Orthopedic Asynchronous Teleconsultation for Primary Care Patients by a Large-Scale Telemedicine Service in Minas Gerais, Brazil

Abstract Backgrounds Telemedicine was implemented in Brazil to support primary care practitioners. As orthopedic complaints are frequent in primary health care (PHC), this study aimed to analyze the profile of orthopedic teleconsultations requested by PHC health professionals. Methods This observational, transversal study analyzed consecutive orthopedic teleconsultations from March/17 to July/19. Teleconsultations were classified as: character (educational or assistance), focus of the doubt (diagnosis, treatment or rehabilitation) and the location of involvement (muscle, bone, joint). Sex of the patients, professional category of the professionals who requested and the ones who responded teleconsultations, and Human Development Indexes (HDI) of the cities were accessed. Results Throughout the study, 415 teleconsultations were accessed from 112 municipalities with an HDI average of 0.651. The professionals who requested most of the teleconsultations were nurses (47%) and physicians (35%) and the ones who answered were mostly internal medicine physicians (61%) and orthopedists (34%). Most doubts were related to assistance of a specific patient (66%). Of those, the majority were female (59%). In 68% of the teleconsultations, there was a request for assistance in patient treatment, 38% for diagnosis and 25% for rehabilitation. Doubts were more often related to bones (46%) and joints (24%). Of those who specified the complaint, 17% were about general pain,14% low back pain and 4% fracture. The main subspecialties were spine (23%), foot (19%) and knee (11%). In 9% of cases, there was an indication for referral for in-person orthopaedic consultation. Conclusions Teleconsultation helps to identify the most frequent doubts in PHC. Most of those were solved in PHC with no need for referral, what evidenced the great potential of using teleconsultations in clinical practice, as a useful tool to qualify the referral to the specialist. Key messages Importance of telehealth tools for a public health system, especially for a country where the distance is a barrier to access healthcare services. Teleconsultation have been proven to be an effective strategy to qualify the referral to the specialist.

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Prevalence of normal electrocardiograms in primary care patients

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.03.012 ◽

2014 ◽

Vol 60 (3) ◽

pp. 236-241 ◽

Cited By ~ 4

Author(s):

Milena Soriano Marcolino ◽

Daniel Moore Freitas Palhares ◽

Maria Beatriz Moreira Alkmim ◽

Antonio Luiz Ribeiro

Keyword(s):

Primary Care ◽

Chest Pain ◽

General Practitioner ◽

Minas Gerais ◽

Progressive Reduction ◽

Telehealth Service ◽

Primary Care Patients ◽

Normal Ecgs ◽

Primary Care Professionals ◽

Ecg Interpretation

Objective: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. Methods: all digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. Results: during the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. Conclusion: the prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality.

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