Opinion – Public Health: Digital health experiences and the UK-Brazil cooperation

The city of Altamira, in Pará, is immense. In it there are towns and villages that are more than a thousand kilometers from the headquarters, a distance greater than the straight line between São Paulo (SP) and Porto Alegre (RS). Within this scenario, ensuring that the local population has permanent access to medical care seems an impossible challenge: in fact, many hard-to-reach territories are unable to attract and retain doctors for a long time. The bill is for the population, whose rights and health are compromised. Telemedicine can help us turn this game around. In Brazil, some promising pilots are underway in the use of this technology, in regions where doctors often do not arrive.

Primary Care is the backbone of our health system. This level of care is oriented to the promotion, protection and maintenance of health, which presupposes comprehensive care and which, at the same time, considers the autonomy of individuals in their own care, the social dynamics existing in the territories and the impact of social determinants on health outcomes. According to the World Health Organization (WHO), Primary Care, whose Basic Health Units (UBS) are the main physical structure for the provision of services, is capable of solving between 80 and 90% of health problems without the need for the patient to seek an emergency room or emergency room.

From the point of view of guaranteeing access, one of the main challenges is the difficulty of allocating and maintaining family doctors and complete family health teams, which involves the geographical layout of the units, availability of adequate infrastructure for work and the offer of competitive salaries. These problems, to some extent, can be solved with the support of technologies already available on the market. Taking into account the high demand for healthcare professionals throughout the Covid-19 pandemic, since November 2021, Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP) together with the UK government, is testing a new model of Digital Primary Care.

Using video call technology, a family doctor in São Paulo was connected to a UBS in Paissandu. The city, which is also located in Pará – one of the ten Brazilian states with the lowest population density (6.07 according to the last IBGE Census) -, despite having approximately 30 thousand residents, has 10 UBS and only two doctors allocated in person to serve the entire region. In the pilot project, the patient goes to the UBS and is received by the nursing team that performs the pre-appointment procedures and determines the type of care to be performed. Thus, the family doctor remotely performs the consultation by video with the support of the nursing team that accompanies the user throughout the consultation. At the end, the patient receives the recommended treatment from the nursing team and/or guidance on other care and referrals. In two months of testing, 30% of the local population was assisted via teleconsultation. And, of all the consultations carried out, 94% of the complaints were resolved right there in the health unit.

The British experience, which has been adapted to the Brazilian reality through cooperation between HCFMUSP and the UK government, took into account what worked best for each population served, always placing the user and the satisfactory outcome of their case as a priority. In numbers, the National Health Service since the beginning of the pandemic has carried out 60% of consultations by video or other digital forms and the expectation is that the service through these channels will remain at 50% even with the reopening of the centers. of health.

In Brazil, HCFMUSP created the Patient Experience Group, the first in a public hospital, which has patients from different institutes, with different health situations, from different regions of São Paulo, men and women. Monthly, the group, led by a clinical and administrative team from the hospital, meets to test new ideas with patients and receive feedback on digital health initiatives being implemented.

Also in the scope of cooperation between HCFMUSP and the UK government, looking at the use of telemedicine in other levels of health care, the expansion and sustainability of the TeleUTI initiative, currently present in 27 states, is being carried out. The initiative seeks to reduce maternal, fetal and neonatal mortality through teleconsultations between HCFMUSP ICU teams and connected ICUs. Through distance training of teams and discussions of individual cases between teams with HCFMUSP, it was possible to reduce maternal mortality by 20% in hospitals participating in the program; on average, ICU stay was reduced by 30%.

The results of the project as a whole point to encouraging paths for the adoption of teleconsultations in Brazil as a concrete possibility of expanding access to health. An important step to be taken concerns the regulation of the practice on a permanent basis beyond emergency use during the Covid-19 pandemic. Associated with this are the need for training professionals and standardization of protocols for the adoption of new technologies, considering technical and bioethical aspects, as well as the availability of adequate infrastructure for the execution of services. Finally, the advancement of digital health initiatives also opens doors for the deepening of the discussion on improving the quality of care in a humanized way, with the user experience as a preponderant factor.