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FERNANDO MENEZES Program Director , Deputy Secretary

CRICS9 eHealth - Reaching universal access to health. Telehealth : models of programs and services Telehealth applied to Primary Health Care : the Brazilian experience. FERNANDO MENEZES Program Director , Deputy Secretary

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FERNANDO MENEZES Program Director , Deputy Secretary

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  1. CRICS9 eHealth - Reaching universal access to health Telehealth: models of programs and servicesTelehealthapplied to PrimaryHealthCare: theBrazilianexperience FERNANDO MENEZES ProgramDirector, DeputySecretary SecretariatofManegmentof Labor andEducation for HumanResources for Health MinistryofHealth

  2. Brazilian Health System

  3. Economic, Political and Social Background • Brasil – Political & Economical Partner • Economical Growth with political stability • Poverty reduced from 20% to 7% of the population from 2004 to 2009 • Worldwide events • Sanitary Reform • Health is recognized as a right , universal access health system - SUS • The definition of health goes beyond its biomedical approach, including the social determinants • Society engagement at SUS trough its representation at the National Counsil of Health • Challenges • High tax of cesareans • High tech interventions sometimes done for the wrong reasons • Violence, alcohol abuse and overweight • The Scientific Community should view Brazil thru the reforms implemented LANCET, MAY 2011

  4. Primary Health Care in the Unified Health System (SUS):Family Health Strategy Numberof Family Health Teams Scenery • Brazilwentfromhaving a verystrictbasicalhealth system tobeingthegreatestinternationalexampleof a universal health system (Harris, M. 2010).

  5. 1998 1999 2000 2001 2004 Evolution of the rate of PHC coverage Actual % of population covered by health family teams – Brazil, 1998 –2005 2011 0% 0 a 25% 25 a 50% 50 a 75% 75 a 100% FONTE: SIAB - Sistema de Informação da Atenção Básica

  6. SUS PrimaryHealthCare: FamilyHealthProgram • Created in 1994 to improvetheaccessofallcitizensto healthcare • Each FHP Team: • Physician • Nurse • AuxiliaryNurses • Dentist • Dental Auxiliary • (6 ) CommunityHealthWorkers

  7. FamilyHealthStrategyCoverage - 2011 FamilyHealthTeam: Physician Nurse Dentist Auxiliary Nurse CommunityHealthWorker

  8. Family Health StrategyImpact • InfantMortalityReductionproportionaltothe time andcoverageoftheprogram. (Aquino, R. 2009). • BetteracessoftheelderlytotreatandpreventtheNCDs (Piccini, R 2006), in comparisonwiththetraditionalmodel.

  9. Brazilian National eHealth Program Objectives: • Improve quality of primary care • Qualify family health teams workers • Teleconsultancy and Formative Second Opinion

  10. How does it works? Tele-assistancyX Tele-education Telehealth Center Question Ready Family Health Teams Answer Teleconsultation Basic Health Units Specialized Team Universities Network for knowledgesharingwith positive impact in healthcare delivery

  11. RR AP AM PA MA CE RN PB PI PE AC AL TO RO SE BA MT DF GO MG MS ES SP RJ PR SC RS SituationalMapaug/2012 In operation In deployment

  12. Budget Worksheet Fonte: SGTES/MS – maio/2012

  13. Budget Worksheet Fonte: SGTES/MS – maio/2012

  14. eHealth in Brasil:3 integratednetworks BrazilianTeleHealthProgram :teleducation and teleassistance www.telessaudebrasil.org.br Open Universisty of SUS :Allows “in service” specializingcoursestothousands of healthprofessionals www.universidadeabertadosus.org.br TeleMedicineUniversitaryHospitals Network: links theuniversitaryhospitals, sharingeducationalproccesses, research and improvements in assistance, in allStates of theBrazilianFederation– http://rute.rnp.br

  15. Ministryof Health partnerships in theBrazilianTeleHealthProgram • MinistryofEducation • Ministryof Science and Technology • Ministeryof Communication • MinistryofDefense • PublicUniversities • Federal Councilof Medicine • BrazilianSocietyof Family & Community Medicine • BrazilianCouncilof Telemedicine andTeleHealth – CBTms • NationalCouncilof Secretaries of States (CONASS) • NationalCouncilofMunicipalities (CONASEMS)

  16. ThreedifferentNormatizationsfollowingtheevolutionoftheProgramThreedifferentNormatizationsfollowingtheevolutionoftheProgram • MinisterEdict n.35/2007: stablishsthePilot Project, defines criteria to implementtheprogrampredomiantly in remoteareasatthefivedifferentregionsofthe country • MinisterEdict n. 402/2010: stablishstheNationalProgramBrazilTelehealthand its structure in the states • Mister Edict n. 2546/2011: conceptsofteleconsultancy, telediagnosis, FormativeSecondOpinion, servicesoftelehealth are incorprated to thelistofhealthcareservicesof SUS andTelehealthProgram is expanded to highcomplexityservicesand as strategy to reinforcethe network ofhealthcaredelivery as a whole

  17. www.telessaudebrasil.org.br 13.000 htppvisited/month

  18. Formative Second Opinion It´s a question-and-answer combo, originatedthruteleconsultation, selectedbeacauseit´srelevanceand link withSUS´sDirectives, in whichtheanswerisbasedonbibliographicresearchandup-to-date cientific evidencies.

  19. Formative Second Opinion CientificKnowlegdere-builttoanswerdailypracticequestionsofhealthprofessionals. Shows whichknowlegdeisthemostneededandalsoguidetheproductionoflearningobjects

  20. Virtual Man Project - FMUSP Ciclo Menstrual

  21. TeleHealth for Primary Health in Rio Grande do Sul: Influence in DecisionMakingEno Castro Filho - PhD Tesis • 664 questionsclassifiedthru CIAP2. • 617 (93%) questionsregardingInternal Medicine. • 47 (7%), questionsaboutthe Health System flowchart, educativeactionsorcommunitaryhealth. • Mental Health wastheareawith more doubts

  22. Teleconsultansweredyourquestion ?

  23. ConclusionsontheTeleconsultationstudy • In thevastmajorityofthe cases, thedoubts in howtoproceed in clinical cases are solved. • The professionalshave a high satsifaction rate whenusingthisservice • Patient´stransportationwhichwouldhavehappenedifthedoubtswerenotanswered are avoided in every 2 teleconsultations. • The challengeofallowingthe use ofsuchinstrument more intensivelyandwidelyshouldbemade a priority. • Studieswith more permeablesceneries in comparisonwithcontrolgroup are necessarytoachieve more solidevidences.

  24. RESEARCH WITH PROFESSIONALS WORKING AT REMOTE AREAS How much has training favored your decision to remain in your job at the village ? Nothing Little Average Very much

  25. Costreductionstudy • A reductionof 5 referal per city per monthor a reductionof 1.5% ofthe total referalavoidedbythe use oftheTeleHealthserviceissufficienttopaythecostsofmantainingtheTeleHealthProgram. • The cost of the consultation that demands reference of the patient is 8 times higher than the teleconsultation that avoids the necessity of reference

  26. www.saude.gov.br/sgtes www.telessaudebrasil.org.br Amazon Thankyou! Gracias ! São Paulo Rio de Janeiro Brasília

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