientes afiliados al Plan de Salud del Hospital Italiano de Buenos Aires. Se realizó análisis cuantitativo y cualitativo. Resultados: hubo una reducción del 70% de las consultas presenciales (de 76 375 en 2019 a 23 200 en 2020) y un aumento concomitante de teleconsultas (de 255 en la SE13 a 1089 en la SE23). En simultáneo, los mensajes aumentaron sustancialmente (de 28 601 en 2019 a 84 916 en 2020), con un inicio abrupto al comienzo del confinamiento, y una tendencia decreciente a lo largo del tiempo. Antes de la pandemia, el contenido estuvo relacionado con órdenes electrónicas de estudios complementarios, control de resultados, recetas de medicación crónica y/o interconsultas a especialistas, mientras que los dominios más frecuentes durante la pandemia fueron necesidades informativas epidemiológicas, como medidas preventivas para COVID-19, vacuna antineumocócica, vacuna antigripal, casos o sospechas, resultados de hisopados, entre otras. Conclusión: el auge de las tecnologías de la comunicación e información durante la pandemia permitió dar continuidad a los procesos asistenciales en salud pese al distanciamiento físico. Hubo mayor utilización de mensajería por necesidades informativas de los pacientes, y la relación médico-paciente se ha modificado. (AU)

Introduction: during the COVID-19 pandemic, there was an unprecedented boom in telemedicine, probably due to the forced adoption of technology in the face of restrictive measures. This study aimed to compare the interaction and communication between general practitioners and patients before and during the pandemic based on scheduled outpatient consultations and Health Portal messages. Materials and methods: Cross-sectional study with a consecutive sampling of scheduled appointments and messages, occurring between epidemiological weeks (EW) 10 and 23 of 2019 and 2020, respectively. We included 147 physicians from the Family and Community Medicine Service and a capita of 73427 patients affiliated with the Hospital Italiano de Buenos Aires health plan. We conducted a quantitative and qualitative analysis. Results: there was a 70% reduction in face-to-face consultations (from 76375 in 2019 to 23200 in 2020) and a concomitant increase in teleconsultations (from 255 in EW13 to 1089 in EW23). Concurrently, messages increased substantially (from 28601 in 2019 to 84916 in 2020), with an abrupt onset at the beginning of confinement and a decreasing trend over time. Before the pandemic, the content involved electronic orders for complementary studies, outcome monitoring, chronic medication prescriptions, or expert consultations. The most frequent domains during the pandemic were epidemiological information needs, such as preventive measures for COVID-19, pneumococcal vaccine, influenza vaccine, cases or suspicions, and swab results, among others. Conclusion: the rise of communication and information technologies during the pandemic allowed the continuity of healthcare processes despite the physical distance. There was increased use of messaging for patients' information needs, and the doctor-patient relationship has changed. (AU)

Acceptability of teleconsultation in a public service specialized in the prevention and care of HIV infection and other sexually transmitted infections / Aceitabilidade da teleconsulta em um serviço público especializado na prevenção e cuidado da infecção pelo HIV e outras infecções sexualmente transmissíveis

Introduction: Telemedicine was leveraged for its contribution to mitigate the impact of COVID-19 in Brazil and worldwide. Objective: We aim to evaluate the acceptability of incorporating teleconsultation through synchronized videoconference by users and professionals in a service specialized in the prevention and treatment of the human immunodeficiency virus and other sexually transmitted infections, and to identify associated factors. Methods: This is a cross-sectional study with 410 users and 57 professionals who answered a category-standardized questionnaire. Predictors of acceptability were assessed using logistic regression model. Results: A total of 364 (88.8%) users said they would accept the modality. The factors positively associated with the odds of acceptance were the self-assessment of having favorable conditions to participate in a teleconsultation (aOR 54.8; 95%CI 12.4­242.1; p<0.001), the perception of saving money (aOR 5.2; 95%CI 1.9­14.0; p=0.001), and perceived convenience of the modality (aOR 6.7; 95%CI 2.9­15.9; p<0.001). Factors associated with reduced odds of acceptance were the fear of not being evaluated well (aOR 0.2; 95%CI 0.1­0.4; p<0.001), or remaining long without seeing the professional (aOR 0.2; 95%CI 0.1­0.5; p<0.001). The acceptance of the modality among professionals was 75.4% and the perception of its convenience (aOR 16.8; 95%CI 2.6­108.4; p=0.003) and that the institution has appropriated conditions (aOR 7.7; 95%CI 1.5­40.6; p=0.016) were associated with increased odds of accepting its incorporation in their routine. Conclusion: Governance should invest in infrastructure and support, secure protocols, digital literacy, and training of its users and employees for video teleconsultation. (AU)

Introdução: A telemedicina foi alavancada por sua contribuição para mitigar o impacto da COVID-19 no Brasil e no mundo. Objetivo: Pretendemos avaliar a aceitabilidade da incorporação da teleconsulta por videoconferência síncrona por usuários e profissionais de um serviço especializado na prevenção e tratamento da infecção pelo vírus da imunodeficiência humana (HIV) e outras infecções sexualmente transmissíveis, bem como identificar fatores associados. Métodos: Estudo transversal com 410 usuários e 57 profissionais, que responderam a um questionário padronizado por categoria. Os preditores de aceitabilidade foram avaliados utilizando-se um modelo de regressão logística. Resultados: O total de 364 (88,8%) usuários disseram que aceitariam a modalidade. Os fatores positivamente associados à probabilidade de aceitação foram a autoavaliação quanto a ter condições favoráveis para participar de uma teleconsulta (razão de chances ajustada ­ aOR 54,8; intervalo de confiança de 95% ­ IC95% 12,4­242,1; p<0,001), a percepção de poupar dinheiro (aOR 5,2; IC95% 1,9­14,0; p=0,001) e a percepção de conveniência da modalidade (aOR 6,7; IC95% 2,9­15,9; p<0,001). As menores probabilidades de aceitação foram o medo de não ser bem avaliado (aOR 0,2; IC95% 0,1­0,4; p<0,001) e de permanecer muito tempo sem ver o profissional (aOR 0,2; IC95% 0,1­0,5; p<0,001). A aceitação da modalidade pelos profissionais foi de 75,4% e a percepção de sua conveniência (aOR 16,8; IC95% 2,6­108,4; p=0,003) e a de que a instituição possui condições favoráveis (aOR 7,7; IC95% 1,5­40,6; p=0,016) foram associadas com a maior probabilidade de aceitar a incorporação da modalidade em sua rotina. Conclusão: A governança deve investir em infraestrutura e apoio, protocolos seguros, literacia digital e treinamento de seus usuários e funcionários para a videoconsulta. (AU)

Teleintervenção guiada por videofeedback à família de uma criança usuária de implante coclear: estudo de caso / Videofeedback-guided teleintervention for the family of a child with a cochlear implant: a case study

RESUMO Intervenções para a capacitação parental de famílias de crianças com deficiência auditiva, incluindo as usuárias de implante coclear, são apontadas como otimizadoras em seus resultados de desenvolvimento. Neste estudo de intervenção de caso único, temos por objetivos descrever o uso do videofeedback em ambiente remoto, bem como identificar a sua efetividade, a partir da análise da interação da mãe e criança, tanto para os comportamentos comunicativos da mãe como para os comportamentos da linguagem receptiva e expressiva da criança. Medidas pré e pós-intervenção foram realizadas, a partir da análise de vídeos de interação da mãe com a criança, por juízes cegos, bem como pela aplicação de instrumentos de avaliação da criança e da mãe. Foram realizadas 13 sessões, sendo 3 de avaliação nos momentos pré e pós-intervenção e 10 sessões de teleconsulta em que se empregou a ferramenta de videofeedback com a mãe. Os dados foram analisados de forma descritiva e inferencial, por meio do método JT, que determinou o Índice de Mudança Confiável (IMC) e a Significância Clínica. Houve mudança positiva confiável na linguagem receptiva e expressiva da criança, bem como mudança positiva confiável e mudança clínica significativa na interação da mãe com a criança após as 10 sessões de intervenção remota com videofeedback. A partir das mudanças confiáveis observadas neste estudo, apresentamos este modelo (Televideofeedback), como potencial para otimizar os recursos e esforços para o sucesso terapêutico na reabilitação auditiva infantil, o qual deve ser estudado em pesquisas com método rigoroso, para a ampla recomendação de seu uso.

ABSTRACT Interventions for parental training for families of hard of hearing children, including cochlear implant users, are identified as optimizing their developmental outcomes. In this single-case intervention study, we aim to describe the use of videofeedback in a remote environment, as well as to identify its effectiveness, based on the analysis of mother-child interaction, both for the mother's communicative behaviors and for the behaviors of the mother, receptive and expressive language of the child. Pre- and post-intervention measurements were performed, based on video analysis of the mother's interaction with the child, by blind judges, as well as through the application of assessment instruments for the child and the mother. There were 13 sessions, 3 of which were for evaluation before and after the intervention and 10 of teleconsultation sessions in which the videofeedback tool was used with the mother. Data were analyzed descriptively and inferentially, using the JT method, which determined the Reliable Change Index (BMI) and Clinical Significance. There was reliable positive change in the child's receptive and expressive language, as well as reliable positive change and clinically significant change in mother-child interaction after the 10 sessions of remote videofeedback intervention. Based on the reliable changes observed in this study, we present this model (televideofeedback) as a potential to optimize resources and efforts for therapeutic success in children's auditory rehabilitation, which should be studied in research with a rigorous method, for the broad recommendation of its use.

Reflexão ética sobre a teleconsulta / Reflections on remote consultation / Reflexión ética sobre la teleconsulta

Resumo As tecnologias da informação e comunicação têm influência cada vez maior na área da saúde, sendo o aumento significativo do recurso à teleconsulta um reflexo disso. Os benefícios que essa modalidade de prestação de serviços de saúde ocasiona são inquestionáveis, a começar pelo facto de auxiliarem a enfrentar os desafios contemporâneos que assolam os sistemas de saúde em todo o mundo. Todavia, a sua crescente utilização vem sublinhar a importância de salvaguardar questões éticas relacionadas com a autonomia, equidade, privacidade e qualidade da relação entre o utente e o profissional de saúde. Este artigo pretende estimular uma reflexão acerca dos desafios éticos que se colocam antes, durante e após o uso da teleconsulta, com o intuito de otimizar e modelar a sua utilização.

Abstract Information and communication Technologies are increasingly present in health care, as exemplified by the recourse to remote consultation. Such care delivery modality brings unquestionable benefits, such as helping to face the contemporary challenges plaguing health systems worldwide. But its ever-increasing use underlines the importance of safeguarding ethical issues related to autonomy, equity, privacy, and the quality of the user-professional relations. This paper reflects on the ethical challenges presented before, during, and after remote consultation as to optimize and shape its use.

Resumen Las tecnologías de la información y la comunicación tienen una influencia cada vez mayor en el área de la salud, y esto lleva a un aumento significativo en el uso de la teleconsulta. Muchos son los beneficios de esta modalidad de prestación de servicios sanitarios, comenzando por el hecho de que ayudan a abordar los desafíos contemporáneos que afectan a los sistemas de salud en todo el mundo. Sin embargo, su uso creciente destaca la importancia de salvaguardar las cuestiones éticas relacionadas con la autonomía, la equidad, la privacidad y la calidad de la relación entre el paciente y el profesional de la salud. Este artículo pretende incitar a una reflexión sobre los desafíos éticos que surgen antes, durante y después del uso de la teleconsulta, con el fin de optimizarlo y modelarlo.

Older people's perceptions of teleconsultation via telephone during the COVID-19 pandemic: a qualitative study / Percepção de idosos sobre teleconsulta por telefone durante a pandemia de COVID-19: um estudo qualitativo

OBJECTIVES: In March/2020, our geriatric outpatient clinic implemented teleconsultation via telephone due to the COVID-19 pandemic. This study aimed to understand older patients' perceptions of this experience through their narratives. METHODS: A qualitative study with Thematic Oral History and thematic analysis. We conducted open-ended interviews in which older patients narrated their perceptions of this experience. RESULTS: Twelve patients were interviewed from December/2021 to January/2022, and 2 themes emerged: older patients' experience of teleconsultation and possibilities and challenges of telemedicine. Some patients did not identify the call as a teleconsultation. Regarding possibilities, patients reported satisfaction and convenience in specific circumstances. As for challenges, patients reported concerns about the effectiveness of communication and need for physical examination. CONCLUSION: Teleconsultation is well accepted, as long as situations that require face-to-face interactions are considered. Considering person-centered medicine, listening to the narratives of older people contributes to a better structuring of telemedicine services in geriatrics

OBJETIVOS: Em março/2020, nosso ambulatório de geriatria iniciou a teleconsulta por telefone em virtude da pandemia de COVID-19. O objetivo desta pesquisa foi conhecer a percepção dessa experiência por esses pacientes, por meio de suas narrativas. METODOLOGIA: Pesquisa qualitativa com História Oral Temática e análise temática. Realizadas entrevistas abertas, nas quais os idosos narraram suas percepções sobre essa experiência. RESULTADOS: Doze pacientes foram entrevistados de dezembro/2021 a janeiro/2022 e dois temas emergiram: vivência ante a teleconsulta e possibilidades e desafios da telemedicina. Alguns não identificaram que se tratava de uma teleconsulta. Nas possibilidades, afirmaram satisfação e conveniência em circunstâncias específicas. Nos desafios, apontaram preocupações com eficácia de comunicação e com necessidade de exame físico. CONCLUSÃO: Existe uma boa recepção da teleconsulta, desde que respeitadas situações que demandem atendimento presencial. Considerando uma medicina centrada na pessoa, a escuta das narrativas dos idosos contribui para melhor estruturação de serviços de telemedicina em geriatria

Teleconsulta por médicos e enfermeiros da Atenção Primária de Florianópolis durante a pandemia de Covid-19: um estudo retrospectivo / Teleconsultations by doctors and nurses from Primary Care in Florianópolis during the Covid-19 pandemic: a retrospective study

Introdução: As teleconsultas só foram permitidas pelos conselhos de classe no Brasil após o início da pandemia de Covid-19. A Atenção Primária (AP) de Florianópolis reunia as condições necessárias para realizar teleconsultas e foi a primeira capital a adotar esse modelo de atendimento em grande escala. Objetivo: Comparar as condições de atendimento e as características dos profissionais de saúde nas consultas realizadas na AP de Florianópolis por médicos e enfermeiros entre as teleconsultas e consultas presenciais. Metodologia: Estudo retrospectivo com todas as consultas realizadas por médicos e enfermeiros da AP no período de 15/04/2020 a 27/07/2020. Resultados: Analisamos 225.507 consultas realizadas por 436 médicos e enfermeiros. Profissionais, médicos e enfermeiros, que realizaram ao menos uma teleconsulta apresentaram maiores números de consultas, tempo médio de consulta pouco maior, bem como média de encaminhamentos e de exames solicitados por consulta discretamente maiores. Porém, as teleconsultas foram mais rápidas, tiveram menos exames solicitados, medicamentos prescritos e encaminhamentos realizados. As condições menos avaliadas por teleconsulta foram: rastreamento de câncer de colo uterino, cerume impactado, amigdalite e puericultura. As condições mais avaliadas, por médicos e enfermeiros, nas teleconsultas foram: hipotireoidismo, dispepsia, contracepção e dor não classificados. Conclusões: A teleconsulta é uma ferramenta útil para realização de atendimentos na AP e permite o atendimento de uma ampla gama de condições. É importante a realização de estudos dessa tecnologia neste período de exceção para embasar decisões futuras quando a sua manutenção após a pandemia (AU).

Introduction: Teleconsultations were only allowed by class councils in Brazil after the start of the Covid-19 pandemic. The Primary Care (PC) of Florianópolis met the conditions to make teleconsultations and was the first capital to adopt this model of assistance on a large scale. Objective: Compare the conditions of care and the characteristics of health professionals in consultations held at the Florianópolis PC by doctors and nurses between teleconsultations and face-to-face consultations. Methodology: Retrospective study with all consultations carried out by doctors and nurses of the PC from 04/15/2020 to 07/27/2020. Results: We analyzed 225,507 consultations performed by 436 doctors and nurses. Professionals, doctors and nurses, who performed at least one teleconsultation had a higher number of consultations, a slightly longer average consultation time, as well as a slightly higher average number of referrals and tests requested per consultation. Teleconsultations were faster, had fewer tests requested, medications prescribed and referrals made. The conditions least evaluated by teleconsultation were: cervical cancer screening, impacted cerumen, tonsillitis and childcare. The conditions most evaluated by doctors and nurses in teleconsultations were: hypothyroidism, dyspepsia, contraception and unclassified pain. Conclusions: Teleconsultation is a useful tool for providing care in the PC and allows the care of a wide range of conditions. It is important to carry out studies of this technology in this period of exception to support future decisions when maintaining it after the pandemic (AU).

Low-Risk Antenatal Care Enhanced by Telemedicine: A Practical Guideline Model / Atenção ao pré-natal de baixo risco potencializada por telemedicina: Diretriz clínica prática

Abstract Objective To develop a protocol for hybrid low-risk prenatal care adapted to Brazilian guidelines, merging reduced face-to-face consultations and remote monitoring. Methods The PubMed, Embase, and Cochrane Library databases were systematically searched on telemedicine and antenatal care perspectives and adaptation of the low-risk prenatal care protocols recommended by the Ministry of Health and by the Brazilian Federation of Gynecology and Obstetrics Associations. Results Five relevant articles and three manuals were included in the review, for presented criteria to develop this clinical guideline. We identified, in these studies, that the schedule of consultations is unevenly distributed among the gestational trimesters, and ranges from 7 to 14 appointments. In general, the authors propose one to two appointments in the first trimester, two to three appointments in the second trimester, and two to six appointments in the third trimester. Only three studies included puerperal evaluations. The routine exams recommended show minimal variations among authors. To date, there are no validated Brazilian protocols for prenatal care by telemedicine. The included studies showed that pregnant women were satisfied with this form of care, and the outcomes of interest, except for hypertensive diseases, were similar between the groups exposed to traditional and hybrid prenatal care. Conclusion The presented guideline comprises the Ministry of Health recommendations for low-risk prenatal care and reduces exposure to the hospital environment and care costs. A randomized clinical trial, to be developed by this group, will provide real-world data on safety, effectiveness, satisfaction, and costs.

Resumo Objetivo Desenvolver uma diretriz clínica híbrida para atendimento pré-natal de baixo risco, mesclando consultas presenciais e remotas por telemedicina, adapta às recomendações brasileiras. Métodos Revisão sistemática da literatura nas bases de dados PubMed, Embase e Cochrane e adaptação dos protocolos de atenção ao pré-natal de baixo risco preconizados pelo Ministério da Saúde e pela Federação Brasileira das Associações de Ginecologia e Obstetrícia. Resultados Cinco artigos relevantes e três manuais foram incluídos na revisão por preencherem critérios para o desenvolvimento desta diretriz clínica. Nos estudos incluídos, identificou-se que o cronograma de consultas se distribui de forma desigual entre os trimestres gestacionais, variando entre 07 e 14 encontros. De forma geral, os autores propõem uma a duas consultas no primeiro trimestre, duas a três consultas no segundo trimestre e duas a seis consultas no terceiro trimestre. Somente três estudos incluíram avaliações puerperais. A rotina de exames preconizada apresenta mínimas variações entre os autores. Até o momento, não existem protocolos brasileiros validados para atendimento pré-natal por telemedicina. Os estudos incluídos evidenciaram a satisfação das gestantes em relação a esta forma de atendimento, e os desfechos de interesse, excetuando doenças hipertensivas, foi semelhante entre os grupos expostos ao pré-natal tradicional e ao pré-natal híbrido. Conclusão A diretriz apresentada contempla as recomendações do Ministério da Saúde para atendimento pré-natal de gestantes de baixo risco, reduz a exposição ao ambiente hospitalar e os custos de atendimento. Seu emprego em um ensaio clínico randomizado, a ser desenvolvido por este grupo, proporcionará dados de mundo real, relativos à segurança, efetividade, satisfação e custos.

Calidad de atención y satisfacción de usuarias atendidas por teleconsulta en Ginecología Oncológica del Hospital Nacional Edgardo Rebagliati Martins de EsSalud, agosto a octubre del 2021 / Quality of care and satisfaction of users treated via gynecologic oncology telemedicine at Hospital Nacional Edgardo Rebagliati Martins of EsSalud from August to October 2021

RESUMEN Objetivo: Determinar la relación entre la calidad de atención y la satisfacción de las usuarias atendidas por teleconsulta en Ginecología Oncológica de agosto a octubre del 2021. Materiales y métodos: Estudio observacional, transversal y prospectivo en 302 usuarias. Instrumentos: cuestionario SERVPERF modificado, para evaluar calidad; lista de cotejo según Minsa, para evaluar la estructura; ficha de registro de tiempos durante la teleconsulta, para evaluar el proceso. El análisis de datos se realizó con SPSS v.27 y con la f de Fisher con p < 0,05. Resultados: El cumplimiento del componente estructura fue de 66,67 % según el Minsa; para el proceso, el tiempo de espera para la teleconsulta fue de 1 a 7 días en 53,31 %, el tiempo de espera para la atención fue <10 minutos en 64,22 % y el tiempo de duración fue de 11 a 15 minutos en 41,39 %. Las dimensiones de calidad como fiabilidad, capacidad de respuesta, seguridad, empatía y aspectos tangibles fueron buenas en 91,72 %, 90,06 %, 91,05 %, 88,41 % y 92,39 %, respectivamente; la calidad de atención fue buena, regular y mala en 95,37 %, 4,32 % y 0,31 %. La satisfacción fue alta, media y baja en 88,35 %, 7,93 % y 3,72 %. La relación entre calidad de atención, con sus respectivas dimensiones, y la satisfacción, aplicando la prueba f de Fischer, fue <0,000. Conclusiones: Existe relación entre calidad de atención y satisfacción de las usuarias en teleconsulta. El componente proceso cumple con los requisitos establecidos y la estructura está en proceso. La calidad de atención es buena y la satisfacción es alta.

ABSTRACT Objective: To determine the relationship between quality of care and satisfaction of users treated via gynecologic oncology telemedicine from August to October 2021. Materials and methods: An observational, cross-sectional and prospective study conducted with 302 users. Instruments: modified SERVPERF questionnaire to evaluate the quality of care, MINSA's checklist to evaluate the structure, and telemedicine time record sheet to evaluate the process. Data was analyzed using IBM SPSS Statistics V27 and Fisher's F test with p < 0.05. Results: Compliance with the structure was 66.67 % according to MINSA. Regarding the process, patient waiting time to get a telemedicine appointment was 1 to 7 days in 53.31 %, patient waiting time to begin a telemedicine consultation was < 10 minutes in 64.22 %, and telemedicine length was 11 to 15 minutes in 41.39 %. Quality of care dimensions such as reliability, responsiveness, safety, empathy and tangible aspects were good in 91.72 %, 90.06 %, 91.05 %, 88.41 % and 92.39 %, respectively. Quality of care was good, fair and bad in 95.37 %, 4.32 % and 0.31 %, respectively. Satisfaction was high, medium and low in 88.35 %, 7.93 % and 3.72 %, respectively. According to Fisher's F test, the relationship between quality of care, with its respective dimensions, and satisfaction was < 0.000. Conclusions: There is a relationship between quality of care and satisfaction of users of telemedicine. The process meets the established requirements and the structure is still in process. Quality of care is good and satisfaction is high.

Impacto de la pandemia por COVID-19 en la consulta ambulatoria endocrinológica y teleconsulta en un hospital Peruano

Introducción: La pandemia por COVID-19 afectó la continuidad de las consultas médicas presenciales, así se implementaron estrategias, como las teleconsultas, para cerrar brechas de atención. El objetivo del estudio fue describir el impacto de la pandemia en la consulta endocrinológica en el Hospital Nacional Alberto Sabogal Sologuren (Callao, Perú). Materiales y métodos: Se realizó un estudio descriptivo de análisis de datos secundarios obtenidos del Sistema de Salud Inteligente del Seguro Social de Perú. Se analizó datos de las consultas ambulatorias entre mayo 2019 y noviembre 2021. Resultados: Debido a la pandemia, la proporción de consultas presenciales disminuyó de 100% (periodo prepandemia) a 29,4% (durante la pandemia), mientras que las teleconsultas predominaron tras su implementación. Mas del 68% de pacientes fueron mujeres, en las consultas presenciales la mediana de edad antes y durante la pandemia fue 59 y 56 años, respectivamente, mientras que en teleconsultas fue 58 años. La diabetes mellitus fue el principal motivo de consulta (entre 32,6% a 34,4% del total de consultas), seguido del hipotiroidismo y la enfermedad nodular tiroidea. Durante la pandemia, la proporción de consultas por hipotiroidismo fue mayor en teleconsultas vs consulta presencial (25,3% vs 18%). Conclusiones: Durante la pandemia, las teleconsultas predominaron sobre la consulta presencial. No hubo diferencias relevantes en la mediana de edad o sexo predominantes entre los pacientes antes o durante la pandemia. La diabetes mellitus fue el principal motivo de consulta en general y durante la pandemia las consultas por hipotiroidismo fueron mayor en teleconsulta.

ABSTRACS Background: The COVID-19 pandemic affected the continuity of face-to-face medical consultations, so strategies, such as teleconsultations, were implemented to close the gaps in care. The objective of this study was to describe the impact of the pandemic in the traditional endocrinology consultation at Hospital Nacional Alberto Sabogal Sologuren (Callao, Peru). Materials and methods: We carried out a descriptive study of analysis of secondary data, that was obtained from the Sistema de Salud Inteligente of the Social Security of Peru. Data from outpatient consultations between May 2019 and November 2021 were analyzed. Results: Due to the pandemic, the proportion of face-to-face consultations decreased from 100% (pre-pandemic period) to 29,4% (during the pandemic), while teleconsultations predominated after its implementation. More than 68% of patients were women, in face-to-face consultations the median age before and during the pandemic was 59 and 56 years, respectively, while in teleconsultations it was 58 years. Diabetes mellitus was the main reason for consultation (between 32,6% and 34,4% of all consultations), followed by hypothyroidism and nodular thyroid disease. During the pandemic, the proportion of consultations for hypothyroidism was higher in teleconsultations vs. face-to-face consultations (25,3% vs. 18%). Conclusions: During the pandemic, teleconsultations predominated over face-to-face consultation. There were no relevant differences in median age or predominant gender among patients before or during the pandemic. Diabetes mellitus was the main reason for consultation in general and during the pandemic consultations for hypothyroidism were higher in teleconsultation.

Telemedicina para seguimiento de pacientes renales trasplantados durante la pandemia por COVID-19

Contexto: la pandemia por COVID-19 generó la reestructuración de los servicios de salud en el mundo. La teleconsulta ofrece el acceso a la atención en salud a distancia como estrategia de mitigación a la propagación del virus y como una forma flexible de telemedicina. Objetivo: describir los resultados de atención en salud por modalidad de teleconsulta en pacientes trasplantados durante el inicio de la pandemia por COVID-19. Metodología: estudio descriptivo de corte transversal que describe la experiencia del uso de la teleconsulta en el inicio de la pandemia por COVID-19 en un centro de trasplante de órganos en Colombia. La información fue obtenida mediante la recolección directa de la atención en el mes de abril de 2020 y a través del envío de un cuestionario electrónico, estructurado para los pacientes atendidos por teleconsulta. Resultados: un total de 1139 pacientes con trasplante renal fueron valorados en la modalidad de teleconsulta. Alrededor del 50 % de los pacientes atendidos vivían fuera de áreas metropolitanas (n = 564) y un total de 292 (de 800 contactados) respondieron la encuesta enviada con una media de edad de 48 años. Los pacientes presentaron altos porcentajes de satisfacción con el modelo de teleconsulta (n = 278, lo que equivale al 94 %). Se presentaron dos casos sospechosos de COVID-19, los cuales fueron negativos al realizar la prueba de PCR-RT. Conclusiones: la teleconsulta es una herramienta útil en la mitigación de la emergencia sanitaria, con un alto potencial que genera mayor acceso y oportunidad de atención en salud, presentando altos índices de aceptación.

Introduction: The COVID-19 pandemic led to the restructuring of health services around the world. Teleconsultation offers access to remote health care and a mitigation strategy. Purpose: Describe the results of a teleconsultation program in a transplant center at the beginning of the COVID-19 pandemic. Methodology: Descriptive cross-sectional study describing the experience of the use of teleconsultation during the beginning of the COVID-19 pandemic at an organ transplant center in Colombia. The information was obtained by directly collecting the total number of patients treated during April 2020 and by sending a structured electronic questionnaire to the patients involved in the care. Results: A total of 1139 renal transplant patients were assessed by teleconsultation. The geographical distribution of patients in metropolitan areas and outside the metropolitan area were similar (n=575 and n=564, respectively). Of the total, 292 patients responded to the survey sent with an average age of 48 years. The patients had high satisfaction with the teleconsultation model (n=278, 94%). There were 2 suspected cases of COVID-19, which were negative when performing the PCR-RT test. Conclusions: Teleconsultation is a useful tool in the mitigation of the health emergency, with a high potential, which generates greater access and health care opportunity, presenting high acceptance rates.

Teleconsulta en Odontología para paciente con síndrome de Down durante la pandemia por COVID-19: reporte de caso / Teleconsulta em Odontología para um paciente com síndromede Down durante a pandemiada COVID-19: RelatodeCaso / Teleconsulting in dentistry for a Down syndrome patient during the COVID-19 pandemic: a case report

En situaciones de crisis sanitarias como la pandemia COVID-19, suele limitarse el acceso a servicios de salud oral, especialmente en pacientes con condiciones especiales que requieren intervenciones clínicas, controles y seguimientos de tratamientos nuevos o ya programados. La Teleconsulta en odontología representa un recurso valioso en salud oral para pacientes que presenten dificultades al acceso de la atención. El presente artículo reporta el caso clínico de una paciente de 8 años con síndrome de Down, atendida mediante teleconsulta en odontología. La intervención se planeó en tres etapas: Etapa 1. Valoración riesgo familiar y oral, Etapa 2. Orientación en salud oral y familiar y Etapa 3. Seguimiento de actividades. En esta intervención, se adaptaron tres instrumentos y se aplicó un cuarto para la recolección de la información. El abordaje en teleodontología con esta paciente tuvo una duración de 3 meses, con consultas semanales usando la aplicación de WhatsApp. Se identificaron factores de riesgo para la salud oral de la paciente y su familia, como el síndrome de Down, presencia de biofilm dental, alto consumo de azúcar, baja frecuencia del cepillado oral y limitada fuente de ingresos económicos a causa de la pandemia COVID-19 entre otros. A partir del seguimiento realizado por teleodontología, se logró aceptación de la orientación educativa para disminuir los factores de riesgo encontrados d en la paciente y su núcleo familiar.

Em situações de crise de saúde como a pandemia COVID-19, o acesso aos serviços de saúde oral é freqüentemente limitado, especialmente para pacientes com condições especiais que requerem intervenções clínicas, monitoramento e acompanhamento de tratamentos novos ou planejados. A teleorientação em odontologia representa um recurso valioso em saúde oral para pacientes que apresentam dificuldades no acesso aos cuidados. Este artigo relata o caso clínico de um paciente de 8 anos com síndrome de Down, atendido por meio de teleconsulta em odontologia. A intervenção foi planejada em três etapas: Etapa 1. Avaliação de risco familiar e oral, Etapa 2. Orientação em saúde oral e familiar e Etapa 3: Acompanhamento das atividades. Nesta intervenção, três instrumentos foram adaptados e um quarto foi aplicado para a coleta de dados. A abordagem teleodontológica com este paciente durou 3 meses, com consultas semanais utilizando o aplicativo WhatsApp. Foram identificados fatores de risco para a saúde oral da paciente e sua família, como a síndrome de Down, presença de biofilme dental, alto consumo de açúcar, baixa freqüência de escovação oral e fonte limitada de renda devido à pandemia COVID-19, entre outros. Com base no acompanhamento realizado pela teleodontologia, a aceitação da orientação educacional foi alcançada a fim de reduzir os fatores de risco encontrados pelo paciente e sua família.

In health crisis situations such as the COVID-19 pandemic, access to oral health services is often limited, especially in patients with special conditions that require clinical interventions, controls and follow-up of new or already scheduled treatments. Teleconsultation in dentistry represents a valuable resource in oral health for patients who present difficulties in accessing care. This article reports the clinical case of an 8-year-old patient with Down syndrome, attended by means of teleconsultation in dentistry. The intervention was planned in three stages: Stage 1. Oral and family risk assessment Stage 2. Orientation in oral and family health and Stage 3: Follow- up of activities. In this intervention, three instruments were adapted and a fourth was applied for data collection. The teleconsulta approach with this patient lasted 3 months, with weekly consultations using the WhatsApp application. Risk factors for the oral health of the patient and her family were identified, such as Down syndrome, presence of dental biofilm, high sugar consumption, low frequency of oral brushing and limited source of income due to the COVID-19 pandemic, among others. From the follow-up carried out by teleodentistry, acceptance of the educational orientation was achieved in order to reduce the risk factors found by the patient and her family.

Teleconsulta en épocas de pandemia. Experiencia de los pediatras del desarrollo del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" / Teleconsultation during a pandemic. Experience of developmental pediatricians at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"

La teleconsulta es uno de los componentes de la telemedicina. Los pediatras del desarrollo realizan evaluaciones y seguimiento de niños y niñas con esafíos en su desarrollo. Durante la pandemia, debido a las restricciones de movilidad y traslado y la importancia de la continuidad de la atención, comenzaron a trabajar de manera remota realizando consultas virtuales. El objetivo del trabajo fue describir la implementación de la atención virtual, las características de los pacientes atendidos y la percepción de sus familias. Se programaron 122 teleconsultas. La media de edad de los pacientes fue de 40 ± 13 meses. Los motivos de consulta más frecuentes fueron ausencia y retraso lenguaje y dificultades conductuales. Si bien un 16 % de las familias encontró alguna dificultad, todas se mostraron agradecidas con las consultas. La atención virtual debe considerarse como un complemento de la presencialidad, que disminuye los costos y los tiempos de traslado y acerca a los pediatras del desarrollo a lugares remotos.

Teleconsultation is one of the components of telemedicine. Developmental pediatricians provide assessments and follow-up to children with developmental challenges. During the pandemic, due to movement and travel restrictions and the importance of continued care, pediatricians started working remotely with virtual consultations. The objective of this study was to describe the implementation of virtual care, the characteristics of patients seen, and their families' perception. A total of 122 teleconsultations were scheduled. Patients' mean age was 40 ± 13 months. The most common reasons for consultation were absence of and delay in language and behavioral difficulties. Although 16 % of families described some obstacles, all were grateful for the consultations. Virtual health care should be regarded as a complement to in-person care, alongside reductions in costs and travel time and the possibility of bringing developmental pediatricians to remote locations

Implementación de un modelo mixto de atención prenatal, presencial y virtual durante la pandemia COVID-19, en el Instituto Nacional Materno Perinatal en Lima, Perú

La pandemia del coronavirus 19 (COVID-19) y las medidas instauradas para su control significaron la interrupción de la atención prenatal, con potencial riesgo en la salud materna y fetal. Por otro lado, la atención prenatal convencional presencial implicaría exposición y riesgo de infección en pacientes y proveedores de salud. El Instituto Nacional Materno Perinatal (INMP) ha incorporado la teleconsulta como parte de un nuevo modelo de atención prenatal mixto, cuyo objetivo es disminuir las citas presenciales y, por tanto, el contacto y riesgo de transmisión viral. El paquete de atención prenatal incluye actividades esenciales para atender gestantes en edades gestacionales específicas con mayor impacto en los desenlaces perinatales y maternos. Este nuevo modelo podría generalizarse a nivel nacional y ser parte de la solución a las disparidades de atención en el Perú, mediante políticas del uso de la telemedicina en la atención prenatal que faciliten su implementación, así como su sostenibilidad después de la pandemia de COVID-19.

The coronavirus 19 (COVID-19) pandemic and the measures implemented for its control meant the interruption of prenatal care, with potential risk to maternal and fetal health. However, conventional in-person prenatal care would imply exposure and risk of infection in patients and health care providers. The Instituto Nacional Materno Perinatal (INMP) has incorporated teleconsultation as part of a new model of mixed prenatal care, which aims to reduce in-person appointments and, therefore, the contact and risk of viral transmission. The prenatal care package performs essential activities to care for pregnant women of specific gestational ages with a greater impact on perinatal and maternal outcomes. This new model could be generalized nationally and be part of the solution to the disparities of healthcare in Peru, through policies for the use of telemedicine in prenatal care that facilitate its implementation, as well as its sustainability after the COVID-19 pandemic.

La edad como factor determinante en la atención por teleconsulta / Age as a determining factor in teleconsultation attention

Objetivo. Determinar si la edad es un factor importante en la prestación de los servicios de teleconsulta por parte de los profesionales de salud, mediante una revisión de la literatura disponible. Materiales y métodos. En las bases de datos se encontraron 34.000 resultados. Se escogieron 50 artículos donde se mencionaba la teleconsulta. El mayor número de investigaciones se llevó a cabo en Estados Unidos, España, Australia, India y Suecia. Se tuvieron en cuenta criterios de inclusión y exclusión. Resultados. En los 50 artículos seleccionados se pudieron establecer cinco categorías: normatividad, importancia de la telemedicina, grupos de edad, factores diferenciales y aceptabilidad por parte de los profesionales de la salud. Se evidencia que los adultos mayores son menos tolerantes a los cambios y a la adherencia a las nuevas tecnologías comparados con los pacientes en edades pediátricas. Sin embargo, son los primeros quienes utilizan con mayor frecuencia los servicios de teleconsulta dado los requerimientos frecuentes de asistencia propios de la edad adulta. Además, en los adultos mayores que necesitan de personal cuidador la atención se vio limitada porque este no ofreció los datos requeridos por dificultad en el uso de los dispositivos tecnológicos. Conclusiones. Esta investigación demuestra que la edad puede comportarse como un factor determinante en la atención por teleconsulta, sobre todo la edad adulta en la que ocurren los cambios fisiológicos propios de la senectud y el requerimiento de acompañantes permanentes se convierte en una necesidad. La escasa adherencia a nuevas tecnologías, secundaria a limitaciones físicas y motrices, impiden una consulta efectiva desde la virtualidad en tal grupo etario

Objective. To determine whether age is an important factor in the provision of teleconsultation services by health professionals, through a review of the available literature. Materials and methods. A total of 34,000 results were found in the databases. Fifty articles mentioning teleconsultation were selected. The largest number of investigations were carried out in the United States, Spain, Australia, India and Sweden. Inclusion and exclusion criteria were taken into account. Results. Five categories could be established in the 50 articles selected: normativity, importance of telemedicine, age groups, differential factors and acceptability by health professionals. It is evident that older adults are less tolerant to changes and adherence to new technologies compared to pediatric patients. However, it is the former who use teleconsultation services more frequently, given the frequent requests for assistance typical of adulthood. In addition, in older adults who need personal caregivers, care was limited because the latter did not provide the required data due to difficulties in the use of technological devices. Conclusions. This research shows that age can be a determining factor in teleconsultation care, especially in adulthood, when physiological changes typical of senescence occur and the need for permanent companions becomes a necessity. The scarce adherence to new technologies, secondary to physical and motor limitations, prevent an effective virtual consultation in this age group.

Teledermatología en pandemia de COVID-19 en un hospital público / Teledermatology during de COVID-19 pandemic in a public hospital

Resumen La telemedicina es la prestación de servicios de salud mediante tecnologías de la información y la comunicación. La dermatología es la especialidad clínica que más se adapta a esta modalidad de atención. La pandemia de COVID-19 aceleró el desarrollo de la telemedicina en todo el mundo. Esta última demostró ser una herramienta útil para promover el distanciamiento social y evitar la sobrecarga del sistema de salud. Presentamos un estudio observacional de teledermatología en el sector colagenopatías de un hospital público de la Ciudad Autónoma de Buenos Aires durante esta pandemia. El objetivo principal fue evaluar si la teledermatología es una herramienta útil para resolver el motivo de consulta del paciente y así evitar la derivación al hospital. Se incluyeron 120 consultas. El 93.3% fue de mujeres. El promedio de edad fue 38.4 años. El 57.5% de las consultas fueron de pacientes de Gran Buenos Aires y 33.3% de Ciudad Autónoma de Buenos Aires. El 47.5% provenían de pacientes sin cobertura de salud. Del total, 17 (14.2%) requirieron derivación a un centro de salud. La mayoría fue por seguimiento y un porcentaje menor por reactivación de la enfermedad de base u otro motivo. Todos los pacientes que contestaron la encuesta refirieron no haber presentado dificultades y haber resuelto su consulta de manera virtual. Todos los médicos se sintieron conformes con la teledermatología, opinaron que fue un recurso válido para continuar con la formación médica y elegirían usarla en un futuro próximo.

Abstract Telemedicine refers to the use of information and communication technologies to provide health care. Dermatology is particularly suited for this virtual modality. The COVID-19 pandemic significantly increased the use of telemedicine worldwide which has demonstrated to be useful in promoting social distancing and in avoiding the overload of the healthcare system. This is an observational study about the use of teledermatology during the pandemic in the area of connective tissue diseases in a public hospital in Buenos Aires City. The main objective was to assess if teledermatology is useful to resolve patient's consultation and thus to avoid the referral to the hospital. There were 120 teledermatological consultations included, from which 93.3% were made by women. The average age was 38.4 years. The 57.5% of the consultations were from patients of the outskirts of Buenos Aires and 33.3% from Buenos Aires City. The 47.5% of consultations were from patients with no medical insurance. Of the total, 17 (14.2%) required referral to a health center. Most of the consultations were follow-up´s and in a lower percentage, due to reactivation of the underlying disease or another reason. Patients who completed the survey reported not having difficulties and were able to resolve their consultations through virtual care. Doctors involved in this study were totally satisfied with the experience and they felt that teledermatology was a valid resource to continue with their medical training and would choose to use it in the near future.

Evaluación de satisfacción en la implementación de un nuevo sistema de telemedicina en el Servicio de Otorrinolaringología del Complejo Asistencial Dr. Sótero del Río (CASR) durante la pandemia de COVID-19

Resumen Introducción: Debido a la pandemia por SARS-CoV-2, las consultas presenciales y cirugías electivas fueron suspendidas o disminuidas para evitar la propagación viral hacia pacientes y personal de salud. En nuestro país se ha implementado la telemedicina como canal alternativo de atención. Debido a su reciente implementación en nuestra especialidad a nivel nacional, es importante conocer la percepción del paciente y proveedor sobre ella, con el fin de evaluar su factibilidad como nueva modalidad de atención en el futuro. Objetivo: Evaluar la satisfacción del paciente y del proveedor sobre el uso de telemedicina en Otorrinolaringología en nuestro hospital. Material y Método: Estudio prospectivo observacional. Se adaptaron dos instrumentos de evaluación de satisfacción reportados en la literatura, para el paciente y proveedor de salud. Las encuestas fueron administradas luego de la consulta de telemedicina a través de correo electrónico para el paciente, y como parte de la plataforma de telemedicina para el proveedor y respondidas en forma voluntaria. Las respuestas fueron analizadas utilizando medidas de frecuencia (porcentajes). Resultados: Se recopilaron 51 encuestas de pacientes y 69 de proveedores. En los pacientes, en un 98% la telemedicina facilitó el acceso a atención, siendo del mismo nivel que una presencial (91%). Un 98% volvería a usarla y la recomendaría a familiares o amigos. En los proveedores, el 98% estuvo satisfecho con la teleconsulta y 89% con la plataforma. Conclusión: La atención por telemedicina es satisfactoria para usuario y proveedor en nuestro hospital. Esta es una herramienta valiosa para complementar la atención clínica otorrinolaringológica.

Abstract Introduction: Due to the SARS-CoV-2 pandemic, clinical consults and elective surgeries were suspended or decreased to avoid spreading the disease to patients and health personnel. In our country telemedicine has been implemented as an alternate way to obtain medical attention. Given that this attention paradigm has only been recently implemented in our specialty at the national level, it is important to know the perception of the patient and health care provider in order to evaluate its feasibility as a new modality of care in the future. Aim: To assess the patients and healthcare providers satisfaction regarding the use of telemedicine in the Otorhinolaryngology Department. Material and Method: Prospective observational study. Two satisfaction surveys previously reported in the literature were adapted for the patient and health provider. The surveys were sent after each telemedicine consultation via email to the patient, and as part of the telemedicine platform for the provider and answered voluntarily. The responses were analyzed using proportions. Results: answered surveys were obtained from 51 patients and 69 healthcare providers. In 98% of patient's telemedicine facilitated access to care, which was found to be as good as a clinical consult in 91% of the telehealth visits. 98% would use it again and recommend it to family or friends. In 98% of providers were satisfied with the teleconsultation and 89% with the platform. Conclusion: teleconsultation is satisfactory for both patients and providers in our hospital. This new attention modality is a valuable tool to complement the standard otolaryngologist clinical assessment.

Telepsiquiatría en niños y adolescentes: aplicación en contexto de pandemia / Telepsychiatry in children and adolescents: application in the context of a pandemic

Telemedicina, se refiere a las prestaciones de salud a distancia. Existen muchos modelos de telemedicina descritos e implementados en distintos lugares del mundo. La telepsiquiatría (y telemedicina) que se está implementando hoy en Chile y el mundo, ya sea desde un marco institucional o privado, es directa hacia el paciente, esto implica que no es una "inter -o tele -consulta" donde hay un profesional presencial que se hace responsable de la indicación, en este caso la atención completa y directa médico-paciente se lleva a cabo a distancia, quebrando, de alguna manera, la regla de oro de la atención clínica que es la consulta presencial entre el médico y el paciente. Se revisan algunas sugerencias descritas en la literatura y otras que ha dado la experiencia. La idea de este artículo es discutir los desafíos clínicos, éticos y legales, junto con los beneficios y oportunidades de la telepsiquiatría en el contexto actual.Palabras claves: Telemedicina, telepsiquiatría, teleconsulta, médico-paciente, covid-19.

Summary. Telemedicine refers to remote health care. There are many telemedicine models described and implemented in different parts of the world. The telepsychiatry (and telemedicine) that is being implemented today in Chile and the world, either from an institutional or private framework, is directed towards the patient, this implies that it is not an "tele-consultation" where there is a another face-to-face professional who is responsible for the prescription of treatment. In our case, the complete and direct doctor-patient care is carried out at a distance, breaking in some way the golden rule of clinical care that is face-to-face consultation between the doctor and the patient. Some suggestions described in the literature are reviewed and we make other suggestions based on our experience. The idea of this article is to discuss clinical, ethical and legal challenges, along with the benefits and opportunities of telepsychiatry in the current context.Key words: Telemecine, telepsychiatry, tele-consultation, physician-patient, covid-19.