Article

DOI: 10.22167/2675-6528-20230059
E&S 2024, 5: e20230059

Átilla Arruda Pereira; Bethania Fernandes da Fonseca Zago

During the covid-19 pandemic, caused by the coronavirus (SARS-Cov-2), the world experienced times of insecurity and fear. The starting point was the city of Wuhan, China, where, in December 2019, health professionals identified patients with a condition similar to pneumonia. Covid-19 is a viral disease that presents symptoms such as fever, cough, and difficulty breathing. Transmission occurs in various ways: sneezing, coughing, phlegm, saliva, physical contact, and contact with surfaces. Some people get infected and show no symptoms, multiplying the virus without realizing it. Others present mild to severe cases that, if not treated in time, can be lethal^[1].

It is known that the coronavirus causes many complications in people with comorbidities, and the recommendation from the Brazilian Society of Geriatrics and Gerontology (SBGG)^[2] was that people over 60 years old, especially if they had diabetes, hypertension, respiratory, cardiological, renal, neurological problems, as well as individuals undergoing cancer treatment or with compromised immunity, as well as all those over 80 years old or who showed signs of frailty, should have their social contact restricted, since the elderly and people with comorbidities were more likely to develop severe cases^[3].

In Brazil, the virus caused many fatal victims during the peak of the disease’s spread, which stimulated social isolation, with people confined to their homes. To combat the pandemic, the health sector had to reinvent itself. Prevention guidelines oriented by the World Health Organization and the Ministry of Health were adopted, with rigorous measures ranging from social isolation to the use of masks and 70% alcohol gel on hands, among others. However, the reception in public and private health units was deficient in terms of equipment, technologies, and human resources, showing the urgent need for adaptation to continue healthcare and the fight against covid-19.

Public and supplementary health services adapted to this new reality using strategies and tools that enabled safe and remote care. Telemedicine was the strategy that best fit this need. The modality allows different health professionals to provide care with a holistic view of attention, while patients do not need to leave their homes. This format of care also occurred in private and associated health insurance hospital units.

This experience showed that virtual consultation during the covid-19 pandemic can be effective. In Brazil, it was guided by the Federal Council of Medicine, under Ordinance No. 467/2020, of the Ministry of Health, which provides for telemedicine in an exceptional and temporary capacity, with the objective of regulating and operationalizing measures to combat public health emergencies of international importance^[4].

For a better understanding of telemedicine, it is important to state that it is a set of information technologies that apply medical actions remotely, bringing information and attention to patients and other professionals who are in different locations in real time. This process can occur through fixed devices (computer) or mobile devices (cell phones or tablets) connected to the internet, and is divided into seven sub-areas: telediagnosis, telesurgery, teleconsultation, teleinformation, telerehabilitation, teleassistance, and finally, telemonitoring^[5],[6].

The objective of this study was to describe the impacts of implementing telemedicine as a tool for continued care in a company and its clients, considering data obtained from a large hospital in a private network in the municipality of São Paulo that provides tertiary healthcare.

The hospital setting for this study is linked to a health insurance provider specializing in the elderly. This study is exploratory-descriptive and documentary in nature, with a qualitative approach, chosen for its work with little-explored themes^[7]. This approach is characterized by observing, classifying, and describing a problem or the little-researched production processes of a phenomenon^[8]. We chose to analyze the daily attendance reports and bulletins during the months of July and August 2020, comparing them with studies by other authors who analyzed telemedicine with information obtained from different databases.  

The hospital analyzed is part of a health insurance operator that has been in the market for 22 years and includes its own and affiliated hospitals and emergency rooms, advanced and diagnostic medicine centers, specialized centers in geriatrics, cardiology, dermatology, oncology, ophthalmology, and orthopedics/traumatology, in addition to other specialties. In April 2020, it provided services to 470,000 patients, who belonged to economic classes D, C, and B.

The analysis was based on daily reports and bulletins of the services provided. It was possible to observe that this type of service positively influenced new enrollments in the health plan associated with this hospital, corroborating the generation of demand for a new consumer market and the increase in the company’s recurring revenue.

Teleconsultations are carried out online via teleconference, performed by a healthcare professional of any specialty for consultation, treatment, examination requests, and digital prescription. In tele-interconsultation, information and opinions are exchanged between doctors or other healthcare professionals to aid in therapy or diagnosis. Telemonitoring, on the other hand, is performed under medical guidance and supervision to remotely monitor health and/or disease parameters.

As a data collection instrument, a form with guiding questions was used for the analysis of attendance records. From these, the sociodemographic characteristics of the population and the studied company were considered, as shown in the results presented below. The application of content analysis in this study unfolds in the stages of pre-analysis, material exploration or coding, and treatment of obtained results/interpretation^[9]. A total of 2,300 tele-attendances were analyzed between July and August 2020, along with 13 weekly consolidated reports, referring to the daily attendance bulletins in teleconsultations.

Table 1. Number of attendances by gender and age

Indicator	Sex		Percentage
Average age	Male %	Female %	Total sales (vendas)/ Invoicing (emissão de doc)%
40 to 49	4,0	9,2	13,2
50 to 59	6,1	13,3	19,4
60 plus	34,5	32,9	67,4
Number of attendances	44,6	55,4	100

Among the 2,300 patients attended, the majority (67.4%) were over 60 years old, 62.4% were female, and 44.6% were male. Regarding the reasons for seeking consultation, clinical intercurrent events formed the majority (67.1%), among which comorbidities related to hypertension with blood pressure fluctuation, decompensated diabetes, anxiety disorders, low back/joint pain, and urinary tract infections were prominent. Next were routine consultations and returns (19.4%), covering prescription renewals, examinations, and medical certificates. In third place were consultations regarding flu-like symptoms and symptoms related to covid-19 (13.5%).

Table 2. Main reasons for consultation

Clinical intercurrences (hypertension with BP fluctuation, decompensated diabetes, anxiety, urinary tract infections, lumbar and joint pain)	67,1%
Routines and returns (revenues, exams, and certificates)	19,3%
Flu-like symptoms and covid 19 symptoms	13,6%

There was significant demand in all the specialties offered, however the ten most sought-after were geriatrics consultations (65), cardiology (50), allergy and immunology (50), gastroenterology (40), ophthalmology (40), orthopedics/traumatology (38), clinical oncology (35), pneumology (34), urology (30), endocrinology (29) and other various specialties with 179 consultations. Another point to highlight was the duration of the consultations, compared to in-person visits, as shown in Table 3, below.

Table 3. Average time and consultation by service format and agenda

Waiting time for consultation	In-person	Digital
Schedule appointment	Three to seven days	Three days
Daily consultation	60 minutes	40 min.
Average time for each query	40 to 50 min.	25 to 30 min.

Regarding the waiting time for the appointment or offer of another service, it was observed that there were no losses. The in-person consultation took an average of seven days, while the virtual one took three days. Waiting on the same day for the appointment time (fitting in) took up to an hour for in-person, versus 40 minutes for virtual. As for the duration of the consultations, in-person ones took up to 50 minutes, and teleconsultations up to 30 minutes.

The research also revealed that the in-person format requires more professionals for service. In the virtual format, whose presence was elaborated by scales, there was more satisfaction with the professional, adequacy of schedule, and promptness in service. The average number of professionals assigned to this service was 50 nurses and 25 doctors.

The hospital assesses in-person care through a color-coded device: green is for what met the patient’s expectations, yellow if the care was reasonable, and red if the care did not meet expectations, in addition to a text box for possible suggestions. In the telemedicine format, the results totaled 81% green, 16% yellow, and only 3% red.

Table 4. Consolidated into categories the testimonials of the elderly attended by telemedicine correlating face-to-face and virtual

Indicator	In-person	Digital
Consultation waiting time: Consider the waiting time very long Consider the waiting time essential	87% 13%	23% 77%
Time spent during the consultation: Considered that the time is enough for your need Considered that it should be a little more time	78% 22%	98% 2%
Regarding the extent to which expectations are met in the demand and supply of consultations, exams, medication, diagnosis and other needs: Consider that it meets their expectations Do not consider that it meets their expectations	97% 3%	98% 2%

Table 4 shows that there is a significant disparity in the satisfaction of elderly people attended at the hospital related to in-person and virtual care: 87% of those who were attended in person considered the waiting time very long, compared to 23% in the virtual modality. Of those attended by the virtual format, 98% considered that their expectations were met in this model.

This result corroborates previous studies^[6] addressing the use of telemedicine systems, which can be used to monitor patients with chronic diseases in their own homes, leading to reduced hospitalization costs, ensuring emergency response with the necessary urgency, and offering comfort to the patient. Table 1 shows some important elements indicated as potentialities and challenges.

Table 1. Use of telemedicine: potentialities and challenges

Source: Elaborated by the authors.

Table 1 shows that the potentialities are more numerous than the challenges, drawing attention to three of them: access to timely consultation, strengthening of bonds, and demand organization. This strengthens the commercial gains of this service, in addition to its usefulness for the continuity of care and patient monitoring.

According to Batista^[10], the benefits for hospital administration are many, as care gains agility and quality, and health managers can better organize work in clinics and hospitals. This result strengthens the image of telemedicine as a powerful tool, making its adoption as a future technology in various sectors of the consumer market possible, with low investment and high return. Table 2 shows the potentialities and challenges encountered with regard to the use of telemedicine in the health sector, according to selected studies.

Table 2. Studies showing potentialities and challenges in the use of telemedicine

Source: Elaborated by the authors.

As can be seen above, studies on this topic are still scarce, but it is possible to observe that telemedicine is gaining ground and that the challenges it faces do not outweigh its potential. The tool has the potential to strengthen the safety and quality of care and, with the evolution of communication methods, it is possible that this modality will offer new revenue streams to hospitals. In summary, the research revealed that telemedicine is a strategy to be used for remote continuous care. In the data obtained, it was clear that the services did not lose quality and that the waiting time for atendimento was reduced, leading to the satisfaction of the hospital and all other stakeholders. Among the challenges pointed out, it is worth highlighting the need to facilitate access for the elderly to telecommunication equipment.

References

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How to cite

Pereira A. A.; Zago B. F. F. Process of implementing telemedicine in a private hospital during covid-19. E&S Journal. 2024; 5: e20230059.

About the authors

Átilla Arruda Pereira , Moaci Avenue, 534, Apt 93ª – Planalto Paulista – Postal Code 04083-001 – São Paulo/SP, Brazil.

Bethania Fernandes da Fonseca Zago, Arlindo Béttio Street, 1000 – Vila Guaraciaba – ZIP Code 03828-000 – São Paulo/SP, Brazil.

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