Theory of change in the evaluation of telehealth in care support to primary health care in brazil / Teoria da mudança na avaliação d0a telehealth no apoio à atenção à saúde primária no brasil

Authors

  • Luana Gabriele Nilson Brazilian Journals Publicações de Periódicos, São José dos Pinhais, Paraná
  • Antonia Angulo- Tuesta
  • Zulmira Maria de Araújo Hartz
  • Maria Cristina Marino Calvo

DOI:

https://doi.org/10.34119/bjhrv3n3-001

Keywords:

Telehealth, Primary Health Care, Program Evaluation.

Abstract

Background: Telehealth for care support in Public Health is a strategy to strengthen, qualify and increase the resolutivity in health care. However, it still faces challenges for widespread use. Introduction: Brazil is a developing country, whose characteristics of the health system and the working conditions of professionals can be improved with the use of telehealth services provided by a national, public and free program. To understand the processes of use of this program, this article presents a model for evaluation of telehealth for care support in Primary Care in Brazil, guided by the Theory of Change. Materials and Methods: It is a qualitative study, built in four stages: bibliographic analysis; elaboration of the theoretical-logical model; validation by consensus conference among experts; construction of the analysis framework and measures to evaluate the use of services in care support. Results and Discussion: The proposed model resulted in a logical framework with three dimensions: organizational and management scope; knowledge and mastery of technology; human scope and comprehensive health care model. The proposed indicators are guided by the impact of the care support provided by telehealth in Primary Health Care: increase of the quality of care and resolubility; reduction and qualification of referrals to other levels of care; expansion of access with reduced waiting time for services; reduction of costs and optimization of the use of resources within the health system; organization and strengthening of networking; satisfaction and professional fixation in locations far from major centers. Conclusions: A proposed evaluation of telehealth, which aims to understand processes and stimulate change, is useful and necessary to ensure the achievement of the results of the program in the qualification of health care.

 

Keywords: Telehealth; Primary Health Care; Program Evaluation.

References

Crane O, Balen J, Devkota B, Ghimire S, Rushton, S. Use of information and communication technologies in the formal and informal health system responses to the 2015 Nepal earthquakes. Health Policy and Planning 2017;32(suppl_3):iii48-iii58.

Lapão LV, Messina LA, Ungerer R, Campos F. Roteiro estratégico para a telessaúde na CPLP: diagnóstico e prioridades para o desenvolvimento da telessaúde. An Inst Hig Med Trop 2016;15(Supl.1):S65-S73.

Gonçalves CM, Correia ADMS, Monreal VRFD, Nunes EA, Haddad PO. A saúde rompendo distâncias para o ensino e a formação: o Programa Telessaúde Brasil Redes em Mato Grosso do Sul. Faculdade de Tecnologia de Guaratinguetá. Revista Científica On-line Tecnologia – Gestão – Humanismo 2014;1:26-35.

Alkmim MB, Marcolino MS, Figueira RM, Sousa L, Nunes MS, Cardoso CS, Ribeiro AL. Factors Associated with the Use of a Teleconsultation System in Brazilian Primary Care. Telemedicine and e-Health Mary Ann Liebert 2015;Inc.,21(6):1-11.

Scott RE, Mars M. Telehealth in the developing world: current status and future prospects. Smart Homecare Technology na telehealth 2015;3:25-37.

Akhlaq A, Mckinstry B, Muhammad KB, Sheikh, A. Barriers and facilitators to health information exchange in low-and middle-income country settings: a systematic review. Health Policy and Planning 2016;31(9):1310-1325.

Maldonado JMSV, Marques, AB, Cruz A. Telemedicina: desafios à sua difusão no Brasil. Cad. Saúde Pública 2016;32Sup 2:e00155615.

Brasil. Ministério da Saúde. Manual de Telessaúde para Atenção Básica / Atenção Primária à Saúde. Brasília: Ministério da Saúde, 2012. 123. Available at: http://189.28.128.100/dab/docs/portaldab/publicacoes/manual_telessaude.pdf (last accessed March 12, 2016).

Brasil. Ministério da Saúde. Nota Técnica nº50/2015-DEGES/SGTES/MS: Diretrizes para a oferta de atividades do Programa Nacional Telessaúde Brasil Redes. Brasília, DF: MinistériodaSaúde,2015.Availableat:ttp://189.28.128.100/dab/docs/portaldab/notas_tecnicas/Nota_Tecnica_Diretrizes_Telessaude.pdf (last accessed June 08, 2016).

Nilson LG, Dolny LL, Natal S, Lacerda JT, Calvo MCM. Telehealth Centers: A Proposal of a Theoretical Model for Evaluation. Mary Ann Liebert, Inc. Telemedicine and e-health 2017;23(11):905-912.

Ascencio ACS. A Teleducação interativa na capacitação de profissionais em saúde auditiva [dissertação]. Bauru: Universidade de São Paulo, 2012. 119.

Castro Filho ED. Telessaúde em apoio à Atenção Primária à Saúde no Brasil. Rev Bras Med Fam e Com 2007;3(11):210-215.

Von Wangeheim A, Cavalcante C, Wagner H. Capítulo 15: Hospital Universitário da Universidade Federal de Santa Catarina (UFSC): Telemedicina e Telessaúde. In: Messina LA, Ribeiro Filho JL. Impactos da rede universitária de telemedicina: ações de educação contínua, pesquisa colaborativa e assistência remota: Fase I (2006-2009). 1.ed. Rio de Janeiro:E-papers, 2013. 158-171.

Schmitz CAA, Harzheim E. Oferta e utilização de teleconsultorias para Atenção Primária à Saúde no Programa Telessaúde Brasil Redes. Rev Bras Med Fam Com, 2017;12(39):1-11.

Cáceres Méndez EA, Castro-Díaz SM, Gómez-Restrepo C, Puyana JC. Telemedicina: historia, aplicaciones y nuevas herramientas en el aprendizaje. Univ Méd Bogotá (Colombia) 2011;52(1):11-35.

Marcolino MS, Alkmim MBM, Assis TGP, Sousa LAP, Ribeiro ALP. Teleconsultorias no apoio à atenção primária à saúde em municípios remotos no estado de Minas Gerais, Brasil. Rev Panam Salud Publica 2014;35(5/6):345-352.

Rogove HJ, Mcarthur D, Demaerschalk BM, Vespa PM. Barriers to Telemedicine: Survey of Current Users in Acute Care Units. Mary Ann Liebert, Inc. Telemedicine and e-health 2012;18(1):48-53.

Pessoa CG, Sousa L, Ribeiro A, Oliveira T, Silva JL, Alkmim MB, Marcolino MS. Description of Factors Related to the Use of the Teleconsultation System of a Large Telehealth Service in Brazil – the Telehealth Network of Minas Gerais. Journal of the International Society for Telemedicine and eHealth 2016;4:1-9.

Young J, Shaxson L, Jones H, Hearn S, Datta A, Cassidy C. ROMA – a guide to policy engagement and influence. ODI Research & Policy in Development. London: Overseas Development Institute, 2014. 84.

Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLos Medicine 2011;8(1):1-16.

Stein D, Valters C. Understandinnderstanding ‘Theory of Change’ in International Development: a Review of Existing Knowledge. This Publication is an Output from a Collaboration Between the Asia Fundation and the Justice and Security Research Programme, 2012. 21.

Vogel I. Review of the Use of ‘Theory of Change’ in International Development, Review Report. Department of International Development, 2012. Available at: http://www.dfid.gov.uk/r4d/pdf/outputs/mis_spc/DFID_ToC_Review_VogelV7.pdf (last accessed May 06, 2018).

Allen W, Cruz J, Warburtun B. How Decision Support Systems can benefit from a Theory of Change approach. B. Gestão ambiental 2017;59(ed.6):956-965.

Cravo TA, Silva GDM. Uma proposta de um painel de indicadores de desenvolvimento regional para o monitoramento da Política Nacional de Desenvolvimento Regional (PNDR). In: Resende GM (ed). Avaliação de políticas públicas no Brasil: uma análise da Política Nacional de Desenvolvimento Regional (PNDR). Brasília: Ipea, 2017. 313-367.

Medina MG, Silva GAP, Aquino R, Hartz ZMA. Uso de modelos teóricos na Avaliação em Saúde: aspectos conceituais e operacionais. In: Hartz ZMA, Vieira da Silva L. (Orgs.). Avaliação em Saúde - dos modelos teóricos à prática na avaliação de Programas e Sistemas de Saúde. Rio de Janeiro / Salvador: Fiocruz / EDIUFBA, 2005. 41-63.

Nerlich M, Balas EA, Schall T, Stieglitz SP, Filzmaier R, Asbach P, Dierks C, Lacroix A, Watanabe M, Sanders JH, Doarn CR, Merrell RC. Teleconsultation Practice Guidelines: Report from G8 Global Health Applications Subproject 4. Telemedicine Journal and e-Health 2002;8(4):411-418.

Haddad AE, Silva DG, Monteiro A, Guedes T, Figueiredo AM. 2016. Follow up of the legislation advancement along the implementation of the Brazilian Telehealth Programme. J Int Soc Telemed eHealth 2016;4(e11):1-7.

Brant H, Atherton H, Ziebland S, Mckinstry B, Campbell JL, Salisbury C. Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice. British Journal of General Practice 2016;66(648):e460-e466.

Campelo VES, Bento RF. Teleaudiometria Automática: Um Método de Baixo Custo para Triagem Auditiva. Arq. Int. Otorrinolaringol 2010;14(1):82-89.

Andrade MV, Maia AC, Cardoso CS, Alkmim MB, Ribeiro AL. Custo-benefício do serviço de telecardiologia no Estado de Minas Gerais: projeto Minas Telecardio. Arq. Bras. Cardiol 2011;97(4):307-316.

Von Wangenheim A, Souza Nobre LF, Tognoli H, Nassar SM, Ho K. User Satisfaction with Asynchronous Telemedicine: A Study of Users of Santa Catarina’s System of Telemedicine and Telehealth. Mary Ann Liebert, Inc. Telemedicine and e-health 2012;18(5):339-346.

Figueiredo AM, Guedes TAL. Programa Nacional Telessaúde Brasil Redes. In: Valentim RAM, Araújo BG, Guedes TAL, Figueiredo AM. (ed). A Telessaúde no Brasil e a inovação tecnológica na atenção primária. Natal: EDUFRN, 2015. 27-46.

Organização Panamericana de la Salud. Marco de Implementación de un Servicio de Telemedicina. Washington, DC: OPAS, 2016. Available at: http://iris.paho.org/xmlui/bitstream/handle/123456789/28413/9789275319031_spa.pdf?sequence=5&isAllowed=y (last accessed June 14, 2016).

Rogers EM. Diffusion of innovations. 5.ed. Nova York: Free Press, 2003.

Helitzer D, Heath D, Maltrud K, Sullivan E, Alverson, D. Assessing or Predicting Adoption of Telehealth Using the Diffusion of Innovations Theory: A Practical Example from a Rural Program in New Mexico. Telemedicine Journal and e-Health 2003; 9(2):179-187.

Organização Mundial de Saúde; Organização Pan-Americana da Saúde. Capacidades Humanas para a Saúde Telessaúde, 2017. Available at: http://www.paho.org/bra/index.php?option=com_content&view=article&id=256:telessaude&Itemid=373 (last accessed September 26, 2017).

Learning for sustainability: supporting, collaboration and adaptation. Theory of change, 2017. Available at: http://learningforsustainability.net/theory-of-change/ (last accessed November 01, 2017).

Jesus WLA, Assis MMA. Revisão sistemática sobre o conceito de acesso nos serviços de saúde: contribuições do planejamento. Ciência e Saúde Coletiva 2010;15(1):161-170.

Oliveira TC, Branquinho MJ, Gonçalves L. State of the art in telemedicine - concepts, management, monitoring and evaluation of the telemedicine programme in Alentejo (Portugal). Stud Health Technol Inform 2012;179:29-37.

Cruz MCC. O conceito de cuidado à saúde [dissertação]. Programa de Pós-Graduação em Saúde Coletiva. Salvador: Instituto de Saúde Coletiva, Universidade Federal da Bahia, 2009. 153.

Marcolino MS, Alkmim MBM, Assis TGP, Palhares DMF, Silva GAC, Cunha LR, Sousa L, Abreu MP, Figueira RM, Ribeiro AL. A Rede de Teleassistência de Minas Gerais e suas contribuições para atingir os princípios de universalidade, equidade e integralidade do SUS - relato de experiência. RECIIS - R Eletr de Com Inf Inov Saúde 2013;7(2):1-21.

Bill G, Crisci CD, Canet T. La Red de Telesalud de las Américas y su papel em la atención primaria de la salud. Rev Panam Salud Publica 2014;35(5/6):442-445.

Rogers P. Theory of Change, Methodological Briefs: Impact Evaluation nº 2. UNICEF Office of Research: Florence, 2014. 16.

De Silva MJ, Breuer E, Lee L, Asher L, Chowdhary N, Lund C, Patel V. Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions. Bio Med Central 2014;15:267.

Lucas H, Bloom G. Capítulo 4: Understanding The Intervention. Institute Of Development Studies. In: Lucas H, Zwarenstein M. Future Health Systems: innovations for equity - A pratical guide to implementation research in Health Sistems, 2015. 13. Available at: http://courses.arcadeproject.org/pluginfile.php/915/mod_resource/content/2/Chapter%204.pdf (last accessed March 11, 2018).

Creating a Framework to Support Measure Development for Telehealth. Final Report. NationalQualityForum2017.Availableat:http://www.qualityforum.org/Publications/2017/08/Creating_a_Framework_to_Support_Measure_Development_for_Telehealth.aspx (last accessed March 11, 2019).

Mendes EV. O cuidado das condições crônicas na atenção primária à saúde: o imperativo da consolidação da estratégia da saúde da família. Brasília: Organização Panamericana da Saúde,2012.512.Availableat:http://bvsms.saude.gov.br/bvs/publicacoes/cuidado_condicoes_atencao_primaria_saude.pdf (last accessed December 20, 2018).

Brasil. A Atenção Primária e as Redes de Atenção à Saúde. Brasília: CONASS, 2015. 127. Disponível em: http://www.resbr.net.br/wp-content/uploads/2015/11/Conass-APS-e-RAS.pdf (last accessed December 20, 2018).

Khoja S, Durrani H, Scott RE, Sajwani A, Piryani U. Conceptual framework for development of comprehensive e-Health evaluation tool. Telemed e-Health 2013;19(1):48-53.

Oliviera DG, Frias PG, Vanderlei LCM, Vidal SA, Novaes MA, Souza WV. Análise da Implantação do Programa Telessaúde Brasil em Pernambuca, Brasil: estudo de caso. Cadernos de Saúde Pública 2015;31(11):2367-2368.

Silva AB, Moraes IHS. The case of Telemedicine University Network: analysis of telehealth entry in the Brazilian political agenda. Physis [online] 2012;22(3):1211-1235.

Chang H. Evaluation Framework for Telemedicine Using the Logical Framework Approach and a Fishbone Diagram. Healthc Inform Res 2015;21(4):230-238.

Valters C. Theories of Change: Time for a radical approach to learning in development. The Asia Foundation. Londres: Overseas Development Institute, 2015. 20.

Nilson LGN. Avaliação de Telessaúde para Apoio Assistencial na Atenção Primária à Saúde [tese]. Florianópolis: Universidade Federal de Santa Catarina, 2018. 240.

Downloads

Published

2020-05-01

How to Cite

NILSON, L. G.; TUESTA, A. A.-.; HARTZ, Z. M. de A.; CALVO, M. C. M. Theory of change in the evaluation of telehealth in care support to primary health care in brazil / Teoria da mudança na avaliação d0a telehealth no apoio à atenção à saúde primária no brasil. Brazilian Journal of Health Review, [S. l.], v. 3, n. 3, p. 3900–3919, 2020. DOI: 10.34119/bjhrv3n3-001. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/9447. Acesso em: 28 mar. 2024.

Issue

Section

Original Papers