Alaneir de Fátima dos Santos

Ética e telessaúde: reflexões para uma prática segura

The term eHealth (or telemedicine, telehealth) has been used to describe activities that employ information and telecommunication technologies to deliver health care. Distance is an important factor hindering the delivery of many important services, such as diagnosis, treatment, prevention, health promotion, and health research assessment. Although eHealth can provide interesting solutions such as a second specialist opinion in geographically isolated areas, a large number of ethical and legal issues must be considered. It is essential to discuss, among others, aspects relating to safety and confidentiality; professional accountability; technical standards relating to digital recording, storage, and transmission of clinical data; copyright; authorization from professional regulatory bodies; and licensing for the remote practice of medicine. In Brazil, the Federal Council of Medicine has already established rules for telemedicine; however, it is still necessary to further this discussion to involve the entire health care sector. Since there are many eHealth projects being developed in Brazil, there is an urgent need to design protocols and training programs for all professionals involved.

Telehealth in Primary Healthcare: An Analysis of Belo Horizonte's Experience

BACKGROUND Telehealth resources were implemented in the city of Belo Horizonte, providing tools for the medical assistance model as well as strengthening the quality of primary healthcare attention. OBJECTIVE The objective of this study was to analyze the characteristics of the incorporation of telehealth resources in Belo Horizonte, Brazil, and its contribution to the structuring of primary healthcare. MATERIALS AND METHODS This study focused on a description of the telehealth projects related to primary healthcare in the city and the results of the implementation process. The sources for this analysis include documents presented to financing institutions, reports from the Belo Horizonte City Department of Health, and articles and technical reports related to the evaluations of the project. RESULTS The BHTelehealth Project has been established in 148 basic health units in Belo Horizonte. It develops assistance and educational activities by using 3D modeling, interactive videos, and animations. The analysis of this implementation process identified both positive and negative aspects. Telehealth has strengthened the role of primary healthcare as the coordinator of attention. It has reinforced primary care units by widening the scope of attention offered at this level and has provided primary care staff with a powerful arsenal of up-to-date information and tools. CONCLUSION BHTelehealth served as a model for implementing the National Telehealth Program, in course in Brazil, involving 900 cities. This is attributed to its positive impact on the training of primary care unit professionals.

Estruturação da área de informação em saúde a partir da gerência de recursos informacionais: análise de experiência

OBJETIVO: Relatar a experiencia da Secretaria Municipal de Saude de Belo Horizonte (SMSA/BH), no Estado de Minas Gerais, Brasil, na aplicacao dos conceitos da gerencia de recursos informacionais (GRI) para o desenvolvimento de um sistema de informacao em saude. METODOS: Neste estudo de caso foram analisados documentos que descrevem as iniciativas na area de informacao, seus mecanismos de estruturacao e resultados alcancados com um sistema de gestao focado no prontuario eletronico, no periodo de 2003 a 2008. Esse processo e descrito e analisado a partir do conceito de GRI. RESULTADOS: O sistema contribuiu para a mudanca do modelo assistencial a partir da informatizacao integrada de 103 unidades basicas de saude, nove unidades especializadas e 503 equipes de saude da familia, com enfase nas informacoes relevantes para o programa saude da familia. CONCLUSOES: Os seguintes componentes da GRI foram aplicados: estruturacao de um locus unico para as tecnologias de informacao e a area de informacao, potencial de alavancagem das tecnologias de informacao e forum estrategico de decisao quanto a informacao. A limitacao encontrada refere-se a utilizacao de informacao estrategica para a tomada de decisao de longo prazo.

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.

Is the Use of Information and Communication Technology Associated With Aspects of Women's Primary Health Care in Brazil?

The use of information and communication technology (ICT) is on the increase in the health systems, representing a means of improving the quality of health care. This study analyzed the ICT incorporation in primary care in Brazil and identified the different aspects that may be associated with better quality in the care provided, in relation to certain aspects of womens care. We noted an unevenness regarding ICT incorporation in Brazil. However, the findings indicate an association between ICT and certain aspects of the quality provided in womens health care, which reinforces the need for further studies on this type of evaluation.

Compreendendo o apoio matricial e o resultado da certificação de qualidade nas áreas de atenção à criança, mulher, diabetes/hipertensão e saúde mental

Este artigo apresenta a distribuicao do apoio matricial (AM) no Brasil, identificando relacoes entre as atividades de AM e a certificacao do PMAQ-AB. Utilizaram-se dois modelos de regressao logistica multipla. As atividades de AM na Atencao Basica sao significativas mas desiguais, com altos graus de AM em lugares desenvolvidos. Existe associacao positiva entre o grau de apoio e o resultado obtido na certificacao. Elevados graus de AM correspondem a 89%, 80%, 89% e 63% de chances de as equipes obterem uma melhor certificacao na atencao a mulher, crianca, hipertensao e diabetes e saude mental, respectivamente. O AM tem ajudado a melhorar a qualidade da Atencao Basica no Brasil.

Evaluation of the use of videoconferencing for distance training of doctors in the family health teams within the national telehealth project

Introduction: the National Telehealth Program aims at updating and training doctors in the Family Health Teams by means of videoconferencing (VCs), with potential impact on improving the health care in remote locations and reducing the displacement of patients. In addition, it proposes increased primary care interaction with specialized centers. Objectives: presentation and evaluation of the use of the videoconferencing system allowing for better planning of action in the project. Methods: 916 evaluation /feedback questionnaires were analyzed, completed by participants at the end of 84 VCs in Medicine, between 2009 and 2013. The VCs are a branch of the National Telehealth Project and reach 50 municipalities in Minas Gerais under the coordination of the FM-UFMG. They are held via web, requiring minimal equipment in diffuser and receiver centers. Results: in the study period, an average of 12.64 municipalities and 19.42 speakers were identified. Of these, the average number of doctors was 12.97. The quality parameters achieved positive assessment (“great” or “good”) in just 62% for the sound, and 84% for the image. The theme was considered “interesting” or “very interesting” by 98%. Conclusions: the VCs have been strengthened as an alternative to educational institutions. However, the participation of speakers and municipalities in this project was less than desired. The comparative analysis of VCs from other areas also reveals a reduced adhesion of doctors. Among the problems detected, especially regarding the sound quality, the low quality of internet connection in the municipalities may have contributed to this result.

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams. METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test. RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23). CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

Incorporation of Telehealth Resources in Belo Horizonte's SAMU: Qualifying and Improving Care

In Brazil the use of information communication technologies increased considerably in this last few years, but there are still very incipient experiments using telemedicine for pre-hospital care. This article reports the deployment of resources of telehealth on SAMU (Emergency Mobile Assistance Service) of Belo Horizonte and the preliminary results of the project, involving European partners, the Federal University of Minas Gerais School of Medicine and the City of Belo Horizonte Department of Health. It is applied to the Brazilian reality, through the appropriation of good practices existing in Europe and the integration of technology development. We have been using multiparametric monitors, videos of the patient and ultrasound, and 3G technology to enhance transfer of pre-hospital data, from ambulances, to data banks in hospitals, to improve patient care.

Avaliação de dados nosológicos em prontuários ambulatoriais

A Medicina Social tem enfrentado inumeras dificuldades na construcao de metodologias que permitam uma correlacao entre o marco teorico desenhado e a realidade sensivel. Nas investigacoes em Saude Coletiva, os dados nosologicos se constituem numa questao da maior importância, pois estes representam as informacoes basicas sobre as quais se construirao os estudos epidemiologicos, o planejamento e a organizacao dos servicos de saude. O estudo se propoe a analisar: (a) os alcances e limites da qualidade dos dados nosologicos contidos em prontuarios de pacientes ambulatoriais; (b) os sistemas classificatorios de doenca utilizados na organizacao destes dados. Foram selecionados, por amostra aleatoria, 340 prontuarios de pacientes de ambulatorio do Hospital das Clinicas da Universidade Federal de Minas Gerais, registrados no periodo de 01/07/87 a 30/06/88. Analisou-se a presenca da hipotese diagnostica (HD) na folha de anamnese e exame fisico, a legibilidade e a apresentacao deste dado. A descricao das HDs encontradas foram agrupadas segundo o padrao da Classificacao Internacional das Doencas (CID - 9). As HDs que nao se enquadravam na CID foram, tambem, analisadas. O estudo concluiu que: (a) os dados nosologicos registrados seguem a logica da CID. Esta tem um padrao no qual enquadra-se o raciocinio clinico, refletindo a concepcao hegemonica da medicina cientifica. Apesar de buscar em suas continuas revisoes um maior grau de especificidade, a CID incorporou mecanismos que refletem suas limitacoes: a existencia da categoria de Sinais, Sintomas e Estados Maldefinidos e a presenca, em todas as categorias, de um digito que expressa a nao-especificidade. No estudo realizado, em 83% dos prontuarios, as HDs eram codificaveis pela CID, apesar de seu uso nao estar normatizado; 6% das HDs encontravam-se na categoria de Sinais, Sintomas e Estados Morbidos Maldefinidos e 38% nao possuiam o grau de especificidade pretendido pela CID; (b) a analise das HDs nao-classificaveis evidenciou que a CID nao incorpora a caracterizacao de aspectos normais, tipicos da Pediatria; as conclusoes nosologicas analiticas, presentes na Psiquiatria, e a dimensao da doenca; (c) nenhum dos sistemas classificatorios alternativos analisados responde aos limites da CID.