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Validation of low cost telemedicine system for the public health system

Abstract

Stroke is a prevalent and disabling disease, whose care in Brazil is insufficient and concentrated in a few centers of high complexity. Among the types of stroke, 80 to 85% are of ischemic etiology, and the only treatment currently available in the hyperacute phase of ischemic stroke with proven impact on the functional outcome is the use of intravenous thrombolytic therapy within 4.5 hours of the onset of symptoms. With the publication of Ordinances No. 664 and 665 GM / MS in 2012, the Ministry of Health approved a Clinical Protocol with Therapeutic Guidelines for Thrombolysis in Acute Ischemic Stroke (Stroke) and the Line of Care for Stroke Patients, associated with the respective incentive to promote its installation within the Unified Health System (SUS). In its article 5, Portaria No. 665 also defines that a reference center for the care of patients with stroke should "provide neurological care coverage, available within thirty minutes of patient admission (by on-call or neurological support through telemedicine). " However, the experience with the use of telemedicine for stroke in Brazil is scarce, having little scientific evidence in our country, and has not yet been adequately tested in the SUS context. Currently, one of the challenges for the implantation of telemedicine systems is the high cost of installation and maintenance of teleconferencing equipment and transmission of radiological images. Thinking about this difficulty, an academic partnership between the neurology team of the Hospital das Clínicas of the Medical School of Ribeirão Preto (HCFMRP) and engineers and computer technologists was initiated, which developed a telemedicine system that performs videoconference and electronic record of care using computer equipment of low cost, based on national guidelines for health information systems and standardized protocols for stroke care. The objective of this project is to validate the use of this system in a regional telemedicine network, connecting secondary level hospitals with the HCFMRP team to support the Acute Stroke, directing the diagnosis and treatment in places without neurological support. The evaluated outcomes will be: 1) security of the information record and 2) quality of the videoconference; 3) diagnostic accuracy for ischemic or hemorrhagic stroke; 4) rate of use of intravenous thrombolysis for ischemic stroke; 5) mortality and functional independence (assessed by a blinded examiner by means of a telephone interview using the modified Rankin scale) within 90 days after treatment. The telemedicine system developed will enable the safe registration of care, the permanent education of the teams and database for clinical research, contributing to the realization of this and other Brazilian telemedicine networks. (AU)

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