by Renata Farias/Rebeca Menezes
Patients from 52 Bahia municipalities will receive distance care for cases of acute myocardial infarction and cerebrovascular accident (CVA). The State Government project was recently announced and also includes the implantation of a telemedicine center in Salvador, where medical specialists will guide generalists in the necessary procedures.
“Bahia is a state of the size of France, our distances are kilometre and it is impossible to guarantee the presence of specialist physicians close to all municipalities. In the issue of acute myocardial infarction and stroke, the need for a specialist doctor in a few minutes makes a difference if the person will survive or not and if it will stay with major or minor sequel, “explained the secretary of Health of Bahia , Fábio Vilas-Boas, in an interview with Bahia Notícias.
According to the manager, the deployment rooms will have an approximate investment of R $2.5 million. In the telemedicine center, which will be built at Solar Boa Vista, in the Brotas neighbourhood, a videowall will be implanted for physicians to accompany the service. The project also provides, in the future, the provision of second medical opinion with the same system.
“We are designing a second opinion system, initially for the urgency and emergency network, which will shelter the upas and intensive care. In a second moment, low-supply specialties, such as dermatology, rheumatology and specialties with few specialists trained in Bahia. This is a very important project that will promote and enable specialized attention to regions never reached, “added Vilas-Boas.
During the interview, the secretary also spoke about the first year of operation of the regional policlinics. Despite evaluating the period as “extremely positive”, he scored difficulties encountered, mainly for hiring professionals.
“The satisfaction rate of the population attended is higher than 98%. However, in order to get to this stage, we had many difficulties. We had difficulty getting professionals, especially physicians and specialized technicians, “he said. “It was necessary to seek professionals in other regions, to launch notices in newspapers of national circulation, to bring physicians from outside to be able to fill all the specialties in the eight polyclinics. This was a difficult experience to be circumpathing, but today we have all the polyclinics with all the specialties, not yet in all the shifts we needed to have, “he explained.
In the last month of November, we completed one year of the implementation of the first polyclinics. I’d like you to take stock of that period.
The balance sheet is extremely positive. From a care standpoint, polyclinics are a success. They took medium complexity assistance to municipalities and regions they did not have, took dozens of exams and consultations with specialists where they did not. The satisfaction rate of the population attended is higher than 98%. However, in order to get to this stage, we had many difficulties. We had difficulty in obtaining professionals, mainly physicians and specialized technicians. We had to train and empower technicians, because in the regions there were no examinations and, consequently, there were no technicians prepared to operate the machines. Regarding physicians, despite paying an extremely competitive salary-our remuneration is R $10400 for a CLT contract to work 20 hours a week, 4 hours a day-we can’t attract doctors. It was necessary to seek professionals in other regions, to launch notices in newspapers of national circulation, to bring physicians from outside to be able to fill all the specialties in the eight polyclinics. This was a difficult experience to be circumpathing, but today we have all the polyclinics with all the specialties, not yet in all the shifts we needed to have. We are still lacking from these medical specialists who should be launched on the market now in February, when the medical residency programs are finished.
You proposed, during a meeting of the National Council of Secretaries of Health (Conarse), the statualization of the more medical program. How would this change benefit the country and how the proposal was received?
The more physicians is a federal program that has very little participation of States and municipalities in its operationalization. The SUS is tripartite, that is, with the participation of the three federate entities. The proposal we made at the Conarse meeting was that it was forwarded to the Transitional Office a proposal to Estadualizar the program, transforming it into a tripartite program. Through this model, the States would make the contract with the physicians and would be responsible for the training program of these physicians. It must be remembered that the more physicians is a program that predicts a postgraduate in family health and that physicians receive a scholarship to qualify during work. With our proposal, we would be closer and with greater control to create a more qualified training program and attract more than 15000 Brazilian physicians trained in Latin American countries and who are now excluded from the market because they cannot Pass the Ministry of Education’s revalidate. Our intention would be to create a training and correction program so that they could correct any deficits in their formations and thus have a greater chance of passing the revalidate. I would like the program to be two years old and to make monthly theoretical and quarterly practical assessments. We’d provide a distance education system so he could qualify. That was the proposal submitted.
You quoted the doctors ‘ training. With this recent announcement of more physicians, a fear arose that the professionals who signed up to leave for residency programs from March onwards.
In fact, it’s not even in March, because residency programs start delivering vacancies in January. It is probable that in February, a part already leaves the more doctors. There was a low adherence here in Bahia, a non-adherence to areas considered without infrastructure by physicians. Some municipalities are without doctors and this should surely get worse. The call of the Ministry of Health for Brazilian physicians trained abroad did not result in a large adherence precisely because there is no guarantee of quality in this training program offered.
Data from the National Council of Municipal Health secretariats (Conasems) showed that some physicians left contracts with municipalities for adherence to the more medical program. What do you think the consequences of this movement can be, both for the population and for the prefectures?
They already exist and are visible. We have a lack of assistance, populations without access to physicians, returning to the status of five years ago, when people needed to move to other municipalities in search of basic attention. This is very bad because it will determine a decrease in the control of chronic and degenerative diseases, such as hypertension and diabetes, as well as determine a reduction in the quality and quantity of prenatal care, which impacts on higher risk deliveries, premature deliveries and Need for hospitalization.
Do you think this can also impact on physicians ‘ demands, especially with regard to wages?
This has already happened. The history before the more doctors was that doctors dictated to the municipalities how much they would like to receive and what workload they accepted to work. With the more medical program, this is over. Doctors receive R $11000 of scholarship and this was working perfectly in all regions. This disassistance will now make the municipalities that have the financial capacity to afford this expense need to hire physicians to weigh gold.
Recently, Governor Rui Costa announced the implementation of 52 stabilization rooms in the interior and construction of the telemedicine state Central. How will this project work? Is there a deadline for delivery? How much will it be invested?
Bahia is a state of the size of France, our distances are kilometre and it is impossible to guarantee the presence of specialist physicians close to all municipalities. In the issue of acute myocardial infarction and stroke, the need for a specialist doctor in a few minutes makes a difference whether the person will survive or not and whether it will stay with major or minor sequel. As it is not possible to guarantee the presence of cardiologists and neurologists within minutes of all municipalities, and thanks to the advancement of technology, today it is possible to centrally guarantee a physician who will make remote access, by video, to the patient, in the place where he is being serviced. We identified 52 localities with a higher incidence of myocardial infarction in Bahia. In these 52 localities, we identified the hospital units with the best conditions, designed a state policy, approved this in the Inter-management committees and we have a defined public policy of teleattendance for these conditions. Fundamentally, each answering room will have a structure where the patient is connected to a monitor that records electrocardiogram, blood pressure, oxygen saturation, such as any ICU monitor and a telemedicine equipment with cameras that will be Filming the patient and the doctor, with high-fidelity microphones. The doctor at the station will be with a videowall seeing that patient as if he were live on his side. He will treat the patient through a physician who will be present taking responsibility for the conducts adopted. It is important to say this because Brazilian legislation prohibits a physician from determining any type of conduct without being present alongside the patient, this is forbidden by the Federal Council of Medicine. Only that he will be serving as a consultant to an emergency physician who will determine the application of medications to treat a stroke or acute myocardial infarction.
The idea is that this generalist physician just stabilizes the patient so that he is transferred?
In the case of these two conditions, there is a strategy that casts a medication that dissolves the thrombi. In the case of an ischemic stroke, you inject a substance that dissolves the clot. With this, you save the patient’s life and gain time to provide a cardiac catheterization in the next few days. In the case of these two conditions, telemedicine will make the physician who is not familiar with the application of this type of medication feel free to use it. We have a very low rate of thrombolytic use in Bahia and this is directly associated with a high rate of specific mortality due to myocardial infarction.
And what will be the total investment in this project?
The investment is small, from the point of view of the centers. They basically will have stabilization equipment, which revolves around R $50000 each assembled room, which would give around R $2.5 million. However, it will not be necessary to provide equipment for all, since most hospitals already have defibrillator and monitor. At the telemedicine center, we’ll have to build a videowall. The broadband system already exists for communication with all these units. The capital invested in this structuring is not going to be great. We will have the highest expense centered on costing, which is basically what we spend with two 24h in an ICU. It’s like I have a neuro and a cardio ICU to serve the entire network. Depending on how this evolves in the future, it is possible that we need to hire more physicians for simultaneous demands. In this project of Telehealth is also foreseen the second opinion distance in other specialties. Today we have a telehealth system in which the question is digitally posted, in writing, by the physician in the basic health units and answered, within a week, by a consultant. There’s no more fitting in these days. The technology allows me to make available the physician online for any type of consultation. We are designing a second opinion system, initially for the urgency and emergency network, which will shelter the upas and intensive care. In a second moment, low-supply specialties, such as dermatology, rheumatology and specialties with few specialists trained in Bahia. This is a very important project that will promote and enable specialized attention to regions never reached.
You’ve said a few times that you have no interest in competing for election. Even so, his name continues to appear as a possible candidate, both in 2020 and 2022. Why do you think that happens? Do you think it’s related to the work you’ve done at the Secretariat, especially for the presence inside the state?
I don’t know, you have to ask people to ventilate my name. Politics is a very new area for me. I am not affiliated with any political party, my party is SUS. I’m a technician who came to work in an area with a technical mission. I can’t tell why my name has been ventilated, why a doctor go on a political mission.
Source: www.bahianoticias.com.br
