The Integration of Telehealth in Regulation Centrals: the Teleconsulting as a Mediator between Primary Care and Specialized Care

ABSTRACT

In 2007, with the aim of developing actions to support primary health care teams through the use of permanent education and virtual technologies, the Health Ministry established the Telehealth Program Brazil, later named the Brazil Telehealth Networks. The pilot project initially involved the establishment of nine Telehealth Centers in Brazil, one of which is in Santa Catarina, and linked to the Federal University of Santa Catarina, and later formed a partnership with the State Health Department (SES). One of the services offered by the Santa Catarina Telehealth Center is teleconsulting, which involves registering and requesting consultation by health professionals in order to clarify questions about clinical procedures, work process and management, by means of two-way remote telecommunication. Despite the service being made available from its implantation, it has always been relatively underused, whereas there is a disproportionally high amount of unnecessary referrals to specialized care that could be managed within Primary Care. This paper reports on the experience of implementing a forced flow through teleconsulting prior to referral to specialists, at the Telehealth Center of Santa Catarina. The established forced flow demonstrated that for most the cases there were possible solutions within Primary Care, resulting in a considerable reduction in the number of referrals to the specialties involved, and a consequently reduced waiting time for consultations with specialists. Furthermore, in these cases where referral was suggested, the teleconsulting allowed for risk assessment, prior request for tests or scans and shared management, thus qualifying the access to the specialist and the actual care of the the patient. Teleconsulting also enhances the quality of communication between the points of care, as it takes on a strategic role in defining the user flow, both for referrals and counter-referrals, with mutual learning and functioning which effectively characterizes a care network. As regards to the compulsory imposition of teleconsulting, although causing some initial discomfort, incipient use of the service implemented spontaneously, coupled with the number of unnecessary referrals to specialties and the quantity of remote consultations that can be handled within primary care justify the decision as a management objective. This combination of factors has a positive impact on the care for whose needs are met and followed up, whether in Primary Care or Specialized Care, in a timely manner and suitable location.

KEYWORDS
Remote Consultation; Telemedicine; Education; Medical; Primary Health Care; Unified Health System