O serviço de teleconsultoria no Norte de Minas Gerais: cenário e fatores associados a não utilização por profissionais médicos na atenção primária

Abstract

In spite of advances regarding the development of primary health care (PHC) in Brazil since the expansion of the Family Health Strategy (FSE), old challenges remain, such as a more adequate distribution of doctors and other health care professionals in the national territory and the effective change of the care model, with an improvement on the quality and effectiveness of health care. There are also important challenges that transcend the health sector, such as investment in infrastructure and the reduction of social inequalities in the different regions of the country. In this context, the application of teleconsulting systems to PHC is an excellent opportunity, especially for the poor and remote regions, where an individual specialized coverage cannot be expected. The teleconsulting has the potential to expand the population's access to specialized services, in addition to improving the quality of care for the population in PHC and reducing costs for the health system. However, these benefits are only evidenced when teleconsulting services are widely used, incorporated into the daily practice of health professionals and also accepted by patients and managers. The present study was developed in the North of Minas aimed at evaluating the prevalence and factors associated to the non-use of the teleconsulting service by the medical professionals who work in the Family Health Strategy in the North of Minas Gerais. It is a cross-sectional study applied to the municipalities of the health macro-region of Northern Minas Gerais, where all the 86 municipal health managers in the region and 385 medical professionals from family health teams participated. The findings of this study indicate that this region presents a scenario that would be greatly benefited from the incorporation of the use of teleconsulting service in the practice of medical professionals working in the FHS (59.3% of the municipalities have a population of up to 10,000 inhabitants, 23.3 % Have a low HDI, 59.3% live further than 100 km from the municipality that receives the highest number of referrals for specialized care), but a significant proportion of non-use of this service was registered by these professionals (55.8% ), And important structural barriers were identified to its implementation, such as the lack of computers with access to the Internet at all basic health units (BHU) in most municipalities (76.7%) and the poor quality of Internet connection in Some sites (16.3%).The factors associated with the non-use of this service by the medical professionals working in the FHS were: lack of motivation strategies by the municipal health managers (p <0.001; PR = 3.13), unavailability of a computer with internet at UBS (P = 0.001, PR = 1.10, 95% CI 1.04-1.17), lack of information about the service (p <0.001, PR = 1.47, 95% CI: 1 , 38-1,56) and lack of training to use it (p <0.001, RP = 1.15, 95% CI: 1.081.24).These results reinforce that the motivation for the use of the service by the local managers, the informatics structure of the UBS, the dissemination of the service and the training offer should guide the strategies for implementation and diffusion of teleconsulting service in APS in the North of Minas Gerais General, a region considered emblematic for areas that can benefit from the use of this service.