Keywords
Echocardiography
Waiting lists
Health care coordination and monitoring
Primary health care
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To evaluate whether the implementation of cardiology teleconsultations was associated with changes in the profile of transthoracic echocardiogram requests by Primary Health Care (PHC) physicians in Recife, regarding adherence to the municipal access protocol. Methods: Analytical observational, quasi-experimental, before-and-after study using retrospective data from the municipal regulation system. A total of 405 requests from 2017 (pre-intervention) and 405 from 2019 (post-intervention), made by the same physicians, were compared. Requests that did not comply with the protocol were classified as sensitive. Absolute and relative frequencies, Pearson’s chi-square test, and Odds Ratio (OR) with 95% confidence intervals (CI) were used, with a significance level of 5%. Results: There was a significant reduction in sensitive requests after the intervention (67.4% in 2017 vs. 57.5% in 2019; p=0.004). The odds of inappropriate requests were 50% higher in the pre-intervention period (OR=1.5; 95% CI: 1.1–2.0). Risk classification distribution also shifted, with fewer requests classified as emergencies. Conclusion: Teleconsultations were associated with greater adherence to the regulatory protocol, suggesting a positive impact on the qualification of referrals and potential contributions to greater efficiency and equity in the management of specialized exam waiting lists.
References
ALBARQOUNI L, et al. Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review. BMJ Global Health, 2022; 7(10): e008696.
ARAÚJO MDSD, et al. Avaliação da implantação de um projeto de telerregulação assistencial em uma capital brasileira. Cadernos de Saúde Pública, 2023; 39(7): e00009623.
BASHSHUR RL, et al. Beyond the covid pandemic, telemedicine, and health care. Telemedicine Journal And E-Health, 2020; 26(11): 1310-1313.
BERWICK DM, HACKBARTH AD. Eliminating waste in US health care. JAMA, 2012; 307(14): 1513-1516.
BRASIL. Ministério da Saúde. Portaria nº 373, de 27 de fevereiro de 2002. Aprova a Norma Operacional da Assistência à Saúde – NOAS-SUS 01/2002. Diário Oficial da República Federativa do Brasil, 2002; 40(1): 52.
BRASIL. Ministério da Saúde. Portaria nº 1559, de 1º de agosto de 2008. Institui a Política Nacional de Regulação do Sistema Único de Saúde – SUS. Diário Oficial da República Federativa do Brasil, 2008; 148(1): 30.
BRASIL. Ministério da Saúde. Portaria nº 2546, de 27 de outubro de 2011. Redefine e amplia o Programa Telessaúde Brasil, que passa a ser denominado Programa Nacional Telessaúde Brasil Redes. Diário Oficial da República Federativa do Brasil, 2011; 208(1): 28.
CAPODICI A, et al. Reducing outpatient wait times through telemedicine: a systematic review and quantitative analysis. BMJ Open, 2025; 15(1): e088153.
CATAPAN SC, et al. Increasing primary care capacity and referral efficiency: a case study of a telehealth centre econsult service in Brazil. Journal of Telemedicine And Telecare, 2025; 31(7): 1014-1023.
DOLNY LL, et al. Serviços de telessaúde como apoio à educação permanente na atenção básica à saúde: uma proposta de modelo avaliativo. Interface (Botucatu), 2019; 23: e180184.
GADENZ SD, et al. Telehealth to support referral management in a universal health system: a before-and-after study. BMC Health Services Research, 2021; 21(1): 1012.
GANGULI I, et al. Telemedicine adoption and low-value care use and spending among fee-for-service medicare beneficiaries. Jama Internal Medicine, 2025; 185(4): 440–449.
HOUSE OF COMMONS LIBRARY. The structure of the NHS in England. London. UK Parliament. 2023. Disponível em: https://researchbriefings.files.parliament.uk/documents/CBP-7206/CBP-7206.pdf.
KATZ N, et al. Access and regulation of specialized care in Rio Grande do Sul: the regulasus strategy of telessaúders-ufrgs. Ciência & Saúde Coletiva, 2020; 25(4): 1389-1400.
LIDDY C, et al. Sustainability of a primary care–driven econsult service. The Annals Of Family Medicine, 2018; 16(2): 120-126.
LIU T et al. Primary care practice telehealth use and low-value care services. Jama Network Open, 2024; 7(11): e2445436.
OLAYIWOLA JN, et al. Electronic consultation impact from the primary care clinician perspective: outcomes from a national sample. Journal of Telemedicine And Telecare, 2019; 25(8): 493-498.
ORGANIZAÇÃO PAN-AMERICANA DA SAÚDE. OPAS. Panorama das DNTs 2025: vigilância e monitoramento das DNTs: mortalidade por doenças não transmissíveis e prevalência de fatores de risco associados na Região das Américas. Washington, D.C., 2025. Disponível em: https://doi.org/10.13140/RG.2.2.12418.54722.
PACHITO DV, et al. Telehealth strategies to support referral management to secondary care in Brazil: a cost-effectiveness analysis. Value In Health Regional Issues, 2022; 31: 74-80.
PFEIL JN, et al. A telemedicine strategy to reduce waiting lists and time to specialist care: a retrospective cohort study. Journal of Telemedicine And Telecare, 2023; 29(1): 10–17.
PFEIL JN et al. Teleconsultations’ impact on referral streamlining and waitlist reduction: a large-scale retrospective cohort study of over 200,000 cases. Telemedicine Journal And E-Health, 2025; 31(8): 1003-1009.
PFEIL JN, et al. Telemedicine gatekeeping over 15,000 patients from specialist consultation waiting lists: a cost-minimization study. Telemedicine Reports, 2025a; 6(1): 363–370.
SILVA JUNIOR CL, et al. A regulação ambulatorial na atenção primária do município do Rio de Janeiro, Brasil, a partir dos médicos reguladores locais. Ciência & Saúde Coletiva, 2022; 27(6): 2481–2493.
SILVA LCD, et al. Regulação assistencial e controle do SUS: revisão de literatura. Europub Journal of Health Research, 2024; 5(2): e5670.
STEWART M e RYAN B. Ecology of health care in Canada. Canadian Family Physician, 2015; 61(5): 449–453.
THIND BS, et al. Evaluating the impact of an econsult platform on specialty care access for medicaid patients. Journal of The American Board Of Family Medicine, 2025; 38(3): 592-598.
WORLD HEALTH ORGANIZATION. WHO. Quality in primary health care. 2018. Disponível em: https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.54.