Enhancing Primary Healthcare Access in Brazil: The UBS+DIGITAL Telehealth Initiative (Preprint)
Authors: Lamas Celina de Almeida , Santana Alves Patrícia Gabriela , Nader de Araújo Luciano , de Souza Paes Ana Beatriz , Cielo Ana Claudia , Maciel de Almeida Lopes Luciana , Longo Araújo de Melo André , Yokoyama Thais , Pagani Savastano Clarice , Gobi Scudeller Paula , Carvalho Carlos ,   Digital Primary Health Unit HCFMUSP Study Group
Published: November 2024

BACKGROUND

Brazil faces significant inequities in healthcare access, particularly in remote communities. The Brazilian Unified Health System grapples with challenges in delivering adequate healthcare to its vast population. To address these issues, the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), a leading institution in Latin America, established the Digital Health Program. This initiative aims to enhance healthcare coverage and reduce disparities through technological innovation. In collaboration with the United Kingdom Government’s Better Health Program, HCFMUSP developed a Digital Primary Care proof of concept in Santarem, Pará, Brazil. This initiative successfully conducted over 220 teleconsultations with higher patient satisfaction. Building on this success, the UBS+DIGITAL project was created, in partnership with the Agência Brasileira de Apoio à Gestão do Sistema Único de Saúde, to expand and test the model of telehealth services in different scenarios in primary healthcare across Brazil.

OBJECTIVE

Describe the results of the UBS+DIGITAL project, a telehealth initiative focused on training healthcare professionals, teleconsultation, and KPIs monitoring, on primary healthcare units (PHU) in Brazil.

METHODS

The study comprehended fifteen Brazilian PHUs by a multi-centric prospective design. Brazilian regulations for service improvement studies do not require ethics approval. Data were collected through anonymous surveys of patients and physicians, recorded in the RedCap® database. PHUs were selected based on criteria such as the absence of an on-site physician and existing technological infrastructure. Synchronous and asynchronous training was provided, focusing on digital health and teleconsultation skills. In loco training included workshops and community events to share experiences and foster local engagement. A community of practice facilitated ongoing knowledge exchange. Teleconsultations followed the Person-Centered Clinical Method and Calgary-Cambridge methodology. KPIs were monitored by a dashboard to guide continuous improvement. The transition of operations was managed based on physician availability and project duration. Microcosting analysis assessed the project’s economic impact using Brazilian guidelines, with statistical analysis performed using Jamovi® software.

RESULTS

From March to November 2023, the project conducted 6,312 teleconsultations. Training goals were met, with over 70% of targeted professionals trained. The Net Promoter Score (NPS) for teleconsultations was 97, indicating excellent service quality. Of the teleconsultations, 66% were pre-scheduled, and 34% were on-demand, depending on family health team organization. Teleconsultations resolved 85% of cases, with 15% requiring in-person referrals or emergency care. The average absenteeism rate was 15%, and consultation durations were between 15 to 20 minutes, suggesting potential adjustments in scheduling.

CONCLUSIONS

The results highlight the effectiveness of telehealth programs in primary care settings with limited medical professionals. The UBS+DIGITAL project demonstrated that telehealth can enhance healthcare access, presenting a pioneering model within the Brazilian Unified Health System for digital primary care.