RESUMO OBJETIVO Apresentar os resultados da análise de custos para a modalidade de consulta remota (teleconsulta) em comparação à consulta presencial, em pacientes com diabetes do tipo 2, no Sistema Único de Saúde (SUS) brasileiro, na cidade Joinville, Santa Catarina. Para além dos custos, sob a perspectiva do gestor local, o artigo também apresenta estimativas sob perspectiva do paciente, a partir dos custos de transporte associados a cada modalidade de consulta. MÉTODO Foram coletados dados de 246 consultas, remotas e presenciais, entre 2021 e 2023, no contexto de um ensaio clínico randomizado sobre o impacto da teleconsulta realizado na cidade de Joinville, SC. As teleconsultas foram realizadas em Unidades Básicas de Saúde (UBS) e as consultas presenciais no Centro de Saúde Especializada. Para o cálculo dos custos, foi utilizado o método de custos baseado em tempo e atividade (TDABC) e, para o cálculo dos custos relativos aos transportes dos pacientes, foram coletados dados diretamente com os participantes da pesquisa. Foram analisados e comparados descritivamente os custos médios e o tempo de realização de cada modalidade de consulta em diferentes cenários e perspectivas. RESULTADOS Considerando apenas a perspectiva do gestor local do SUS, os custos para a realização da teleconsulta se mostraram 4,5% maiores do que para uma consulta presencial. Contudo, quando considerados os custos de transporte associados a cada paciente, o valor estimado da consulta presencial passa a ser 7,7% maior e, no caso de consultas em outros municípios, 15% maior do que a teleconsulta. CONCLUSÃO Os resultados demonstram que a incorporação da teleconsulta dentro do SUS pode trazer vantagens econômicas, a depender da perspectiva e do cenário considerado, além de ser uma estratégia com potencial para aumentar o acesso à atenção especializada na rede pública.

ABSTRACT OBJECTIVE To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager’s perspective, the article also presents estimates from the patient’s perspective, based on the transportation costs associated with each type of consultation. METHOD Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. RESULTS Considering only the local SUS manager’s perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. CONCLUSION The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

SUMMARY OBJECTIVE: This study aimed to characterize teleconsultations in neurology executed by Regula+Brasil project in Recife, a capital city in northeastern Brazil. METHODS: A descriptive study carried out by four private hospitals, in a partnership with the Ministry of Health in Brazil. Teleconsultation was performed preferably in the video modality. Conditions eligible for teleconsultation were headache, epilepsy, and cerebrovascular disorders. Period of analysis was May to September 2020. RESULTS: A total of 243 teleconsultations were analyzed, of which 76.95% was a first appointment. In 48.97% of cases, the teleconsultation represented the first opportunity for the patient to be consulted with the specialist. Among cases of first appointment, 20.16% were further referred to a face-to-face consultation and 21.81% could be redirected to primary health care. Headache disorders were the most predominant clinical conditions. CONCLUSIONS: The implementation and development of telemedicine by Regula+Brasil during the COVID-19 pandemic represented an opportunity to assess the value of having teleconsultations added along the line of care from primary care to a medical specialty, promoting the coordination of care across different levels of complexity of care in the health system and improving access to specialized care.

RESUMO Doppler transcraniano (DTC) é um componente estratégico da prevenção primária do acidente vascular cerebral (AVC) em crianças com doença falciforme (DF). Este estudo foi realizado para examinar as características do DTC de crianças com DF em nove centros médicos diferentes no Brasil. Métodos: DTC foi realizado de acordo com o protocolo de Stroke Prevention Trial in Sickle Cell Anemia Protocol (STOP). Resultados: Dos 396 pacientes avaliados, 69,5% eram homozigotos para hemoglobina SS. DTC foi anormal em 4,8%, condicional em 12,6%, inadequado em 5,3% e anormalmente baixo em 1%. As máximas velocidades de fluxo médio foram 121 ± 23,83cm/s e 124 ± 27,21 cm/s nas artérias cerebrais media esquerda e direita, respectivamente. Um total de 28,8% dos pacientes (média de 9,19 ± 5,92 anos) foram avaliados com o DTC pela primeira vez. Conclusões: Pacientes com DF foram avaliados com DTC numa idade considerada avançada, o que representa uma importante oportunidade perdida para a prevenção de AVC nessa população. Uma vez que a triagem com DTC em pacientes com DF é essencial para detectar aqueles com alto risco de AVC, recomenda-se que essa triagem seja amplamente disponível no país.

ABSTRACT Transcranial doppler (TCD) is a strategic component of primary stroke prevention in children with sickle cell disease (SCD). This study was conducted to examine the TCD characteristics of children with SCD in nine different medical centers in Brazil. Methods: Transcranial doppler was performed in accordance with the Stroke Prevention Trial in Sickle Cell Anemia Protocol. Results: Of the 396 patients, 69.5% had homozygous SS hemoglobin. The TCD result was abnormal in 4.8%, conditional in 12.6%, inadequate in 4.3% and abnormally low in 1% of patients. The highest mean flow velocities were 121±23.83cm/s and 124±27.21cm/s in the left and right middle cerebral artery respectively. A total of 28.8% patients (mean age 9.19±5.92 years) were evaluated with TCD for the first time. Conclusions: The SCD patients were evaluated with TCD at an older age, representing an important missed opportunity for stroke prevention. Since TCD screening in patients with SCD is important to detect those at high risk for stroke, it is recommended that this screening should be made more readily available.