Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil

Abstract

Introduction

eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction.

Methods

Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis.

Results

Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service.

Conclusion

Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults’ success.

Keywords

eConsults telehealth telemedicine primary care referral and consultation

Introduction

Electronic consultations, also known as eConsults, are a secure asynchronous digital communication tool for primary care professionals, including general practitioners, to seek timely specialist advice. Among their benefits, eConsults can promote educational opportunitiesfor primary care providers, increasing primary healthcare capacity and reducing the need for referrals.^1–3 It can also decrease the time for specialist input, improving communication between healthcare providers, promoting integrated care, and reducing health system costs.^1,2,4

The adoption of eConsults to increase access to specialist care and referral efficiency can be particularly beneficial in large countries with extensive primary care coverage.^4,5 Brazil has the world's largest public and universal healthcare system in the quantity of healthcare users, centres, and covered areas.⁶ Free of cost to anyone at any point of service, the Brazilian public health system has primary care centres distributed across the territory. Primary care centres aim to solve over 85% of health-related issues from their catchment area and function as gatekeepers,⁶ while specialist services are predominantly located in metropolitan and coastal areas.⁷

Implemented in Brazil as part of the National Telehealth Program in 2011, eConsults aims to improve the quality of primary care services and increase access to specialist care.^8,9 Some states and municipalities have successfully implemented eConsults as a compulsory component of their referral workflows since 2015.¹⁰ One example is the largest municipality of Santa Catarina where eConsults became compulsory for referrals to endocrinology, orthopaedic, and rheumatology. Santa Catarina is a southern Brazilian state with 295 municipalities, a territory of over 95,000 square kilometres, and over 7 million inhabitants. Primary care coverage in Santa Catarina reaches approximately 80% of its population.¹¹

In order to increase service efficiency and sustainability, in 2015, the Brazilian Ministry of Health recommended that the adoption of eConsults as a compulsory part of workflows before referring patients to specialised care should attend three criteria: (a) expressive outpatient waiting lists and times for specialist appointments; (b) focused on primary care-sensitive health conditions,¹² and; (c) specialists should be available locally to perform eConsults and provide a specialist consultation in case the referral is needed.¹⁰ From January to October 2023, more than 51,000 eConsults were performed by the Santa Catarina Telehealth Centre,¹² with increasing specialities and municipalities across the state adopting the service.^9,13 eConsults performed in Santa Catarina in 2022 represented 61.9% of the total national and by September 2023 this number reached 73.0%.¹³

However, the magnitude and benefits of eConsult service, such as avoiding referrals deemed unnecessary and the satisfaction of primary care professionals with the service, remain unexplored. Also, the sustainability of eConsults workflows, whether they meet or not the criteria established by the Brazilian Ministry of Health, is questionable. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction with the service. More specifically, this study aims to (a) describe the main characteristics and features of the eConsults service provided by the Santa Catarina Telehealth Centre, performed by each specialty since its implementation in 2015; (b) identify the potential reduction in the number of referrals to specialist services since the detailed eConsults outcome was implemented in 2019; (c) identify the differences between eConsult workflows that follow or do not follow Brazilian Ministry of Health recommendations; and (d) assess primary care professionals satisfaction with eConsult service.

Method

Study design

This is a retrospective longitudinal study, with descriptive analyses of eConsult activity data from 2015 to 2022. The period included in each analysis was defined according to the available data to calculate the outcome measures in order to respond each research question. Domains 1, 3, and 6 of the Model for Assessment of Telemedicine Applications (MAST) were adopted to structure the analyses (Table 1).^14–16

Table 1.

Objectives, research questions, analysis period, and outcome measures.

Objectives	Research question	Period	Outcome measure
MAST domain 1: characteristics of the application
1) Describe the main characteristics and features of the eConsult service provided by the Santa Catarina Telehealth Centre	What is the magnitude of eConsult services performed by Santa Catarina Telehealth Centre?	2015 to 2022	Total number of eConsults performed per year
	What is the predominant modesof communication between primary care professionals and specialists?	2015 to 2022	The proportion of synchronous or asynchronous eConsults per year
MAST domain 3: clinical effectiveness
2) Identify the potential reduction in the number of referrals to specialist services since the detailed eConsult outcome was implemented in 2019	What is the potential of eConsults to reduce referrals for specialist care?	2019 to 2022	Number of eConsults requested to refer the patient to specialist service, per speciality, according to eConsult outcomes: (a) primary care management; (b) referral to specialist care; (c) others, including requests for more information or tests to be able to proceed
MAST domain 6: organisational aspects
3) Identify differences between eConsult workflows that follow or do not follow Brazilian Ministry of Health recommendations	What differences can be identified between established and discontinued eConsult workflows?	2019 to 2022	Total number of eConsults performed per specialty and eConsult outcomes
4) Assess primary care professionals’ satisfaction with eConsult service.	Are primary care professionals satisfied with eConsult service?	2015 to 2022	Level of satisfaction of primary care professionals requesting eConsult when receiving the result through the platform

Study setting

eConsult activity data were collected from the Santa Catarina state-wide telemedicine and telehealth platform (STT), the web-based secure online platform developed and hosted by the Federal University of Santa Catarina and used by the Santa Catarina Telehealth Centre.

Santa Catarina Telehealth Centre

The Santa Catarina Telehealth Centre is a research centre and service provider linked to the Federal University of Santa Catarina. In partnership with the Santa Catarina State Health Department, Santa Catarina Telehealth Centre has been providing a variety of telehealth services, including eConsults, to primary care public centres since 2007.

Among the eConsult-related activities performed are technical support to establish and monitor referral workflows and clinical protocols; development and maintenance of the STT platform; health professionals’ training; and quality assessment of eConsults. Most healthcare professionals requesting and performing eConsults are employed by state or municipal public healthcare services, from different medical (orthopaedists, endocrinologists, cardiologists, nephrologists, psychiatrists, gynaecologists, etc.) and allied healthcare specialities (dietitians, psychologists, nurses, speech pathologist).¹⁷

eConsults can be requested for three purposes: (a) to refer a patient to specialist care (part of a compulsory workflow or not); (b) clinical queries; and (c) workflow queries. STT platform interface for eConsults has evolved to attend to clinical and service needs. Initial synchronous eConsults evolved to asynchronous, where an open written field for both eConsult requests (case description and questions) and responses (eConsult outcome) was used, similar to e-mail communication. To increase the quality of information exchanged and eConsult efficiency, eConsult request and response templates were developed following recommendations from technical and clinical staff and collated from stakeholders’ debriefing meetings. Those templates include an eConsult request form completed by the primary care clinician with compulsory information [patient identification, international classification of diseases (ICD) code, comorbidities, current treatment] or recommended information (clinical history, life habits), with the option to attach images and documents to better describe the case and the query. The eConsult response form, completed by the specialist, has fields conditioned to previous responses and which differ according to the outcome – primary care management or referral to specialist care. All eConsult templates are available online on the STT platform with restricted access according to the user profile and three options have been translated into a document format for future reference: eConsult request, eConsult response with primary care management, and eConsult response with referral to specialist care (Supplementary Material).¹⁷

In 2019, a classification of eConsult outcomes was implemented for cases where the referral to specialist care is intended (Figure 1). Option 1 comprises specialist advice for the case to be managed at primary care, including or not a specialist clinical recommendation, depending on the case. In some referred cases, more information is required to enable better clinical decisions (Option 2). In cases where the referral is maintained, the patient enters the local or state-wide queue for specialist care (Option 3), and a second clinical opinion from the local or state-wide specialist can either give priority to the referral (Categories 3 and 4) or recommend the case to be sent back to primary care (Categories 1 and 2). In cases where the referral is maintained, pathology or image tests can also be requested before the specialist appointment, promoting integrated and more efficient care.⁴

Data collection and analysis

All-purpose eConsult activity data was collected from STT from January 2015 to December 2022, to characterise the use of the service with the yearly overall number of eConsult performed. Possible eConsult outcomes (primary care management, referral to specialist care, or more information needed) were collected from 2019, only in cases where the referral was intended. Specialties that requested less than 1,000 eConsults per year were grouped as ‘other specialties’. When receiving the result of an eConsult for any purpose, primary care professionals were asked how satisfied they were with the service, and responses were collected on a 5-point Likert scale. Retrospective data analysis was performed using R software (version 4.4.1).¹⁸

Ethical considerations

A secondary anonymised dataset was used for this analysis by Santa Catarina Telehealth Centre employees (GB, LN, MC, AB) under a specific agreement. Since there was no identified information in the dataset, a full review by the ethical board was not required.

Results

The results are presented according to the three MAST domains used to framework the analysis.

MAST domain 1: Characteristics of the application

The total number of eConsults performed by the Santa Catarina Telehealth Centre over the 8-year period (2015–2022) was 223,734. This total included eConsults requested to solve clinical or workflow queries or to refer a patient to specialist care. The yearly volume of eConsults performed since 2015 is shown in Figure 2.

While in 2015, approximately 30% of eConsults were performed by video conference using Skype, from 2021 onwards, synchronous modalities did not exist anymore, remaining only asynchronous electronic communication (Table 2).

Table 2.

Proportion of synchronous and asynchronous eConsults performed per year.

Interaction	2015 (%)	2016 (%)	2017 (%)	2018 (%)	2019 (%)	2020 (%)	2021 (%)	2022 (%)
Synchronous	30.3	9.0	6.8	1.9	0.1	0.1	0.0	0.0
Asynchronous	69.7	91.0	93.2	98.1	99.9	99.9	100.0	100.0

MAST domain 3: Clinical effectiveness

Table 3 outlines the total number of eConsults requested to refer patients to specialist care from 2019 to 2022 for specialties that requested over 1,000 eConsults in at least one of the years analysed. The proportion of eConsult outcomes, including primary care management, specialist care referral, or the need for further information, was also presented. The total percentage of eConsults resulting in primary care management was maintained above 30% across the entire period for all specialties, and the need for further information has decreased. Hematology had the highest percentage of eConsults resulting in primary care management, kept above 52% across the period, followed by psychiatry/mental health (above 38.7%), endocrinology (above 31.4%), and orthopaedics (above 30.5%). The lowest percentage of eConsults resulting in primary care management was rheumatology (lower than 21.3%) and gynaecology/obstetrics (lower than 26.4%). Gastroenterology had 17.8% of eConsults resulting in primary care management in 2019, but this workflow was discontinued in 2020.

Table 3.

eConsult outcomes per year grouped by clinical specialities (n > 1000) from 2019 to 2022.

	2019				2020				2021				2022
	eConsult outcome			Total No.	eConsult outcome			Total No.	eConsult outcome			Total No	eConsult outcome			Total No.
Specialties	PC manage^a (%)	Referral^b (%)	More info^c (%)	Total No.	PC manage (%)	Referral (%)	More info (%)	Total No.	PC manage (%)	Referral (%)	More info (%)	Total No	PC manage (%)	Referral (%)	More info (%)	Total No.
Cardiology	24.4	70.8	4.8	689	39.9	55.9	4.2	1749	34.3	60.6	5.1	3545	38.7	58.9	2.4	4,818
Endocrinology	31.4	48.1	20.5	6150	34.5	55.5	10.0	3929	36.6	54.2	9.2	5882	33.1	62.4	4.5	6,913
Gastroenterology	17.8	80.7	1.5	3050	0.0	0.0	100.0	1	0.0	0.0	0.0	0	0.0	0.0	0.0	0
Gynaecology/obstetrics	26.4	70.5	3.1	888	23.5	67.1	9.4	3932	23.4	56.3	20.3	3584	24.2	58.9	16.9	1,780
Hematology	52.5	42.2	5.3	3801	54.8	39.9	5.3	2461	53.9	36.1	10.0	3072	60.1	34.3	5.6	3,762
Nephrology	38.5	55.6	5.9	2722	57.1	42.9	0.0	7	0.0	0.0	0.0	0	42.1	52.5	5.5	2,321
Neurology	17.3	80.3	2.4	4682	22.4	76.3	1.3	621	35.0	61.3	3.7	1422	35.0	64.7	0.3	1,561
Orthopaedics	35.0	50.9	14.1	6643	37.9	51.1	11.0	7465	30.5	64.3	5.2	7335	33.8	62.9	3.3	9,961
Pulmonology	0.0	0.0	0.0	0	48.9	37.8	13.3	45	55.1	39.4	5.5	216	94.1	5.8	0.2	2,421
Psychiatry/mental health	38.7	60.2	1.1	181	60.4	38.7	0.9	111	54.6	44.5	0.9	436	54.1	45.9	0.0	1,567
Rheumatology	15.8	54.9	29.3	3618	21.3	55.4	23.3	525	12.0	61.5	26.5	723	18.4	54.1	27.4	809
Proctology/urology	28.1	56.0	15.9	591	35.0	57.5	7.5	1193	43.6	51.6	4.8	1444	46.6	50.1	3.3	1,811
Other specialties^d (n < 1000)	46.9	50.8	2.3	859	74.0	24.5	1.5	653	23.5	71.2	5.3	153	53.4	45.0	1.7	238
Total	30.2	58.0	11.6	33,874	37.0	54.1	8.9	22,508	34.9	56.2	8.9	27,752	42.1	53.5	4.4	37,962

Source: STT/SC, 2023.

Key: ^aPC manage = eConsult outcome was a recommendation to manage the case at the primary care level; ^bReferral = eConsult outcome to maintain the referral to in-person specialist consultation; ^cMore info = eConsult outcome includes a request for further descriptive case information or pathology/image tests, in order to proceed; ^dOther specialties are those that totalise less than 1,000 eConsults each year and include allergology and immunology, wound care, leprosy, nutrition, ophthalmology, periodontics, and sexual violence.

MAST domain 6: Organisational aspects

Facing high demand for gastroenterology, nephrology, and rheumatology services and a lack of specialists distributed across the state, the Santa Catarina Telehealth Centre employed clinicians to respond to eConsults for these specialities in 2016/2017. These workflows were suspended at the end of 2019 due to the interruption of national funding for the Santa Catarina Telehealth Centre. Nephrology initially had a general workflow for all patients. Once implemented back in 2022 using local specialists, nephrology eConsults have been used exclusively to respond to cases of advanced chronic kidney disease, a condition with expressive waiting lists and times for specialist appointments. Established workflows implemented with local specialists responding to eConsults, such as cardiology, endocrinology, hematology, and orthopaedics, have maintained their performance in terms of the overall number of eConsults and the proportion of cases resulting in primary care management – after recovering from the steep decrease of service use in 2020 (Table 3).

As shown in Figure 3, over 90% of primary care professionals were either satisfied or very satisfied with the service since its implementation in 2015.

Discussion

This article describes the eConsult services provided by the Santa Catarina Telehealth Centre, including the number of eConsults performed and primary care healthcare professionals’ satisfaction with the service since 2015. It also identifies the potential to manage cases in primary care, reducing referrals to specialist care from 2019 to 2022.

The total number of eConsults over the 8-year period (2015–2022) was 223,734. Overall, service use increased from 2015 to 2019, with a reduction in 2020, followed by a steady increase since 2021. The eConsult service has evolved to an asynchronous way of communication with overall primary care professionals’ satisfaction. eConsults resulted in recommended primary care management in more than 30% of cases across the period (2019 to 2022) for all specialties where there was an intention of referring the patient to specialist care. Established workflows with local specialists responding to eConsults – cardiology, endocrinology, hematology, and orthopaedics – maintained or increased their overall number of eConsults and sustained their proportion of primary care management, once recovered from the 2020 reduction in service use. Hematology had the highest percentage of eConsults resulting in primary care management.

The potential to manage cases in primary care, still with access to specialist advice, and increasing referral efficiency is one of the main advantages of eConsults reported in the literature.^1,19–22 Two North American studies reported a 13–31% reduction in the need for a referral for multiple specialties for a 12-month period following implementation,^20,21 and a single specialty study reported a 46% reduction in referrals for hematology.²³ Our study reported a steady proportion of over 30% of all eConsults recommended primary care management across the period, above 52% for hematology and 38% for psychiatry/mental health. The only identified study with higher referral efficiency adopts a specialist-to-specialist eConsult model, where there was no need to refer the patient in 69% of the cases.²⁴

A few hypotheses might explain why the proportion of eConsults resulting in primary care management in this study was higher than those reported in the literature. First, hiring local specialists to respond to eConsults, who will consult those patients who still need specialist appointments, promotes sustainable workflows. Locally hired clinicians usually are on permanent contracts with local public health services and the increased electronic communication between primary care and specialists enhances integrated care with primary care coordination.⁴ Second, the use of eConsults to support primary care-sensitive conditions has the potential to increase primary care capacity to deal with complex cases. Despite the lack of agreement in establishing a list of primary care-sensitive conditions – also known as ambulatory care-sensitive conditions (ACSC) – these are conditions for which early intervention, continuity of care, and integration of service delivery can prevent complications and hospitalisations.^25,26

Making specialist advice available to enable primary care providers to deal with these conditions effectively, in a timely and person-centred manner,¹² optimises not only health outcomes but also upskills primary care professionals. The potential of eConsults to provide education for primary care workers can reach over 50% of the cases, with incremental cost-saving benefits and improved patient experience.²⁷ eConsults can potentially increase primary care professionals’ knowledge, capacity, and confidence to deal with complex cases – another potential benefit of eConsults reported in the literature.¹⁹ Further studies could qualitatively analyse the development of eConsult requests per primary care professional to verify if the complexity of cases or queries changes.

Regarding the overall eConsult service use, it is important to chronologically locate two events that potentially explain the reduction in the overall number of eConsults performed in 2020. At the end of 2019, the Santa Catarina Telehealth Centre suffered a drastic funding cut imposed by the new Federal Government budget. In early 2020, for the first time since its implementation in 2008, the Santa Catarina Telehealth Centre had to partially close its doors,²⁸ relying on the voluntary work of its collaborators and running in its lowest capacity with eConsults responded only by clinicians employed by the Santa Catarina State Health Department or local public health services. National funding was re-established in June 2021, and gradually eConsult workflows were resumed, some new workflows were estabilished and others revamped. Also in 2020, Brazil was devastated by the COVID-19 pandemic, with the second-highest death toll in the world. The nationwide chaos with over 700,000 deaths since January 2020,²⁹ generated different and disproportionate state responses. In Santa Catarina, in-person outpatient consultations were suspended from April to August 2020, and many telehealth initiatives to allow continuity of care with teleconsultations were promptly developed, however, not recommended for first appointments with a new specialist.³⁰

Excluding the 18-month funding-related constraints in 2020–2021, the eConsult service provided by the Santa Catarina Telehealth Centre has continued to grow in use, adoption, workflow efficiency, and clinicians’ satisfaction since its implementation in 2008, here demonstrated from 2015. Initiatives to sustain the service beyond its implementation were in place from the start,³¹ for example, the development and maintenance of a skilled workforce competent to perform telehealth. Different tele-education modalities have been offered to healthcare, administrative, and management professionals focusing on their needs aiming to increase primary care efficiency.^32,33

Other initiatives to promote the sustainability of service refer to the constant development of the digital ecosystem, taking advantage of strong stakeholder engagement established over the years. Santa Catarina Telehealth Centre has been working together with the Federal University of Santa Catarina, Santa Catarina State Health Department, local primary care and regional outpatient networks to consolidate the triad of clinical service provision, research, and education. This strong stakeholder engagement has also been pivotal to maintain the service running, still at minimum capacity during funding interruption. Far from being an ideal scenario, major funding-related constraints indicate the urgent need for funding reforms to sustain telehealth services during government changes and policy redefinitions.³⁴

Still, in relation to the increased overall service use across the analysed period, it is important to acknowledge that eConsults generates a demand previously non-existent, with the possibility of having specialist input to queries that would not necessarily demand a specialist referral. A nephrology study in a North American hospital reported that 45% of primary care professionals would not refer the patient to specialist care if eConsult services did not exist and 41% would not even seek any informal nephrology advice by e-mail or telephone.³⁵

Strengths and limitations

This study showcases a successful eConsult service implemented more than 15 years ago, which complies with best practices recently reported in the literature.³⁶ Some of these practices include eConsult templates with fields for specific questions and case details (Supplemental Material), nationally established criteria eConsult appropriateness,¹⁰ and evolving data recording and evaluation plans. The Santa Catarina Telehealth Centre eConsult service is a model that can be pursued.

The results presented in this study were called ‘potential’ to reduce referrals to specialist care due to the impossibility of identifying if patients were really managed at primary care or referred to specialist care for an in-person appointment. We had access to state-wide specialist service data, but the discrepancy between the higher number of patients with suggested referral as an eConsult outcome compared to the lower number of specialist appointments has raised a few hypotheses. One would be that a large proportion of patients were making private arrangements for their specialist appointment or being referred to local public specialist workflows, a customary practice across the state that was not captured by the state-wide database accessed. Further research could partner with local specialist services to identify if eConsult outcomes recommendations are being followed by primary care professionals.

Constant eConsult interface evolvements explain yearly differences in the datasets and thus limitations in the analysis. For example, eConsult outcome classification was implemented in 2019 and only then assessing the potential reduction of referrals for a large dataset was possible.

In terms of increased primary care capacity, competence, and confidence, further research could explore if eConsult requests by the same primary care professional change over time in terms of the complexity of cases. Also, the potential to increase primary care capacity through the continuous learning that takes place with the exchanging of digital communication with a specialist could be further explored.

Conclusion

In summary, this study unveils the significant impact of eConsults provided by the Santa Catarina Telehealth Centre. Over 8 years, a substantial 223,734 eConsults were performed, showcasing a steady increase in service utilization after a temporary decline in 2020. The shift to asynchronous communication proved effective, and primary care professionals consistently expressed high satisfaction rates.

Importantly, eConsults demonstrated a substantial potential for managing cases at the primary care level, reducing the need for specialist referrals, particularly in hematology and other specialities dealing with primary care-sensitive conditions. This success can be attributed to the practice of hiring local specialists, fostering integrated care, and enabling sustainable workflows.

Despite challenges like funding suspension and COVID-19 pandemic-related restrictions, eConsults emerged as a vital tool in enhancing healthcare delivery. Adopting sustainable practices from implementation has been pivotal to ensure the continuity of service provision in lean times. Further research can delve into eConsult long-term effects on primary care providers’ competence and capacity. Overall, this study underscores the transformative role of eConsults in healthcare efficiency and effectiveness, with implications for broader implementation worldwide.

Supplemental Material

sj-docx-1-jtt-10.1177_1357633X241235426 - Supplemental material for Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil

Supplemental material, sj-docx-1-jtt-10.1177_1357633X241235426 for Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil by Soraia de Camargo Catapan, Guilherme Bruckmann, Luana Gabrielle Nilson, Liam J Caffery, Jaimon T. Kelly, Maria Cristina Marino Calvo, and Antonio Fernando Boing in Journal of Telemedicine and Telecare

Footnotes

Author contributions

SC, LN, LC, MC, AB, project conception; SC, LN, GB, experimental design; GB, LN, MC, AB, data collection; GB, SC, LN, MC, AB, data analysis; all authors, writing and editing the paper; SC, submission.

Conflict of interest

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Maria Cristina Marino Calvo, Antonio Fernando Boing, Luana Gabrielle Nilson, and Guilherme Bruckmann are all staff members of the Santa Catarina Telehealth Centre.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: JK was supported by a postdoctoral fellowship (106081) from the National Heart Foundation of Australia.

ORCID iDs

Soraia de Camargo Catapan

Liam J Caffery

Jaimon T Kelly

Data availability statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Supplemental material

Supplemental material for this article is available online.

References

Liddy

Keely

. Using the quadruple aim framework to measure impact of heath technology implementation: a case study of eConsult. J Am Board Fam Med 2018; 31: 445–455.

Liddy

Moroz

Mihan

, et al. A systematic review of asynchronous, provider-to-provider, electronic consultation services to improve access to specialty care available worldwide. Telemed e-Health 2019; 25: 184–198.

Kwok

Olayiwola

Knox

, et al. Electronic consultation system demonstrates educational benefit for primary care providers. J Telemed Telecare 2018; 24: 465–472.

Maeyama

Calvo

MCM

. A Integração do Telessaúde nas Centrais de Regulação: A Teleconsultoria como Mediadora entre a Atenção Básica e a Atenção Especializada. Rev Bras Educ Med 2018; 42: 63–72.

Liddy

Moroz

Afkham

, et al. Sustainability of a primary care–driven econsult service. Ann Fam Med 2018; 16: 120–126.

Giovanella

Escorel

Lobato

LVC

, et al. Políticas e sistema de saúde no Brasil. 2nd ed. Rio de Janeiro: FIOCRUZ, 2012.

Scheffer

Cassenote

Guilloux

AGA

, et al. Demografia médica no Brasil 2018. 286 p, http://www.flip3d.com.br/web/pub/cfm/index10/?numero=15&edicao=4278#page/1 (2018).

Brasil. Ministério da Saúde. Portaria n^o 2.546, de 27 de outubro de 2011: redefine e amplia o Programa Telessaúde Brasil, que passa a ser denominado Programa Nacional Telessaúde Brasil Redes. pp. 1–7, https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2546_27_10_2011.html (2011).

Nilson

Maeyama

Dolny

, et al. TELESSAÚDE: DA IMPLANTAÇÃO AO ENTENDIMENTO COMO TECNOLOGIA SOCIAL. Rev Bras Tecnol Soc 2018; 5: 33–47.

10.

Brasil. Ministério da Saúde. Secretaria de Gestão do Trabalho e da Educação na Saúde. Departamento de Gestão da Educação na Saúde. Secretaria de Atenção à Saúde. De¬partamento de Atenção Básica. Coordenação Nacional do Programa Telessaúde Brasil Redes. Nota Técnica n^o 5/2015 – DEGES/SGTES/MS. Diretrizes para oferta de atividades do Programa Nacional Telessaúde Brasil Redes. Brasilia; 2015. Report No.: 5.

11.

Ministério da Saúde. Secretaria de Atenção Primária à Saúde (SAPS). e-Gestor. Informação e Gestão da Atenção Básica [Internet]. Cobertura da Atenção Básica do Município de Santa Catarina. [cited 2023 Aug 8], https://egestorab.saude.gov.br/paginas/acessoPublico/relatorios/relHistoricoCoberturaAB.xhtml;jsessionid=jV1314r8LC85MHF+tN7CTW39 (2020).

12.

Gibbons

Bindman

Soljak

, et al.

Defining primary care sensitive conditions: a necessity for effective primary care delivery?

J R Soc Med 2012; 105: 422–428.

13.

Sistema de Monitoramento e Avaliação dos Resultados do Programa Telesaúde – SMART. Modelo Nacional de Interoperabilidade do BTBR. Natal, 2018.

14.

Kidholm

Clemensen

Caffery

, et al. The model for assessment of telemedicine (MAST): a scoping review of empirical studies. J Telemed Telecare 2017; 23: 803–813.

15.

Kidholm

Ekeland

Jensen

, et al. A model for assessment of telemedicine applications: mast. Int J Technol Assess Health Care 2012; 28: 44–51.

16.

Kidholm

Bowes

Dyrehauge

, et al. The MAST manual, https://www.telemed.no/methotelemed (2010).

17.

Universidade Federal de Santa Catarina, Secretaria de Estado da Saúde de Santa Catarina. Projeto Telessaúde VIII para Manutenção do Programa Nacional Telessaúde Brasil Redes em Santa Catarina. Florianópolis, https://www.ufsc.br (2019).

18.

Venables

Smith

. An introduction to R notes on R: a programming environment for data analysis and graphics. [cited 2023 Aug 18], https://cran.r-project.org/doc/manuals/r-release/R-intro.pdf (2023).

19.

Osman

Schick-Makaroff

Thompson

, et al. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health 2019; 4: e001629.

20.

Gaye

Mehrotra

Byrnes-Enoch

, et al. Association of eConsult implementation with access to specialist care in a large urban safety-net system. JAMA Health Forum 2021; 2: E210456.

21.

Anderson

Porto

Angelocci

, et al. The impact of eConsults on access to specialty care for the uninsured in rural Texas. J Health Care Poor Underserved 2022; 33: 779–789.

22.

Russell

Adkins

Hayes

, et al. Electronic consultations (eConsults): a proof of concept trial in Australia. Intern Med J 2022; 52: 2150–2156.

23.

Fogel

Khamisa

Afkham

, et al. Ask the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system. J Telemed Telecare 2017; 23: 421–427.

24.

Keely

Guglani

Mitchell

, et al. Specialists accessing specialty advice: Evaluating utilization, benefits, and impact of care of an e-consultation service. J Telemed Telecare 2023. Online ahead of print.

25.

Health Organization Regional Office for Europe W. Assessing health services delivery performance with hospitalizations for ambulatory care sensitive conditions Working document, http://www.euro.who.int/pubrequest (2016).

26.

Purdy

Paranjothy

Huntley

, et al. Interventions to reduce unplanned hospital admission: a series of systematic reviews. [cited 2024 Feb 5], https://www.bristol.ac.uk/primaryhealthcare/docs/projects/unplannedadmissions.pdf (2012).

27.

Olayiwola

Potapov

Gordon

, et al. Electronic consultation impact from the primary care clinician perspective: Outcomes from a national sample. J Telemed Telecare 2019; 25: 493–498.

28.

Calvo MCM. Telessaude Santa Catarina. Carta sobre o encerramento das atividades do Núcleo de Telessaúde da UFSC. [cited 2023 Aug 29], https://telessaude.ufsc.br/carta_encerramento_telessaudesc_ufsc/ (2020).

29.

World Health Organization. WHO COVID-19 Dashboard. Brazil Situation. 2020.

30.

de Camargo Catapan

Taylor

Calvo

MCM

. Health professionals’ views of medical teleconsultation uptake in the Brazilian Unified Health System: a description using the NASSS framework. Int J Med Inform 2022; 168: 1–8.

31.

Thomas

Haydon

Mehrotra

, et al. Building on the momentum: Sustaining telehealth beyond COVID-19. J Telemed Telecare 2022; 28: 301–308.

32.

Dolny

de Lacerda

Natal

, et al. Serviços de Telessaúde como apoio à Educação Permanente na Atenção Básica à Saúde: uma proposta de modelo avaliativo. Interface - Comunic Saúde Educ 2019; 23: 1–18.

33.

Monteiro

Dolny

Lacerda

. Tele-educação em Santa Catarina: Serviços de suporte à Educação Permanente na Atenção Básica. Rev Catarinense Saúde Família 2017; 7: 43–48.

34.

Catapan

Willemann

MCA

Calvo

MCM

. Structure and work process for implementing medical teleconsultation in the Brazilian National Health System, a cross-sectional study using 2017-2018 data*. Epidemiol Serv Saude 2021; 30: 1–11.

35.

Mendu

McMahon

Licurse

, et al. Electronic consultations in nephrology: Pilot implementation and evaluation. Am J Kidney Dis 2016; 68: 821–823.

36.

Baltaro

Henderson

Batch

, et al. Electronic consultation: A vision for primary care management. J Telemed Telecare 2023: 1357633X2311749. Online ahead of print.

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