Alkmim MBM, 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 2015: 21(6): 473-483. doi:10.1089/tmj.2014.0112.
The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service that provides support to primary healthcare in Minas Gerais, Brazil, performing teleconsultation and tele-electrocardiography. The aim of this study was to assess teleconsultation requests received by the TNMG and to investigate the factors associated with low teleconsultation utilization in most municipalities. Materials and Methods: A cross-sectional study was carried out including 214 municipalities. Indicators were defined to analyze teleconsultation requests. A structured questionnaire was used to investigate factors associated with teleconsultation utilization, which were analyzed by multivariate analysis through a decision tree algorithm (chi-squared automatic interaction detector) to the entire population of the study and logistic regression for municipalities that had used the system during the analyzed period. Results: From May to September 2009, 1,954 teleconsultations were performed. The average number ( – standard deviation) of teleconsultations per municipality was 1.71 ( – 1.50) per month. The majority of the users were located in remote regions with a low Human Development Index. The decision tree showed ‘‘conduction of sufficient training’’ (p = 0.0015) as the factor with the greatest positive impact on teleconsultation utilization, followed by ‘‘ability to discuss clinical cases outside the teleconsultation system’’ (p = 0.0192). Logistic regression analysis revealed two factors associated with increased use of the system: ‘‘complexity of the system’’ (odds ratio = 3.35; 95% confidence interval [CI], 1.58–7.09) and whether they considered that the ‘‘service helps to solve everyday problems’’ (odds ratio = 4.37; 95% CI, 1.14–16.69). Conclusions: The study of factors associated with the low use of the teleconsultation system of the TNMG may help policy makers define strategies to improve the use of teleconsultation services.