Brazil has continental dimensions and large number of cities. Specialized healthcare is concentrated in the bigger cities, therefore the referral of patients from primary to specialized care may be difficult and costly. Telehealth can be an effective tool to increase the access to specialized healthcare, especially for remote areas. Our aim is to report a successful and sustainable experience of a large scale telehealth service in support of primary care practitioners, the Telehealth Network of Minas Gerais (TNMG). The network was implemented by public funds, mainly from the state government and research development agencies, to connect specialists from 6 public universities to primary health caregivers in remote cities. The project begun in 2006 with 82 cities and was expanded several times, reaching 722 cities in Minas Gerais state, Brazil, in 2014. The main activities developed by the service were tele-electrocardiography (EKG) and teleconsultations. Satisfaction of healthcare practitioners was systematically evaluated. A detailed cost evaluation was performed.
Since 2006, the TNMG performed more than 2 million EKGs and 65,000 teleconsultations. An average ratio of users’ satisfaction was 96%. The teleconsultations questions were associated with a clinic case in 82%, and 18% were theoretical questions. The activities averted potential referrals for specialized health care services by 80%. The return on investment was 4:1. Some factors support the sustainable and continuity of the TNMG: government-academia partnership, support of public managers, services provided by a collaborative network, systematic monitoring of the services, audit system for EKG and teleconsultations, response time, ease of use of the system, growth and diversification of telehealth activities, research development and economic viability monitoring. In conclusion, the large number of activities performed by TNMG show its important role in improving the access to specialized care, facilitating universality, equality and integrality of healthcare.
Conflict of interest. The author declare no conflict of interest
