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      Sistema de agendamento online: uma ferramenta do PEC e-SUS APS para facilitar o acesso à Atenção Primária no Brasil Translated title: PEC e-SUS APS online appointment scheduling system: a tool to facilitate access to Primary Care in Brazil

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          Abstract

          Resumo A existência de barreiras nos serviços de demanda agendada resulta no elevado índice de absenteísmo. O objetivo deste manuscrito é apresentar as principais características do Sistema de Agendamento Online da estratégia e-SUS APS no Brasil. O Sistema de Agendamento Online desenvolvido pelo Laboratório Bridge da Universidade Federal de Santa Catarina, o qual também desenvolve o sistema de Prontuário Eletrônico do Cidadão (PEC e-SUS APS), e permite o agendamento de consultas através do aplicativo Conecte SUS Cidadão. O PEC e-SUS APS possui, entre outros, o módulo de agenda do profissional onde são realizadas as marcações e cancelamentos de consultas, permitindo a visualização de seus horários e disponibilidades. Embora o uso de sistemas de agendamento online seja capaz de fornecer benefícios, infelizmente eles têm sido pouco explorados na APS. Os principais motivos estão relacionados com a falta de informação e capacitação dos profissionais sobre o sistema e os impactos nos serviços prestados pelos estabelecimentos de saúde da APS. A fim de garantir a maior adoção e utilização do Sistema de Agendamento Online, é necessário ampliar a divulgação do sistema de modo a instituí-lo na rotina dos serviços como um instrumento facilitador do acesso à APS.

          Translated abstract

          Abstract Barriers faced by health services providing scheduled care result in high no-show rates. This article describes the main characteristics of an online appointment scheduling system incorporated into the citizens’ electronic health record system (PEC e-SUS APS). Developed by the Bridge Laboratory, Federal University of Santa Catarina, which also developed the PEC e-SUS APS, the system allows patients to schedule appointments using the national patient communications hub, Conecte SUS Cidadão. The PEC e-SUS APS includes a professional’s agenda module that allows patients to view available time slots and book and cancel appointments. Unfortunately, despite the benefits of online scheduling systems, their potential has been poorly exploited in Brazil. The main reasons for this include lack of information and training of health professionals on how to use the system and its potential benefits for Primary Health Care (PHC) services. Wider dissemination is needed to improve the adoption of the system and promote the routine use of this tool in health services in order to facilitate access to primary health care.

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          The breadth of primary care: a systematic literature review of its core dimensions

          Background Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health.
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            No-shows in appointment scheduling – a systematic literature review

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              Mobile phone messaging reminders for attendance at healthcare appointments.

              This review is an update of the original Cochrane review published in July 2012. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments. Patient reminders may help reduce missed appointments. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), could provide an important, inexpensive delivery medium for reminders for healthcare appointments. To update our review assessing the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of costs; health outcomes; patients' and healthcare providers' evaluation of the intervention and perceptions of safety; and possible harms and adverse effects associated with the intervention. Original searches were run in June 2009. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2012, Issue 8), MEDLINE (OvidSP) (January 1993 to August 2012), EMBASE (OvidSP) (January 1993 to August 2012), PsycINFO (OvidSP) (January 1993 to August 2012) and CINAHL (EbscoHOST) (January 1993 to August 2012). We also reviewed grey literature (including trial registers) and reference lists of articles. Randomised controlled trials (RCTs) assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions.   Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third author. Two authors assessed the risk of bias of the included studies. As the intervention characteristics and outcome measures were similar across included studies, we conducted a meta-analysis to estimate an overall effect size. We included eight randomised controlled trials involving 6615 participants. Four of these studies were newly identified during this update.We found moderate quality evidence from seven studies (5841 participants) that mobile text message reminders improved the rate of attendance at healthcare appointments compared to no reminders (risk ratio (RR) 1.14 (95% confidence interval (CI) 1.03 to 1.26)). There was also moderate quality evidence from three studies (2509 participants) that mobile text message reminders had a similar impact to phone call reminders (RR 0.99 (95% CI 0.95 to 1.02). Low quality evidence from one study (291 participants) suggests that mobile text message reminders combined with postal reminders improved the rate of attendance at healthcare appointments compared to postal reminders alone (RR 1.10 (95% CI 1.02 to 1.19)). Overall, the attendance to appointment rates were 67.8% for the no reminders group, 78.6% for the mobile phone messaging reminders group and 80.3% for the phone call reminders group. One study reported generally that there were no adverse effects during the study period; none of the studies reported in detail on specific adverse events such as loss of privacy, data misinterpretation, or message delivery failure. Two studies reported that the costs per text message per attendance were respectively 55% and 65% lower than costs per phone call reminder. The studies included in the review did not report on health outcomes or people's perceptions of safety related to receiving reminders by text message. Low to moderate quality evidence included in this review shows that mobile phone text messaging reminders increase attendance at healthcare appointments compared to no reminders, or postal reminders.Text messaging reminders were similar to telephone reminders in terms of their effect on attendance rates, and cost less than telephone reminders. However, the included studies were heterogeneous and the quality of the evidence therein is low to moderate. Further, there is a lack of information about health effects, adverse effects and harms, user evaluation of the intervention and user perceptions of its safety. The current evidence therefore still remains insufficient to conclusively inform policy decisions.There is a need for more high-quality randomised trials of mobile phone messaging reminders, that measure not only patients' attendance rates, but also focus on the cost-effectiveness of these interventions. Health outcomes, patients' and healthcare providers' evaluation and perceptions of the safety of the interventions, potential harms, and adverse effects of mobile phone messaging reminders should be assessed. Studies should report message content and timing in relation to the appointment.
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                Author and article information

                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                June 2021
                : 26
                : 6
                : 2023-2034
                Affiliations
                [1] Florianópolis SC orgnameLaboratório Bridge orgdiv1Centro Tecnológico Brasil postal@ 123456bridge.ufsc.br
                [2] Florianópolis Santa Catarina orgnameUniversidade Federal de Santa Catarina orgdiv1Centro de Ciências da Saúde orgdiv2Departamento de Enfermagem Brazil
                [5] Florianópolis SC orgnameUFSC orgdiv1Centro de Ciências da Saúde orgdiv2Departamento de Análises Clínicas Brasil
                [4] Florianópolis SC orgnameUFSC orgdiv1Centro Tecnológico orgdiv2Departamento de Informática e Estatística Brasil
                [3] Florianópolis SC orgnameUFSC orgdiv1Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde Brasil
                Article
                S1413-81232021000702023 S1413-8123(21)02600602023
                10.1590/1413-81232021266.38072020
                5cde0ee4-0978-4e5d-8754-6bafc3948590

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 08 October 2020
                : 25 January 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 44, Pages: 12
                Product

                SciELO Public Health

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                Artigo

                Agendamento de Consultas,Sistema Único de Saúde,Electronic Health Records,Mobile Applications,Appointments and Schedules,Primary Health Care,Unified Health System,Registros Eletrônicos de Saúde,Aplicativos Móveis,Atenção Primária à Saúde

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