Análise nacional das teleconsultorias assíncronas do Telessaúde

Abstract

The Telehealth Brazil Networks Program was implemented in Brazil by an initiative from Ministry of Health in 2006. Studies have shown that the Program improves the quality of care, however, a national evaluation of dental teleconsulting has not yet been carried out. This study nationally evaluated the asynchronous dental teleconsulting of the Telehealth Brazil Networks Program in the period of 2019 and 2020 and was approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais, CAAE 17400319.9.0000.5149. Secondary data were extracted from the Monitoring and Evaluation System of the Results of the Telehealth Program. The following variables were collected: macro-region and municipality of the requested teleconsulting; dentist’s sex and specialty; date/time of question and answer; time until teleconsulting answer; professional satisfaction and whether the teleconsulting avoided patient referral. The dental fields of the teleconsulting sessions were categorized as per International Code of Diseases and International Classification of Primary Care 2 informed at the system. The macro-regions and municipalities were socioeconomically characterized. In this document, three articles will be presented: Article 1 was a cross-sectional study that included all the individual variables of the study; on teleconsulting and macro-regions in the country in 2019. A total of 3,387 teleconsulting sessions were carried out, with the highest demand from Southeast macro-region (45.3%). Most dentists were female (60.3%) and from dental surgeons of the Family Health Strategy (57.4%). Most teleconsultings were requested during working hours (85.4%) and answered within 72 hours (63.9%). 70.8% of professional satisfaction and 70.2% of avoided referrals were observed between professionals who answered that question. The dental clinic was the dental field with the highest demand for teleconsulting (35.1%). Regions had different demands because of regional differences. Professionals have incorporated teleconsulting into their work routine and teleconsultings have been returned within the stipulated time. Feedback from professionals should be encouraged. Article 2 analyzed the associated factors with the professional satisfaction with teleconsulting sessions in 2020. The association between the dependent and independent variables was tested by binary logistic regression models. 26.7% of professional satisfaction was observed. There was an association between “avoided referral” (OR 1.55; 95%CI 1.17-2.04; p=0.002) and “stomatology area” (OR 0.61; 95%CI 0.43-0.87; p=0.006) with the professional satisfaction. Dentists showed low satisfaction with teleconsulting sessions. The professionals who reported that teleconsulting avoided patient referral were more likely to be satisfied with teleconsulting. Dentists who sent stomatology questions were significantly less satisfied with the teleconsulting. Article 3 analyzed the associated factors with the “avoided referral” of patients by teleconsulting through a multilevel analysis. Teleconsulting sessions avoided patient referral to other care levels in 65.1%. Female dentists (OR=1.74; CI=0.99-3.44; p=0.055) and municipalities with greater coverage of Oral Health Teams (OR=1.01; CI=1.00-1.02; p=0.02) were more likely to avoid referral. Contextual variables explained part of the variability in the prevalence of avoided referrals. It is necessary the encouragement by the government on the use and feedback of Telehealth tools for a better understanding of their impact as a support to Primary Health Care.