Saúde digital na atenção primária à saúde em tempos de Covid-19: perspectivas para avaliação e melhoria da qualidade

Abstract

The COVID-19 pandemic brought social, economic and health impacts, which required rapid adaptation of health systems not only from a quantitative point of view, but also in terms of quality. In this context, digital health has gained strength in Primary Health Care (PHC) and has significantly highlighted the importance of timely and accurate information as a decision-making instrument for short, medium and long-term needs. This study aimed to highlight the scope of digital health strategies and relevant aspects for their evaluation in PHC, from the COVID-19 pandemic. With the development of a scoping review literature, a concept analysis and a methodological study with a qualitative approach, we sought to apprehend the state of the art of digital health and its impact on the quality of care in PHC in the world, to analyze how the concept of digital health relates to PHC, in the context of the COVID-19 pandemic, and to develop a model for its evaluation in Brazil. The scoping review was based on the Joanna Briggs Institute manual, guided by the PRISMA Extension for Scoping Reviews. Data collection was performed in June and July 2021, in multidisciplinary databases of health sciences and gray literature. The concept analysis, carried out in February 2022, was based on Rodgers' Evolutionary method, making it possible to outline the historical knowledge and contextual aspects built on a concept. The methodological study, carried out between June 2021 and March 2022 followed the steps of literature review, model elaboration, model validation and elaboration of the indicator matrix. The review revealed positive and negative impacts of remote strategies on the quality of care in PHC, but above all some inability to take advantage of the potential of technologies, which can demonstrate differences in the organization of the rapid and emergency implementation of digital strategies around the world. The conceptual analysis made it possible to understand the nature of the concept of digital health in PHC, expand its conception and reflect on situations that precede and follow it. Thus, it showed the importance of the rapid transition in the provision of digital health care, its scope and multiple identified terms, which reveals the heterogeneity of a concept that is in increasing use among publications in the scientific environment. The modeling took as assumptions the context, antecedents in digital health, delimitation of the evaluative research and qualifying attributes of PHC. It incorporated into its activities, technical (scope of actions and accuracy), organizational (organization of care and management) and relational (interpersonal) dimensions in the care and management processes of care. Thus, given the importance of digital health in the current global health situation, and the possibility of integrating and advancing this strategy after the pandemic, primary care must strengthen its response capacity, expand the use of information and communication technologies, managing changeable challenges in an adaptive and evidence-based way. It is reinforced that the guidance, planning and execution of actions that gear digital health need to be evaluated in order to reach an understanding of how decisions, actions and investments are contributing to the improvement of access and quality of services and the health of populations.