{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:27Z","timestamp":1782841647421,"version":"3.54.5"},"reference-count":74,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The COVID-19 pandemic accelerated the adoption of telehealth as a key strategy within Brazil\u2019s Unified Health System. In S\u00e3o Paulo State, digital health initiatives have been developed to implement telehealth-based care models across all 3 levels of health care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The aim of this study is to describe the implementation process of the telehealth model in public health facilities to a lesser extent.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This descriptive study reports on the implementation of telehealth services at the primary, secondary, and tertiary levels of health care in S\u00e3o Paulo State. Thirty primary health units, 4 specialty care outpatient clinics, and 18 hospitals were selected by the institutions participating in the project based on technical, health care, and infrastructure criteria. Teleconsultations were conducted through the institutional teleconferencing platform, ensuring data security and privacy. Data were collected through REDCap (Research Electronic Data Capture) between April and December 2024, including operational metrics and satisfaction scores (Net Promoter Score [NPS]). All participating health care facilities signed a term of adherence and data sharing agreement. Patients received care only after being informed and after signing a consent and adherence term for telehealth form.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Telehealth was implemented in 52 health care facilities across 47 municipalities in S\u00e3o Paulo State. A total of 19,053 teleconsultations were conducted in primary health units (NPS 97) and 218 in specialty care outpatient clinics (NPS 74), and 4178 intensive care unit case discussions were held (NPS 86).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The findings suggest that telehealth is a feasible strategy across all levels of health care, even when implemented at a limited scale, contributing to expanded access and service coverage.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/86254","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T07:20:06Z","timestamp":1769412006000},"page":"e86254-e86254","source":"Crossref","is-referenced-by-count":0,"title":["Telehealth as a Strategy to Expand Access in Brazil\u2019s Unified Health System: Analysis of S\u00e3o Paulo State\u2019s Experience Across the Three Levels of Health Care"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0732-0755","authenticated-orcid":false,"given":"Marcele S S","family":"Buto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3318-5588","authenticated-orcid":false,"given":"Gabrielli B","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0182-9975","authenticated-orcid":false,"given":"Michelle L","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1507-8849","authenticated-orcid":false,"given":"Maria Cristina C L B","family":"de Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8160-1423","authenticated-orcid":false,"given":"Roberta R","family":"de Lima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-8721","authenticated-orcid":false,"given":"Giovanni G","family":"Cerri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1618-8509","authenticated-orcid":false,"given":"Carlos R R","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"R1","unstructured":"WHO director-general\u2019s opening remarks at the media briefing on COVID-19 - 11 March 2020. 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Pan American Health Organization (PAHO), World Health Organization (WHO) & International Telecommunication Union (ITU); 2023. URL: https:\/\/www.itu.int\/cities\/wp-content\/uploads\/2023\/04\/The-role-of-Digital-Technologies-in-Aging-and-Health.pdf [Accessed 27-02-2026] [doi: 10.37774\/9789275126554]","DOI":"10.37774\/9789275126554"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12992-022-00875-9","article-title":"The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil","volume":"18","author":"Scheffer","journal-title":"Global Health"},{"issue":"3","key":"R8","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1590\/1516-3180.2021.0475.R3.03112021","article-title":"Reactions of physicians in the state of S\u00e3o Paulo to the use of telemedicine during the SARS-CoV-2 pandemic: cross-sectional study","volume":"140","author":"Amaral","journal-title":"Sao Paulo Med J"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1590\/1414-431X2022e11959","article-title":"Using data from a private provider of telemedicine to assess the severity of the early 2021 COVID-19 wave in Brazil","volume":"55","author":"Barbosa","journal-title":"Braz J Med Biol Res"},{"issue":"7775","key":"R10","doi-asserted-by":"publisher","first-page":"S114","DOI":"10.1038\/d41586-019-02876-y","article-title":"The future of electronic health records","volume":"573","author":"Hecht","journal-title":"Nature New Biol"},{"key":"R11","unstructured":"Global strategy on digital health 2020-2025. 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Minist\u00e9rio da Sa\u00fade; 2020. 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Presid\u00eancia da Rep\u00fablica. 2019. URL: https:\/\/www.planalto.gov.br\/ccivil_03\/_ato2019-2022\/2019\/lei\/l13853.htm [Accessed 01-08-2025]"},{"key":"R28","unstructured":"Seade Popula\u00e7\u00e3o [Website in Portuguese]. URL: https:\/\/populacao.seade.gov.br\/ [Accessed 03-10-2025]"},{"key":"R29","unstructured":"Diagn\u00f3stico preliminar do estado de s\u00e3o paulo: desafios para o planejamento plurianual do per\u00edodo de 2024-2027 [Report in Portuguese]. Governo do Estado de S\u00e3o Paulo, Secretaria da Fazenda e Planejamento; 2023. URL: http:\/\/planejamento.sp.gov.br\/static\/arquivos\/ppa\/ppa2027\/DIAGNOSTICO_PRELIMINAR_DO_ESTADO_DE_SAO_PAULO.pdf [Accessed 01-08-2025]"},{"key":"R30","unstructured":"PORTARIA N\u00ba 4.279, DE 30 DE DEZEMBRO DE 2010 \u2014 Estabelece diretrizes para a organiza\u00e7\u00e3o da Rede de Aten\u00e7\u00e3o \u00e0 Sa\u00fade no \u00e2mbito do Sistema \u00danico de Sa\u00fade (SUS) [Web page in Portuguese]. Minist\u00e9rio da Sa\u00fade. 2010. URL: https:\/\/bvsms.saude.gov.br\/bvs\/saudelegis\/gm\/2010\/prt4279_30_12_2010.html [Accessed 01-08-2025]"},{"key":"R31","unstructured":"Curso I: regula\u00e7\u00e3o de sistemas de sa\u00fade do SUS: m\u00f3dulo 4: redes de aten\u00e7\u00e3o \u00e0 sa\u00fade [recurso eletr\u00f4nico] [Report in Portuguese]. Minist\u00e9rio da Sa\u00fade; Secretaria de Aten\u00e7\u00e3o Especializada \u00e0 Sa\u00fade; Departamento de Regula\u00e7\u00e3o Assistencial e Controle; 2022. URL: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/aula4_regulacao_redes_atencao_saude.pdf [Accessed 01-08-2025]"},{"key":"R32","unstructured":"Decreto n\u00ba 12.560, de 23 de julho de 2025. Disp\u00f5e sobre a Rede Nacional de Dados em Sa\u00fade e sobre as Plataformas SUS Digital e regulamenta o art. 47 e o art. 47\u2011A, caput, \u00a7 1 [Web page in Portuguese]. Presid\u00eancia da Rep\u00fablica. 2025. 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URL: https:\/\/www.ibge.gov.br\/cidades-e-estados\/sp.html [Accessed 16-09-2025]"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1109\/titb.2006.879588","article-title":"Managing medical images and clinical information: InCor\u2019s experience","volume":"11","author":"Furuie","journal-title":"IEEE Trans Inf Technol Biomed"},{"issue":"2","key":"R35","doi-asserted-by":"publisher","DOI":"10.36416\/1806-3756\/e20200545","article-title":"Implanta\u00e7\u00e3o de telemedicina de terapia intensiva durante a pandemia de COVID-19 [Article in Portuguese]","volume":"47","author":"Macedo","journal-title":"J Bras Pneumol"},{"issue":"12","key":"R36","first-page":"46","volume":"81","author":"Reichheld","journal-title":"Harv Bus Rev"},{"key":"R37","unstructured":"Pan American Health Organization (PAHO). Policy on integrated care for improved health outcomes. 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