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[巴西初级医疗保健中远程医疗的纳入情况及相关因素]

[Incorporation of telehealth in primary healthcare and associated factors in Brazil].

作者信息

Sarti Thiago Dias, Almeida Ana Paula Santana Coelho

机构信息

Universidade Federal do Espírito Santo, Vitória, Brasil.

出版信息

Cad Saude Publica. 2022 May 9;38(4):PT252221. doi: 10.1590/0102-311XPT252221. eCollection 2022.

DOI:10.1590/0102-311XPT252221
PMID:35544879
Abstract

The study aimed to analyze the Brazil Networks Telehealth Program in the context of primary healthcare (PHC) in Brazil and to identify related factors. This cross-sectional study used data from the second cycle of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB). The sample consisted of 29,756 healthcare teams who joined the program voluntarily. Independent variables included contextual characteristics (region and population size), healthcare unit (type, telephone access, broadband, number of physicians and nurses, consultation offices, community health workers' room, meeting room, existence of telehealth) and health team characteristics (institutional support). Crude and Poisson regression-adjusted analyses assessed which variables are associated with greater use of telehealth. Prevalence of use of telehealth was 32.7% in the total sample and 73.3% among teams with the Program implemented. Tele-education was the most frequently used modality. Higher rates of prevalence of use were found in the South and Southeast of Brazil, in municipalities with up to 30,000 inhabitants, with telehealth implemented in the unit, with presence of at least one physician, and with at least one telephone available in the service. Institutional support had a 40% positive impact on prevalence of use of telehealth. Infrastructure variables such as Internet and availability of rooms with different purposes appeared not to significantly impact the use of these technologies, indicating that institutional support and the implementation of telehealth itself in the unit are more important for increasing adherence to the Program.

摘要

该研究旨在分析巴西初级卫生保健背景下的巴西网络远程医疗项目,并确定相关因素。这项横断面研究使用了基本医疗保健可及性与质量改善项目(PMAQ-AB)第二轮的数据。样本包括29756个自愿加入该项目的医疗团队。自变量包括背景特征(地区和人口规模)、医疗单位(类型、电话接入、宽带、医生和护士数量、咨询办公室、社区卫生工作者房间、会议室、远程医疗的存在情况)以及卫生团队特征(机构支持)。粗分析和泊松回归调整分析评估了哪些变量与远程医疗的更多使用相关。在总样本中,远程医疗的使用率为32.7%,在已实施该项目的团队中为73.3%。远程教育是最常用的方式。在巴西南部和东南部、居民人数达3万以下的城市、单位实施了远程医疗、至少有一名医生以及服务中至少有一部电话的情况下,发现使用率较高。机构支持对远程医疗的使用率有40%的积极影响。诸如互联网和不同用途房间的可用性等基础设施变量似乎对这些技术的使用没有显著影响,这表明机构支持和单位自身实施远程医疗对于提高项目依从性更为重要。