Abstract
Background
Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization.
Objective
To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care.
Methods
Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication.
Results
The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care.
Discussion
Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research.
Community mental health; computers; education – psychiatric; social and political issues; interdisciplinary relations
Introduction
Access to proper mental health treatment worldwide is disturbingly low, with a substantial mental health workforce shortage, particularly in low and middle-income countries11 Collins PY, Patel V, Joestl SS, March D, Insel TR. Grand challenges in global mental health. Nature. 2011;475:27-30.. In Brazil, the diversity of primary health structures and staff training hinders the development of standardized approaches for the identification and treatment of mental disorders22 Guimarães FJ, Santos PKS, Soares NS, Cunha IPV, Farias JCLA, Campos Filho AS, et al. Fluxo de cuidado na rede pública de saúde mental. Cad Bras Saúde Ment. Submitted on: 3/5/2013.. In São Paulo, only 30.2% of severe mental disorder cases, 17.2% of moderate cases and 11.6% of mild cases received any type of general practitioner or specialized care within the previous 12 months33 Andrade LH, Wang Y-P, Andreoni S, Silveira CM, Alexandrino-Silva C, Siu ER, et al. Mental Disorders in Megacities: Findings from the São Paulo Megacity Mental Health Survey, Brazil. PLoS One. 2012;7(2):e31879.. In addition, a lack of familiarity with psychiatric diagnosis by primary care health professionals impairs proper identification, which is commonly delayed after several assessments44 Lampe L, Shadbolt N, Starcevic V, Boyce P, Brakoulias V, Hitching R, et al. Diagnostic processes in mental health: GPs and psychiatrists reading from the same book but on a different page. Australas Psychiatry. 2012;20:374-8.. To improve treatment and expand access to care, the World Health Organization’s (WHO) Grand Challenges in Global Mental Health Initiative incorporated the integration of mental screening and services into routine primary health care and the application of information technologies (such as mobile technologies and telemedicine) for increased access to evidence-based care within its 25 mental health priorities for improved global mental health11 Collins PY, Patel V, Joestl SS, March D, Insel TR. Grand challenges in global mental health. Nature. 2011;475:27-30.. In alignment with these priorities, the application of telemedicine for mental health education and supervision of non-specialists has been identified as a priority for reducing barriers for seeking mental health treatment in Brazil55 Gregório G, Tomlinson M, Gerolin J, Kieling C, Moreira HC, Razzouk D, et al. Setting priorities for mental health research in Brazil. Rev Bras Psiquiatr. 2012;34(4):434-9..
Information technologies has been applied in the medical and public health domains to
promote clinical and mental health and improve the delivery of care through various
mechanisms such as routine electronic data collection or the remote exchange of
health information. mHealth is a term used to refer to the use of mobile devices
(e.g., mobile phones, patient monitoring devices) in clinical
and public health practice. Together, these mechanisms are referred as
Telehealth66 American Telemedicine Association. Last accessed on 2014, March 4.
Available from: http://www.americantelemed.org/home.
http://www.americantelemed.org/home...
.
Telehealth has been associated with certain benefits including the improvement of
qualified health services in disadvantaged and remote areas, training, professional
communications and information processing between different levels of care,
reductions in cost, time and travels66 American Telemedicine Association. Last accessed on 2014, March 4.
Available from: http://www.americantelemed.org/home.
http://www.americantelemed.org/home...
. It may be applied synchronously (e.g.,
real-time videoconferencing and telephone communication) or asynchronously
(e.g., email, text messaging)66 American Telemedicine Association. Last accessed on 2014, March 4.
Available from: http://www.americantelemed.org/home.
http://www.americantelemed.org/home...
.
The delivery of mental health services through Telehealth is known as Telemental
Health (TMH) or Telepsychiatry (TP)66 American Telemedicine Association. Last accessed on 2014, March 4.
Available from: http://www.americantelemed.org/home.
http://www.americantelemed.org/home...
. Promising TMH results have been reported in the diagnosis,
assessment, and satisfaction of patients among various populations
(e.g., adult, child, geriatric, and ethnic), disorders
(e.g., depression, post-traumatic stress, substance abuse,
autism), and a wide range of services (e.g., emergency, at home
care)77 Hilty DM1, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees
PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health.
2013;19(6):444-54.,88 Shore JH. Telepsychiatry: videoconferencing in the delivery of
psychiatric care. Am J Psychiatry. 2013;170:256-62.. TMH has been shown to be as
efficient as in-person care and allows the establishment of proper doctor-patient
relationships77 Hilty DM1, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees
PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health.
2013;19(6):444-54.,88 Shore JH. Telepsychiatry: videoconferencing in the delivery of
psychiatric care. Am J Psychiatry. 2013;170:256-62.. Additionally, the collection of
data by electronic means provides specific advantages for mental health service
delivery, including time savings, prevention of personal bias in the screening of
disorders and reduction of stigmas77 Hilty DM1, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees
PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health.
2013;19(6):444-54.,88 Shore JH. Telepsychiatry: videoconferencing in the delivery of
psychiatric care. Am J Psychiatry. 2013;170:256-62.. TMH facilitates successive evaluations and provides
valuable information on treatment response, improving the quality of care77 Hilty DM1, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees
PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health.
2013;19(6):444-54.,88 Shore JH. Telepsychiatry: videoconferencing in the delivery of
psychiatric care. Am J Psychiatry. 2013;170:256-62..
Based on the scenario presented above, this paper presents an update of Telehealth and the integration of TMH into primary care in Brazil.
Methods
A non-systematic literature review was conducted based on MEDLINE, using the terms “telemedicine”, “primary health care”, “mental health”, and “telemental health”. Further information was collected through the Brazilian Ministry of Health and Brazilian Telehealth Network Program websites and personal communication.
Results
The outlook of telehealth in Brazil
Initiated within university academic and research circles99 Santos AF, Souza C, Alves HJ, Melo MCB, Santos SF. Structuring of
the Brazilian Public Health System and the Development of Telehealth Activities
in Brazil. Latin Am J Telehealth. 2009;1(1):5-38., the practice of Telehealth in Brazil, has been
bold and innovative, providing positive results, improving the quality of care
and has taken a significant role in the public health system1010 Haddad AE. Experiência Brasileira do Programa Nacional Telessaúde
Brasil. In: Mathias I, Monteiro A. Gold Book [on-line]: inovação tecnológica em
educação e saúde. Rio de Janeiro: Ed. UERJ; 2012. Available from:
http://www.telessaude.uerj.br/resource/goldbook/pdf/2.pdf. Accessed on: March 4,
2014.
http://www.telessaude.uerj.br/resource/g...
.
Structure
The practice of telemedicine began in early 1990’s with local research projects
and applications. In 2006, an initial nationwide strategy was established with
the creation of the Rede Universitária de Telemedicina (University Telemedicine
Network-RUTE, http://www.rnp.br), which linked academic hospitals into a
national high-capacity information backbone to provide telemedicine and
videoconferencing capabilities. In 2007, the Brazilian Telehealth Program was
created by nine universities in partnership with the Brazilian government and
integrated with the Primary Care Health System99 Santos AF, Souza C, Alves HJ, Melo MCB, Santos SF. Structuring of
the Brazilian Public Health System and the Development of Telehealth Activities
in Brazil. Latin Am J Telehealth. 2009;1(1):5-38.. In 2011 the program was expanded and denominated
Programa Telessaúde Brasil Redes (Brazilian Telehealth Network Program - BTNP -
www.saude.gov.br and www.telessaudebrasil.org.br)1111 BRASIL. Ministério da Saúde. Programa Telessaúde Brasil. Brasília:
Ministério. Available at: http://www.saude.gov.br. Accessed on: March 4,
2014.
http://www.saude.gov.br...
. BTNP proposes to integrate primary care Family
Health Teams (FHT) with designated university telehealth centers to improve the
quality of primary care services, reduce health costs through professional
training, reduce travel for patients and professionals, increase activities
focused on disease prevention and support strategies that strengthen the
integration between health centers. Until 2013, the BTNP was implemented in 14
states, with 14 telehealth centers in universities linking 5,034 telehealth
sites (usually based on primary care health facilities) in 3,000
municipalities1111 BRASIL. Ministério da Saúde. Programa Telessaúde Brasil. Brasília:
Ministério. Available at: http://www.saude.gov.br. Accessed on: March 4,
2014.
http://www.saude.gov.br...
.
Standards and regulations
The Brazilian Medicine Board defines and regulates telemedicine services and
establishes technological infrastructure standards and regional boards to
monitor services. Activities are restricted to medical video-consultations and
inspections, second opinion consulting and education with physicians present in
all environments1212 Conselho Federal de Medicina. Resolução CFM 1643/2002. Available
from: http://www.portalmedico.org.br/resolucoes/cfm/2002/1643_2002.htm. Accessed
on: March 4, 2014.
http://www.portalmedico.org.br/resolucoe...
. The use of
video conferencing for primary care is widely used in various medical
specialties within the BTNP and features extensive technical, ethical and legal
support from the Ministry of Health1313 BRASIL. Ministério da Saúde. Manual de telessaúde para a atenção
básica/atenção primária em saúde. Brasília, Ministério da Saúde,
2012..
Education
In 2010, the Brazilian Ministry of Health initiated the Universidade Aberta do Sistema Unificado de Saúde (Health System Open University for the Unified Health System – UNA-SUS – www.unasus.gov.br), an internet educational environment in collaboration with several educational institution, local authorities and other agencies, to support the ongoing training of health professionals and facilitates interactions between academic centers.
Patient care
The BTNP is most used by primary care health professionals to obtain asynchronous
second opinions, usually performed in the regional telehealth centers and has
been recommended before authorizing the removal of a patient to a secondary
health1010 Haddad AE. Experiência Brasileira do Programa Nacional Telessaúde
Brasil. In: Mathias I, Monteiro A. Gold Book [on-line]: inovação tecnológica em
educação e saúde. Rio de Janeiro: Ed. UERJ; 2012. Available from:
http://www.telessaude.uerj.br/resource/goldbook/pdf/2.pdf. Accessed on: March 4,
2014.
http://www.telessaude.uerj.br/resource/g...
,1111 BRASIL. Ministério da Saúde. Programa Telessaúde Brasil. Brasília:
Ministério. Available at: http://www.saude.gov.br. Accessed on: March 4,
2014.
http://www.saude.gov.br...
. These activities have been
effective in reducing referrals to medical specialists1313 BRASIL. Ministério da Saúde. Manual de telessaúde para a atenção
básica/atenção primária em saúde. Brasília, Ministério da Saúde,
2012.. National second opinion platforms have been
created, such as the HealthNet1414 Barbosa AK, Novaes MA, Vasconcelos AML. A Web Application to Support
Telemedicine Services in Brazil. AMIA Annu Symp Proc.
2003;2003:56-60. for areas without local reference.
Telemental health in Brazil
The first TMH experiment in Brazil took place in 2007 with a pilot project for video-conference in São Lourenço do Sul between a mental health public facility for chronic mental disorders, the Centro de Atenção Psicossocial (CAPS), and outpatient units with participation of psychiatrists, general practioners, patients and relatives. After initial skepticism, the experience was incorporated in daily practice activity, reducing the number of hospitalizations1515 Resmini F, Tavares AP, Sparenberg A, Russomano T, Bainy S, Timm R, et al. Telepsychiatry: a new tool for remodelling mental health assistance in South Brazil. The International eHealth, Telemedicine and Health ICT Forum, Luxembourg, 2008 – Proceedings – Chapter 12 Telepsychiatry: Why Not?, 395.. In 2008, the first papers about TMH in Brazil were published, stressing the future impact of Telepsychiatry in Brazil1616 Guzman CS, Pignatiello A. The benefits of implementing telepsychiatry in the Brazilian Mental Health System. Rev Bras Psiquiatr. 2008;30(3):300-1. and the relevance of internet-based strategies to deliver effective mental health interventions for children1717 Graeff-Martins AS, Flament MF, Fayyad J, Tyano S, Jensen P, Rohde LA. Diffusion of efficacious interventions for children and adolescents with mental health problems. J Child Psychol Psychiatry. 2008;49(3):335-52., and a tele-education program for primary care teams using webconferencing1818 Novaes MA, Machiavelli JL, Villa-Verde FC, Campos-Filho AS, Rodrigues TRC. Tele-educação para educação continuada das equipes de saúde da família em saúde mental: a experiência de Pernambuco, Brasil. Interface, Comunicação, Saúde, Educação. 2012;16(43):545-56.. The four most actives centers in Brazil are the Psychiatry Institute from the Federal University of Rio de Janeiro (www.ipub.ufrj.br/portal/ensino-e-pesquisa/telessaude), Rio Grande do Sul (RS) State Telehealth Program (www.ufrgs.br/telessauders), the Telehealth Center of the Federal University of Pernambuco (NUTES-UFPE – www.nutes.ufpe.br) and Amazonas State University (www.twlwssaudeam.org.br). Although there are several mHealth initiatives in Brazil, there is no one in progress for mental health1919 Iwaya LH, Gomes MA, Simplício MA, Carvalho TC, Dominicini CK, Sakuragui RR, et al. Mobile health in emerging countries: a survey of research initiatives in Brazil. Int J Med Inform. 2013;82(5):283-98..
Structure
Local structural changes to establish and integrate TMH activities (i.e., video-conference environments) occur in many centers with mental health teams involved in the BTNP. The integration of mental health care into primary care is restricted to academic initiatives associated with the following areas and objectives:
-
Coverage: extend assistance coverage of assistance to the most prevalent mental disorders.
-
Recognition/Resolution: increase mental disorder recognition and resolution rates in primary care settings.
-
Referral and Counter-Referral Services Integration: facilitate a direct channel of communication between the different services networks and improve medical record tracking.
-
Training and Continuing Education: expand training and technical skills for the detection and treatment of the most prevalent mental disorders.
-
Integration with eSUS-AB: the Brazilian ehealth strategy and patient electronic health record to primary care (http://dab.saude.gov.br/portaldab/esus.php).
Two projects are in progress at the Riberão Preto Medical School-USP, aiming to
develop intuitive electronic health records management in the mental health care net
via web and evaluate CAPS performance2020 Sasso AM. Desenvolvimento de um sistema para a gestão de desempenho
de um Centro de Atenção Psicossocial (CAPS). Monografia (Graduação) – Faculdade
de Medicina de Ribeirão Preto e Faculdade de Filosofia Ciências e Letras de
Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2012. 118
p.,2121 Yoshiura VT, Del-ben CM, Alves D. Desenvolvimento e implantação de
um sistema web para o acesso e monitoramento da rede de saúde mental. Available
from: http://wiki.icmc.usp.br/images/2/2f/Mat07-atencaoHospitalar-01.pdf.
Accessed on: August 12, 2014.
http://wiki.icmc.usp.br/images/2/2f/Mat0...
.
The PROMENTAL (personal communication) project, a trans-disciplinary participatory management structure with a Collaborative Community-Based Care approach2222 Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unutzer J. Grand challenges: integrating mental health services into priority health care platforms. PLoS Med. 2013;10(5):e1001448. model for mental health delivery (already initiated in Pernambuco and to be implemented in São Paulo), consists of four modules: Module 1: Brief home screening of psychiatric disorders applied by community health agents during regular home visits. Module 2: Primary Care waiting room mental health screening and therapeutic guidance. Module 3: Second Opinion Consulting and Collaborative Community Care Management, an online platform dedicated to case management and referrals provided through asynchronous and synchronous methods. Module 4: Web interactive educational platform updates and best practice of common psychiatric disorders and the use of technology tools.
Data collection will be performed using Dynamic Interview Database software (developed by University of São Paulo – USP – www.escience.ime.usp.br/data/index.php/related-projects/didb), and the HealthNet Mobile platform (developed by NUTES/UFPE, www.nutes.ufpe.br/healthnet) using tablets, smartphones and psychometric screening properties will be evaluated in São Paulo and Pernambuco.
Standards and regulations
The Brazilian Medicine Board does not have specific TMH standards and regulations for
physicians; therefore, the activity is restricted to medical video-consultations and
inspections, second opinion consulting and education1212 Conselho Federal de Medicina. Resolução CFM 1643/2002. Available
from: http://www.portalmedico.org.br/resolucoes/cfm/2002/1643_2002.htm. Accessed
on: March 4, 2014.
http://www.portalmedico.org.br/resolucoe...
. The Federal Board of Psychology (FBP) is less
restrictive, allowing up to 20 clinical sessions staff selection activities,
application testing, and the supervision of in-training psychologists. Psychologists
are required to have regional board certification and follow the FBP technical
standards for telehealth activities2323 Conselho Federal de Psicologia. Resolução CFP 011/2012. Available
from:
http://site.cfp.org.br/wp-content/uploads/2012/07/Resoluxo_CFP_nx_011-12.pdf.
Accessed on: March 4, 2014.
http://site.cfp.org.br/wp-content/upload...
. To date, nonspecific resolutions control nursing
telemedicine activities.
Education
Fontanive2424 Fontanive PVN. Necessidades em educação permanente percebida por profissionais médicos das equipes da estratégia saúde da família dos municípios do projeto telessaúde – RS. Tese-Mestrado. Porto Alegre: Universidade Federal do Rio Grande do Sul, 2009. described the relevance of mental health education in the BTNP. Of the top 5 medical education needs, 4 lie within the mental health field (i.e. alcohol and drug abuse, depression and mood disorders, psychosis, and dementia). The mental health videoconference education program implemented by The Telehealth Center at the Federal University of Pernambuco has been rated as relevant by 95% of participants1818 Novaes MA, Machiavelli JL, Villa-Verde FC, Campos-Filho AS, Rodrigues TRC. Tele-educação para educação continuada das equipes de saúde da família em saúde mental: a experiência de Pernambuco, Brasil. Interface, Comunicação, Saúde, Educação. 2012;16(43):545-56.. Two educational programs for child and adolescent mental health have been created and evaluated at the Institute of Developmental Psychiatry for Children and Adolescents (INPD – www.inpd.org.br) to: train family physician to detect and monitor children with mental health problems2525 Lowental R. Saúde mental na infância: proposta de capacitação para atenção primária. 1. ed. São Paulo: Editora Mackenzie, 2013. v. 1. 103 p. and training elementary schools teachers on the detection of mental health disorders in children2626 Pereira CA, Wen CL, Miguel EC, Polanczyk GV. A randomized controlled trial of a web-based training program in childhood mental health for school teachers. Eur Child Adoles Psy. Submitted July, 2013.. In 2013, the Federal University of Maranhão (UFMA) with UNA-SUS (http://www.unasus.ufma.br), in partnership with the Institute of Psychiatry from the University of São Paulo (IPq-USP), completed the first distance education course for specialization in mental health in primary care and certified 364 primary care health professionals. The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) at the Federal University of São Paulo2626 Pereira CA, Wen CL, Miguel EC, Polanczyk GV. A randomized controlled trial of a web-based training program in childhood mental health for school teachers. Eur Child Adoles Psy. Submitted July, 2013. and the UNASUS-UFMA has been developing web educational programs on alcohol and other drugs dependencies2727 Laranjeira R, Mitsuhiro SS. Addiction research centers and the nurturing of creativity. National institute on alcohol and drugs policies, Brazil. Addiction. 2012;107(4):727-32.. The IPq-USP in collaboration with the USP’s Telemedicine Department are developing the Telepsychiatry for Primary Care (Telepsiquiatria para Atenção Primária) educational web page for primary care health professionals (www.nuvemdasaude.org.br/aia/index.php).
Patient care
In the area of patient care, NUTES-UFPE and the INPD proposed a cohort study to evaluate the effectiveness of mental telehealth and the screening of mental health disorders applied through mobile devices (http://inpd.org.br/projetos/projeto-15). The projects presented at the two former sections are deeply associated with providing mental health care support as well (www.nutes.ufpe.br/telessaudemental). At IPq-USP the first Brazilian randomized clinical trial on the effectiveness of telemental health for the outpatient treatment of depression is in progress (personal comunication).
Discussion
The BTNP program is well positioned to improve the quality of primary care services
and the integration of FHTs with academic centers. However, telehealth standards and
regulations for physicians’ activities remain very restrictive. Brazilian Telemental
health initiatives are in accordance with the new model for mental health in primary
health-care settings2222 Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unutzer J.
Grand challenges: integrating mental health services into priority health care
platforms. PLoS Med. 2013;10(5):e1001448. and aligned
with other examples around the world focused on integration of mental health care
into primary care around the world2828 Rebello T, Marques AH, Gureie O. Pike K. Innovative strategies for
closing the mental health treatment gap globally. Curr Opin Psychiatry.
2014;27(4):308-14.. A huge challenge must be overcome considering the
regional differences and the telehealth implementation already experienced in
Brazil’s public health. Mainly, regarding resistance of technology implementation in
the work environment, higher number of cases and with greater complexity to be
followed, as well as confidentiality and health record usability by
multidisciplinary teams1515 Resmini F, Tavares AP, Sparenberg A, Russomano T, Bainy S, Timm R,
et al. Telepsychiatry: a new tool for remodelling mental health assistance in
South Brazil. The International eHealth, Telemedicine and Health ICT Forum,
Luxembourg, 2008 – Proceedings – Chapter 12 Telepsychiatry: Why Not?,
395.,2929 Reitz R, Common K, Fifield P, Stiasny E. Collaboration in the
presence of an electronic health record. Fam Syst Health.
2012;30(1):72-80.
30 Mourão AD, Neves TR. Impactos da implantação do prontuário
eletrônico do paciente sobre o trabalho dos profissionais de saúde da Prefeitura
Municipal de Belo Horizonte. Associação Educacional Dom Bosco. Available at:
http://www.aedb.br/seget/artigos07/56_SEGET.pdf. Access on: Mar 4,
2014.
http://www.aedb.br/seget/artigos07/56_SE...
-3131 Cofiel LPV, Ray RK, Dias RS, Roedel PM, Gutierrez MA, Brentani H.
Electronic health records requirements from the psychiatry point of view: the
result of a 18 month implementation experience. BMC Medical Informatics and
Decision Making, 2014.. Historically, now there is an opportunity to articulate a
TMH national program and coordinated research to detect high-risk status, early
stage disorder, combine pharmacological and psychosocial interventions in a
stepped-care fashion with long-term follow-up based on scientific evidences looking
forward to improve mental health care service delivery and access to proper mental
health care in primary care.
References
-
1Collins PY, Patel V, Joestl SS, March D, Insel TR. Grand challenges in global mental health. Nature. 2011;475:27-30.
-
2Guimarães FJ, Santos PKS, Soares NS, Cunha IPV, Farias JCLA, Campos Filho AS, et al. Fluxo de cuidado na rede pública de saúde mental. Cad Bras Saúde Ment. Submitted on: 3/5/2013.
-
3Andrade LH, Wang Y-P, Andreoni S, Silveira CM, Alexandrino-Silva C, Siu ER, et al. Mental Disorders in Megacities: Findings from the São Paulo Megacity Mental Health Survey, Brazil. PLoS One. 2012;7(2):e31879.
-
4Lampe L, Shadbolt N, Starcevic V, Boyce P, Brakoulias V, Hitching R, et al. Diagnostic processes in mental health: GPs and psychiatrists reading from the same book but on a different page. Australas Psychiatry. 2012;20:374-8.
-
5Gregório G, Tomlinson M, Gerolin J, Kieling C, Moreira HC, Razzouk D, et al. Setting priorities for mental health research in Brazil. Rev Bras Psiquiatr. 2012;34(4):434-9.
-
6American Telemedicine Association. Last accessed on 2014, March 4. Available from: http://www.americantelemed.org/home.
» http://www.americantelemed.org/home -
7Hilty DM1, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health. 2013;19(6):444-54.
-
8Shore JH. Telepsychiatry: videoconferencing in the delivery of psychiatric care. Am J Psychiatry. 2013;170:256-62.
-
9Santos AF, Souza C, Alves HJ, Melo MCB, Santos SF. Structuring of the Brazilian Public Health System and the Development of Telehealth Activities in Brazil. Latin Am J Telehealth. 2009;1(1):5-38.
-
10Haddad AE. Experiência Brasileira do Programa Nacional Telessaúde Brasil. In: Mathias I, Monteiro A. Gold Book [on-line]: inovação tecnológica em educação e saúde. Rio de Janeiro: Ed. UERJ; 2012. Available from: http://www.telessaude.uerj.br/resource/goldbook/pdf/2.pdf. Accessed on: March 4, 2014.
» http://www.telessaude.uerj.br/resource/goldbook/pdf/2.pdf -
11BRASIL. Ministério da Saúde. Programa Telessaúde Brasil. Brasília: Ministério. Available at: http://www.saude.gov.br. Accessed on: March 4, 2014.
» http://www.saude.gov.br -
12Conselho Federal de Medicina. Resolução CFM 1643/2002. Available from: http://www.portalmedico.org.br/resolucoes/cfm/2002/1643_2002.htm. Accessed on: March 4, 2014.
» http://www.portalmedico.org.br/resolucoes/cfm/2002/1643_2002.htm -
13BRASIL. Ministério da Saúde. Manual de telessaúde para a atenção básica/atenção primária em saúde. Brasília, Ministério da Saúde, 2012.
-
14Barbosa AK, Novaes MA, Vasconcelos AML. A Web Application to Support Telemedicine Services in Brazil. AMIA Annu Symp Proc. 2003;2003:56-60.
-
15Resmini F, Tavares AP, Sparenberg A, Russomano T, Bainy S, Timm R, et al. Telepsychiatry: a new tool for remodelling mental health assistance in South Brazil. The International eHealth, Telemedicine and Health ICT Forum, Luxembourg, 2008 – Proceedings – Chapter 12 Telepsychiatry: Why Not?, 395.
-
16Guzman CS, Pignatiello A. The benefits of implementing telepsychiatry in the Brazilian Mental Health System. Rev Bras Psiquiatr. 2008;30(3):300-1.
-
17Graeff-Martins AS, Flament MF, Fayyad J, Tyano S, Jensen P, Rohde LA. Diffusion of efficacious interventions for children and adolescents with mental health problems. J Child Psychol Psychiatry. 2008;49(3):335-52.
-
18Novaes MA, Machiavelli JL, Villa-Verde FC, Campos-Filho AS, Rodrigues TRC. Tele-educação para educação continuada das equipes de saúde da família em saúde mental: a experiência de Pernambuco, Brasil. Interface, Comunicação, Saúde, Educação. 2012;16(43):545-56.
-
19Iwaya LH, Gomes MA, Simplício MA, Carvalho TC, Dominicini CK, Sakuragui RR, et al. Mobile health in emerging countries: a survey of research initiatives in Brazil. Int J Med Inform. 2013;82(5):283-98.
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Funding/financial disclosure statementThis study did not receive funding.
Publication Dates
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Publication in this collection
Mar-Apr 2015
History
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Received
26 Jan 2015 -
Accepted
2 Mar 2015