Telemedicine in the fight against COVID-19: old and new challenges in health accessibility in Vitória/ES, Brazil

Martínez, Henny Luz Heredia; Artmann, Elizabeth; Cruz, Sheila Cristina de Souza; Farias, Dilzilene Cunha Sivirino

doi:10.1590/0103-1104202213404I

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Brasil

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ORIGINAL ARTICLE • Saúde debate 46 (134) • Jul-Sep 2022 • https://doi.org/10.1590/0103-1104202213404I copy

Telemedicine in the fight against COVID-19: old and new challenges in health accessibility in Vitória/ES, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze telemedicine care in Vitória, Espírito Santo, Brazil, from April 2020 to March 2021.

Method:

based on Thied et al.’s dimensions of access, a case study was conducted using secondary data collected from the Bem Estar Network’s telemedicine reports. All 29 Basic Health Units of the municipality were included.

Results:

a total of 15,548 users were assisted in 21,481 consultations, 64% female (9,953) and 36% male (5,595). The most attended age group was 30-39 years old (19.5%). The number per 10,000 inhabitants for all causes ranged between 35.86/10,000 inhabitants from Oct-Dec/2020 and 65.75 from Apr-Jun/2020. Of these calls, 56% (11,946) targeted coronavirus (causes B342 and B972), ranging from 22.54 consultations per 10,000 inhabitants in Oct-Dec/2020 to 31.96 in Apr-Jun/2020.

Conclusions:

Results reflect the transformative impact COVID-19 had on telemedicine care as part of the first-line response to the pandemic in Vitória, Brazil. Inequalities in face-to-face access are reproduced in telemedicine, making it essential to maintain a strong relationship between the health system, health teams, and users when implementing telemedicine. Both forms of health care remain interdependent and complementary in the search to ensure equitable access to health.

KEYWORDS
Telemedicine; COVID-19; Health services accessibility; Primary Health Care; Health information systems

	2020			2021	Overall total
	Apr-Jun	Jul-Sep	Oct-Dec	Jan-Mar	n	%
Total	4,936	4,071	3,020	3,521	15,548	100.0
Gender
F	3,087	2,634	1,944	2,288	9,953	64.0
M	1,849	1,437	1,076	1,233	5,595	36.0
Age groups
<1	44	40	18	14	116	0.7
1-9	274	240	148	173	835	5.4
10-19	331	235	231	242	1,039	6.7
20-29	794	660	492	533	2,479	15.9
30-39	1,083	757	577	611	3,028	19.5
40-49	903	701	541	616	2,761	17.8
50-59	703	655	503	564	2,425	15.6
60-69	460	442	312	441	1,655	10.6
70-79	230	210	133	216	789	5.1
80-89	100	111	53	94	358	2.3
90-99	13	19	12	17	61	0.39
100 and older	1	1	0	0	2	0.01
Ethnicity/color
Asian	10	10	9	8	37	0.3
White	1,696	1,518	1,366	1,421	6,001	38.6
Indigenous	5	1	8	4	18	0.1
Brown	1,761	1,419	890	1,141	5,211	33.5
Black	457	299	156	285	1,197	7.7
No information	1,007	824	591	662	3,084	19.8
Health regions^* * Distribution refers to the user’s UBS of source. The following details the geographic coverage of the six health regions in the municipality of Vitoria:
Santo Antônio	604	659	448	694	2,405	15.5
Maruípe	1,421	1,050	729	898	4,098	26.4
São Pedro	562	293	143	186	1,184	7.6
Forte São João	718	591	424	400	2,133	13.7
Continental	1,283	1,212	1,060	1,100	4,655	29.9
Centro	348	266	216	243	1,073	6.9

	2020			2021	Overall total
	Apr-Jun	Jul-Spt	Oct-Dec	Jan-Mar	n	%
Total	7,216	6,134	3,936	4,195	21,481	100.0
Number of consultations
1	4,253	3,039	2,271	2,299	11,862	55.2
2	1,600	1,515	861	966	4,942	23.0
3-5	1,138	1,281	646	749	3,814	17.8
6-10	211	261	128	159	759	3.5
11 and more	14	38	30	22	104	0.5
Type of professional
General practitioner	2,286	2,674	1,559	1,487	8,006	37.3
Pediatrician	1,858	1,428	1,183	1,266	5,735	26.7
Family health strategy physician	428	482	358	473	1,741	8.1
General surgeon	302	471	341	589	1,703	7.9
Homeopathic physician	898	400	202	74	1,574	7.3
Gynecologist and obstetrician	701	403	4	0	1,108	5.2
Cardiologist	519	274	137	100	1,030	4.8
Otorhinolaryngologist	165	0	25	80	270	1.3
Endocrinologist and metabologist	0	0	49	117	166	0.8
Neurologist	0	0	51	2	53	0.2
Ophthalmologist	12	2	27	7	48	0.2
Psychiatrist	24	0	0	0	24	0.1
Rheumatologist	23	0	0	0	23	0.1
Health regions^* * Distribution refers to the user’s UBS of source. The following details the geographic coverage of the six health regions in the municipality of Vitoria:
Santo Antônio	1,040	1,120	706	848	3,714	17.3
Maruípe	2,087	1,607	936	1,070	5,700	26.5
São Pedro	740	373	174	213	1,500	7.0
Forte São João	1,017	884	520	472	2,893	13.4
Continental	1,847	1,754	1,325	1,297	6,223	29.0
Centro	485	396	275	295	1,451	6.8

	2020			2021	Overall total
	Apr-Jun	Jul-Spt	Oct-Dec	Jan-Mar	n	%
Total	3,508	3,380	2,474	2,584	11,946	100.0
Number of consultations
1	2,387	2,061	1,716	1,649	7,813	65.4
2	711	799	501	583	2,594	21.7
3-5	380	469	233	319	1,401	11.7
6-10	30	46	18	32	126	1.1
11 and more	0	5	6	1	12	0.1
Risk classification
No warning signs	2,468	2,517	2,020	2,076	9,081	76.0
With warning signs	829	801	396	401	2,427	20.3
With severity signs	19	3	3	8	33	0.3
No information	192	59	55	99	405	3.4
Health regions^* * Distribution refers to the user’s UBS of source. The following details the geographic coverage of the six health regions in the municipality of Vitoria:
Santo Antônio	398	426	259	420	1,503	12.6
Maruípe	1,040	834	583	692	3,149	26.4
São Pedro	403	218	121	160	902	7.6
Forte São João	479	536	386	323	1,724	14.4
Continental	903	1,118	928	776	3,725	31.2
Centro	285	248	197	213	943	7.9

Health region^* * Distribution presented refers to the user’s UBS of origin according to the geographic coverage of the six health regions in the municipality of Vitoria:	Telemedicine care per 10,000 inhabitants
	2020						2021
	April-June		July-Sept		Oct-Dec		Jan-March
	All causes	B342 and B972	All causes	B342 and B972	All causes	B342 and B972	All causes	B342 and B972
1. Santo Antônio	106.12	40.61	114.28	43.47	72.04	26.43	86.53	42.86
2. Maruípe	95.64	47.66	73.64	38.22	42.89	26.72	49.03	31.71
3. São Pedro	65.48	35.66	33.01	19.29	15.40	10.71	18.85	14.16
4. Forte São João	52.75	24.84	45.85	27.80	26.97	20.02	24.48	16.75
5. Continental	51.25	25.06	48.67	31.02	36.77	25.75	35.99	21.53
6. Centro	56.50	33.20	46.13	28.89	32.03	22.95	34.36	24.81
Municipality of Vitória	65.75	31.96	55.89	30.80	35.86	22.54	38.22	23.54

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[1] Conflict of interests: non-existent