Telemedicine: services grow 172% in 2023 – 04/13/2024 – Balance and Health

There are many difficulties in dealing with health care in a continental country, generally involving scarcity of resources, lack of qualified professionals and precarious infrastructure in municipalities far from large urban centers.

Because of this, telemedicine can be an asset in promoting greater access and equality in medical care for the population.

At the end of 2022, then-president Jair Bolsonaro (PL) sanctioned the law that regulates telemedicine in the country. Until then, a previous bill, from March 2020, had allowed the modality on an emergency basis due to the Covid pandemic.

The regulation of telemedicine in Brazil, a desire of the health sector for years, is a regulatory framework that made it possible to advance “20 years in 2”, explains Carlos Pedrotti, medical manager of telemedicine at Hospital Israelita Albert Einstein. “Today, access [à telemedicina] is broad, largely due to an increase in demand for remote care during the pandemic, which led to ’20 years in 2′ progress”, he says.

From 2020 to the end of 2022, 11 million remote consultations were carried out, according to Fenasaúde (National Supplementary Health Federation), which brings together 14 groups of health plan operators. In 2023, the number increased to 30 million services, a jump of 172%.

And, for 2024, the federal government, through the Ministry of Health, has already allocated R$460 million for new projects involving digital health, according to the Secretary of Information and Digital Health, Ana Estela Haddad. The expectation is that another 50 million teleservices will occur this year.

One of the actions is SUS Digital, launched last Monday (8) at an event for journalists about actions to strengthen the assistance provided to the population in the SUS (Unified Health System).

A Sheet, Nísia Trindade, Minister of Health, said that the department is committed to innovation in health as a way of guaranteeing equal access to the entire population dependent on the SUS. “We have been working on a more comprehensive vision of telehealth, because telemedicine is often seen as a medical consultation, and the concept of telehealth has been used in the ministry since 2007, in the first government of President Lula (PT).”

While telemedicine refers to clinical patient care, telehealth can be defined as a more comprehensive set of actions, involving educational, administrative and other non-clinical health activities, explains the minister.

In the notice released at the beginning of the month, 99.9% of Brazilian municipalities (5,566 of 5,570) joined the program. Now, it is necessary to diagnose the care networks, where the service bottlenecks are and which of these bottlenecks should be brought digital, says Haddad.

“The first barrier, without a doubt, is infrastructure, but there is another point which is the education of patients, health professionals, managers, to be prepared to use technology”, he states.

One of the strategies to expand access to telehealth was the implementation of programs in partnership with private hospitals, which help to train professionals remotely and work in the so-called teleinterconsultation, assesses the secretary. “This helps bring more resolvability to the interface between primary care, family health strategy and specialized care. Telehealth can support both expert opinion and help organize the queue.”

While the private sector’s role in digital health grows, the ministry seeks to expand service in remote areas through government development and innovation programs, such as Proadi-SUS (Support Program for Institutional Development of the Unified Health System), initiative that involves the development of actions to improve the SUS by private hospitals, which are exempt from taxes in return.

Two initiatives have emerged in recent years: TeleAMEs, a partnership between Hospital Israelita Albert Einstein and the ministry, and TeleNordeste, which involves five hospitals (BP – Beneficência Portuguesa de São Paulo, Oswaldo Cruz, HCor, Moinhos de Vento and Sírio-Libanês) .

TeleAmes has been operating since 2020 in the North region and, in 2023, expanded its service locations to the Central-West region as well. By the end of last year, it had 12 medical specialties and more than 200,000 consultations provided (average of 2,000 per week). “Today, the objective is to prevent the patient, when they need to move from one municipality to another, in order to receive specialized care, from being abandoned on the way. You have a gain in efficiency in the system”, explains Pedrotti, from Einstein.

TeleNordeste is responsible for bringing specialized assistance to the Northeast region, as the name suggests, and has provided more than 50 thousand services since 2022, the year of its creation. It currently has 20 medical specialties.

There is also a stage that was implemented involving field visits with primary care professionals, says Dante Gambardella, executive manager of social programs at Benciência Portuguesa.

“We invite all professionals to understand what this is, what telehealth is, and begin a training process with the teams that helps, among other things, to stratify risk, forward consultations, follow-up, all of this also bringing the population as subject of the process”, he says.

Teleinterconsultations, as consultations involving specialist doctors from private networks with generalists at the other end, in this case within UBSs (Basic Health Units), are called, have already increased service in areas such as cardiology and ophthalmology, reducing the queue for exams , explains Haddad. “We are performing an average of 6,000 teleelectrocardiograms [exame cardiológico] per day, which also helps with medical diagnosis.”

“We had a very pent-up demand, especially from chronically ill patients during the pandemic, which is rebounding now, so there is also pressure from municipalities to provide this service”, says Gambardella.

The next stages of the SUS Digital program, according to Trindade, involve advancing the connectivity of UBSs (around 70% are already connected) and actions in conjunction with municipalities.

While at the national level the project must still advance to define the strategies of each entity —federal, state, municipal—, the two programs run by Einstein and BP are already reaping the rewards, including indirect results, such as an increase in the prescription of medications that previously did not exist. in the region with specialized consultations and individualized care.

“There is an abysmal difference in medical demographics in Brazil, with around 2.7 doctors per thousand inhabitants in São Paulo and the same rate equivalent to 0.1 in Roraima. So, telemedicine is a way of offering dignity, articulating the health network, diagnose in a timely manner and treat”, adds Gambardella.

_{This project was funded by the ICFJ (International Center for Journalists) through the Innovation in Health notice}