The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil

Abstract BackgroundThe use of Telemedicine, or the provision of healthcare and communication services through distance-based technologies, has increased substantially since the 2019 novel coronavirus (COVID-19) pandemic. However, it is still unclear what are the innovative features of the widespread use of such modality, its forms of employment and the context in which it is used across pluralist health systems, particularly in low- and middle-income settings. We have sought to provide empirical evidence on the above issues by analysing the responses of medical doctors in a representative cross-sectional survey in two states in Brazil: São Paulo and Maranhão.ResultsIn our sample from two Brazilian states, telemedicine was employed as a form of clinical collaboration by the majority of doctors, but only a third of them used it as a modality to provide healthcare services. During the pandemic, this modality was used predominantly in COVID-19-related areas, particularly for hospital-based in-patient services and in private clinics and ambulatory settings. Male, younger doctors used this modality the most. The use of telemedicine in São Paulo was more frequent than in Maranhão; doctors in urban settings reported using such a modality more than doctors in rural areas. Approximately three-quarters of doctors in large hospitals reported using telemedicine services, followed by doctors working for smaller private clinics. Only by a minority of primary care doctors used telemedicine services.ConclusionsOur study suggests that telemedicine may have helped ensure and expand the range of communication and healthcare services in low- and middle-income settings during the pandemic. However, the modality appears to lend itself to be disproportionally used by doctors working in specific sections of pluralistic health systems, and presumably by patients seeking care there. Regulation and incentives will be required to support the adoption and use of the technology across health systems in low- and middle-income countries in order to increase access to services for less disadvantaged populations.