Introdução: A estratégia Saúde da Família (SF) se apresenta como uma concretização em larga escala da reorganização de cuidados públicos em saúde baseados em Atenção Primária à Saúde (APS). Avaliada de modo amplamente favorável pelas populações servidas por ela, alcançou também impacto efetivo sobre seu perfil epidemiológico. Enfrenta ainda limitações e contradições. Seu desenlace depende, em importante medida, da continuidade de investimentos em seu aperfeiçoamento estrutural, na qualificação das pessoas que nela trabalham e no desenvolvimento do papel de coordenação do conjunto da rede de serviços do Sistema Único de Saúde. Uma das operações concebidas pelo governo brasileiro com foco na qualificação da SF é o Programa Telessaúde Brasil, com presença inicial em 900 unidades de SF em 9 estados brasileiros. Contribuir para uma avaliação deste Programa é o objetivo desta tese. Métodos: Uma revisão sistemática da literatura foi realizada para conhecer a experiência internacional com telessaúde para qualificação de médicos de APS. Para conhecer as repercussões do Programa Telessaúde Brasil junto a médicos da SF, desenvolveu-se um estudo descritivo sobre a experiência do núcleo Rio Grande do Sul (RS) do mesmo Programa entre 2007 e março de 2010. Resultados: De 8702 artigos filtrados na revisão sistemática, 63 foram incluídos por pertinência temática e estrutura metodológica. Apenas 5 Ensaios Clínicos Randomizados (ECRs), heterogêneos, faziam parte do conjunto, avaliando modo síncrono e assíncrono. Os ECRs apontaram para evitação significativa de exames e referências (exceto cirúrgicas), alta concordância diagnóstica e satisfação de médicos e pacientes. Redução de custos para os pacientes foi verificada no modo síncrono. Demais estudos foram amplamente favoráveis a intervenções de telessaúde para APS. No período considerado em relação ao núcleo RS, 226 médicos de 95 municípios foram integrados ao Programa. Desses, 161 médicos de 54 municípios solicitaram 673 teleconsultorias. Houve 68 médicos que avaliaram as respostas recebidas, perfazendo 294 consultorias avaliadas. Familiaridade prévia com informática prediz maior uso do serviço, mas permanência na SF prediz menor. Solução de dúvidas clínicas ou sobre o processo de trabalho em APS ocorrem na grande maioria dos casos. Os solicitantes têm alta satisfação com seu resultado. Uma referência (ou "encaminhamento") que ocorreria caso tais dúvidas não fossem solucionadas é evitada aproximadamente a cada 2 teleconsultorias. Conteúdo clínico predomina em 93% delas. Conclusões: O conhecimento disponível sobre a contribuição de telessaúde no suporte a médicos de APS carece de consolidação através de estudos que levem em conta os diferentes contextos. É fundamental saber não apenas se um tipo de intervenção é efetiva, mas quando, para quem e com quais recursos ela é efetiva. Além disso, é essencial disseminar a utilização de metodologia mais robusta nas pesquisas. As evidências até aqui coletadas sugerem que telessaúde seja uma intervenção útil para ampliar a resolutividade dos serviços de APS. Embora possam ser questionados em função das limitações já apontadas, os estudos de melhor qualidade até aqui realizados tendem a confirmar os resultados positivos do conjunto do material publicado. No RS, o objetivo de qualificar a prática médica em APS via telessaúde demonstrou-se viável, conforme foi avaliado pelos médicos que utilizaram este serviço junto ao núcleo RS e remeteram suas avaliações. No entanto, os desafios para que a utilização desse tipo de suporte seja mais ampla e intensa devem ser encarados com prioridade. Além disso, estudos em cenários mais permeáveis a comparação com grupo controle serão necessários para conclusões de maior solidez. / Context: The Family Health Strategy (FH) is presented as an achieving large-scale reorganization of public health care based on Primary Health Care (PHC). Evaluated so broadly supportive by the populations served by it, also reached an effective impact on its epidemiological profile. Still faces limitations and contradictions. Its outcome depends, in a significant extent, on the continued investment in its structural improvement, on the qualification of the people who works there and on development of a coordinating role in the whole network of the Unified Health System. One of the operations designed by brazilian government focused on qualification of FH is the Brazilian Telehealth Program. Methods: A systematic literature review was performed to meet the international experience with telehealth on qualifying primary care physicians. To assess the implementation of the Brazilian Telehealth Program to doctors of FH, it was developed an descriptive study on the experience of the Rio Grande do Sul's nucleus of this Program between 2007 and March 2010. Results: Of 8702 articles filtered in the systematic review, 63 were included in due to relevance and methodological structure. Only 5 Randomized Clinical Trials (RCTs) heterogeneous were part of this set, evaluating the synchronous and asynchronous modes. RCTs pointed to significant avoidance of tests and referrals (except surgicals), high diagnostic agreement and satisfaction of physicians and patients. Costs reduction for patients has been seen in synchronous mode. Further studies were broadly supportive to telehealth interventions for primary care. In the period considered, in relation to the RS nucleus, 226 doctors from 95 cities were integrated into the Program. Of these, 161 physicians in 54 municipalities requested 673 teleconsultants. Only 68 doctors assessed the responses, comprising 294 consultants evaluated. Prior familiarity to computer predicts greater use of the service, but remaining in the FH team predicts lower. Solving clinical doubts or work process troubles in PHC occur in the vast majority of cases. Applicants have high satisfaction with their result. Each referral that would occur if such question was not settled are avoided approximately every 2 teleconsultants. Clinical content predominates in 93% of them. Conclusions: The available knowledge about the contribution of telehealth in support of PHC physician needs consolidation through studies that take into account the different contexts. It is essential to know not only whether an intervention is effective, but when, to whom and with which resources it is effective. Moreover, it is essential to disseminate the use of more robust methodology in research. The evidence so far collected suggests that telehealth is an effective intervention for extend the resolution of PHC services. Although they can be questioned due to the limitations already mentioned, the better qualified studies made so far tend to confirm the positive results of all the published material. At Rio Grande do Sul (RS), the objective of qualifying medical practice in PHC via telehealth has been revealed feasible, according rated by doctors who used this service of the RS's nucleus and has sent their ratings. However, the challenges to using this type of support in wider and intense way must be addressed with priority. Furthermore, studies in scenarios more permeable to comparisons to control groups will be needed for more solid conclusions. / Telemedicina

Esta pesquisa teve por objetivo avaliar um website com informações da área de Fonoaudiologia com enfoque em Doença de Parkinson. Foi elaborado um website contendo informações sobre a temática, com linguagem simples, clara e objetiva, com conteúdos concisos, embasados em livros, artigos indexados em bases de dados e manuais sobre a temática. A elaboração do website seguiu as etapas: análise e planejamento, modelagem, implementação e avaliação. Foram convidados avaliadores que fizeram parte das seguintes categorias: idoso (I), cuidador de idoso (CI) e fonoaudiólogo (F). Os grupos preencheram um formulário online com informações sobre identificação, frequência de uso da internet e nível de escolaridade. A amostra foi composta por 45 participantes sendo a maioria do sexo feminino (64,4%), sendo 15 idosos (média etária 68,13 anos), 15 cuidadores de idosos (média etária de 32,20 anos) e 15 fonoaudiólogos (média etária de 26,13 anos). A análise estatística foi realizada por meio do teste Kruskal-Wallis e Coeficiente de Correlação de Spearman. O conteúdo do website foi avaliado como adequado com maior classificação no submenu S4 (84%) e menor nos submenus S5 e S8 (77%). A comparação entre os 3 grupos das notas atribuídas ao conteúdo pelo teste de Kruskal-Wallis não mostrou diferença estatisticamente significante entre eles em nenhum dos submenus. Houve correlação significativa foi do grupo fonoaudiólogo no submenu S3, em relação ao tempo (p=0,006) e idade (p=0,014) com as notas atribuídas. O Coeficiente de Correlação de Spearman deu negativo implicando que quanto maior a idade e o tempo de formado do fonoaudiólogo, menores foram as notas atribuídas no submenu S3. Conclui-se que os conteúdos elaborados fundamentados em literatura científica, compondo um website de fonte de consulta e de complementação de informações confiáveis sobre Doença de Parkinson. / This research aimed to evaluate a website with information from the field of Speech Therapy with a focus on Parkinson\'s Disease. A website containing information on the subject was developed with simple, clear and objective language, with concise content, based on books, articles indexed in databases and manuals on the subject. The preparation of the website followed the steps: analysis and planning, modeling, implementation and evaluation. The evaluators were invited to participate in the following categories: elderly (I), caregiver of elderly (CI) and speech therapist (F). The groups completed an online form with information on identification, frequency of internet use and level of education. The sample consisted of 45 participants, the majority being female (64.4%), 15 elderly (mean age 68.13 years), 15 elderly caregivers (mean age 32.20 years), and 15 speech pathologists (average age of 26.13 years). Statistical analysis was performed using the Kruskal-Wallis test and Spearman\'s correlation coefficient. The content of the website was evaluated as \"appropriate\" with higher ranking in sub-menu S4 (84%) and lower in sub-menus S5 and S8 (77%). The comparison between the 3 groups of grades attributed to the content by the Kruskal-Wallis test did not show a statistically significant difference between them in any of the submenus. There was a significant correlation between the speech-language pathologist group in submenu S3, in relation to time (p = 0.006) and age (p = 0.014) with assigned scores. Spearman\'s Correlation Coefficient was negative, implying that the higher the age and the training time of the speech-language pathologist, the lower the scores assigned in submenu S3. It is concluded that the contents prepared based on scientific literature, composing a source website for consultation and complementing reliable information on Parkinson\'s Disease.

Introduction In Senegal, as in many countries, physicians are unevenly distributed. This situation leads to health inequalities, but the solutions adopted to distribute physicians equitably do not give satisfactory results. This situation pushes decision-makers and researchers to look for other solutions such as telemedicine. This technology-based solution is considered to be a good means to improve physician recruitment and retention in underserved areas, thus improving access to healthcare in these areas, but it is still underused in Senegalese health facilities. Objective This study aimed to identify the determinants of the use of telemedicine in Senegal. More specifically, it aimed to identify the individual (micro) and contextual (meso and macro) factors that influence the use of telemedicine in Senegal. Method The study involved mixed methods: a descriptive qualitative study involving individual interviews and a cross-sectional quantitative study involving questionnaires. The first method was used to study the individual (micro) factors such as physicians’ beliefs on the use of telemedicine and physicians’ perception of the impact of telemedicine on their recruitment and retention in underserved areas. It was also used to study the contextual meso (technical, organizational and ethical) and macro (financial, political, legal and socioeconomic) factors that influence the use of telemedicine. The second method was used to study participants’ intention to use telemedicine in their professional activities, another individual (micro) factor. This study included physicians working in public hospitals, those working in district health, and telemedicine projects managers. Qualitative data was collected through individual interviews, transcribed and imported into NVivo 10 where they were coded thematically. Quantitative data was collected by administering questionnaires and analyzed using SPSS 23. Results The results showed that telemedicine could contribute to, but could not guarantee the recruitment and retention of Senegalese physicians in underserved areas. It was found that physicians in Senegal have both positive and negative behavioural, normative and control beliefs that can encourage or discourage them from using telemedicine in their professional practice. The most salient behavioural beliefs were that telemedicine makes experts’ opinions accessible across distances (positive behavioural belief), but could lead to medical errors (negative behavioural belief). The most common normative beliefs were that their patients would most probably approve the use of telemedicine (positive normative belief) while their colleagues working in the public sector might disapprove of it (negative normative belief). The most reported control beliefs were that the use of telemedicine is easy (positive control belief), but could be time-consuming (negative control belief). For physicians in Senegal, the findings also demonstrate that the probability that they will use telemedicine in their professional activities is moderate and influenced by their perceived behavioural control which, in turn, is influenced by their positive and negative control beliefs. Finally, the results demonstrate that many contextual meso (technical, organizational and ethical) and macro (financial, political, legal and socioeconomic) factors influence the use of telemedicine in Senegal. Conclusion The results of this study can inform the choice of telemedicine development strategies. These strategies can help to promote the use of telemedicine in Senegal, which in turn can help to increase physician recruitment and retention in underserved areas, resulting in better access to healthcare and, and as a result improved population health.

O objetivo do presente trabalho de pesquisa é reduzir o nível de atenção requerido para o uso do sistema Borboleta por meio de reconhecimento de fala na navegação através das funcionalidades do sistema, permitindo ao profissional dar maior atenção ao paciente. A metodologia de desenvolvimento do projeto inclui uma revisão bibliográfica para definir o estado da arte da área, uma pesquisa sobre o software disponível para reconhecimento de fala, uma coleta de dados dos comandos do sistema em português brasileiro para treinar e testar o sistema, uma etapa de projeção e desenvolvimento para definir a arquitetura de integração com o Borboleta, e uma fase de testes para medir a precisão do sistema e seus níveis de usabilidade e aceitação por parte do usuário. / The current document presents research that addresses the goal of reducing the user attention level required by Borboleta operation by providing speech recognition capabilities to augment navigation through the software functions, allowing the professional to pay more attention to the patient. The project methodology is composed of a bibliography revision to establish the state-of-the-art of the field, a review of available speech recognition software, data collection of Brazilian utterances to train and test the system, a design and development stage that defined the system architecture and integration with Borboleta and a testing process to measure the system accuracy, its usability and acceptance level.

No description available.

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non-probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended.

Technology is a promising means for increasing rural individuals’ access to behavioral healthcare. However, the range of technology use in rural areas is currently unknown. The aims of this study were to examine the use of technology in rural areas, the relationship between technology use and willingness to access pediatric mental health services via videoconferencing, and this relationship within the context of other critical variables linked to service uptake. Data were collected at 2 pediatric primary care clinics. While no significant relationship was found between technology use and willingness to use videoconferencing, a significant relationship emerged between previous service seeking and willingness to use videoconferencing. These findings indicate the need for more research examining other variables’ relationships to willingness to seek help via technology, such as general help-seeking attitudes, unfamiliarity with videoconferencing services, or other variables included in previously established models of technology adoption.

Background Due to the COVID-19 pandemic, there was a significant reduction in in-person healthcare visits as a precautionary measure to minimize the risk of infection for both patients and healthcare provides. Consequently, there was a remarkable surge in the adoption of telehealth services, although mental healthcare services were already using it more frequently than primary and specialty care services before the pandemic. Despite the continued increase in telehealth services, there are differing views among healthcare providers on the efficacy of providing healthcare services remotely, leading to an opportunity to investigate this matter further. Objective The primary goal of this study was to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods The proposed study collected primary data through surveying providers across the United States from November 2022-March 2023. The surveys were conducted through REDCap, and disseminated through research staff outreach and recruitment. Providers were asked to complete a 33-item survey, which took them about 30 minutes to finish and queried them about their satisfaction, utilization, and experiences with telehealth. The provider survey was disseminated to both mental health providers and non-mental health providers who use telehealth technology. Descriptive analysis was conducted to determine the characteristics of the population surveyed. Data was then dichotomized by mental health providers vs. non-mental health providers. Differences in mean responses for all variables between mental health and non-mental health providers was assessed using Mann-Whitney U (MW) tests. Results A Mann-Whitney Wilcoxon test indicated that the satisfaction with the telemedicine platform was greater for non-mental healthcare providers than mental healthcare providers (p < .05). A Mann-Whitney Wilcoxon test indicated that the reliability of the telemedicine app for facilitating health care services, that the ability to trust the telemedicine application to work, the lack of physical contact during a video visit being a problem, the video visits being a convenient form of healthcare delivery, the visits on the telehealth system are the same as in-person visits, and that continued use of telehealth services in the future was greater for mental healthcare providers than non-mental healthcare providers (p < .05). Conclusions Looking forward, we expect to see more extensive studies involving providers from various regions and the implementation of additional approaches to enhance their experiences.

No description available.

Telehealth and telemedicine have revolutionized the healthcare system in terms of access to information and remote medical treatment. While there is a great deal of literature on current perceptions of telehealth care systems, relatively little is known about perceived user needs and acceptance of future telehealth systems. One way to assess future attitudes is to evaluate anticipated usage of telehealth devices through perceived advantages and disadvantages. Additionally, this study seeks to assess the reliability of a new measure of technology acceptance that capitalizes on human motivation using self-determination theory. An online survey consisted of an original 40-item measure of motivation to use telehealth technology, the Psychosocial Impact of Assistive Devices Scale (PIADS; Jutai & Day, 1996), questions adapted from Edwards et al. (2014) about perceived advantages and disadvantages of telehealth devices, and open-ended questions about advantages, disadvantages, and concerns of interacting with telehealth devices in the future. The open-ended questions were coded for themes. Results also indicated that there was a high reliability between the MUTT and the PIADS, however the MUTT was slightly more reliable. Significant correlations were found between the overall MUTT and subscales of autonomy, competence, relatedness, and goals, as well as moderate correlations between the subscales of the PIADS (i.e., competence, adaptability, self-esteem) and the MUTT. The results of this research will be discussed further.