Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 21, 2025
Date Accepted: Jan 26, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Telehealth as a Strategy to Expand Access in Brazil’s Unified Health System (SUS): An Analysis of São Paulo State’s Experience Across the Three Levels of Healthcare
ABSTRACT
Background:
The COVID-19 pandemic accelerated the adoption of telehealth as a key strategy within Brazil’s Unified Health System (SUS). In São Paulo State, digital health initiatives have been developed to implement telehealth-based care models across all three levels of healthcare.
Objective:
To describe the implementation process of the telehealth model in public health facilities in a lesser extent.
Methods:
This descriptive study reports on the implementation of telehealth services at the primary, secondary and tertiary levels of healthcare in São Paulo State. Thirty Primary Health Units (PHU), four Specialty Care Outpatient Clinic (AME), and eighteen hospitals were selected by the institutions participating in the project, based on technical, healthcare, and infrastructure criteria. Teleconsultations were conducted via the institutional teleconferencing platform, ensuring data security and privacy. Data were collected through REDCap between April and December 2024, including operational metrics and satisfaction scores (Net Promoter Score – NPS). All participating healthcare facilities signed a Term of Adherence and Data Sharing. Patients received care only after being informed and signed a Consent and Adherence Term for Telehealth.
Results:
Telehealth was implemented in 52 healthcare facilities across 47 municipalities in São Paulo State. A total of 19,053 teleconsultations were conducted in PHU (NPS 97), 218 in AME (NPS 74), and 4178 ICU case discussions were held (NPS 86).
Conclusions:
The findings suggest that telehealth is a feasible strategy across all levels of healthcare, even when implemented at a limited scale, contributing to expanded access and service coverage.
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