Rafael Saad Fernandez

BACKGROUND: Telemedicine can promote access to specialized care and avoid travel to referral centers. OBJECTIVES: To present the environmental impacts and the positive results for the sustainability of the Brazilian public health system after the implementation of the TeleNordeste Project developed by hospital BP – A Beneficência Portuguesa de São Paulo. DESIGN AND SETTING: A retrospective cohort study was developed in three states in the Brazilian Northeast, Alagoas, Maranhão, and Piauí. METHODS: This study was conducted between August 2022 and December 2023. All patients participating in telemedicine care were selected for this type of care by Primary Health Care (PHC) doctors according to the need for clinical discussion. The variables analyzed were the total distance and time (round trip) saved by telemedicine care, the amount of carbon emissions not released into the environment, gasoline costs, resolution of care through teleconsultation, and evaluation of the Net Promoter Score. RESULTS: In total, 25,194 consultations were conducted via telemedicine, requiring in-person referral in 775 tele-interconsultations, representing a resolution rate of 96.92%. It saved approximately 10,737,287 miles (17,279,988.6 km) and 264,302 hours for patients and the municipal health department, and reduced carbon dioxide (CO2) emissions according to Environmental Protection Agency (EPA) parameters, estimated at 4,294,915 kg, saving US$ 1,660,068.89 (R$ 8,532,754.09) on gasoline. CONCLUSION: To our knowledge, in Brazil, this study is one of the first to present results on the impact of telemedicine on reducing carbon emissions in relation to the movement of patients to reference centers in healthcare networks and the resolution of care provided in health units in the context of the PROADI-SUS TeleNordeste Project developed by BP and promotes reflection on the potential benefits of telemedicine according to current evidence.

Objective: To describe the process of conception and articulation of the Care Pathways in Palliative Care in Primary Health Care in the locations served by BP’s TeleNordeste project in the interior of the Brazilian Northeast. Methods: Experience report on the process of designing and articulating Care Pathways in Palliative Care for regions far from urban centers in 3 states in Brazil: Alagoas, Maranhão and Piauí, through the TeleNordeste Project of Hospital Beneficência Portuguesa in São Paulo through the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (SUS) in the 2021-2023 period. After pre-operational alignments with health representatives, processes were defined and training was carried out for local teams on the flows and modalities of care available through telehealth, connecting the patient, doctor from the Basic Health Unit and palliative doctor to establish a care plan timely to the needs of patients. Results: A total 178 teleconsultations were carried out in the specialty of Palliative Care, 124 (69.7%) were teleinterconsultations and 54 (30.3%) were teleconsulting. The median age was 75 years with an interquartile range of 16. Approximately 74,699 miles and 1845 hours of patient time in palliative care were saved. Approximately 29,880 kg of CO2 emissions were avoided. Discussion: The development of Care Pathways presented an innovative proposal for access to specialized Palliative Care in the SUS, considering the sustainability of the health system and promoting better equity in access to palliative care for regions far from reference centers.

The aim of this study was to identify the epidemiological profiles of violence against children, victims, and their aggressors, and their correlations between socioeconomic and demographic factors analyzed before and during the COVID-19 pandemic. This was a cross-sectional, retrospective observational study based on a review of Individual Notification Forms from the Information System for Notifiable Diseases, including child victims of violence, under 18 years, assisted by a pediatric emergency service in Brazil, from 2016–2020. Data were stratified, then statistical analysis was performed using the two-proportion equality test and the Chi-square test, with p < 0.05 and a 95% confidence interval. A total of 609 notifications were analyzed and a prevalence of sexual violence (63.2%) was reported. The prevalent profile of victim was female (76.7%), aged between 2–9 years (38.1%) and 14–18 years (35.6%). The violence occurs in the victim’s home (58.9%). The prevalent profile of perpetrator was male (82.4%), young adolescent (59.2%), living as family (64%), mainly the parents (18.4%). No correlation was found between the classified socioeconomic and demographic variables and violence. There was an increase in notifications during the COVID-19 pandemic, compared to the same period in the previous year; self-harm was reported in 59.7% of physical violence in 2020. Prevalence of sexual violence was higher for females, aged between 2–9 and 14–18 years, victimized in their homes, by male offenders, living as family, mainly by their parents. No association was found between child violence and the socioeconomic and demographic.