Assistência remota por teledermatologia a Unidades Básicas de Saúde: um projeto piloto

Abstract

This prospective observational intervention study analyzed the implementation of an asynchronous teledermatology service within the Unified Health System (SUS) in Brazil. The study aimed to provide remote assistance based on asynchronous teledermatology for primary care physicians (PCPs) working in a Brazilian municipality. This implementation sought to reduce referrals, train PCPs in dermatology, and assess their proficiency by evaluating the diagnostic concordance with specialists. Conducted in Votorantim, São Paulo, over five months during the second half of 2024, the study involved seven physicians from three primary care units (PCUs) who submitted patient data and photos via a customized platform to three dermatologists with experience in medical education. The teleconsultations included the primary diagnostic hypothesis, management guidance, and educational materials, with responses provided within seven business days, compared to months for specialist evaluation through traditional referrals. The sample included 32 patients, with 27 completed cases. Diagnostic hypotheses from PCPs and dermatologists were discordant in 53.12% of cases. Of the 32 patients, 29 would have been referred for in-person consultations prior to teleconsultation. After excluding five incomplete cases, referrals were avoided in 18 out of 24 cases, achieving an efficiency rate of 75% (95% CI: 53.3%-90.2%). Six patients required in-person referrals for biopsies (4), dermoscopy (1), or rheumatology evaluation (1). Primary care physicians unanimously reported significant learning and improved case management through teleconsultations. In addition, pre- and post-study questionnaires showed a reduction in referrals (p = 0.017) and diagnostic uncertainty (p = 0.014), as well as increased confidence (p = 0.028) and a more positive perception of teledermatology (p = 0.045). The pilot project brought both clinical and educational benefits, despite the notable lack of access to diagnostic resources in primary care units. Given the widespread resource limitations in many PCUs across the country, this project provides a theoretical and practical foundation for long- term studies to evaluate the cost-effectiveness and broader benefits of this model within public health systems, particularly in resource-limited settings such as Brazil.