Desenvolvimento de consultas remotas no Hospital de Clínicas de Porto Alegre : descrição dos atendimentos, facilitadores para sua implantação e benefícios adicionais desta modalidade de atenção à saúde

Introdução: no final do ano de 2019 casos de uma pneumonia atípica causando grave adoecimento na cidade de Wuhan, na China, chamaram a atenção do mundo e as consequências catastróficas da Doença causada pelo Novo Coronavírus de 2019 (COVID-19) ainda estão em desenvolvimento no primeiro semestre de 2022. Com as restrições necessárias para conter o vírus, os serviços de saúde precisaram se reinventar para não deixar de atender seus pacientes ambulatoriais. Comparada ao resto do mundo, mas principalmente aos países de alto desenvolvimento humano, a legislação brasileira encontrava-se, no início da pandemia por COVID-19, vinte anos atrasada, não permitindo a realização de consultas médicas remotas. Entre os meses de março e abril de 2020, tanto uma portaria do Ministério da Saúde, quanto uma lei federal autorizaram a realização de atendimentos a distância enquanto durassem os efeitos desta pandemia. Várias características permitiram ao Hospital de Clínicas de Porto Alegre (HCPA) posicionar-se na vanguarda do oferecimento de consultas remotas durante a pandemia, tais como proximidade institucional com o Núcleo Técnico-Científico de Telessaúde do Rio Grande do Sul, da Universidade Federal do Rio Grande do Sul, presença de sistemas de prontuários e de gestão informatizados e em atualização constante há décadas e apoio institucional por parte da direção do Hospital. O impacto das consultas remotas tem sido avaliado em diversas dimensões e estudos tem demonstrado efeitos positivos na redução da emissão de gases de efeito estufa com intuito de melhorar a saúde planetária. Método: esta tese é composta por três estudos. Um estudo descritivo das características que permitiram ao HCPA a rápida implantação da nova modalidade de atendimento; um estudo transversal que apresenta a produção e as características das consultas remotas realizadas pelo HCPA ao longo do ano de 2020; e um estudo transversal que estimou a redução da pegada de carbono com a realização dessas consultas no primeiro ano da pandemia. Resultados: realizou-se entre 17 de março e 31 de dezembro de 2020 um total de 52.878 consultas remotas atendidas por 849 profissionais diferentes de variadas especialidades médicas, profissões da saúde e níveis de formação. A soma das distâncias deixadas de percorrer com a realização dessas consultas foi de 4.108.208 quilômetros que geraram a redução da emissão de 939,64 toneladas de gases de carbono na atmosfera. Conclusões: Os estudos dessa tese demonstram que é factível para um hospital público universitário como o HCPA implantar as consultas remotas em larga escala e em diversas especialidades médicas e profissões da saúde de forma ágil e abrangente, beneficiando pacientes com redução de deslocamentos e consequentemente a saúde planetária.Introduction: at the end of 2019, cases of an atypical pneumonia causing serious illness in the city of Wuhan, China, drew the world's attention and the catastrophic consequences of the Disease caused by the Novel Coronavirus 2019 (COVID-19) are still developing in the first semester of 2022. With the restrictions necessary to contain the virus, health services had to reinvent themselves in order not to stop serving their outpatients. Compared to the rest of the world, but especially to high human development countries, Brazilian legislation was, at the beginning of the COVID-19 pandemic, twenty years late, not allowing remote medical consultations. Between March and April 2020, both an ordinance from the Ministry of Health and a federal law authorized remote care for the duration of the effects of this pandemic. Several characteristics allowed the Hospital de Clínicas de Porto Alegre (HCPA) to position itself at the forefront of offering remote consultations during the pandemic, such as institutional proximity to the Technical-Scientific Telehealth Center of Rio Grande do Sul, at the Federal University of Rio Grande do Sul, presence of computerized medical records and management systems that have been constantly updated for decades and institutional support from the Hospital's management. The impact of remote consultations has been evaluated in several dimensions and studies have shown positive effects in reducing the emission of greenhouse gases in order to improve planetary health. Method: This thesis consists of three studies. A descriptive study of the characteristics that allowed the HCPA to quickly implement the new service modality; a cross-sectional study that presents the production and characteristics of remote consultations carried out by the HCPA throughout 2020; and a cross-sectional study that estimated the reduction of the carbon footprint by carrying out these consultations in the first year of the pandemic. Results: A total of 52,878 remote consultations were carried out between March 17 and December 31, 2020, attended by 849 different professionals from different medical specialties, health professions and training levels. The sum of the distances left to travel with these consultations was 4,108,208 kilometers, which generated a reduction in the emission of 939.64 tons of carbon gases in the atmosphere. Conclusions: The studies of this thesis demonstrate that it is feasible for a public university hospital like the HCPA to implement remote consultations on a large scale and in various medical specialties and health professions in an agile and comprehensive way, benefiting patients with reduced travel and consequently planetary health

Methodological course of creating a long distance course on food and nutrition for primary health care professionals

Objetivos: O trabalho descreve e discute a criação de um curso a distância sobre alimentação e nutrição para profissionais de saúde de nível superior da Atenção Primária à Saúde (APS) de todo Brasil. Materiais e métodos: O desenvolvimento do curso ocorreu entre dezembro de 2016 e dezembro de 2017. A descrição do percurso metodológico foi baseada no modelo ADDIE (Analysis, Design, Development, Implementation e Evaluation). Resultados: A análise envolveu a identificação dos profissionais da APS como públicoalvo, suas necessidades de aprimoramento e objetivos de aprendizagem. Na fase de desenho foram escolhidos os assuntos do curso: alimentação saudável, mitos e verdades, materno-infantil, alergias e intolerâncias, doenças crônicas, transtornos alimentares e terapia nutricional enteral domiciliar. Na etapa de desenvolvimento foram criados os recursos educacionais. Na implementação, houve a disponibilização na plataforma e o acompanhamento pedagógico iniciou. Na avaliação, o desempenho e satisfação foram avaliados. Conclusão: O emprego do modelo ADDIE permitiu desenvolver recursos mais adequados à realidade do público-alvo, no entanto, é necessário discutir acerca dos obstáculos durante a formulação do curso e propor estratégias para minimizá-los. Espera-se que esse trabalho contribua para compreender as limitações e potencialidades da educação a distância como estratégia de educação permanente no campo da alimentação e nutrição.Aims: This paper describes and discusses the creation of an online course on food and nutrition for graduated health professionals from Primary Health Care (PHC) throughout Brazil. Materials and methods: Course development occurred between December 2016 and December 2017. The description of the methodology was based on ADDIE (Analysis, Design, Development, Implementation and Evaluation) model. Results: The analysis involved the identification of PHC professionals as a target audience, their needs for improvement and the learning objectives. In the design phase, the topics were chosen: healthy eating, myths and truths, nutrition for mothers and infants, allergies and intolerances, non-communicable diseases, eating disorders and home enteral nutritional therapy. At the development, audio-visual and text-based educational resources were created. In the implementation, the course was made available in the learning environment and the pedagogical support begin. At the evaluation, performance and satisfaction were assessed. Conclusion: The use of ADDIE model allows developing resources appropriated to target audience, however, it is necessary to discuss the obstacles in the formulation of the course and propose strategies to minimize them. This work is expected to contribute to understand the limitations and possibilities of distance education as a continuing education strategy in the field of food and nutrition.Teleducaçã

Processo e plataforma de telessaúde

Universidade Federal do Rio Grande do SulMedicinaDepositad

The management of COVID-19 cases through telemedicine in Brazil.

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil's response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were "asymptomatic" patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management

Evaluation of the Quality of Learning Objects in the Health Care Area: Evidence of Validity and Internal

In Brazil, distance education plays an important role in the training of human resources in the health area. In this context, learning objects, understood as modular digital resources used to support learning, are widely used tools in the process of knowledge construction, although not all are valid resources. To date, the literature does not have a specific instrument in Portuguese to evaluate the quality of learning objects in the health area. In order to fill this gap, this paper describes the search for evidence of validity of internal structure and convergent validity of Equalis-OAS: Scale to evaluate the quality of learning objects in the health area. For the study, Equalis-OAS was applied to professionals and undergraduate students from the different areas of Health Sciences, all participants taking a continuing education health course about Food and Nutrition in Primary Health Care. One thousand and sixty-nine volunteers participated in the study. An Exploratory Factor Analysis revealed that the instrument, which has as its construct “Quality of learning objects for the health area”, covers three dimensions: “Intrinsic Concepts of Learning Objects in the Health Area”, “Educational Characteristics” and “Presentation”. The final instrument consisted of 41 items, which explained 66.8% of the total variance of the scores. The scale had excellent internal consistency indexes (overall scale: α = 0.979; “Intrinsic Concepts of Learning Objects”: α = 0.927; “Educational”: α = 0.947; “Presentation”: α = 0.977). Regarding convergent validation, Pearson’s correlation indicated that Equalis-OAS had a moderate correlation (r=0.59, p<0.01) with LORI version 2.0, translated into Portuguese, an instrument for the evaluation of learning objects in general (i.e., not specific to the health area). These results indicate that Equalis-OAS is an instrument that presents good evidence of validity, indicating its use in the context of health education and research

The management of COVID-19 cases through telemedicine in Brazil

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil’s response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (Telessa´udeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were “asymptomatic” patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.Telemedicin

Educación a distancia para mejorar la calidad del tratamiento del asma en la atención primaria de salud : ensayo clínico aleatorizado grupal - RESPIRANET

Objective: The mere dissemination of standard care recommendations has been insufficient to improve clinical results in patients with asthma. The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers. Methods: Cluster randomized controlled trial. Full primary care teams were included if they had access to telehealth support and free basic asthma treatment. Before randomization, selected teams indicated asthma patients between 5-45 years old for inclusion. The intervention group received three interactive online sessions, printed educational material, reminders, booklet for patients, and frequent stimulus to use consulting services. The control group received no intervention. Symptomfree days per two weeks was the primary result. Controlled asthma, unscheduled asthma doctor visits, and preventive inhaled corticosteroid use were the secondary results. Six months after intervention, the results were compared with baseline data using generalized estimating equations for repeated measures and clustering effect. Results: Were enrolled 71 primary care teams and 443 individuals. Most patients (60.3%) were female, and 44% were younger than 12 years old. The attendance of interactive sessions by the teams was 50%. The odds ratio (OR) for additional symptom-free day was 1.31 (95%CI 0.61-2.82; p=0.49). For the secondary results, the results were: controlled asthma OR 1.29 (95%CI 0.89-1.87; p=0.18); unscheduled asthma doctor visits OR 0.81 (95%CI 0.60-1.10; p=0.17); and preventive inhaled corticosteroid use OR 1.02 (95%CI 0.71-1.47; p=0.91). Conclusions: Multifaceted distance education in asthma care for primary care providers was not effective to improve patients’ results. Telemedicine needs to deal with significant obstacles in professional education.Objetivo: A mera disseminação de recomendações de cuidados padronizados tem sido insuficiente para melhorar os desfechos clínicos em pacientes com asma. O objetivo do presente estudo foi avaliar a eficácia clínica de uma intervenção educativa multifacetada a distância sobre asma para profissionais da atenção primária à saúde. Métodos: Ensaio clínico randomizado por cluster. Equipes completas de atenção primária foram incluídas se tinham acesso a suporte de telessaúde e tratamento básico gratuito para asma. Antes da randomização, as equipes selecionadas indicaram pacientes asmáticos entre 5-45 anos para inclusão. O grupo de intervenção recebeu três sessões online interativas, material educativo impresso, lembretes, folheto para pacientes e estímulos frequentes para o uso de serviços de consultoria. O grupo controle não recebeu intervenção. O desfecho primário foi dias sem sintomas por duas semanas. Asma controlada, consultas médicas não programadas para asma e uso preventivo de corticosteroides inalatórios foram os desfechos secundários. Seis meses após a intervenção, os resultados foram comparados com a linha de base, usando equações de estimativas generalizadas para medidas repetidas e efeito de agrupamento. Resultados: Foram inscritas 71 equipes de atenção primária e 443 indivíduos. A maioria dos pacientes (60,3%) era do sexo feminino e 44% tinha menos de 12 anos de idade. A frequência das equipes nas sessões interativas foi de 50%. O odds ratio (OR) para dias sem sintomas adicionais foi de 1,31 (IC 95% 0,61-2,82; p=0,49). Para os desfechos secundários, os resultados foram: asma controlada 1,29 (IC 95% 0,89-1,87; p=0,18); visitas não programadas de asma ao médico OR 0,81 (IC 95% 0,60-1,10; p=0,17); e uso preventivo de corticosteroides inalatórios OR 1,02 (IC 95% 0,71-1,47; p=0,91). Conclusões: Ações multifacetadas de educação a distância em cuidados de asma para profissionais de saúde da atenção primária não foram eficazes para melhorar os resultados nos pacientes. A telemedicina precisa lidar com obstáculos significativos na educação profissional.Objetivo: La mera difusión de las recomendaciones de atención estándar ha sido insuficiente para mejorar los resultados clínicos en pacientes con asma. El objetivo del presente estudio fue evaluar la efectividad clínica de una educación multifacética a distancia sobre el asma para los proveedores de atención primaria. Métodos: Ensayo controlado aleatorizado por grupos. Se incluyeron equipos completos de atención primaria si tenían acceso a apoyo de telesalud y tratamiento básico gratuito para el asma. Antes de la aleatorización, los equipos seleccionados indicaron pacientes con asma entre 5-45 años de edad para inclusión. El grupo de intervención recibió tres sesiones interactivas en línea, material educativo impreso, recordatorios, folleto para los pacientes y estímulos frecuentes para utilizar los servicios de consultoría. El grupo control no recibió ninguna intervención. El resultado primario fue días sin síntomas por dos semanas. Los resultados secundarios fueron asma controlada, visitas médicas no programadas para el asma y el uso preventivo de corticosteroides inhalados. Seis meses después de la intervención, los resultados se compararon con los datos de referencia utilizando ecuaciones de estimación generalizadas para medidas repetidas y efecto de agrupación. Resultados: Se inscribieron 71 equipos de atención primaria y 443 personas. La mayoría de los pacientes (60,3%) eran mujeres y el 44% eran menores de 12 años. La asistencia a sesiones interactivas por parte de los equipos fue del 50%. La razón de probabilidades (OR) para un día sin síntomas adicional fue de 1.31 (IC del 95%: 0.61 a 2.82; p=0.49). Para los resultados secundarios, los resultados fueron: asma controlada O 1.29 (IC del 95%: 0.89 a 1.87; p=0.18); visitas al médico para el asma no programadas O 0,81 (IC del 95%: 0,60 a 1,10; p=0,17); y el uso preventivo de corticosteroides inhalados OR 1.02 (IC del 95%: 0.71 a 1.47; p=0.91). Conclusiones: La educación a distancia multifacética en el cuidado del asma para los proveedores de atención primaria no fue efectiva para mejorar los resultados de los pacientes. La telemedicina debe enfrentar obstáculos significativos en la educación profesional.Teleducaçã