RESUMO

BACKGROUND: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world's highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. OBJECTIVE: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. METHODS: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. RESULTS: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. CONCLUSIONS: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users.

Assuntos

COVID-19 , Serviços de Saúde Mental , Consulta Remota , Humanos , COVID-19/epidemiologia , Peru/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto Jovem , Consulta Remota/estatística & dados numéricos , Criança , Idoso , Telemedicina/estatística & dados numéricos , Pré-Escolar , Pandemias , Lactente , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos

RESUMO

BACKGROUND: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce. OBJECTIVE: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. METHODS: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. RESULTS: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). CONCLUSIONS: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.

Assuntos

COVID-19 , Telemedicina , Humanos , COVID-19/mortalidade , Brasil/epidemiologia , Estudos Retrospectivos , Telemedicina/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Hospitalização/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Influenza Humana/mortalidade , Influenza Humana/epidemiologia , Estudos de Coortes

RESUMO

There are several difficulties in evaluating interventions seeking to promote public health policies. In this article, we analyzed the promotion of the use of telemedicine during COVID-19 in Brazil. Using the random promotion method with instrumental variables, we showed that the policy of promoting telemedicine was adequate, with intense use of this type of care. Our results showed that telemedicine works if it is encouraged in the population. We contributed to the discussion of public health policies and their impact on the population's health in times of health crisis, such as during the COVID-19 pandemic.

Assuntos

COVID-19 , Política de Saúde , Telemedicina , Brasil , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , SARS-CoV-2 , Pandemias

RESUMO

Medicine is a discipline based on and nurtured by scientific research and technological development. The use of health services supported by information technology is increasing worldwide, and Latin America is no exception. Factors such as needing more specialists in peripheral cities, large geographic areas, and socio-cultural aspects limit the possibility of receiving timely and quality medical care services. Information Technology (IT) for health purposes, such as e-health, is a cost-effective solution for equitable access to quality healthcare services and optimization of the rising associated costs. As an e-health service, telemedicine facilitates and mediates distance communication between the patient and medical staff. Even though Latin America is at the beginning of the development of telemedicine, it would have a relevant impact, given the geographic and socioeconomic conditions of the population in this part of the world. Drawing on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) theory, we developed a theoretical model to identify the latent factors influencing the public acceptance of telemedicine and examined their interrelationships. A survey questionnaire was designed and administered to 391 residents in Antofagasta, a mine region of Chile. After that, structural equation modeling was employed to analyze the survey data. The results reveal that the UTAUT2 factors' performance expectancy, social influence, and price value significantly impact the intention to use (R2 = 0.693). Additionally, the model presented a good fit. This study enriches the existing theoretical research on the acceptance of telemedicine services and offers insights into understanding and managing technology in the Chilean health sector.

RESUMO

Introduction: One of the challenges faced by the Colombian Health System is to improve access to health services for the dispersed and isolated rural population, particularly in the field of dermatology. This article examines the implementation of a teledermatology service using a PC and camera versus smartphone technology. Methods: A total of 542 teledermatology visits were conducted, involving 478 patients, in addition to 64 visits for clinical follow-up for patients as per the dermatologist's recommendation. Out of the 478 patients, 461 met the inclusion criteria and agreed to participate in the study. The data collection instrument from the general practitioner or referring provider covered three consultation moments: (1) sending an initial consultation, (2) providing a response to the patient, and (3) sending a follow-up consultation. Seven hundred forty-seven records were completed by the general practitioner for the three consultation moments. Furthermore, 372 consultations were documented by the dermatologist or referring provider for two moments: (1) response to the initial consultation by the dermatologist, and (2) response to the follow-up consultation by the dermatologist. After validating the information reported in the instruments, a descriptive analysis of the data was conducted, utilizing absolute frequencies and percentages for qualitative variables and measures of central tendency (mean, median, standard deviation, and interquartile range) for quantitative variables. The data were analyzed from 747 records of the referring provider instrument related to 461 patients, between 18 and 98 years of age, with a predominantly female representation. Results: The results indicated that for teleconsultations conducted using a mobile device, the average total duration of the teleconsultation was longer on the traditional platform compared with the mobile device (13.03 vs. 8.27 min). Additionally, it was observed that the time taken to store, send, and capture a single image (clinical or dermoscopic) using the mobile device was three times lower than that on the conventional platform (25 vs. 75 s). Similar findings were noted for teleconsultations carried out by the dermatologist, predominantly utilizing a mobile device. The average consultation time was shorter for the mobile device compared with the traditional platform (8.14 vs. 12 min). Conclusions: The cost reduction suggests that the operation of the service is more efficient with smartphone technology in comparison to the use of a PC and camera. Teledermatology with smartphones provides a streamlined, efficient, and technically sound process for obtaining clinical and dermoscopic images.

Assuntos

Dermatologia , Fotografação , Smartphone , Telemedicina , Humanos , Feminino , Dermatologia/métodos , Dermatologia/economia , Dermatologia/instrumentação , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Fotografação/instrumentação , Idoso , Adulto Jovem , Colômbia , Telemedicina/economia , Dermatopatias/diagnóstico , Dermatopatias/terapia , Consulta Remota/economia , Consulta Remota/instrumentação , Idoso de 80 Anos ou mais

RESUMO

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.

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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.

Assuntos

Humanos , Criança , Adulto , Consulta Remota , COVID-19/epidemiologia , Pandemias , Hospitais Pediátricos

RESUMO

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.

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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.

Assuntos

COVID-19 , Consulta Remota , Criança , Humanos , Feminino , Adulto , Masculino , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Hospitais Pediátricos

RESUMO

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)

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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)

Assuntos

Humanos , Atenção Primária à Saúde/métodos , Consulta Remota/estatística & dados numéricos , Assistência Ambulatorial/métodos , Relações Médico-Paciente , Estudos Transversais , Correio Eletrônico , Comunicação em Saúde , Anonimização de Dados , COVID-19

RESUMO

Objective The study aimed to compare whether the diagnoses of orthopedic diseases at telemedicine (TM) consultations are the same as those established at face-to-face visits. Method Primary, observational, prospective, analytical study, with subjects from the local municipal network who were referred to the orthopedics outpatient clinic from May to June 2021. Subjects underwent two assessments: a telemedicine (TM) consultation and a face-to-face (FF) visit. Two different physicians attended to the patients and established a diagnosis. The physician performing the FF visit was not aware of the previous diagnoses. We compared the diagnoses obtained at both modalities to assess the degree of similarity. In addition, we determined the time required for consultations and the degree of satisfaction of the physicians. Results We evaluated 43 patients and seven physicians, totaling 44 TM and 43 FF visits. The diagnostic similarity index was 81.4%. TM consultations were shorter (mean time, 4.8 minutes) than FF visits. Physicians were less satisfied with TM in the four criteria evaluated (respective scores of 79.1, 23.3, 46.6, and 37.2). Conclusion TM consultations have a diagnoses agreement higher than 80% compared with FF visits. On the other hand, TM consultations were faster, and physicians were less satisfied with them in comparison with FF visits.

RESUMO

The coronavirus disease (COVID-19) pandemic leveraged telemedicine worldwide mainly due to the need for social distancing, patient safety, and infection prevention. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) was a key reference site in the treatment of COVID-19 severe cases in the country. To continue patient's health care, it became necessary to increase the number of teleconsultations and standardize it institutionally. Herein, we briefly described how the HCFMUSP improved the teleconsultation health care service during the COVID-19 pandemic, highlighting the implementation of important innovations and the throughout standardization process, including patients and professional workflow. We also detailed the methodology used to implement or improve teleconsultation in a medical/multidisciplinary specialty at HCFMUSP. All these efforts made the HCFMUSP reach the goal of converting 15% of all face-to-face consultations into teleconsultations only in 2021. In addition, there were more than 370,000 teleconsultations until the end of 2022. Our experience has shown that having a supporting team, a digital certification process, and the data integration were key factors toward the successful implementation of the teleconsultation services. We believe that progressing toward teleconsultation will improve the population covered by health care services in Brazil, as well as contribute to a reduction of waiting time, and solving costs to health care institutions and patients. We expect this report of our experience in teleconsultation implementation could inspire and guide other health care institutions in the development of telemedicine.