Telemedicina no acesso à saúde durante a pandemia de covid-19: uma revisão de escopo

Authors

DOI:

https://doi.org/10.11606/s1518-8787.2023057004748

Keywords:

COVID-19, Telemedicine, Telemedicine Emergency Care, Continuity of Patient Care, Health Services Accessibility

Abstract

OBJECTIVE: Mapping the role of telemedicine in the health access of patients with chronic diseases in continuous care actions (except for covid-19) during the pandemic. METHODS: This is a scope review, with an adapted version of the Prisma-Scr methodology and using the Population (patients with chronic diseases), Concept (telemedicine as a health access tool) and Context (covid-19 pandemic) strategy. We searched through the following databases: PubMed, Scopus, Embase, Web of Science, LILACS and SciELO, resulting in 18 articles at the end of the review. We used the technological, sociocultural and assistance analysis dimensions. RESULTS: Eighty-eight percent of the analyzed papers posited that telemedicine use to provide care increased during the pandemic. We identified that this use was positively related to the reduction of complications and the absence of physical displacement for care, expanding it to rural areas. Important barriers were presented, most importantly the digital exclusion, language sociocultural barriers, and inaccessibility to technological instruments for disabled people. CONCLUSIONS: Innovation in care arrangements calls attention to how living labor is important to produce healthcare, using various technologies, and reveals tensions caused by the forces acting on healthcare micro politics. We conclude that, despite important barriers, telemedicine contributed to the care of chronic patients during the COVID-19 pandemic.

References

World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [citado 10 jan 2022]. Disponível em: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

Tasca R, Massuda A. Estratégias para reorganização da Rede de Atenção à Saúde em resposta à Pandemia COVID-19: a experiência do Sistema de Saúde Italiano na região de Lazio. APS Rev. 2020;2(1):20-7. https://doi.org/10.14295/aps.v2i1.65

Tyrrell CS, Mytton OT, Gentry SV, Thomas-Meyer M, Allen JL, Narula AA, et al. Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review. Thorax. 2021 Mar;76(3):302-12. https://doi.org/10.1136/thoraxjnl-2020-215518

Farrington WJ, Mack CA, Karas MG, Ivascu NS, Robinson NB, Iannacone E, et al. A Perspective from New York of COVID 19: effect and impact on cardiac surgery. J Card Surg. 2021 May;36(5):1668-71. https://doi.org/10.1111/jocs.15043

Pedroso MC, Pires JT, Malik AM, Pereira AJ. HCFMUSP: resiliência como resposta à pandemia de COVID-19. Rev Adm Contemp. 25(spe):e-200245, 2021. https://doi.org/10.1590/1982-7849rac2021200245.por

Macinko J, Woolley NO, Seixas BV, Andrade, FB, Lima-Costa MF. Health care seeking due to COVID-19 related symptoms and health care cancellations among older Brazilian adults: the ELSI-COVID-19 initiative. Cad Saúde Pública. 2020;36(suppl 3):e00181920. https://doi.org/10.1590/0102-311x00181920

John N, Wang GM, Cioffi G, Waite K, Patil N, Kyasaram R, et al. The negative impact of the COVID-19 pandemic on oncology care at an Academic Cancer Referral Center. Oncology (Williston Park). 2021 Aug;35(8):462-70. https://doi.org/10.46883/ONC.2021.3508.0462

Stralen AC, Carvalho CL, Girardi SN, Massote AW, Cherchiglia ML. Estratégias internacionais de flexibilização da regulação da prática de profissionais de saúde em resposta à pandemia da COVID-19: revisão de escopo. Cad Saúde Pública. 2022;38(2):e00116321. https://doi.org/10.1590/0102-311x00116321

Chamboredon P, Roman C, Colson S. COVID-19 pandemic in France: health emergency experiences from the field. Int Nurs Rev. 2020 Sep;67(3):326-33. https://doi.org/10.1111/inr.12604

Carroll WD, Strenger V, Eber E, Porcaro F, Cutrera R, Fitzgerald DA, et al. European and United Kingdom COVID-19 pandemic experience: the same but different. Paediatr Respir Rev. 2020 Sep;35:50-6. https://doi.org/10.1016/j.prrv.2020.06.012

Eze ND, Mateus C, Hashiguchi TCOI. Telemedicine in the OECD: an umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One. 2020 Aug;15(8):e0237585. https://doi.org/10.1371/journal.pone.0237585

Cordioli E. Telemedicina nas especialidades: da teoria à prática. In: Santos AO, Lopes LT, editores. Acesso e cuidado especializados. Brasília, DF: Conselho Nacional de Secretários de Saúde; 2021. p. 136-47.

Caetano R, Silva AB, Guedes AC, Paiva CC, Ribeiro GD, Santos DL, et al. Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro. Cad Saúde Pública. 2020;36(5):e00088920. https://doi.org/10.1590/0102-311x00088920

Maldonado JM, Marques AB, Cruz A. Telemedicina: desafios à sua difusão no Brasil. Cad Saúde Pública. 32(suppl 2): e00155615. https://doi.org/10.1590/0102-311X00155615

Tanaka OY. Avaliação no contemporâneo: dilemas e desafios. Rev Bras Aval. 2021;10(1):e100721. https://doi.org/10.4322/rbaval202110007

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616

Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid-Based Healthc. 2015 Sep;13(3):141-6. https://doi.org/10.1097/XEB.0000000000000050

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018 Oct;169(7):467-73. https://doi.org/10.7326/M18-0850

Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais. Base de dados. [citado 23 mar 2022]. Disponível em: https://www.aguia.usp.br/Bases-Dados/

Albert SL, Paul MM, Nguyen AM, Shelley DR, Berry CA. A qualitative study of high-performing primary care practices during the COVID-19 pandemic. BMC Fam Pract. 2021 Nov;22(1):237. https://doi.org/10.1186/s12875-021-01589-4

Boyce DM, Thomashow BM, Sullivan J, Tal-Singer R. New adopters of telemedicine during the Coronavirus-19 pandemic in respondents to an online community survey: the case for access to remote management tools for individuals with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis (Miami). 2021 Apr;8(2):213-8. https://doi.org/10.15326/jcopdf.2020.0181

Haynes SC, Kompala T, Neinstein A, Rosenthal J, Crossen S. Disparities in telemedicine use for subspecialty diabetes care during COVID-19 shelter-In-place orders. J Diabetes Sci Technol. 2021 Sep;15(5):986-92. https://doi.org/10.1177/1932296821997851

Ladin K, Porteny T, Perugini JM, Gonzales KM, Aufort KE, Levine SK, et al. Perceptions of telehealth vs in-person visits among older adults with advanced kidney disease, care partners, and clinicians. JAMA Netw Open. 2021 Dec;4(12):e2137193. https://doi.org/10.1001/jamanetworkopen.2021.37193

McGinley MP, Ontaneda D, Wang Z, Weber M, Shook S, Stanton M, et al. Teleneurology as a solution for outpatient care during the COVID-19 pandemic. Telemed J E Health. 2020 Dec;26(12):1537-9. https://doi.org/10.1089/tmj.2020.0137

Solomon GM, Bailey J, Lawlor J, Scalia P, Sawicki GS, Dowd C, et al. Patient and family experience of telehealth care delivery as part of the CF chronic care model early in the COVID-19 pandemic. J Cyst Fibros. 2021 Dec;20 Suppl 3:41-6. https://doi.org/10.1016/j.jcf.2021.09.005

Tsutsui M, Gerayeli F, Sin DD. Pulmonary rehabilitation in a Post-COVID-19 world: telerehabilitation as a new standard in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2021 Feb;16:379-91. https://doi.org/10.2147/COPD.S263031

Uscher-Pines L, Thompson J, Taylor P, Dean K, Yuan T, Tong I, et al. Where virtual care was already a reality: experiences of a nationwide telehealth service provider during the COVID-19 pandemic. J Med Internet Res. 2020 Dec;22(12):e22727. https://doi.org/10.2196/22727

Womack C, Farsin R, Farsad M, Chaudary N. Emerging alternatives to conventional clinic visits in the era of COVID-19: adoption of telehealth at VCU Adult Cystic Fibrosis Center. Int J Gen Med. 2020 Nov;13:1175-86. https://doi.org/10.2147/IJGM.S274193

Turner K, Bobonis Babilonia M, Naso C, Nguyen O, Gonzalez BD, Oswald LB, et al. Health care providers’ and professionals’ experiences with telehealth oncology implementation during the COVID-19 pandemic: a qualitative study. J Med Internet Res. 2022 Jan;24(1):e29635. https://doi.org/10.2196/29635

Kruse MH, Durstine A, Evans DP. (2021). Effect of COVID-19 on patient access to healthservices in Latin America: a key informant survey. Int J Equity Health (Preprint), 2021 [citado dia mês ano ], Disponível em: https://doi.org/10.21203/rs.3.rs-738539/v1

Gudi N, Konapur R, John O, Sarbadhikari S, Landry M. Telemedicine supported strengthening of primary care in WHO South East Asia region: lessons from the COVID-19 pandemic experiences. BMJ Innov. 2021;7(3):580-5. https://doi.org/10.1136/bmjinnov-2021-000699

Volpato E, Centanni S, Banfi P, D’Antonio S, Peterle E, Bugliaro F, et al. Narrative analysis of the impact of COVID-19 on patients with chronic obstructive pulmonary disease, their caregivers, and healthcare professionals in Italy. Int J Chron Obstruct Pulmon Dis. 2021 Jul;16:2181-201. https://doi.org/10.2147/COPD.S312372

Lewis A, Knight E, Bland M, Middleton J, Mitchell E, McCrum K, et al. Feasibility of an online platform delivery of pulmonary rehabilitation for individuals with chronic respiratory disease. BMJ Open Respir Res. 2021 Mar;8(1):e000880. https://doi.org/10.1136/bmjresp-2021-000880

Kayser MZ, Valtin C, Greer M, Karow B, Fuge J, Gottlieb J. Video consultation during the COVID-19 pandemic: a single center’s experience with lung transplant recipients. Telemed J E Health. 2021 Jul;27(7):807-15. https://doi.org/10.1089/tmj.2020.0170

Wickerson L, Helm D, Gottesman C, Rozenberg D, Singer LG, Keshavjee S, et al. Telerehabilitation for lung transplant candidates and recipients during the COVID-19 pandemic: program evaluation. JMIR Mhealth Uhealth. 2021 Jun;9(6):e28708. https://doi.org/10.2196/28708

Alvarez-Risco A, Del-Aguila-Arcentales S, Yáñez JA. Telemedicine in Peru as a result of the COVID-19 pandemic: perspective from a country with limited internet access. Am J Trop Med Hyg. 2021 May;105(1):6-11. https://doi.org/10.4269/ajtmh.21-0255

Deng D, Liang A, Chui JN, Wong G, Cooper TE. The COVID-19 pandemic and access to health care in people with chronic kidney disease: A systematic review and meta-analysis. Nephrology (Carlton). 2022 May;27(5):410-20. https://doi.org/10.1111/nep.14016; Online ahead of print

Vidal-Alaball J, Acosta-Roja R, Pastor Hernández N, Sanchez Luque U, Morrison D, Narejos Pérez S, et al. Telemedicine in the face of the COVID-19 pandemic. Aten Primaria. 2020;52(6):418-22. https://doi.org/10.1016/j.aprim.2020.04.003

Soriano JB, Abajobir AA, Abate KH, Abera SF, Agrawal A, Ahmed MB, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017 Sep;5(9):691-706. https://doi.org/10.1016/S2213-2600(17)30293-X

Zamith M, Gomes MJ. Novas tecnologias da informação em pneumologia. Rev Port Pneumol. 2005;11(3):S21-8. https://doi.org/10.1016/S0873-2159(15)30544-4

Martins SM, Salibe-Filho W, Tonioli LP, Pfingesten LE, Braz PD, McDonnell J, et al. Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study. NPJ Prim Care Respir Med. 2016 Aug;26(1):16047. https://doi.org/10.1038/npjpcrm.2016.47

Freire MP, Louvison M, Feuerwerker LC, Chioro A, Bertussi D. Regulação do cuidado em redes de atenção: importância de novos arranjos tecnológicos. Saude Soc. 2020;29(3):e190682. https://doi.org/10.1590/s0104-12902020190682

Kluge HH, Wickramasinghe K, Rippin HL, Mendes R, Peters DH, Kontsevaya A, et al. Prevention and control of non-communicable diseases in the COVID-19 response. Lancet. 2020 May;395(10238):1678-80. https://doi.org/10.1016/S0140-6736(20)31067-9

Malta DC, Gomes CS, Silva AG, Cardoso LSM, Barros MBA, Lima MG, et al. Uso dos serviços de saúde e adesão ao distanciamento social por adultos com doenças crônicas na pandemia de COVID-19, Brasil, 2020. Cien Saúde Coletiva, 26(7), 2833-2842. https://doi.org/10.1590/1413-81232021267.00602021

Catapan SC, Calvo MC. Contexto macro-institucional brasileiro para implantação da teleconsulta médica. Braz J Health Rev. 2022;5(1):27-46. https://doi.org/10.34119/bjhrv5n1-003

Lee A, Morling J. COVID19: the need for public health in a time of emergency. Public Health. 2020 May;182:188-9. https://doi.org/10.1016/j.puhe.2020.03.027

Lee D, Choi B. Policies and innovations to battle Covid-19: a case study of South Korea. Health Policy Technol. 2020 Dec;9(4):587-97. https://doi.org/10.1016/j.hlpt.2020.08.010

Rockwell KL, Gilroy AS. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am J Manag Care. 2020 Apr;26(4):147-8. https://doi.org/10.37765/ajmc.2020.42784

Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med. 2021 Mar;181(3):388-91. https://doi.org/10.1001/jamainternmed.2020.5928

Franco TB, Merhy EE. Cartografias do trabalho e cuidado em saúde. Tempus - Actas Saúde Pública. 2021;6(2):151-163. https://doi.org/10.18569/tempus.v6i2.1120

Merhy EE. Um ensaio sobre o médico e suas valises tecnológicas: contribuições para compreender as reestruturações produtivas do setor saúde. Interface (Botucatu). 2000;4(6):109-16. https://doi.org/10.1590/S1414-32832000000100009

Xu J, Willging A, Bramstedt KA. A scoping review of the ethical issues within telemedicine: lessons from COVID-19 pandemic. J Health Soc Sci. 2021;6(1):31-40.

Wen CL. Telemedicina do presente para o ecossistema de saúde conectada 5.0. São Paulo: Instituto de Estudos de Saúde Suplementar; 2020.

Ministério da Saúde (BR). Portaria no 467, de 20 de março de 2020. Dispõe, em caráter excepcional e temporário, sobre as ações de Telemedicina, com o objetivo de regulamentar e operacionalizar as medidas de enfrentamento da emergência de saúde pública de importância internacional previstas no art. 3º da Lei nº 13.979, de 6 de fevereiro de 2020, decorrente da epidemia de Covid-19. Diário Oficial União, 21 mar 2021.

Brasil. Lei no 13.979, de 6 de fevereiro de 2020. Dispõe sobre as medidas para enfrentamento da emergência de saúde pública de importância internacional decorrente do coronavírus responsável pelo surto de 2019. Diário Oficial União. 7 fev 2020.

Feuerwerker LCM. Micropolítica e saúde: produção do cuidado, gestão e formação. Porto Alege : Rede Unida; 2014.

Merhy EE, Bertussi DC, Santos MLM, Rosa NSF, Slomp Junior H, Seixas CT. Pandemia, Sistema Único de Saúde (SUS) e Saúde Coletiva: com-posições e aberturas para mundos outros. Interface (Botucatu), 2022;26:e210491. https://doi.org/10.1590/interface.210491

Rhoden PA, Bonilha H, Harvey J. Patient satisfaction of Telemedicine remote patient monitoring: a systematic review. Telemed J E Health. 2022 Sep;28(9):1332-41. https://doi.org/10.1089/tmj.2021.0434

Caetano R, Silva AB, Guedes AC, Paiva CC, Ribeiro GD, Santos DL, et al. Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro. Cad Saúde Pública. 2020;36(5):e00088920. https://doi.org/10.1590/0102-311x00088920

Massuda A, Malik AM, Vecina Neto G, Tasca R, Ferreira Junior WC. A resiliência do Sistema Único de Saúde frente à COVID-19. Cadernos EBAPE.BR. 2021;19(spe):735-744. https://doi.org/10.1590/1679-395120200185

Published

2023-05-11

How to Cite

Freire, M. P., Silva, L. G., Meira, A. L. P., & Louvison, M. C. P. . (2023). Telemedicina no acesso à saúde durante a pandemia de covid-19: uma revisão de escopo. Revista De Saúde Pública, 57(Supl.1), 4. https://doi.org/10.11606/s1518-8787.2023057004748