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

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

E-Learning and Simulation on a Pré-Hospital Emergency Course: A Participant’s Perspective / Curso de emergência utilizando E-learning e simulação: visão do participante

ABSTRACT The use of simulation and e-learning has increased considerably in healthcare related educational activities, enabling the acquisition of skills ethically and safely. The objective is to describe the design and evaluation of a semi-distance pre-hospital emergency course for physicians and nurses at the Public Health Department of Belo Horizonte City, Minas Gerais, Brazil. The course comprised 13 online lessons and ten stations, which used simulated scenarios. The participants answered a semi-structured questionnaire using the Likert scale to evaluate the course. Course participation included 203 (63.6%) physicians and 116 (36.4%) nurses; most physicians (72.1%) had finished their studies over five years prior to the study, and had little practice (72.9%) on advanced life support measures. The distance course was well evaluated in terms of general quality, video quality, use of images and animations and usability. The e-learning system was considered to be user friendly by doctors and nurses, and the practical activities were well rated. The course used methodology based on simulation and distance education, and received positive evaluations. The system was rated as good and easy to use.

RESUMO O uso da simulação e da educação a distância tem aumentado consideravelmente na área da saúde, permitindo o desenvolvimento de competências de forma ética e segura. O objetivo deste artigo é descrever a concepção e a avaliação de um curso semipresencial de emergência pré-hospitalar para médicos e enfermeiros da Secretaria Municipal de Saúde de Belo Horizonte, Brasil. O curso a distância foi composto por 13 aulas, e a parte presencial por dez estações temáticas. Os participantes responderam a um questionário semiestruturado (escala de Likert) como forma de avaliar o curso. Participaram do curso 203 (63,6%) médicos e 116 (36,4%) enfermeiros. A maioria dos médicos (72,1%) tinha terminado seus estudos havia mais de cinco anos e tinha pouca prática (72,9%) em medidas de suporte avançado de vida. O curso a distância foi bem avaliado quanto a qualidade geral e dos vídeos, uso de imagens e animações, e usabilidade do sistema. A plataforma de ensino foi considerada amigável. A parte de simulação foi bem avaliada. O curso utilizou metodologia baseada em simulação e educação a distância, sendo bem avaliado. A plataforma de ensino foi classificada como boa e de fácil utilização.

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

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

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

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

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

Este artigo pretendeu sistematizar a visão de telessaúde na América Latina e apresentar a experiência de elaboração de um instrumento para o monitoramento do desenvolvimento de ações de telessaúde a partir da realidade dessa região. Foi estruturada uma coordenação de telessaúde na América Latina, com membros indicados pelos ministérios da saúde de16 países, além de cinco grupos temáticos. Partindo das experiências internacionais e com foco na realidade de telessaúde do continente, foi elaborado um instrumento para acompanhar o desenvolvimento de telessaúde na América Latina. Vários países mantêm projetos nacionais de telessaúde: Brasil, Colômbia, Equador, México, Panamá. Estão em processo de elaboração e início de implantação: Bolívia, Costa Rica, Cuba, El Salvador, Guatemala, Peru, Venezuela. O instrumento descrito pelo artigo propõe a caracterização do grau de desenvolvimento da telessaúde nos países da América Latina como inexistente, incipiente, intermediário, avançado e exemplar, e ainda está em fase de teste. Atualmente, a América Latina já possui ações importantes na área de telessaúde.

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

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

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

Evaluating the experience of training through videoconferences in primary care.

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

Quantification of bone mass gain in response to the application of biphasic bioceramics and platelet concentrate in critical-size bone defects.

Biphasic bioceramics have been widely indicated for bone reconstruction; however, the real gain in bone mass due to the presence of such biomaterials has not been established yet nor the advantages of its association with platelet concentrate. This study aims at quantifying the volume of bone matrix, osteoblasts, osteocytes, blood vessels and adipose tissue after the application of a biphasic bioceramics composed of 65% hydroxyapatite and 35% beta-tricalcium phosphate. Critical-size bone defects were produced in rabbit femora and reconstructed with bioceramics only, with bioceramics combined with platelet concentrate, with platelet concentrate alone, and with no treatment (blood clot). The quantitative evaluation was performed on histological sections using histomorphometry. Our data provide original evidence that consolidates the indication of bioceramics for clinical bone loss reconstruction. The application of biphasic bioceramics alone led to major bone mass gain and was followed by its association with platelet concentrate. On the other hand, platelet concentrate can contribute to the augmentation and maintenance of the adipose tissue, representing a new field for future applications in plastic surgery.