Categorización y revisión de reevaluaciones en tomografía computada en una unidad de telerradiología de urgencia / Categorization and review of reevaluations in computed tomography in an emergency teleradiology unit

INTRODUCCIÓN La telerradiología se basa en el despliegue de radiólogos a distancia para evaluar estudios de dicha especialidad. Actualmente hay evidencia limitada sobre las tasas de error de evaluaciones en telerradiología. Este estudio corresponde a una revisión de las discrepancias entre los informes preliminares y finales de tomografía computada (TC) de una unidad de urgencia telerradiológica. OBJETIVO Determinar las discrepancias de las reevaluaciones (addendum) en los informes radiológicos de TC en una unidad de telerradiología de urgencia. MATERIALES Y MÉTODOS La recolección de datos se planificó a modo de tabla de cotejo, en la cual se tabularon casos de reevaluaciones de urgencia desde el mes de enero hasta mayo del año 2021, en base a la categorización Agrawal. RESULTADOS De una total de 111.599, 836 informes presentaron addendum, que corresponden al 0,74% del total informado, La categoría Agrawal 0 agrupó la mayor cantidad de casos y los exámenes de TC especialidad de cuerpo se encuentran los segmentos con mayores requerimientos de reevaluación. Discusión: Los valores obtenidos permiten establecer una baja incidencia de reevaluaciones y de la gravedad de estas, apuntando a errores asociados a canales de comunicación, redacción y elaboración de informes con especial énfasis en estudios TC Tórax y Abdomen/Pelvis. CONCLUSIÓN El porcentaje de cumplimiento de un 99,26% de exactitud en los informes permite concluir la alta confiabilidad y la calidad del servicio de telerradiología de la empresa en cuestión durante el periodo evaluado y el empleo de medidas correctivas basadas en organización, gestión e instrumentalización tecnológica

Implementação do modelo híbrido da teleaudiologia: aceitação, viabilidade e satisfação em um programa de implante coclear / Implementation of the hybrid teleaudiology model: acceptance, feasibility and satisfaction in a cochlear implant program

RESUMO Objetivo descrever a incorporação da teleaudiologia na rotina de um programa público referência em implante coclear e avaliar a satisfação dos usuários e de seus familiares com a assistência híbrida. Métodos foram desenvolvidas ações que proporcionaram a conexão entre usuários e especialistas, por meio do modelo híbrido da teleaudiologia, combinando práticas remotas (síncronas/ assíncronas) e/ou atendimentos presenciais. Para verificar a satisfação dos pacientes com a teleaudiologia, foi aplicado o Questionário de Satisfação do Cliente. Resultados foram realizados 218 atendimentos remotos e 23 atendimentos presenciais coordenados, entre teleconsultas para orientação e aconselhamento, coaching de pais, terapia para reabilitação auditiva, validação dos resultados, resolução de problemas, ativação e mapeamentos, procedimentos intraoperatórios, teleconsultas com especialistas e entregas de peças de manutenção da tecnologia auditiva. Dos participantes, 36 responderam ao questionário, relataram estar muito satisfeitos com os serviços prestados de maneira geral, ou em grande parte (88,9%) e com a quantidade de atendimentos que receberam (72,2%). Este estudo sugeriu que, em algum momento durante a pandemia, a maioria dos pacientes teve suas necessidades atendidas usando teleaudiologia para cuidados continuados. Conclusão a abordagem de atendimento híbrida em audiologia foi viável, aceita e alcançou satisfação dos usuários.

ABSTRACT Purpose This article aims to describe the incorporation of teleaudiology in the routine of a highly regarded, government funded, cochlear implantation program and evaluate the satisfaction of users and their families with hybrid assistance. Methods Actions were developed that provided the connection between users and specialists, through the hybrid model of teleaudiology, combining remote practices (synchronous/asynchronous) with face-to-face care. To check patient satisfaction with teleaudiology, the Customer Satisfaction Questionnaire (CSQ) was applied. Results 218 remote appointments and 23 other presential attendances were coordinated, between teleconsultations, guidance and counseling; parent coaching and hearing rehabilitation validation, therapy; troubleshooting, cochlear implant first activations and mappings, intra-operative measures, teleconsultations with specialists and delivery of repaired electronic devices. Of the participants, 36 patients responded to the questionnaire and reported being very satisfied with the services provided in general or in large part (88.9%) and with the amount of care they received (72.2%).This study suggested that, at some point during the pandemic, most patients had their needs met using teleaudiology long term care. Conclusion The hybrid approach to audiology care was feasible, accepted and achieved user satisfaction.

Análise de questionários de avaliação de aplicativos na área da saúde: uma revisão sistemática / Evaluation of mobile application questionnaires in the health care setting: a systematic review

Este estudo teve como objetivo identificar modelos de questionários para avaliação de aplicativos móveis na área da saúde. Trata-se de uma Revisão sistemática da literatura, em que a busca foi realizada em julho de 2021, nas bases de dados PubMed, ScienceDirect, Scopus, SciELO e Web of Science. Foram utilizados os descritores: "mobile", "mhealth", "evaluation", "questionnaire", "guide", "assessing", "validation" e "assessment", sendo necessárias adaptações para atender as especificidades das bases. Foram identificados 1.786 estudos e após aplicar os critérios de seleção, 37 publicações alcançaram o nível de qualidade para inclusão e síntese. Os artigos revisados apresentam perguntas significativas para os usuários, sobre os aplicativos avaliados. Este estudo é recomendado para auxiliar nos estudos de pesquisa visando o aumento da qualidade dos aplicativos móveis na saúde.

The objective of this study was to identify questionnaire models for the evaluation of mobile health applications. We conducted a systematic literature review in July 2021 in PubMed, ScienceDirect, Scopus, SciELO, and Web of Science databases using the following descriptors: "mobile," "mhealth," "evaluation," "questionnaire," "guide," "evaluating," "validation," and "evaluation." Adaptations were required to meet database specificities. Of 1,786 studies initially identified, only 37 met the quality criteria for inclusion and synthesis. All studies analyzed in this review asked relevant app-related questions to users. This study is intended to assist scientific research in the development of quality mobile health applications.

Brechas en telemedicina: caracterización de consultas ambulatorias a teledermatología en Chile entre 2018-2020 / Gaps in telemedicine: characterization of ambulatory teledermatology consultations in Chile, between 2018 and 2020

Introducción: La teledermatología (TD) se ha desarrollado de manera importante en los últimos años. Además de mejorar el acceso de la población a consultas médicas, permite el diagnóstico precoz de lesiones complejas. En Chile, la TD forma parte de la plataforma Hospital Digital del Ministerio de Salud desde el 2018, en modalidad asincrónica. El objetivo de este estudio es la caracterización epidemiológica de las consultas ambulatorias a TD en Chile entre los años 2018-2020. Materiales y Métodos: Estudio descriptivo retrospectivo. Se analizaron las consultas ambulatorias a TD y a dermatología en el período 2018-2020, a partir de los datos del Departamento de Estadísticas e Información de Salud, y los datos de población total a partir del Instituto Nacional de Estadísticas, por lo que no se requirió comité de ética. Resultados: Del total de teleconsultas realizadas entre 2018-2020, un 14,2% correspondió a TD. De ellas, el 86,1% corresponden a consultas nuevas, y el 13,9% a controles. Del total de pacientes, el 63,0% fueron mujeres, mientras que el 78,9% fueron mayores de 15 años. Se realizaron 20,35 consultas a TD por cada 10.000 habitantes a nivel nacional, y 17,21 consultas dermatológicas por cada consulta a TD. Discusión: La TD es una de las principales aplicaciones de la telemedicina en Chile. La variación entre las regiones con respecto al número de consultas a TD podría deberse a factores que requieren mayor estudio. Es probable que la TD mantenga un rol creciente debido al desarrollo tecnológico y los beneficios demostrados de esta herramienta.

Introduction: Teledermatology (TD) has greatly developed in recent years. Besides improving access to medical consultations, it also allows the early diagnosis of complex lesions. In Chile, TD forms part of the Digital Hospital platform of the Ministry of Health since 2018, in a store-and-forward form. The objective of this study is to characterize ambulatory consultations with TD in Chile between 2018 and 2020. Materials and Methods: A retrospective descriptive study was performed. Ambulatory consultations with TD and dermatology between 2018-2020 were analyzed from data obtained from the Department of Statistics and Health Information, and population data were obtained from the Statistics National Institute, which did not require ethical approval. Results: Of the total teleconsultations made in the 2018-2020 period, 14.2% belonged to TD. From that, 86.1% were new consultations, and 13.9% were controls. Women represented 63.0% of the patients, while 78.9% were older than 15 years old. For every 10,000 inhabitants, 20.35 total consultations were made with TD nationwide, and 17.21 dermatological consultations were made for each consultation with TD. Discussion: TD is one of the main applications of telemedicine in Chile. The variation in the number of consultations with TD between regions could be caused by factors that require further study. It is likely that TD will keep a growing role due to technological development and benefits shown by this tool.

La imperiosa necesidad de telemedicina en la atención de diabetes durante la pandemia de COVID-19. Un estudio de abordaje integral / The imperious need for telemedicine for the care of diabetes during the COVID-19 pandemic. A comprehensive approach study

Resumen Introducción: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. Objetivo: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. Métodos: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. Resultados: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. Conclusiones: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.

Abstract Introduction: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. Objective: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. Methods: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. Results: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. Conclusions: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.

Cardiología digital (e-Cardiología): herramientas de utilidad para el diagnóstico y el manejo del paciente con fibrilación auricular / Digital Cardiology (e-Cardiology): useful tools for diagnosis and management of atrial fibrillation / Cardiologia digital (e-Cardiologia): ferramentas úteis para o diagnóstico e tratamiento de pacientes com fibrilação atrial

La tecnología digital móvil (mSalud), recurso aún subutilizado, tiene el potencial para transformarse en un auxiliar imprescindible en la práctica clínica, en particular en Cardiología. La fibrilación auricular es la arritmia más frecuente, cuya prevalencia aumenta con la edad y tiene como complicación más temida el accidente cerebrovascular. Su prevención depende de un diagnóstico oportuno, una adecuada estratificación de riesgo y el uso de anticoagulantes orales. Sin embargo, es con frecuencia paroxística y asintomática, lo que dificulta su diagnóstico. El aporte de la tecnología mediante el desarrollo de aplicaciones para celulares, relojes, dispositivos portátiles o implantables que registran el ritmo cardíaco y permiten el monitoreo prolongado, ambulatorio y a distancia facilitan su detección. Se repasan las principales evidencias que justifican la aplicación de estas estrategias de tamizaje, cuando está indicado realizarlo, cómo y a quiénes hacerlo. Por último, se plantea también la utilidad de estas estrategias de monitoreo prolongado en el manejo y la prevención de la fibrilación auricular.

The mobile digital technology (mHealth), a tool still underutilized, has the potential to become an essential aid in clinical practice, particularly in Cardiology. Atrial fibrillation is the most frequent arrhythmia whose prevalence increases with age and its most feared complication is cerebrovascular accident. Its prevention depends on a timely diagnosis, an adequate risk stratification and the use of oral anticoagulants. However, it is frequently paroxysmal and asymptomatic, which makes its diagnosis difficult. The contribution of technology through the development of applications for cell phones, watches, portable or implantable devices that record the heart rhythm and allow prolonged, outpatient and remote monitoring, facilitate its detection. The main evidences that justify the application of these screening strategies are reviewed, when it is indicated to perform it, how and to whom to do it. Finally, the usefulness of these prolonged monitoring strategies in the management and prevention of atrial fibrillation is also considered.

A utilização da tecnologia digital móvel (m-Saúde), ainda pouco utilizada, tem potencial para se tornar um auxílio essencial na prática clínica, principalmente na Cardiologia. A fibrilação atrial é a arritmia mais frequente, cuja prevalência aumenta com a idade e sua complicação mais temida é o acidente vascular cerebral. Sua prevenção depende de um diagnóstico oportuno, de uma estratificação de risco adequada e do uso de anticoagulantes orais. Porém, freqüentemente é paroxística e assintomática, o que dificulta seu diagnóstico. A contribuição da tecnologia por meio do desenvolvimento de aplicativos para telefones celulares, relógios, dispositivos portáteis ou implantáveis ​​que registram o ritmo cardíaco e permitem monitoramento prolongado, ambulatorial e remoto, facilitam sua detecção. São revisadas as principais evidências que justificam a aplicação dessas estratégias de rastreamento, quando é indicado fazê-lo, como e para quem fazê-lo. Finalmente, a utilidade dessas estratégias de monitoramento prolongado no manejo e prevenção da fibrilação atrial também é considerada.

Telessaúde em um centro de referência em Diabetes Mellitus: uma análise transversal / Telehealth in a reference center in Diabetes Mellitus: a cross-sectional analysis

Resumo Objetivo Analisar uma ferramenta de telessaúde de um centro de referência em Diabetes Mellitus sob a ótica dos cuidadores. Método Estudo transversal, com abordagem quantitativa, desenvolvido em um centro de referência em Diabetes Mellitus, com cuidadores de crianças e adolescentes que utilizaram a Hot-Line e responderam ao questionário online, no período de novembro de 2018 a fevereiro de 2019. Resultados A amostra foi constituída de 90 participantes, sendo 76 (84,4%) do sexo feminino, tendo como o maior parentesco o materno 68 (75,6%). Quanto aos motivos das ligações, 31 (34,4%) referem-se às orientações gerais, 41 (45,6%) ao ajuste de dose de insulina, 6 (6,7%) à hipoglicemia aguda, 6 (6,7%) à hiperglicemia aguda, 2 (2,2%) aos dias de doença e 4 (4,4%) referem-se aos resultados de exames. Os participantes apresentaram um alto índice de satisfação com o uso da linha telefônica. Conclusão e implicações práticas O teleatendimento produz benefícios imediatos aos pacientes, sendo resolutivo no manejo da doença. Cabe ressaltar que o uso da telessaúde como forma de promoção da saúde contribui para a prevenção de agravos de maneira rápida, satisfatória e sem o deslocamento do paciente e sua família.

Abstract Objective To analyze a telehealth tool of a reference center in Diabetes Mellitus from the caregivers' perspective. Method A cross-sectional study, with a quantitative approach, developed at a reference center in Diabetes Mellitus, with caregivers of children and adolescents who used the Hot-Line and responded to the online questionnaire, from November 2018 to February 2019. Results The sample consisted of 90 participants, 76 (84.4%) were female, and the highest kinship was the maternal 68 (75.6%). Regarding the reasons for the telephone callings, 31 (34.4%) refer to general guidelines, 41 (45.6%) to the insulin dose adjustment, 6 (6.7%) to the acute hypoglycemia, 6 (6.7%) acute hyperglycemia, 2 (2.2%) to the days of disease and 4 (4.4%) refer to the test results. The participants presented a high level of satisfaction with the use of the telephone line.Conclusion and implications for practice: The call center produces immediate benefits to patients, being effective in the management of the disease. It should be emphasized that the use of telehealth as a form of health promotion contributes to the prevention of health problems in a fast, satisfactory way and without the displacement of the patient and his family.

Telemedicina en las Unidades de Cuidados Intensivos Pediátricos: Desarrollo de una nueva modalidad asistencial / Telemedicinein Pediatric Intensive Care Units: Development of a new care model

Los Programas telemédicos entre unidades de cuidados intensivos han demostrado ser eficaces en el mundo. En Argentina realizamos el primer programa piloto entre una Unidad de Cuidados Intensivos Pediátricos de Buenos Aires (UCIP- BA) y Santiago del Estero (UCIP-S). En el presente trabajo describimos el desarrollo y la evaluación de una nueva modalidad de asistencia para el diagnóstico, tratamiento y seguimiento a distancia de los pacientes en UCIP. Se implementó un programa de atención sincrónica para pacientes internados y seleccionados por la UCIP-S. Se utilizó un sistema de videoconferencia y se realizó un seguimiento en conjunto de los pacientes. La evaluación se realizó con una encuesta de satisfacción de los usuarios. Ingresaron al estudio 29 pacientes, 72 % del sexo masculino. La edad promedio fue de 35 meses (2-168). El diagnóstico más frecuente fue shock séptico y el acompañamiento en el diagnóstico la conducta más frecuente. Solo cinco pacientes obitaron y se registraron 3 derivaciones al Hospital Garrahan. Se realizaron 155 teleconferencias y 396 consultas, con un tiempo promedio diario de 48 minutos, La media de seguimientos por pacientes fue de 20,6 días (2-107). Tele-UCI mejoró la capacidad de comprensión de la situación clínica (96%) y modificó la relación con la familia (65%). El modelo asistencial demostró un 88.5% de satisfacción. A través de estos resultados concluimos que según los profesionales participantes, Tele-UCI respaldó al equipo que se encarga del seguimiento diario de los pacientes, generando una disminución de traslados de pacientes (AU)

Telemedicine programs between intensive care units have proven effective worldwide. In Argentina we conducted the first pilot program between a Pediatric Intensive Care Unit in Buenos Aires (PICU- BA) and another in Santiago del Estero (PICU-S). In this study, we describe the development and evaluation of a new care modality for the diagnosis, treatment, and remote monitoring of patients in the PICU. A synchronous care program for inpatients selected by PICU-S was implemented. A videoconferencing system was used and patients were monitored together. The program was evaluated with a user satisfaction survey. Twenty-nine patients, 72% of the male sex, were included in the study. Mean age was 35 months (2-168). The most common diagnosis was septic shock and in the majority of cases the diagnosis was confirmed. Only five patients died and three were referred to Garrahan Hospital. Overall, 155 teleconferences and 396 consultations were conducted, with a mean daily time of 48 minutes. Mean monitoring time per patient was 20.6 days (2-107). Tele-ICU improved the ability to understand the clinical situation (96%) and changed the relationship with the family (65%). The care model showed an 88.5% satisfaction rate. Based on these results, we conclude that according to the participating professionals, TeleICU supported the team that is in charge of the daily monitoring of patients, leading to a decrease in patient transfers (AU)

Acesso e regulação ao cuidado especializado no Rio Grande do Sul: a estratégia RegulaSUS do TelessaúdeRS-UFRGS / Access and regulation of specialized care in Rio Grande do Sul: the RegulaSUS strategy of TelessaúdeRS-UFRGS

Resumo Na Atenção Primária à Saúde (APS) acesso e integralidade são fortemente influenciados pela coordenação do cuidado, que por sua vez recebe impacto positivo da articulação de ações de telessaúde para a telerregulação da assistência. Criamos uma metodologia de telerregulação (Projeto RegulaSUS) baseada em protocolos específicos firmemente alicerçados em evidências. A partir de dados do sistema de regulação e do TelessaúdeRS exploramos os efeitos do RegulaSUS na APS e no acesso ao cuidado especializado. A metodologia foi capaz de criar protocolos abrangentes, com expressiva redução média da fila de consultas especializadas de 30% em 360 dias. Reduziu o tempo de espera na marcação de consultas em especialidades clínicas (mediana de 66 dias), mas não em cirúrgicas. Tempos de espera nos casos mantidos em fila variaram de forma inversa, aumentado em especialidades clínicas e diminuindo em cirúrgicas. O uso de teleconsultorias espontâneas aumentou com a exposição dos profissionais ao RegulaSUS. A intervenção tem potencial na integração de sistemas de saúde, principalmente em países de baixa e média renda, e faz com que a telessaúde atue como metasserviço, construindo redes eficientes, qualificadas e equânimes.

Abstract In Primary Health Care (PHC), access, and integrality are strongly influenced by the coordination of care, which in turn receives a positive impact from the articulation of telehealth actions for teleregulation of care. We created a teleregulation method (RegulaSUS Project) based on specific protocols firmly grounded in scientific evidence. From data of the regulatory system and TelessaúdeRS, we explored the effects of RegulaSUS on PHC and access to specialized care. This method set comprehensive protocols, with a significant mean reduction of 30% in the specialized visits queue over 360 days. It reduced waiting time for medical clinical visits (median of 66 days) but not for surgical appointments. Waiting times for queued cases varied inversely, increasing for clinical and declining for surgical specialties. The use of teleconsultations unrelated to regulation increased with the exposure of professionals to RegulaSUS. The intervention evidence potentiality in the integration of health systems, mainly among low- and middle-income countries, and makes telehealth act as a meta-service, building efficient, qualified, and equitable networks.

Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review

Abstract Introduction Post-traumatic stress disorder (PTSD) is one of the most common psychiatric disorders found among victims of disaster, kidnapping, accidents, sexual assaults and war in Indonesia. However, lacking and unequal distribution of psychiatric medical personnel remains a barrier to its management. This review aims to introduce and evaluate the potential contribution of telepsychiatry to the management of PTSD based on published literature. Methods Original studies were obtained from PubMed, Science Direct, ProQuest, High Wire, and Elsevier Clinical Key databases. Results A total of 125 articles were found, of which 15 articles (12 randomized controlled trials, 2 open trials and 1 pilot study) fulfilled the inclusion criteria. A total of 991 subjects were found with a follow-up period ranging between 5 weeks and 18 months. Telepsychiatry is an innovative use of technology to aid the delivery of PTSD treatments in areas difficult to reach. The quality of care given by telepsychiatry both through video conferencing as well as web- and application-based is comparable to that of face-to-face therapy. Patient satisfaction, quality of doctor-patient relationship also remains high, with lower costs and shorter therapeutic time when compared to face-to-face therapy. Conclusion Various studies have shown that telepsychiatry is an effective solution for the management of PTSD. Studies have also reported that the quality of treatment through telepsychiatry is as effective as face-to-face therapy, with greater efficiency. Countries, especially those with a low patient-to-mental health professional ratio, should be encouraged to develop telepsychiatry systems to manage PTSD.

Healthcare telemonitoring and business dynamics: challenges and opportunities for SUS / Telemonitoramento e a dinâmica empresarial em saúde: desafios e oportunidades para o SUS

ABSTRACT OBJECTIVE To point out challenges and opportunities for the Brazilian Unified Health System (SUS) with the use of telemonitoring to face the increasing costs of non-communicable chronic diseases, based on its general panorama in Brazil, business dynamics and reapplication of data from American studies. METHODS Quali-quantitative approach with exploratory research. The field work focused on the analysis of the national market from private companies, since no experiences or studies related to this theme were identified in the SUS. To analyze the panorama and market dynamics, we investigated the offer of this technology based on the products and services available and their demand by reference hospitals the ten largest private health plan companies. To support the central discussion, we analyzed the reduction of costs with hospital admissions by the SUS due to chronic non-communicable diseases sensitive to telemonitoring (HCDST), using data from Datasus and some American studies from the MEDLINE/PubMed database. RESULTS Although in the embryonic phase, business agents search for new business opportunities, whereas public initiatives for the use of telemonitoring in collective health seem inexistent. The reapplication of U.S. data would reduce spending on HCDST and provide benefits, such as the reduction in emergency room care, acute hospitalizations, readmissions and home care time, among others, which point to even greater economic gains. CONCLUSIONS The development of a major project to reduce HCDST using this technology has the potential to advance in a comprehensive network of primary care, contribute to a greater dynamism of the national productive and innovative base and induce innovations along the chain of this emerging industry.

RESUMO OBJETIVO Apontar desafios e oportunidades para o Sistema Único de Saúde (SUS) com o uso do telemonitoramento para enfrentar o aumento crescente dos custos com as doenças crônicas não transmissíveis, a partir do seu panorama geral no Brasil, dinâmica empresarial e reaplicação de dados de estudos americanos. MÉTODOS Este trabalho se enquadra na abordagem quali-quantitativa com pesquisa do tipo exploratória, e o trabalho de campo se concentrou na análise do mercado nacional a partir das empresas privadas, pois não se identificaram experiências ou estudos relacionados a esse tema no SUS. Para análise do panorama e da dinâmica do mercado, investigou-se a oferta a partir dos produtos e serviços disponíveis e a demanda por meio dos hospitais de referência, bem como as dez maiores empresas de planos de saúde privados. Para subsidiar a discussão central deste estudo, analisou-se a redução de custos com as internações hospitalares pelo SUS decorrentes das doenças crônicas não transmissíveis mais impactadas pelo telemonitoramento (IDCST), utilizando-se dados do Datasus e de alguns estudos americanos da base de dados MEDLINE/PubMed. RESULTADOS Embora em fase embrionária, os agentes empresariais se posicionam na busca por novas oportunidades de negócios, enquanto na saúde coletiva não há aparentemente iniciativas públicas para o uso do telemonitoramento. A reaplicação dos dados estadunidenses implicaria uma redução significativa nos gastos com IDCST pelo SUS, sem considerar outros benefícios, tais como a redução nos atendimentos nas salas de emergência, internações agudas, reinternações e tempo de cuidados domiciliares, entre outros, que apontam para ganhos econômicos ainda superiores com o uso do telemonitoramento. CONCLUSÕES O desenvolvimento de um grande projeto para a redução das IDCST a partir dessa tecnologia tem potencial para avançar em uma rede integral de atenção básica, contribuir para uma maior dinamização da base produtiva e inovativa nacional e induzir inovações em toda a cadeia dessa indústria emergente.

Impact of teleconsultations on the conduct of oral health teams in the Telehealth Brazil Networks Programme

Abstract Telehealth has been applied in the Unified Health System (SUS) as a tool for qualifying professionals and improving the healthcare provided to the population served by the system. The aim of the present study was to evaluate the impact of teleconsultations on the qualifications of the clinical approach of the oral health teams involved in primary health care (PHC) in the state of Rio Grande do Sul under the Telehealth Brazil Networks Programme. The sample population of the study was composed of 285 dentists and 132 oral health assistants belonging to the Family Health Teams. A chi-square test was used to investigate possible associations between the absolute number of teleconsultations performed and several independent variables, namely, gender, age, dental specialty, time since graduation, time working in the Family Health Strategy (FHS), employment status, type of training institution, familiarity with information technology, and work satisfaction at the health facility. The level of significance was p < 0.05. Use of the oral health teleconsultation service led to a reduction of more than 45% in the number of referrals to other levels of care. However, no significant association was found between the number of teleconsultations and the independent variables analysed. The use of teleconsultations proved to be a powerful tool for professional training, for increasing the effectiveness of PHC, and for improving the oral healthcare provided.

Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA / Prevalência de Hipertensão Mascarada e do Avental Branco em Pré-Hipertensos e Hipertensos Estágio 1 com o uso da TeleMRPA

Abstract Background: The diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy. Objective: To evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients. Method: Retrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensive medication and who underwent exams on the HBPM platform by telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function. Results: The sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m2. The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%. Conclusion: MH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis.

Resumo Fundamento: O diagnóstico de hipertensão arterial baseado nas medidas do consultório tem baixa acurácia. Objetivo: Avaliar a prevalência de hipertensão mascarada (HM) e do avental branco pela monitorização residencial da pressão arterial (MRPA) em pacientes pré-hipertensos e hipertensos estágio. Método: Estudo retrospectivo com amostra constituída de indivíduos com pressão arterial (PA) na clínica ≥ 120/80 mmHg e < 160/100 mmHg sem uso de medicação anti-hipertensiva e que realizaram exames na plataforma de MRPA por telemedicina (TeleMRPA) entre maio de 2017 e setembro de 2018. Foi utilizado o protocolo MRPA de quatro dias, com 24 medidas, com equipamentos automáticos, validados, calibrados e com memória. Resultados: A amostra foi constituída de 1.273 participantes, sendo 739 (58,1%) mulheres. A idade média foi 52,4 ± 14,9 anos, índice de massa corporal (IMC) médio 28,4 ± 5,1 kg/m2. A PA casual foi maior que a MRPA em 7,6 mmHg para pressão arterial sistólica (PAS) e 5,2 mmHg para a pressão arterial diastólica (PAD), ambas com significância estatística (p < 0,001). Foram diagnosticados 558 (43,8%) normotensos; 291 (22,9%) hipertensos sustentados; 145 (11,4%) com HM e 279 (21,9%) com hipertensão do avental branco (HAB), com erro diagnóstico pela PA casual na amostra total em 424 (33,3%) pacientes. Em hipertensos estágio 1, a prevalência de HAB foi de 48,9%; nos pré-hipertensos a prevalência de HM foi de 20,6%. Conclusão: HM e HAB têm elevada prevalência na população adulta; entretanto, na população de pré-hipertensos ou hipertensos estágio 1 a prevalência é maior. Medidas da PA fora do consultório, nestes subgrupos, devem ser realizadas sempre que possível para evitar erro diagnóstico.

Fatores associados à não utilização da teleconsultoria por médicos da Estratégia Saúde da Família / Factors associated with the non-use of telehealth consultancy by physicians of the Family Health Strategy

Resumo Este estudo objetivou avaliar a frequência e os fatores associados à não utilização do serviço de teleconsultoria por médicos que atuam na Estratégia Saúde da Família (ESF) no Norte de Minas Gerais. Trata-se de um estudo transversal que utilizou questionário autoaplicado, previamente testado. A análise de regressão de Poisson com variância robusta foi empregada após análises bivariadas para identificação dos fatores associados à não utilização do serviço de teleconsultoria. Participaram do estudo 385 médicos de 73 municípios. A frequência de não utilização do serviço de teleconsultoria pelos médicos da ESF foi de 55,8%. Foram identificadas como variáveis associadas após análise múltipla a indisponibilidade de computador com internet na Unidade Básica de Saúde (UBS) para uso do profissional médico (p = 0,001; RP = 1,10; IC95%: 1,04-1,17), a falta de informação sobre o serviço (p < 0,001; RP = 1,47; IC95%: 1,38-1,56) e a falta de treinamento para uso da teleconsultoria (p < 0,001; RP = 1,15; IC95%: 1,08-1,24). Os resultados reforçam que a infraestrutura de informática das UBS, a divulgação do serviço e a oferta de treinamento devem direcionar as estratégias para implementação, difusão e melhoria da qualidade do serviço de teleconsultoria na atenção primária.

Abstract This study sought to evaluate the frequency and factors associated with non-use of telehealth consultancy by physicians who work in the Family Health Strategy (FHS) in the North of the State of Minas Gerais. It is a cross-sectional study that used a previously-tested self-administered questionnaire. Poisson regression analysis with robust variance was used after bivariate analysis to identify the factors associated with non-use of telehealth consultancy. A total of 385 physicians from 73 municipalities participated in the study. The frequency of non-use of telehealth consultancy by physicians in the FHS was 55.8%. After multiple analysis, the following variables were identified: the lack of availability of computers and Internet access in the Basic Health Units (BHU) for medical professionals (p = 0.001; PR = 1.10; 95% CI: 1.04-1.17), the lack of information about telehealth consultancy (p< 0.001; PR = 1.47; 95% CI: 1.38-1.56) and lack of training in telehealth consultancy (p < 0.001; PR = 1.15; 95% CI: 1.08-1.24). The results support that the informatics infrastructure of the BHU, the dissemination of the service and the training should orient the strategies for implementation, diffusion and improvement of the quality of telehealth consultancy services in primary health care.

Modelo de manejo en red y por telemedicina de la retinopatía diabética en dos comunas del Servicio de Salud Metropolitano Oriente / Management of diabetic retinopathy using telemedicine and network integration

Background: If we are able to increase the resolution of complex medical problems at primary health care levels, we would improve the efficiency of the health care systems and would reduce the burden of specialists. Aim: To describe the result of a telemedicine and network management of diabetic retinopathy supervised by an ophthalmological service. Material and Methods: Diabetic patients attended in primary health care centers of the East Metropolitan Health Service in Santiago, Chile, derived for 45° digital retinographies were evaluated using telemedicine by the ophthalmologists of the base hospital. These professionals screened for diabetic retinopathy and classified it. Those patients with diabetic retinopathy were derived to the base hospital for specialized management. Results: Of 2,566 patients evaluated, 22% had signs of diabetic retinopathy, 75% did not have the condition and 2% could not be evaluated with retinography. Seventy percent of patients with retinopathy, equivalent to only fifteen percent of total diabetics, were referred to the specialists for treatment. Conclusions: This model allowed a reduction of referrals to ophthalmologists, reducing the burden of secondary and tertiary health care systems.

Weblog "How Do I Breathe?"-Design and View Statistics

Abstract Introduction Breathing is one of the vital functions of the body and is essential for the maintenance of life. Preventive measures for respiratory disorders can be used by the population, as well as early self-diagnosis and immediate search for treatment based on knowledge of this subject. Objective this study developed a weblog on the breathing function targeting young people and analyzed the statistical data of views until the present moment. Methods The weblog was developed, and the stages of analysis, design, development and implementation were followed. All texts were evaluated by the Flesch Reading Index to verify the language, and the statistical data were analyzed by the number of views, countries with the highest number of views, search terms used, most viewed pages and number of comments on the blog. Results Issues related to the breathing function and thosemost cited in the literature were selected. The blog was structured using pages with content and curiosities, with texts with minimum readability of 50%, and was made available on the internet by means of the Wordpress tool. The statistics showed an increase in the number of visits after August 2015; the countries with the highest number of views were Brazil, United States and Portugal; the search terms used were unknown or related to mouth breathing; the most viewed pages related to mouth breathing and the comments addressed questions on mouth breathing, reports and compliments. Conclusion The blog "How do I breathe?," aimed at young people and containing information about the breathing function, was developed and is available on the internet at the address: https://comoeurespiro.wordpress.com. (AU)

Aporte del uso de herramientas básicas de Telemedicina en la atención de niños y adolescentes con Artritis idiopática juvenil, en el Hospital de Puerto Montt. Chile / Contribution of the use of basic telemedicine tools to the care of children and adolescents with juvenile idiopathic arthritis at the Puerto Montt Hospital, Chile

Resumen: Niños y adolescentes con enfermedades reumatológicas, requieren atención especializada e integral, sin embargo, reumatólogos e inmunólogos pediátricos se concentran en hospitales con tecnología específica, costosa y moderna. Como algunos pacientes con Artritis idiopática juvenil (AIJ) vive en áreas rurales, lejanas y de accesibilidad limitada, el uso de Telemedicina (TM) puede optimizar el diagnóstico, seguimiento y pronóstico. Objetivo: Mostrar 10 años de experiencia de un modelo de atención mixta: presencial y a distancia, usando TM básica; el impacto institucional, ventajas, des ventajas y aceptación reportados por padres y pacientes. Pacientes y Método: Estudio exploratorio, descriptivo, retrospectivo con componente cualitativo. Previa autorización de comité ético-científico del Servicio de salud del Reloncaví y la aplicación de consentimiento/asentimiento informado, se efectuó revisión de historias clínicas y se aplicó encuesta cualitativa a padres y niños mayores de 14 años con AIJ, atendidos entre 2005-2015 en el policlínico de reumatología infantil Hospital Puerto Montt. Resultados: Participaron 27/35 pacientes con AIJ atendidos por pediatra capacitado, aseso rado a distancia (1.000 km) por inmunólogo. 8/35 pacientes no contestaron por opción o cambio de domicilio. 70 % de padres y pacientes aceptaron el modelo de atención y 4% preferirían atención esporádica solo por especialista para diagnóstico y seguimiento. El número de pacientes trasladados anualmente disminuyó de 10 a 1. Las ventajas del modelo de atención superaron las desventajas per cibidas por padres y pacientes con AIJ. Conclusión: El uso de herramientas de TM en AIJ disminuyó los traslados, mejoró el seguimiento y fue considerado ventajoso por los padres y pacientes.

Abstract: Children and adolescents with rheumatologic diseases require specialized and comprehensive care, but pediatric rheumatologists and immunologists are concentrated in hospitals with specific, high-cost and modern technology. Considering that some patients with juvenile idiopathic arthritis (JIA) live in rural, remote and limited accessibility areas, the use of Telemedicine (TM) can optimize diag nosis, follow-up and prognosis. Objective: Reporting 10 years of experience of a mixed care model: face-to-face and distance, using basic TM; the institutional impact, advantages, disadvantages and acceptance informed by parents and patients. Patients and Method: Exploratory, descriptive, and re trospective study with qualitative component. After the authorization of a scientific-ethics committee of the Reloncaví Health Service and the application of informed consent, a review of medical records was carried out and a qualitative survey was applied to parents and children over 14 years of age with JIA, seen between 2005-2015 in the pediatric ambulatory rheumatology polyclinic of Puerto Montt Hospital. Results: The were 27/35 participating patients with JIA attended by a trained pediatrician and assisted by distance (1,000 km) by an immunologist. The 8/35 patients did not answer by choice or change of address. The 70% of parents and patients accepted the model of care and 4% would pre fer sporadic care only by specialists for diagnosis and follow-up. The number of patients transferred annually decreased from 10 to 1. The advantages of the care model outweighed the disadvantages perceived by parents and JIA patients. Conclusion: The use of TM tools in JIA decreased transfers, improved follow-up and were considered advantageous by patients and their parents.

Impact of telemedicine in hospital culture and its consequences on quality of care and safety / Impacto da telemedicina na cultura hospitalar e suas consequências na qualidade e segurança do cuidado

ABSTRACT Objective To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice. Methods The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein. Results Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis. Conclusion The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care.

RESUMO Objetivo Analisar o impacto da aplicação de telemedicina no processo clínico de cuidado e seus diferentes efeitos sobre a cultura hospitalar e na prática assistencial. Métodos O conceito de telemedicina, por meio de uma cobertura integral em tempo real, foi implementada em dois hospitais diferentes em São Paulo, um secundário e público, o Hospital Municipal Dr. Moysés Deutsch, e um terciário e privado, o Hospital Israelita Albert Einstein. Resultados Os dados foram obtidos a partir de 257 teleconsultas registradas ao longo de um período de 12 meses e comparados a igual período antes da implementação. Em 18 pacientes (7,1%), a telemedicina influenciou no diagnóstico e, para 239 pacientes (92,9%), a consulta contribuiu para o manejo clínico. Após a implementação da telemedicina, o protocolo de trombólise para acidente vascular cerebral foi aplicado em 11% dos pacientes com acidente vascular cerebral. A introdução da telemedicina reduziu a necessidade de transferir pacientes para avaliação neurológica externa em 25,9%. O protocolo de sepse foi adotado, sendo observada redução da mortalidade em 30,4% nos casos de sepse grave. Conclusão A aplicação da telemedicina está associada com diferenças na utilização dos serviços de saúde: transferências, mortalidade, implementação de protocolos e apoio à decisão médica, especialmente em relação à trombólise. Estes resultados destacam o papel da telemedicina como um vetor de transformação da cultura hospitalar e seu impacto sobre a segurança e na qualidade assistencial.

Teledermatología: experiencia en un centro de salud familiar urbano chileno / Teledermatology: experience in a chilean urban Family Health Center

INTRODUCCIÓN: Los problemas dermatológicos son un importante motivo de consulta en Atención Primaria de Salud (APS). Existe una extensa lista de espera para la evaluación especializada. La teledermatología (TD) se implementó para soslayar esta situación. OBJETIVOS: Describir atenciones de TD y determinar concordancia diagnóstica inter observador entre médico general de APS y dermatólogo. MATERIALES Y MÉTODO: Estudio descriptivo, transversal, de concordancia inter observador. Los criterios de inclusión fueron: pertenencia del usuario al registro del Centro de Salud Familiar (CESFAM) "Jean y Marie Thierry" de Valparaíso y registro en el programa de TD. Se excluyeron atenciones de control. La población considerada corresponde a todas las atenciones realizadas entre marzo de 2014 a julio de 2015. Las variables cuantitativas fueron descritas con media y desviación estándar; las variables cualitativas con frecuencia y porcentajes. Se determinó concordancia con el test Kappa. Se consideró estadísticamente significativo un valor p menor a 0,05. RESULTADOS: Se incluyeron 147 atenciones: 84 (57%) se realizaron a usuarios de sexo femenino. Los usuarios presentaron una media de edad de 46 años (desviación estándar de 25 años). En 112 atenciones (76%) no fue necesaria la evaluación presencial por especialista. Los diagnósticos más frecuentes en APS fueron acné, psoriasis y rosácea; a través de TD fueron psoriasis y acné. Se obtuvo un coeficiente Kappa de 0,65 (IC 95% 0,6-0,67) con valor p<0,05. DISCUSIÓN: Existen pocos trabajos similares en Chile. Los resultados son similares a otros trabajos. En el contexto descrito resulta conveniente la baja proporción de usuarios que requirieron evaluación especializada