Telemental health in Brazil: past, present and integration into primary care

Background Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research

eHealth Conversations : using information management, dialogue, and knowledge exchange to move toward universal

The publication of eHealth Conversations, developed with the support of the Spanish Agency for International Development Cooperation (AECID), represents a major step forward for the PAHO/WHO Strategy, since it explores ways of implementing regional mechanisms with free and equitable access to information and knowledge sharing. These initiatives aim to advance the goals of more informed, equitable, competitive, and democratic societies, where access to health information is considered a basic right. This publication is one of the instruments used by PAHO/WHO to develop the initiatives outlined in the Strategy, which coincides with the global eHealth strategy. One of the fundamental needs for the improvement of eHealth is the dissemination of information, and PAHO/WHO is assuming a leading role in this effort. The development of this new electronic publication is a key step in disseminating information that will be useful for decision makers on applying these technologies for the health of the Americas. This electronic book is one of the products of PAHO/WHO’s project: “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health.” Participants in these conversations included experts on electronic health and other specialties. Through virtual dialogues, the experts contributed with knowledge and reflections on the present and the future of eHealth in the Americas, analyzed the situation, and made recommendations for the implementation of electronic health initiatives. These recommendations are not only intended for PAHO/ WHO, but also for governments and the private sector. The aim of the project is to guarantee the convergence of local, national, and regional initiatives regarding the adoption and application of ICTs for public health, with special attention on critical issues in this field. It also intends to strengthen individual and collective capacities of health workers and institutions, connecting them in a network of on-line health networks, as well as to reinforce the PAHO/WHO eHealth program.Acknowledge the Spanish Agency for International Development Cooperation (AECID) for its financial support in preparing this publication and developing the project titled “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health;

Educação de pós-graduação em enfermagem à distância: avaliação sob a perspectiva dos discentes

Objective: To evaluate the distance learning Graduate Nursing Management Program according to the students' perspective.Methods: This exploratory-descriptive study with a quantitative approach involved 484 students who had completed the nursing program. for the assessment we used an instrument divided into the following categories: access location, hours dedicated to the program, professors, mentors, students' expectations and general assessment. Association among numerical variables was done using a Pearson's chi-square test, and measurement reliability was assessed with the Cronbach's alpha coefficient.Results: Main results showed that students felt welcomed by mentors and professors and that two courses helped improve professional performance and development of competencies related to management.Conclusion: Courses were evaluated positively and were perceived as a useful tool for training of nurses aim to support transformation of management scenario of Brazilian nursing.Conselho Reg Enfermagem São Paulo, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Enfermagem, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Enfermagem, São Paulo, SP, BrazilWeb of Scienc

Impacto da teleconsulta farmacêutica no controle glicêmico de pessoas com diabetes mellitus tipo 2 em uma farmácia pública no Brasil: Protocolo de ensaio clínico randomizado (TelePharmaceutical Care Diabetes Trial) – TPCDT

Telepharmacy is a fundamental tool to ensure glycemic control in patients who don’t access health services. The objective of this protocol is to report the procedures of a randomized clinical trial that will evaluate the impact and economic evaluation of a pharmaceutical teleconsultation service for patients using dapagliflozin, recently incorporated by the Brazilian public health system for the treatment of type 2 diabetes (T2D). Patients aged 65 years or older, with T2D, and who withdraw dapagliflozin in a public pharmacy located in southern Brazil will be recruited. They will be electronically randomized with allocation for intervention or control group. The intervention will be conducted out through three teleconsultations, one per month, with a pharmacist. The main outcomes will be glycemic control (hemoglobin A1c) and treatment adherence. Secondary outcomes will include lipid profile, blood pressure, and body mass index, number of hospital admissions, number of emergency room visits, number of medical consultations performed, number of problems related to pharmacotherapy identified and resolved, cost related to service and quality of life. The economic evaluation will be carried out using time-driven activity-based costing. Through this research, we will be able to identify whether pharmaceutical teleconsultation services can complement face-to-face consultations to improve health outcomes in T2D patients on dapagliflozin. The study was registered in Clinical Trials (NCT05380596).La telefarmacia es una herramienta fundamental para asegurar el control glucémico en pacientes que no acceden a los servicios de salud. El objetivo de este protocolo es relatar los procedimientos de un ensayo clínico aleatorizado que evaluará el impacto y la evaluación económica de un servicio de teleconsulta farmacéutica para pacientes que utilizan dapagliflozina, recientemente incorporado por el sistema de salud pública brasileño para el tratamiento de la diabetes tipo 2 (DM2). ). Se reclutarán pacientes de 65 años o más, con DM2 y que retiren dapagliflozina en una farmacia pública ubicada en el sur de Brasil. Serán aleatorizados electrónicamente con asignación al grupo de intervención o de control. La intervención se realizará a través de tres teleconsultas, una por mes, con un farmacéutico. Los principales resultados serán el control glucémico (hemoglobina A1c) y la adherencia al tratamiento. Los resultados secundarios incluirán el perfil de lípidos, la presión arterial y el índice de masa corporal, la cantidad de ingresos hospitalarios, la cantidad de visitas a la sala de emergencias, la cantidad de consultas médicas realizadas, la cantidad de problemas relacionados con la farmacoterapia identificados y resueltos, el costo relacionado con el servicio y la calidad de vida. . La evaluación económica se realizará mediante costeo por actividades en función del tiempo. A través de esta investigación, podremos identificar si los servicios de teleconsulta farmacéutica pueden complementar las consultas presenciales para mejorar los resultados de salud en pacientes con DM2 que usan dapagliflozina. El estudio fue registrado en Ensayos Clínicos (NCT05380596).A telefarmácia é uma ferramenta fundamental para garantir o controle glicêmico em pacientes que não acessam os serviços de saúde. O objetivo deste protocolo é relatar os procedimentos de um ensaio clínico randomizado que avaliará o impacto e a avaliação econômica de um serviço de teleconsulta farmacêutica para pacientes em uso de dapagliflozina, recentemente incorporado pelo sistema público de saúde brasileiro para o tratamento do diabetes tipo 2 (DM2). Serão recrutados pacientes com idade igual ou superior a 65 anos, portadores de DM2 e que retirem dapagliflozina em uma farmácia pública localizada no sul do Brasil. Eles serão randomizados eletronicamente com alocação para grupo intervenção ou controle. A intervenção será realizada através de três teleconsultas, uma por mês, com um farmacêutico. Os principais desfechos serão o controle glicêmico (hemoglobina A1c) e a adesão ao tratamento. Os desfechos secundários incluirão perfil lipídico, pressão arterial e índice de massa corporal, número de internações hospitalares, número de atendimentos de emergência, número de consultas médicas realizadas, número de problemas relacionados à farmacoterapia identificados e resolvidos, custo relacionado ao serviço e qualidade de vida. A avaliação econômica será realizada usando o custeio baseado em atividades baseado no tempo. Por meio desta pesquisa, poderemos identificar se os serviços de teleconsulta farmacêutica podem complementar as consultas presenciais para melhorar os resultados de saúde em pacientes com DM2 em uso de dapagliflozina. O estudo foi registrado em Clinical Trials (NCT05380596)

The Future of Healthcare Delivery: IPE/IPP Audiology and Nursing Student/Faculty Collaboration to Deliver Hearing Aids to Vulnerable Adults via Telehealth

A multi-departmental, two-city initiative to provide hearing aid service via a telepractice approach was developed whereby nursing and auditory students with supervisory faculty used AV conferencing for training and interaction with referred patients. Located in two cities, 21 nursing and 15 doctoral level audiology students met virtually, and students received teleaudiology education and practicum with interprofessional education and practice components. Nursing students in one city and a supervising faculty in another city could interact with providers and patients in both cities to provide hearing care. The teleaudiology project delivered hearing health care services, including fitting of digital mini hearing aids, to 181 patients over 29 months of the project. During that time period, 205 total patients were referred to the teleaudiology clinic. Over 90% of these patients, as assessed by either patient teleaudiology clinic visits or telephone follow-up, successfully wore their hearing aids. Students administered selected published surveys related to patient outcomes both pre and post fitting. Patients reported significant hearing handicap reduction and were very satisfied with the teleaudiology mode of digital hearing aid and hearing health care service delivery. The experience provided interprofessional pre-service exposure to cutting edge technology and an innovative delivery system for future members of the healthcare workforce