Department of Human Rights, Health and Cultural Diversity, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Medicines and Pharmaceutical Services Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One. 2020 Nov 25;15(11):e0242869. doi: 10.1371/journal.pone.0242869. eCollection 2020.
This study characterized the evolution of Brazilian public telemedicine policy in the Brazilian Unified Health System for 30 years from 1988 to 2019 by analyzing its legal framework. We identified 79 telemedicine-related legislations from the federal government (laws, decrees, and ordinances) and 31 regulations of federal councils of health professionals. Three historical phases were established according to the public policy cycle, and material was classified according to the purpose of the normative documents. The content analysis was based on the advocacy coalition framework model. Of the federal legislations, 8.9% were for the Formulation/Decision-Making phase, 43% for the Organization/Implementation phase, and 48.1% for the Expansion/Maturation phase of telemedicine policy in Brazil. The Federal Council of Medicine was the most active in standardizing telemedicine and was responsible for 21 (67.7%) regulations. The first legislations were passed in 2000; however, the coalitions discussed topics related to telemedicine and created their belief systems from the 1990's. The time cycle which included formulation and decision making for Brazilian telemedicine policy, extended until 2007 with the creation of several technical working groups. The expansion and maturation of telemedicine services began in 2011 with the decentralization of telemedicine policy actions across the country. Telemedicine centers which performed telediagnosis influenced the computerization of primary health care units. We conclude that Brazilian telemedicine field has greatly grown and changed in recent years. However, despite the proliferation of legislations and regulations in the period studied, there is still no fully consolidated process for setting up a wholly defined regulatory framework for telemedicine in Brazil.
本研究通过分析法律框架，描述了 1988 年至 2019 年 30 年来巴西在统一卫生系统中公共远程医疗政策的演变。我们从联邦政府（法律、法令和条例）中确定了 79 项与远程医疗相关的立法，以及 31 项联邦卫生专业人员理事会的法规。根据公共政策周期，确定了三个历史阶段，并根据规范文件的目的对材料进行了分类。内容分析基于倡导联盟框架模型。在联邦立法中，8.9%处于制定/决策阶段，43%处于组织/实施阶段，48.1%处于巴西远程医疗政策的扩展/成熟阶段。联邦医学理事会在规范远程医疗方面最为活跃，负责制定了 21 项（67.7%）法规。第一批立法于 2000 年通过；然而，各联盟从 20 世纪 90 年代开始就已经开始讨论与远程医疗相关的话题，并建立了自己的信仰体系。巴西远程医疗政策的制定和决策周期一直持续到 2007 年，当时成立了几个技术工作组。2011 年，远程医疗服务的扩展和成熟开始，全国各地的远程医疗政策行动开始分散。开展远程诊断的远程医疗中心影响了基层医疗单位的计算机化。我们的结论是，近年来，巴西的远程医疗领域有了很大的发展和变化。然而，尽管在研究期间颁布了大量的法规和条例，但巴西仍未建立一个完全统一的远程医疗监管框架。
