BACKGROUND: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260.

No description available.

To address emerging challenges in empowering patients through telehealth, this dissertation has the following objectives: (a) find the key characteristics that enable patient empowerment [PE], (b) determining when will PE work as a solution, (c) find the optimal telehealth care method that enables PE, and (d) evaluate the impact of telehealth on health care outcomes (such as, patient satisfaction, patient trust with primary care providers, etc.) that ultimately enhances PE. These objectives are addressed in three studies presented here as three essays. Collectively, these essays contribute to the knowledge on PE, patient trust, and telehealth by providing insights on leveraging PE towards better health care services and delivery systems. Essay 1 aims to systemically map the concept of PE using principles of systems thinking with the Boardman soft systems methodology that enables a graphical visualization (i.e., systemigrams). Essay 2 investigates the practical and theoretical implications of connecting patients to empowerment care plans and minimizing wait times in healthcare service delivery using electronic prescriptions (s-scripts), phone calls, and video calls. In Essay 3, the mediating role of telehealth services between patient empowerment and patient satisfaction was analyzed, along with patient trust was assessed as a moderator between telehealth usability and patient satisfaction. Two hundred sixty-two responses from patients in North America with chronic illnesses were collected through an online survey questionnaire were analyzed using partial least squares-structural equation modeling (PLS-SEM). The findings of the research show that patients with chronic illnesses in North America feel empowered by using telehealth as they can get diagnosis of the illness even in remote areas and face no obstacle.

Recent years have seen an influx of medical technologies capable of remotely monitoring the health and behaviours of individuals to detect, manage and prevent health problems. Known collectively as personal health monitoring (PHM), these systems are intended to supplement medical care with health monitoring outside traditional care environments such as hospitals, ranging in complexity from mobile devices to complex networks of sensors measuring physiological parameters and behaviours. This research project assesses the potential ethical implications of PHM as an emerging medical technology, amenable to anticipatory action intended to prevent or mitigate problematic ethical issues in the future. PHM fundamentally changes how medical care can be delivered: patients can be monitored and consulted at a distance, eliminating opportunities for face-to-face actions and potentially undermining the importance of social, emotional and psychological aspects of medical care. The norms evident in this movement may clash with existing standards of 'good' medical practice from the perspective of patients, clinicians and institutions. By relating utilitarianism, virtue ethics and theories of surveillance to Habermas' concept of colonisation of the lifeworld, a conceptual framework is created which can explain how PHM may be allowed to change medicine as a practice in an ethically problematic way. The framework relates the inhibition of virtuous behaviour among practitioners of medicine, understood as a moral practice, to the movement in medicine towards remote monitoring. To assess the explanatory power of the conceptual framework and expand its borders, a qualitative interview empirical study with potential users of PHM in England is carried out. Recognising that the inherent uncertainty of the future undermines the validity of empirical research, a novel epistemological framework based in Habermas' discourse ethics is created to justify the empirical study. By developing Habermas' concept of translation into a procedure for assessing the credibility of uncertain normative claims about the future, a novel methodology for empirical ethical assessment of emerging technologies is created and tested. Various methods of analysis are employed, including review of academic discourses, empirical and theoretical analyses of the moral potential of PHM. Recommendations are made concerning ethical issues in the deployment and design of PHM systems, analysis and application of PHM data, and the shortcomings of existing research and protection mechanisms in responding to potential ethical implications of the technology.

L’amélioration de la prise en charge du cancer est un enjeu de santé publique important compte tenu des impacts de cette maladie pour la santé publique. Les technologies de l’information et de communication (TIC) sont perçues comme une solution pouvant contribuer à l’amélioration de cette prise en charge. Malgré cela, peu d’expériences évaluent leur utilisation dans un contexte de coordination des soins en cancérologie. Le but de ce mémoire est d’apprécier comment les TIC peuvent être utilisées pour améliorer la coordination des soins en cancérologie et de décrire quelles sont les stratégies pouvant permettre leur succès. Deux articles ont été rédigés avec chacun un objectif rattaché au but global du mémoire. L’objectif du premier article est de rassembler les connaissances existantes relatives aux usages des TIC pouvant être à même de fournir une amélioration de la coordination des soins en cancérologie. Il présente les résultats d’une revue de littérature ayant identifié six types d’usages des TIC pouvant être utilisés dans un parcours coordonné. Il propose six recommandations pouvant contribuer à la réussite de leur conception et de leur implantation. Les plus importantes sont la planification rigoureuse du design de l’intervention et l’amélioration des stratégies de gestion de projet. Le deuxième article a comme objectif de connaître la perception des professionnels de soins par rapport à l’utilisation des technologies mobiles. Il analyse les perceptions et les attentes de professionnels oeuvrant dans un centre de cancérologie spécialisé (France) à partir de 10 entretiens faits auprès d’individus rattachés à divers services. Leur analyse permet de constater l’attitude favorable à l’utilisation de TIC mobiles en cancérologie et le peu de craintes associées aux impacts néfastes qu’il pourrait avoir. Elle met en évidence l’importance des enjeux organisationnels nécessaire à la mise en place et au succès de cette intervention. Ces deux études permettent de constater les rapprochements et les écarts entre les usages et recommandations tirés de la littérature et les perceptions des répondants en cancérologie. Mots-clés : technologies de l’information, cancérologie, parcours coordonné, étude de cas, revue de littérature, coordination des soins, enjeux organisationnels, usages des TIC. / The impact of cancer care is a major public health issue, mainly because of both its major health and economic impacts. The use of information technologies (IT) is seen as a solution that can contribute to reduce the load associated with cancer. Despite this, there are only few experiments evaluating their use in the cancer care. The purpose of this memoir is to find ways how IT can be used to improve this situation and describe what strategies can help them succeed. To do so, this memoir presents two articles each pursuing a goal related to that global objective. The first article aims to gather existing knowledge on how the use of IT may provide better coordination of cancer care. It presents the results of a literature review that built a typology of six uses in which IT can be used to provide better care coordination. It also offers six recommendations to insure the success of their design and their implementation. The two most important ones are rigorous planning and strong intervention design. The second article reports and analyse the perception of health professionals in relation to the use of mobile technologies in a cancer care setting. It presents data gathered from 10 interviews conducted a the cancer center (France). Their analysis shows that most of them have a positive attitude towards the use of IT in cancer care. It also denotes some of the fears associated with the adverse impacts it may bring. The results highlights the importance of considering organizational issues for the implementation of sucessful interventions. These two studies show that there are many similarities and few differences between the usages and recommendations from the literature and the perceptions of the professionnals working in a specialized cancer care center. / Réalisé en cotutelle avec Claude Sicotte PhD Université de Montréal et le Pr. Étienne Minvielle École des Hautes Études en Santé Publique à Paris.

Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.

Ce mémoire est un des segments d'une recherche de plus grande envergure sur le service Info-Santé, et qui se déroule au Centre de Santé et de Services sociaux de Laval. / Les services téléphoniques de consultation en soins infirmiers sont en progression partout dans le monde. On sait que les infirmières qui possèdent une plus longue expérience de pratique au téléphone obtiennent davantage d’informations sur la condition de santé du client qui les consulte que celles qui comptent moins d’années d’expérience. Nous pouvons présumer que les niveaux d’expertise décrits par Benner (1984) expliquent cette différence. Toutefois aucune étude à ce jour ne décrit comment se manifeste cette différence entre les niveaux d’expertise dans la conversation au cours d’une intervention entre l’infirmière et l’appelant. Le but de cette étude descriptive était d’identifier les manifestations de cette expertise dans la communication, lors de la consultation téléphonique. À l’aide du Roter Interaction Analysis System (RIAS), 190 enregistrements d’appels, entre infirmières (N = 15), de divers niveaux de compétence selon la nomenclature de Benner (1984) et les appelants qui les ont consultées, ont été analysés. Les appels étudiés, issus d’une étude de plus grande envergure, devaient être faits par le parent d’un enfant de moins de cinq ans, et devaient faire l’objet d’une première consultation. Il a été possible de nommer des caractéristiques, des forces et des faiblesses communes aux infirmières de chaque niveau d'expertise à l’étude. Bien qu’il existe des différences entre les moins expérimentées et celles qui ont une longue expérience clinique au téléphone, les résultats semblent indiquer que les infirmières de tous les niveaux d’expertise sont fortement centrées sur la tâche d’évaluation de la situation de santé de l’appelant, mais que leurs interventions incluent peu d’énoncés orientés vers l’établissement d’un réel partenariat avec l’appelant. Les résultats obtenus fournissent des informations qui pourraient être utilisées pour élaborer des stratégies de développement professionnel, et guider les administrateurs de ce service dans le choix des indicateurs d’évaluation de la qualité du service et de ses retombés sur sa clientèle. Toutefois un plus grand nombre d’infirmières participantes et un plus grand nombre d’appels permettraient de confirmer les résultats obtenus à partir de ces 190 appels. / Nurse telephone consultation services are rapidly progressing throughout the world. It is known that nurses with a greater experience in telephone practise obtain more information on the client’s health condition when in consultation, than nurses with less experience. We can presume that Patricia Benner’s «levels of nursing experience», (1984), will provide us with an explanation for these differences. Yet, to this day, no study describes how these differences between levels of experience are manifested in conversation during an intervention between the nurse and the client. The object of this descriptive study was to identify the manifestations of this communication expertise during a telephone consultation. Using the Roter interaction analysis system (RIAS), 190 recorded calls between nurses (N = 15) with differing levels of expertise, according to Benner’ nomenclature (1984), and the callers who have consulted them were analyzed. The calls that were studied, from a larger study, were first calls from parents regarding their child aged five years or less. It was possible to observe characteristics, strengths, and weaknesses common to nurses within each level of expertise in this study. Despite the fact that there are differences between nurses with fewer years of experience and nurses with more clinical telephone experience, results seem to indicate that, regardless of their experience, nurses are strongly centered on the task of assessing the caller’s health situation; however, their interventions include few phrases aimed at establishing a true partnership with the caller. Results obtained provide information that could be used to elaborate professional developmental strategies, and guide administrators in their choice of indicators when evaluating service quality and its effect on clientele. Nevertheless, an increased number of nurse participants and a greater number of calls would enable us to confirm the results obtained from these 190 calls.

Réalisé en cotutelle avec Claude Sicotte PhD Université de Montréal et le Pr. Étienne Minvielle École des Hautes Études en Santé Publique à Paris. / L’amélioration de la prise en charge du cancer est un enjeu de santé publique important compte tenu des impacts de cette maladie pour la santé publique. Les technologies de l’information et de communication (TIC) sont perçues comme une solution pouvant contribuer à l’amélioration de cette prise en charge. Malgré cela, peu d’expériences évaluent leur utilisation dans un contexte de coordination des soins en cancérologie. Le but de ce mémoire est d’apprécier comment les TIC peuvent être utilisées pour améliorer la coordination des soins en cancérologie et de décrire quelles sont les stratégies pouvant permettre leur succès. Deux articles ont été rédigés avec chacun un objectif rattaché au but global du mémoire. L’objectif du premier article est de rassembler les connaissances existantes relatives aux usages des TIC pouvant être à même de fournir une amélioration de la coordination des soins en cancérologie. Il présente les résultats d’une revue de littérature ayant identifié six types d’usages des TIC pouvant être utilisés dans un parcours coordonné. Il propose six recommandations pouvant contribuer à la réussite de leur conception et de leur implantation. Les plus importantes sont la planification rigoureuse du design de l’intervention et l’amélioration des stratégies de gestion de projet. Le deuxième article a comme objectif de connaître la perception des professionnels de soins par rapport à l’utilisation des technologies mobiles. Il analyse les perceptions et les attentes de professionnels oeuvrant dans un centre de cancérologie spécialisé (France) à partir de 10 entretiens faits auprès d’individus rattachés à divers services. Leur analyse permet de constater l’attitude favorable à l’utilisation de TIC mobiles en cancérologie et le peu de craintes associées aux impacts néfastes qu’il pourrait avoir. Elle met en évidence l’importance des enjeux organisationnels nécessaire à la mise en place et au succès de cette intervention. Ces deux études permettent de constater les rapprochements et les écarts entre les usages et recommandations tirés de la littérature et les perceptions des répondants en cancérologie. Mots-clés : technologies de l’information, cancérologie, parcours coordonné, étude de cas, revue de littérature, coordination des soins, enjeux organisationnels, usages des TIC. / The impact of cancer care is a major public health issue, mainly because of both its major health and economic impacts. The use of information technologies (IT) is seen as a solution that can contribute to reduce the load associated with cancer. Despite this, there are only few experiments evaluating their use in the cancer care. The purpose of this memoir is to find ways how IT can be used to improve this situation and describe what strategies can help them succeed. To do so, this memoir presents two articles each pursuing a goal related to that global objective. The first article aims to gather existing knowledge on how the use of IT may provide better coordination of cancer care. It presents the results of a literature review that built a typology of six uses in which IT can be used to provide better care coordination. It also offers six recommendations to insure the success of their design and their implementation. The two most important ones are rigorous planning and strong intervention design. The second article reports and analyse the perception of health professionals in relation to the use of mobile technologies in a cancer care setting. It presents data gathered from 10 interviews conducted a the cancer center (France). Their analysis shows that most of them have a positive attitude towards the use of IT in cancer care. It also denotes some of the fears associated with the adverse impacts it may bring. The results highlights the importance of considering organizational issues for the implementation of sucessful interventions. These two studies show that there are many similarities and few differences between the usages and recommendations from the literature and the perceptions of the professionnals working in a specialized cancer care center.

Les services téléphoniques de consultation en soins infirmiers sont en progression partout dans le monde. On sait que les infirmières qui possèdent une plus longue expérience de pratique au téléphone obtiennent davantage d’informations sur la condition de santé du client qui les consulte que celles qui comptent moins d’années d’expérience. Nous pouvons présumer que les niveaux d’expertise décrits par Benner (1984) expliquent cette différence. Toutefois aucune étude à ce jour ne décrit comment se manifeste cette différence entre les niveaux d’expertise dans la conversation au cours d’une intervention entre l’infirmière et l’appelant. Le but de cette étude descriptive était d’identifier les manifestations de cette expertise dans la communication, lors de la consultation téléphonique. À l’aide du Roter Interaction Analysis System (RIAS), 190 enregistrements d’appels, entre infirmières (N = 15), de divers niveaux de compétence selon la nomenclature de Benner (1984) et les appelants qui les ont consultées, ont été analysés. Les appels étudiés, issus d’une étude de plus grande envergure, devaient être faits par le parent d’un enfant de moins de cinq ans, et devaient faire l’objet d’une première consultation. Il a été possible de nommer des caractéristiques, des forces et des faiblesses communes aux infirmières de chaque niveau d'expertise à l’étude. Bien qu’il existe des différences entre les moins expérimentées et celles qui ont une longue expérience clinique au téléphone, les résultats semblent indiquer que les infirmières de tous les niveaux d’expertise sont fortement centrées sur la tâche d’évaluation de la situation de santé de l’appelant, mais que leurs interventions incluent peu d’énoncés orientés vers l’établissement d’un réel partenariat avec l’appelant. Les résultats obtenus fournissent des informations qui pourraient être utilisées pour élaborer des stratégies de développement professionnel, et guider les administrateurs de ce service dans le choix des indicateurs d’évaluation de la qualité du service et de ses retombés sur sa clientèle. Toutefois un plus grand nombre d’infirmières participantes et un plus grand nombre d’appels permettraient de confirmer les résultats obtenus à partir de ces 190 appels. / Nurse telephone consultation services are rapidly progressing throughout the world. It is known that nurses with a greater experience in telephone practise obtain more information on the client’s health condition when in consultation, than nurses with less experience. We can presume that Patricia Benner’s «levels of nursing experience», (1984), will provide us with an explanation for these differences. Yet, to this day, no study describes how these differences between levels of experience are manifested in conversation during an intervention between the nurse and the client. The object of this descriptive study was to identify the manifestations of this communication expertise during a telephone consultation. Using the Roter interaction analysis system (RIAS), 190 recorded calls between nurses (N = 15) with differing levels of expertise, according to Benner’ nomenclature (1984), and the callers who have consulted them were analyzed. The calls that were studied, from a larger study, were first calls from parents regarding their child aged five years or less. It was possible to observe characteristics, strengths, and weaknesses common to nurses within each level of expertise in this study. Despite the fact that there are differences between nurses with fewer years of experience and nurses with more clinical telephone experience, results seem to indicate that, regardless of their experience, nurses are strongly centered on the task of assessing the caller’s health situation; however, their interventions include few phrases aimed at establishing a true partnership with the caller. Results obtained provide information that could be used to elaborate professional developmental strategies, and guide administrators in their choice of indicators when evaluating service quality and its effect on clientele. Nevertheless, an increased number of nurse participants and a greater number of calls would enable us to confirm the results obtained from these 190 calls. / Ce mémoire est un des segments d'une recherche de plus grande envergure sur le service Info-Santé, et qui se déroule au Centre de Santé et de Services sociaux de Laval.

Submitted by Augusto João Américo de Sousa (augustojas@yahoo.com.br) on 2018-08-31T00:51:15Z No. of bitstreams: 1 DissertaçãoFinalMestradoAugusto_Teletriagem2017.pdf: 1598011 bytes, checksum: 1ada674249fd062716dbb942fa347a79 (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2018-09-03T20:28:35Z (GMT) No. of bitstreams: 1 DissertaçãoFinalMestradoAugusto_Teletriagem2017.pdf: 1598011 bytes, checksum: 1ada674249fd062716dbb942fa347a79 (MD5) / Made available in DSpace on 2018-09-11T17:55:38Z (GMT). No. of bitstreams: 1 DissertaçãoFinalMestradoAugusto_Teletriagem2017.pdf: 1598011 bytes, checksum: 1ada674249fd062716dbb942fa347a79 (MD5) Previous issue date: 2017-11-30 / Objetivo – Esta dissertação teve como principal objetivo estudar a existência ou não de benefícios aos usuários na adoção da teletriagem nos sistemas de saúde. Metodologia – Como método optou-se por um estudo exploratório através de pesquisa bibliográfica buscando dados na literatura de experiências internacionais que pudessem fundamentar este estudo. Comparou-se os resultados de serviços de teletriagem implantados em 5 países. Aplicando a metodologia de Kim e Mauborgne buscou-se identificar o tipo de inovação introduzida e seu impacto nos custos e benefícios advindos da inovação. Resultados – Os resultados da análise dos dados mostram que os serviços de teletriagem das experiências internacionais conseguiram reduzir a utilização dos serviços de urgência e emergência e levaram os usuários a priorizar a atenção primária nos sistemas de saúde. Limitações – A principal limitação da pesquisa é que se baseia em experiências internacionais. Houve limitação de tempo e recursos para realização de testes laboratoriais, experimentais e para desenvolvimento de projetos pilotos que pudessem ser aplicado numa pesquisa de campo. Aplicabilidade do trabalho – Os resultados do trabalho permitiram recomendar sua aplicação em estudos com testes e pesquisas de campo, experimentos e simulações realísticas, em serviços de telessaúde no Brasil. Contribuições para a sociedade - O estudo sugere que os serviços de teletriagem teriam potencial de gerar benefícios para os usuários do Sistema Único de Saúde gerando educação em saúde, orientação para o autocuidado e fortalecimento das políticas de atenção primária em saúde. Originalidade – Pelo nosso conhecimento, este é o primeiro estudo que relaciona com teletriagem para os sistemas universais de saúde no Brasil. / Purpuse - This thesis of masters had as main objective to study the existence or not of benefits to the users in the adoption of the teletriage in the healthcare systems. Design/Methodology - As method, we opted for an exploratory study through bibliographical research seeking data in the literature of international experiences that could base this study. The results of teletriage services implemented in 5 countries were compared. Applying the Kim and Mauborgne methodology sought to identify the type of innovation introduced and its impact on the costs and benefits of innovation. Findings - The results of the data analysis show that the telephone triage services of the international experiences have managed to decrease the use of emergency/urgent care services and have led users to prioritize primary care in health systems. Research limitations - The main limitation of the research is that it is based on international experiences. There was limited time and resources for laboratory and experimental tests and pilot project development that could be applied in fieldwork. Practical implications - The results of the study allowed to recommend its application in studies with tests and fieldwork, experiments and realistic simulations, in telehealth services in Brazil. Social implications - The study suggests that teletriage services would have the potential to produce benefits for the users of the Brazilian Public Healthcare System, generating health education, orientation for self-care and strengthening of primary health care policies. Originality - To our knowledge, this is the first study that relates to telegraphy for universal health systems in Brazil.