Abstract

This study aimed to analyze the perception of the use of teleconsultation by physicians of the Unified Health System in Campo Grande-MS, as an auxiliary tool for the care of SUS patients, addressing effectiveness, satisfaction and access to results, directed to physicians of different specialties. Of a total population of 127 professionals, 100 voluntarily participated in the survey. The results demonstrated that teleconsultation was perceived as advantageous, highlighting the exchange of knowledge (44.1%) and the reduction of waiting time (42.5%). Disadvantages included low investment in the operational structure (25.2%) and technical difficulties of communication (23.6%). Teleconsultation proved to be innovative, providing intense exchange of knowledge and reducing waiting time. Although it presents technical challenges, most physicians perceived it as effective and safe.

Key words:
Telemedicine; Remote Consulting; Information Technology; Health Services

Introduction

One of the primary objectives and challenges of Health Care Networks (RAS) is to provide adequate and timely care, expanding and democratizing access to health services¹1 Brasil. Ministério da Saúde (MS). Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União; 2017.^,22 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Implantação das Redes de Atenção à Saúde e outras estratégias da SAS. Brasília: MS; 2014.. To implement a health care model focused on preserving life, it is crucial to expand the scope of Telehealth in order to support the health professionals involved³3 Brasil. Ministério da Saúde (MS). Diretrizes para Organização das Redes de Atenção à Saúde do SUS [Internet]. 2010 [acessado 2023 dez 12]. Disponível em: https://www.gov.br/saude/pt-br/acesso-a-informacao/gestao-do-sus/articulacao-interfederativa/cit/pautas-de-reunioes-e-resumos/2010/dezembro/2-b-documento-de-diretrizes-para-organiza-o-das-redes-de-aten-o-sa-de-do-sus.pdf.
https://www.gov.br/saude/pt-br/acesso-a-... .

The COVID-19 pandemic represented a global challenge, especially for Education and Health. The growth of initiatives and implementation of actions related to the use of information and communication technologies (ICTs) through Telehealth as a way of offering guidance and care was an essential and strategic step for prevention, surveillance, and monitoring in public health, improving user access to consultations and services, reducing waiting times and qualifying referrals for specialized procedures⁴4 Schmitz CAA. Telessaúde como suporte assistencial para a Atenção Primária à Saúde no Brasil [tese]. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul; 2015..

Incorporating Telehealth and the need for the public health system to increase its resolution through PHC favors the knowledge and application of the different modalities of its tools, their applications, and implications, especially when considering the regional disparities in the distribution of health professionals and access to technologies⁵5 Caetano R, Silva AB, Guedes ACCM, Paiva CCN, Ribeiro GR, Santos DL, Silva RMD. Challenges and opportunities for telehealth during the covid-19 pandemic: ideas on spaces and initiatives in the Brazilian context. Cad Saude Publica 2020; 36(5):e00088920.^,66 Paloski GR, Barlem JGT, Brum NA, Barlem ELD, Rocha LP, Castanheira JS. Contribuição da telessaúde para o enfrentamento da covid-19. Esc Anna Nery 2020; 24(n. esp.):e20200287..

In the context of RAS, Teleinterconsulting can be highlighted among Telehealth possibilities, a modality that allows dialogue between general practitioners and specialists about the same patient case⁷7 Lisboa KO, Hajjar AC, Sarmento IP, Sarmento RP, Gonçalves SHR. A história da telemedicina no Brasil: desafios e vantagens. Saude Soc 2023; 32(1):e210170pt..

By allowing the specialist doctor access to the patient’s images and information history, analyses are performed, and opinions are issued in real time or asynchronously, using store-and-forward technology⁸8 Chaet D, Clearfield R, Sabin JE, Skimming K; Council on Ethical and Judicial Affairs American Medical Association. Ethical practice in Telehealth and Telemedicine. J Gen Intern Med 2017; 32(10):1136-1140.. The underlying expectation is that the service will be more effective and quicker, reducing unnecessary referrals to specialists⁹9 Lopes MACQ, Oliveira GMM, Maia LM. Digital Health, Universal Right, Duty of the State? Arq Bras Cardiol 2019; 113(3):429-434..

In practice, positive Teleinterconsulting experience reports conclude that the Teleinterconsulting model is effective when adopted by professionals working in Emergency Care in the care of severe patients in pandemic situations¹⁰10 Accorsi TAD, Brigido ARD, Amicis K, Belfort DSP, Habrum FC, Scarpanti FG, Magalhães IR, Silva Filho JRO, Sampaio LPC, Lira MTSS, Morbeck RA, Pedrotti CHS, Racy FCJ, Cordioli E. Clinical features of a series of patients in life-threatening situations at a COVID-19 pandemic field hospital, evaluated by teleconsultation: evidence for Telemedicine expansion. Einstein 2021; 19:eCE6370.. Another report from the Santa Catarina Telehealth Center showed that most cases could be managed in primary care, which resulted in a significant reduction in the number of referrals to specialists and decreased waiting time for appointments with them¹¹11 Maeyama MA, Calvo MCM. A Integração do Telessaúde nas Centrais de Regulação: a Teleconsultoria como Mediadora entre a Atenção Básica e a Atenção Especializada. Rev Bras Educ Med 2018; 42(2):63-72..

In this context, in 2021, Campo Grande-MS implemented a Teleinterconsulting system in the Unified Health System through the TEIAS (Integrated Health Care Territories) program, using digital communication technologies in which family and community doctors can connect with specialist doctors, seeking a second opinion to assist in the diagnosis or treatment of a patient, in order to promote greater user care resolution. Therefore, the present study aimed to analyze the perception of the teleinterconsulting system used by doctors of the Unified Health System of Campo Grande-MS as an auxiliary tool to improve the care of the Mato Grosso do Sul population.

Materials and methods

This study used two methodologies to analyze health professionals’ perceptions of using technologies as a tool to support user care in the public network: a survey of evidence-based literature and exploratory qualitative research.

The evidence-based practice steps were followed for the research framework: problem identification, formulation of the guiding question, search for scientific evidence, evaluation of the evidence and its applicability, implementation of the evidence, and evaluation of the results of change. The construction of the guiding question followed the PICO strategy: P = health professionals, I = teleinterconsulting, C = COVID-19 pandemic, and O = impact and perception of professionals¹²12 Santos CMC, Pimenta CAM, Nobre MRC.A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latinoam Enferm 2007; 15(3):508-511..

The literature selection process included original, open-access articles published between 2007 and 2024, available for reading in full in Portuguese and English, found in the following databases: LILACS via the Virtual Health Library (BVS), MEDLINE via PubMed and Scopus, using the combination of the descriptors DeCS and MeSH: (((Telemedicine) AND (Health Services)) AND (Information Technology)) AND (Remote Consultation).

The medical professional’s perception tool

The application of an electronic questionnaire focused on the target audience of 127 health professionals (doctors) distributed across the 12 health units in Campo Grande (Mato Grosso do Sul) part of the TEIAS program and the Outpatient Regulation Management, registered in the National Registry of Health Establishments (CNES), in a search made on the website https://cnes.datasus.gov.br/ on 19.01.2024¹³13 Cadastro Nacional de Estabelecimentos de Saúde (CNES) [Internet]. [acessado 2024 jan 19]. Disponível em: https://cnes.datasus.gov.br/.
https://cnes.datasus.gov.br... . All participants signed the Informed Consent Form.

The information collected was directed to a database, where it was analyzed using the R Statistical Software, with descriptive analyses of the data, including absolute and relative frequencies, means, standard deviations, medians, and minimum and maximum values. The variables were described based on the professional’s specialty and the census survey as a whole.

The Research Ethics Committee approved the study under CAAE: 70461323.2.0000.5282.

The difficulty in finding a single questionnaire in the literature applied in the public health service, validated and with the characteristics of this study (teleinterconsulting use) led to the adaptation of two instruments developed and applied to health professionals regarding their perceptions in using technology for patient care and interface with other professionals¹⁴14 Marcolino MS, Alkmim MB, Assis TGP, Sousa LAP, Ribeiro ALP. Teleconsultorias no apoio à atenção primária à saúde em municípios remotos no estado de Minas Gerais, Brasil. Rev Panam Salud Publica 2014; 35:345-352.^,1515 Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(18):11532.. One of the questionnaires aimed to analyze the use, effectiveness, and resolution of teleconsulting sessions conducted by the Minas Gerais telecare network in primary health care. This instrument consists of three questions: (1) “Did the teleconsulting avoid the patient being referred?” - the question concerns the patient’s referral to other cities and explores the activity’s efficiency; (2) “Did the teleconsulting you just completed answer your question?” - the question assesses the quality and resolution of the professional’s response; (3) “How satisfied are you with the teleconsulting system?” - the question is linked to the general level of satisfaction of the professional using the system¹⁴14 Marcolino MS, Alkmim MB, Assis TGP, Sousa LAP, Ribeiro ALP. Teleconsultorias no apoio à atenção primária à saúde em municípios remotos no estado de Minas Gerais, Brasil. Rev Panam Salud Publica 2014; 35:345-352..

The other questionnaire was developed to analyze the level of perception and attitudes of health professionals who used the teleconsulting system and whether this system affected the quality of the therapeutic process. Its questions/statements are linked to the following criteria: work method preference, working conditions, advantages and disadvantages of the system, and evaluation of the effectiveness and resolvability of the teleconsulting system¹⁵15 Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(18):11532..

The final questionnaire was prepared using Research Electronic Data Capture (REDCap, http://redcap.uerj.br/), a secure web platform for building and managing online databases and surveys, and made available electronically through a link sent by the health manager of the Municipality of Campo Grande-MS, open to receive responses for 30 calendar days. The municipal management sent invitations to participate through email addresses and cell phone numbers available in the database, and the research team did not have direct access to this information.

A message was sent, linked to the questionnaire link, inviting eligible participants. When clicking on the survey link, participants were directed to the questionnaire, and the first page contained the electronic informed consent form, in which consent should be given by selecting “I agree to participate”. Upon agreeing, the participant started completing the questionnaire with demographic data and then specific questions about their perception of using the teleinterconsulting system.

The part of the questionnaire on the professionals’ perception included opinions on the advantages and disadvantages of using teleinterconsulting, access to laboratory results or images during the use of teleinterconsulting, comparison of the duration between in-person consultation and teleinterconsulting, the effectiveness of consultations through teleinterconsulting, and reliability of the system regarding data security and connectivity.

The instrument was applied only to the group of medical professionals, and any responses identified as not belonging to the target population, such as responses given by nurses and psychologists, were excluded from the database for the analysis of results.

Teleinterconsulting flow in Campo Grande-MS

All information in the questions was adapted to the term teleinterconsulting, given that it uses Information and Communication Technologies (ICTs) to allow for the exchange of information and opinions between doctors remotely, with or without the physical presence of the patient, to assist in diagnosis, treatment, monitoring, or prevention of diseases. It is presented as another option for health care to promote it and provide better care to the population, as shown in Figure 1.

Results

The survey was sent to the 12 primary health units in Campo Grande-MS, belonging to the TEIAS program (Integrated Health Care Territories), representing a total of 123 family and community doctors and four specialist doctors assigned to the Outpatient Regulation Management, making up a sample of 127 participants.

Some professionals, such as the cardiologist (1), gastroenterologist (3), pulmonologist (1), and orthopedist (1), are registered with the CNES as Family and Community Doctors despite having indicated the specialties above in the questionnaire responses.

Women represented 60.6% of respondents, and the predominant age group was people up to 40 years old (81.8%). Almost all doctors (93.9%) worked in the specialty of “family and community medicine” (data not tabulated).

Table 1 presents the responses regarding the professionals’ perception and the advantages of using the teleinterconsulting system, in which most of the group of family doctors indicated the item “exchange of knowledge” (42.3%) as the main advantage, followed by the items “reduced waiting times in specialized service queues” (41.5%) and “reduced number of referrals for in-person consultations” (36.6%). In the group of other specialist doctors, two items were classified as most advantageous: “reduced number of referrals for in-person consultations” (100%) and “exchange of knowledge between professionals” (100%), followed by the items “better resolution for diagnosis” (75%), “reduced number of referrals for in-person consultations” (75%), “reduced waiting times in specialized service queues” (75%), and “greater efficiency in the regulation and hierarchization of elective cases” (75%). The general classification shows as the most significant advantages pointed out by professionals (both groups) the “exchange of knowledge between professionals” (44.1%) followed by the items “reduced waiting times in specialized service queues” (42.5%) and “reduced number of referrals for face-to-face consultations” (37.8%).

Analyzing responses regarding the disadvantages of the teleinterconsulting system revealed differences in perception when comparing the two groups of professionals in the sample. Family and community doctors perceive that the most significant disadvantage is “Technical communication difficulties” (42.4%), while other specialist doctors believe it is “Low investment in operational structure” (66.7%). The second most significant disadvantage, which was pointed out by both groups of professionals (family doctors and other specialist doctors), concerns the item “Inability to meet in person to assess the patient” (36.4% and 44.4%, respectively). The general analysis reveals that the most significant disadvantage pointed out was “Technical communication difficulties” (42.9%) (Table 2).

Another aspect analyzed was the perception regarding the duration of teleinterconsulting. Although, in this case, the number of respondents was lower, the results suggest that this duration is longer than an in-person appointment for both groups compared to family and community doctors and doctors from other specialties (data not tabulated).

Finally, the questions about the teleinterconsulting system analysis regarding its effectiveness, reliability concerning security and data sharing, and reliability concerning stability and connectivity are shown in Table 3. The three questions were presented to the participants and associated with a scale from 0 (zero) to 10 (ten), where zero is the lowest evaluation and 10 is the highest evaluation. We can observe in the results that the two groups of doctors have a similar perception of the effectiveness, safety, and connectivity of the teleinterconsulting system used by the Municipality of Campo Grande-MS, family and community doctors (average=7.9) and other specialist doctors (average=7.4).

Discussion

Government public policies have highlighted the importance of using technologies to improve care, access, and relationships between professionals in the Unified Health System. This fact can be shown through the Ministry of Health’s ordinance (Ordinance GM/MS No. 3,232/2024) on the SUS Digital Program, which aims to promote digital transformation within the SUS to expand the population’s access to its actions and services in order to achieve comprehensive and resolvable healthcare, including the training and continuing education of health workers and professionals¹⁶16 Brasil. Ministério da Saúde (MS). Portaria GM/MS nº 3.232, de 1º de março de 2024. Altera a Portaria de Consolidação GM/MS nº 5, de 28 de setembro de 2017, para instituir o Programa SUS Digital. Diário Oficial da União; 2024..

The rapid advancement of ICTs has opened up a range of possibilities in health for professionals and patients in the exchange of real time (or not)¹⁷17 Azevedo Junior R. Teleatendimento, revolução com ética e segurança. Rev Soc Cardiol 2019; 29(4):362-364. information and dialogues in the form of text, voice, and image transmission. In this sense, it gained relevant prominence and urgency during the COVID-19 pandemic, giving Telehealth the status of authorization for use nationwide¹⁸18 Brasil. Presidência da República. Lei nº 14.510, de 27 de dezembro de 2022. Altera a lei nº 8.080, de 19 de setembro de 1990, para autorizar e disciplinar a prática da telessaúde em todo o território nacional, e a lei nº 13.146, de 6 de julho de 2015; e revoga a lei nº 13.989, de 15 de abril de 2020. Diário Oficial da União; 2022..

Confinement and the characteristics of the COVID-19 pandemic have increased the substantial use of technologies such as telephone, videoconferencing, applications, and virtual reality for telemonitoring, teleconsulting, and virtual visits¹⁹19 Mehraeen E, SeyedAlinaghi S, Heydari M, Karimi A, Mahdavi A, Mashoufi M, Sarmad A, Mirghaderi P, Shamsabadi A, Qaderi K, Mirzapour P, Fakhfouri A, Cheshmekabodi HA, Azad K, Bagheri Zargande S, Oliaei S, Yousefi Konjdar P, Vahedi F, Noori T. Telemedicine technologies and applications in the era of COVID-19 pandemic: A systematic review. Health Informatics J 2023; 29(2):14604582231167431..

Therefore, health managers at all levels started seeking solutions and implementing systems that could assist the population care process in Campo Grande-MS. Records in the literature show more significant use of Telehealth in the South and Southeast regions, indicating the need for positive induction by local, state, and national governments in other regions to qualify services and empower health teams and professionals²⁰20 Sarti TD, Almeida APSC. Incorporação de telessaúde na atenção primária à saúde no Brasil e fatores associados. Cad Saude Publica 2022; 38(4):PT25222..

Implementing the teleinterconsulting system has stood out as an innovative approach in the health field, as it enables the exchange of information between health professionals, both for diagnostic assistance and therapeutic definition, receiving wide acceptance by medical professionals.

We can observe that such a tool generates a collaborative learning network²¹21 Vituri PP, Vituri LP, Smarczewski JVP, Uscocovich LB. A teleinterconsulta em tempos de pandemia: a tecnologia em favor da saúde pública. In: Klauss J, organizadora. Os profissionais de saúde durante a pandemia de COVID-19: atitudes e barreiras. São Paulo: Editora Científica Digital; 2022. p. 12-24. through this exchange of information, which is a practice recommended by the SUS when we work on the permanent and continuing education of health professionals²²22 Silveira ER. Práticas que integram a saúde mental à saúde pública: apoio matricial e a interconsulta. Cien Saude Colet 2012; 17(9):2377-2386..

The intense exchange of knowledge provided by teleinterconsulting was one of the main advantages perceived by the doctors in this research, corroborating the findings in the literature: 44.1% of professionals stated that this modality enables the rapid and efficient exchange of knowledge between specialists, promoting a more collaborative and comprehensive approach in the treatment of complex clinical cases. An example of this can be seen in interpreting images or electrocardiograms via teleconference between general practitioners and specialists, successfully used in primary care¹⁷17 Azevedo Junior R. Teleatendimento, revolução com ética e segurança. Rev Soc Cardiol 2019; 29(4):362-364..

Another highlight was the overall perception of 42.5% of doctors about the significant reduction in waiting time in specialized care queues, and for 37.8%, the reduced number of referrals for in-person appointments as a significant advantage in teleinterconsulting. The findings in the literature corroborate this perception where the application of technologies contributes to greater PHC resolution, reduced number of referrals, and, consequently, fewer waiting queues²³23 Santos AF, Mata-Machado ATG, Melo MCB, Fonseca Sobrinho D, Araújo LL, Silva ÉA, Lima AMLD, Abreu DMX, Rocha HAD. Implementation of telehealth resources in primary care in Brazil and its association with quality of care. Telemed J E Health 2019; 25:996-1004..

Teleinterconsulting uses a working model similar to a support matrix, with the participation of different professionals, including patients when necessary, which produces resolute responses to health demands, benefiting the service management, the team, and the patient²⁴24 Ahmed A, Mutahar M, Daghrery AA, Albar NH, Alhadidi IQI, Asiri AM, Boreak N, Alshahrani AAS, Shariff M, Shubayr MA, Al Moaleem MM. A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic. Med Sci Monit 2024; 30:e943383., which can be evidenced by the items “Reduced number of referrals for in-person consultations”, mentioned by another 37.8% of professionals, and “Streamlining the diagnostic process”, mentioned by 32.3% of doctors. The exchange of information and joint analysis of clinical cases contribute to more precise and assertive diagnoses and more effective and personalized therapeutic plans, directly benefiting the quality of care provided to patients. It shows the possibility of this modality in resolving demands without the need for physical travel.

Immediate remote access to medical advice, treatment, and diagnosis, eliminating the need for individuals to travel long distances, and greater adherence to therapeutic plans have also been highlighted in the literature on the advantages of remote consulting systems in health²⁴24 Ahmed A, Mutahar M, Daghrery AA, Albar NH, Alhadidi IQI, Asiri AM, Boreak N, Alshahrani AAS, Shariff M, Shubayr MA, Al Moaleem MM. A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic. Med Sci Monit 2024; 30:e943383.

25 Gomez T, Anaya YB, Shih KJ, Tarn DM, A qualitative study of primary care physicians' experiences with telemedicine during COVID-19. J Am Board Fam Med 2021; 34(Supl.):S61-S70.

26 Jiménez-Rodríguez D, Santillán García A, Montoro Robles J. Increase in video consultations during the COVID-19 pandemic: Healthcare professionals' perceptions about their implementation and adequate management: Int J Environ Res Public Health 2020; 17(14):5112.^-2727 Srinivasan M, Asch S, Vilendrer S, Qualitative assessment of rapid system transformation to primary care video visits at an academic medical center. Ann Intern Med 2020; 173(7):527-535..

The teleinterconsulting system speeds up access to specialists, providing a faster response to patient’s needs and, consequently, improving the efficiency of the health system. However, some studies indicate that the willingness to use the system is directly related to the age of professionals - younger professionals are more willing to use technology, and there is no difference between genders¹⁵15 Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(18):11532..

Despite the positive analysis of health professionals regarding teleinterconsulting, some more significant disadvantages can be highlighted are the impossibility of examining the patient in person and collecting reliable information from the patient, technical difficulties, and the patient’s advanced age¹⁵15 Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(18):11532.^,2828 Mubaraki AA, Alrabie AD, Sibyani AK, Aljuaid RS, Bajaber AS, Mubaraki MA. Advantages and Disadvantages of Telemedicine during the COVID-19 Pandemic Era among Physicians in Taif, Saudi Arabia. Saudi Med J 2021; 42:110-115.. Our results revealed differences in this type of perception between the two groups but also indicated the following as the most damaging items (global sample): “Technical communication difficulties” (42.9%), “Low investment in operational structure” (40.5%) and “Inability to meet in person to assess the patient” (38.4%). However, regarding the face-to-face aspect, some studies indicate that videoconferencing can visually assess patients and provide visual clues to make comprehensive assessments and empower them to take control of their treatments²⁴24 Ahmed A, Mutahar M, Daghrery AA, Albar NH, Alhadidi IQI, Asiri AM, Boreak N, Alshahrani AAS, Shariff M, Shubayr MA, Al Moaleem MM. A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic. Med Sci Monit 2024; 30:e943383..

The availability and access to laboratory and imaging tests for patients during teleinterconsulting sessions by health professionals is something frequently realized. However, it depends on their role when we compare the professions¹⁵15 Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(18):11532.. Our study observed similar access between family doctors and other specialist doctors.

Regarding the duration of consultations, when comparing the in-person and virtual methods, studies indicate that primary care health professionals mention that they have longer virtual consultations than traditional methods²⁹29 Verhoeven V, Tsakitzidis G, Philips H, Van Royen P. Impact of the COVID-19 pandemic on the core functions of primary care: Will the cure be worse than the disease? A qualitative interview study in Flemish GPs. BMJ Open 2020; 10(6):e039674.. This perception is the same among the two groups of professionals in this study, in which 61.9% indicated the duration item “Longer than an in-person consultation”.

The analysis of the effectiveness of the teleinterconsulting system, reliability concerning security in data sharing and reliability concerning system stability and connectivity presupposes several conditions described in isolation and overlapping.

Final considerations

The exponential growth of internet access for the use of Digital Health needs to be linked to government incentives, with local and regional analyses according to their demands and implementation possibilities, as regional inequalities, the distribution of professionals, and government changes generate fragmentation, lower investments, or disrupted services offered persist in Brazil³⁰30 Comitê Gestor da Internet no Brasil. Núcleo de Informação e Coordenação do Ponto BR, editor. Pesquisa sobre o uso das tecnologias de informação e comunicação nos estabelecimentos de saúde brasileiros. TIC Saúde 2018 [Internet]. São Paulo: Cetic; 2019 [acessado 2020 abr 3]. Disponível em: https://www.cetic.br/publicacao/pesquisa-sobre-o-uso-das-tecnologias-de-informacao-e-comunicacao-nos-estabelecimentos-de-saude-brasileiros-tic-saude-2018.

31 Albuquerque MV, Viana ALA, Lima LD, Ferreira MP, Fusaro ER, Iozzi FL. Desigualdades regionais na saúde: mudanças observadas no Brasil de 2000 a 2016. Cien Saude Colet 2017; 22(4):1055-1064.^-3232 Uchimura LYT, Felisberto E, Fusaro ER, Ferreira MP, Viana ALA. Avaliação de desempenho das regiões de saúde no Brasil. Rev Bras Saude Mater Infant 2017; 17(1):S259-S270.. Furthermore, the needs for care and access to services are also influenced by social determinants and the need to consider the different settings of access to the Internet and technological equipment, among other aspects³³33 Catapan SC, Calvo MCM. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med 2020; 44(1):e002.^,3434 Taques TI, Pinto EB, Romanowski KL, Ditterich RG, Muller EV, Silva Junior MF. Expansão da telessaúde na Atenção Primária à Saúde e as desigualdades regionais no Brasil. Reciis 2023; 17(2):349-371..

However, some small and medium-sized municipalities in different regions of the South and Southeast have higher percentages of Telehealth use, indicating the possibility of implementing teleconsultations in locations with fewer specialist professionals, overcoming the barrier of the unequal geographic distribution of doctors in Brazil³⁴34 Taques TI, Pinto EB, Romanowski KL, Ditterich RG, Muller EV, Silva Junior MF. Expansão da telessaúde na Atenção Primária à Saúde e as desigualdades regionais no Brasil. Reciis 2023; 17(2):349-371.^,3535 Scheffer M. Demografia médica no Brasil 2018 [Internet]. São Paulo: FMUSP, CFM, Cremesp; 2018 [acessado 2020 jan 20]. Disponível em: http://www.flip3d.com.br/web/pub/cfm/index10/?numero=15&edicao=4278..

The analysis of teleconsultation effectiveness and reliability also depends on specialization - family medicine specialists classified its effectiveness as superior to other specialist doctors¹⁵15 Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(18):11532.. However, in our study, the results for both groups, family doctors (Average 7.9) and other specialist doctors (Average 7.4), had a similar perception of the effectiveness, safety, and connectivity of the teleinterconsulting system used by Campo Grande-MS.

With encouraging results, implementing teleinterconsulting emerges as a powerful tool, enriching medical practice, reducing access barriers and providing substantial benefits for health professionals and patients.

References

Publication Dates

History