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THE IMPACT OF TELEMEDICINE ON ACCESS TO PRIMARY CARE:
CHALLENGES AND OPPORTUNITIES IN POST-PANDEMIC PRIMARY
CARE
Matheus Carvalho Meneghetti1
Daiany Bromonschenkel De Angeli2
Luna Musso Rabelo3
Leonardo Gomes Santos4
João Marcelo Pacheco Kokis5
Isabela Silva Barbieri6
Mariana Costa dos Santos7
Jhennyfer Barcelos Bicalho8
Bárbara Wagmacker Barbosa9
Lucas Frasson Venturini10
Beatriz Rebonato de Souza Ribeiro11
Gabriela Silva Pereira12
Bruno de Figueiredo Moutinho13
1 University of Western Paulista (UNOESTE)
2 School of Sciences of Santa Casa de Misericórdia de Vitória (EMESCAM)
3 University Vila Velha (UVV)
4 University of Western Paulista (UNOESTE)
5 University Estácio de Sá (IDOMED Cittá)
6 Brazilian College Multivix
7 Metropolitan College São Carlos (FAMESC)
8 School of Sciences of Santa Casa de Misericórdia de Vitória (EMESCAM)
9 Federal University of Espírito Santo (UFES)
10 Federal University of Espírito Santo (UFES)
11 Maurício de Nassau University Center (UNINASSAU)
12 University Center of Espírito Santo (UNESC)
13 Metropolitan College São Carlos (FAMESC)
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Pedro Paulo Ladeira Junior14
Abstract: The COVID-19 pandemic has driven the implementation of telemedicine as a solution
for maintaining access to healthcare, transforming the primary care landscape in many parts of the
world. In Brazil, telemedicine has established itself as an essential tool for overcoming geographical
and social barriers, facilitating access to basic care for populations that traditionally faced difculties
in accessing health services. This study seeks to investigate the impact of telemedicine on access
to primary care, analyzing its main challenges and opportunities in the context of post-pandemic
primary care. This study seeks to analyze the impact of telemedicine on access to primary care,
exploring the main challenges and opportunities that arise with this modality of care. It also aims
to identify practices and policies that can strengthen the implementation of telemedicine in Primary
Care, ensuring that remote care is effective, safe and inclusive. This is a literature review, based
on a qualitative approach, using the Scielo, Google Scholar and PubMed databases. To rene the
research, the health descriptors “telemedicine”, “primary care”, “COVID-19”, and “equity in access
to health” were selected, with a time frame between 2021 and 2023. Through a literature review,
the study explores recent data on telemedicine in primary care, focusing on the main opportunities
it offers, such as improved access and efciency of services, as well as the challenges, including
limited technological infrastructure in poor regions, privacy and condentiality issues, and the need
for adequate training for health professionals. Telemedicine enables more agile care and coverage of
a larger population, but still faces obstacles related to digital accessibility and maintaining quality
and continuity of care, especially for vulnerable groups. Telemedicine has therefore proved to be a
strategic tool for expanding access to primary care, offering a viable alternative for reducing gaps in
primary care. However, in order to maximize its impact, it is essential to overcome the technological
challenges, guarantee information security and train health professionals in this new type of care. The
continued use of telemedicine in the post-pandemic context presents an opportunity to strengthen the
14 City University of São Paulo (UNICID)
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Unied Health System (SUS) in Brazil, expanding the reach of primary care and promoting greater
equity in access to health.
Keywords: Telemedicine; Primary Care; Health Technology and Advances; Pandemic; COVID-19.
INTRODUCTION
Telemedicine has emerged as a crucial tool in accessing health care, especially in Primary
Care, playing a key role during the COVID-19 pandemic. The pandemic scenario has accelerated the
implementation of telemedicine services in many countries, creating new paths for patient care and
enabling the continuity of medical care without the need for physical displacement (Melo and Silva,
2022).
Thus, the use of telemedicine proved to be especially relevant for populations in remote areas
or with limited resources, where access to health services has always been a challenge. In this context,
telemedicine has not only expanded the reach of primary care, but has also proven to be a promising
instrument to meet pent-up demand and relieve health units (Santos et al., 2023).
However, the expansion of telemedicine in Primary Care still faces signicant barriers, such as
unequal access to the internet, difculties in adapting patients and professionals to new technologies, and
concerns about the security and privacy of medical data. Such issues are especially evident in contexts
of greater social vulnerability, where technological and nancial limitations are more pronounced,
making accessibility difcult for part of the population. These challenges highlight the importance of
careful planning in the integration of telemedicine into the health system, in order to ensure equity and
effectiveness in remote care, preventing the format from becoming a new exclusion factor (Almeida and
Nogueira, 2021).
In addition, in the post-pandemic scenario, telemedicine presents opportunities for integration
with face-to-face practices, allowing Primary Care to benet from a hybrid model of care. This
combination can enhance the quality and continuity of care, facilitating the regular follow-up of chronic
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patients and enabling rapid triage for cases that require face-to-face care. As a result, telemedicine is not
limited to being an emergency measure, but emerges as a permanent and strategic component for the
modernization and efciency of health systems, especially in primary care units (Ferreira and Costa,
2022).
This paper seeks to analyze the impact of telemedicine on access to primary care, exploring
the main challenges and opportunities that arise with this modality of care. In addition, it aims to
identify practices and policies that can strengthen the implementation of telemedicine in Primary Care,
ensuring that remote care is effective, safe, and inclusive.
MATERIALS AND METHODS
This is a literature review, based on a qualitative approach, using the Scielo, Google Scholar
and PubMed databases. To rene the research, the health descriptors “telemedicine”, “primary care”,
“COVID-19”, and “equity in access to health” were selected, with a time frame between the years 2021
and 2023.
Inclusion Criteria:
1. Articles published between 2021 and 2023.
2. Studies that address the use of telemedicine in the context of Primary Health Care.
3. Peer-reviewed publications in recognized scientic journals.
4. Studies that explore challenges and impacts of telemedicine on access to health, especially
in vulnerable regions or remote areas.
Exclusion Criteria:
1. Articles that do not focus on telemedicine within primary care.
2. Studies that do not present empirical data or clear methodologies.
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3. Publications in non-indexed journals or with a low impact factor.
4. Reviews that do not consider the impact of COVID-19 on telemedicine practice.
Guiding Question:
What are the challenges and opportunities presented by telemedicine in strengthening access
to health in primary care in the context of the COVID-19 pandemic and in the subsequent period?
Boolean Markers:
“telemedicine” AND “primary care”.
“COVID-19” OR “pandemic”.
“telemedicine” NOT “face-to-face consultations”.
THEORETICAL FOUNDATION
Telemedicine has gained fundamental importance during the COVID-19 pandemic, emerging
as an essential alternative to ensure the continuity of health care in a context of social distancing. In
Primary Health Care (PHC), telemedicine offers a model that expands patients’ access to the system,
especially in areas of difcult access, promoting consultations, screening, and monitoring of chronic
diseases. This model addressed the lack of health professionals in several regions and allowed access to
specialists previously unavailable in geographically isolated areas (Silva and Pereira, 2021).
However, the implementation of telemedicine faces signicant challenges, one of the main ones
being inadequate technological infrastructure, especially in rural and low-income areas. Thus, regions
with social vulnerability still lack adequate structure, with low connection quality and insufcient
technological devices. In addition, digital literacy is a limiting factor, especially among the elderly, who
have difculties in using digital platforms for consultations and health monitoring (Costa and Souza,
2021).
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In addition, data security is another essential concern: With the growth in the use of digital
platforms, it is necessary to ensure the protection of sensitive information of patients who report that
Brazilian legislation requires rigor in terms of condentiality and data protection, which makes the
secure implementation of telemedicine an additional challenge (Borges et al., 2022).
Therefore, telemedicine offers valuable opportunities to expand access to care and optimize
resources in Primary Care. Studies indicate that its adoption can reduce operating costs, expanding
service without the need for travel or long waits. It is suggested that remote care optimizes the workload
of health professionals, since follow-up consultations, especially for patients with chronic diseases, can
be carried out at a distance, promoting preventive care and avoiding the progression of clinical conditions.
In addition, telemedicine enables health education, allowing professionals to instruct patients about
their conditions, encouraging self-care and adherence to treatment. They demonstrated that remote care
facilitates frequent communication between patients and professionals, which helps maintain healthy
habits and adherence to drug treatment, reducing readmissions and improving quality of life (Mendes
et al., 2023).
In the post-pandemic context, telemedicine is consolidated as a sustainable practice integrated
with PHC. The hybrid model, which combines face-to-face and remote care, can make the health
system more resilient to crises and ensure quality coverage, particularly in health emergencies. The
sustainability of telemedicine also requires public policies that encourage investments in infrastructure
and the training of health professionals. As a result, telemedicine should be recognized as a permanent
practice, supported by management systems that promote its effective integration into traditional health
services (Nascimento and Lima, 2023).
In addition, telemedicine plays a crucial role in promoting health equity, expanding access
for marginalized populations. The technology represents a step towards the democratization of health
in Brazil, allowing the care of patients in regions with difcult access to specialized professionals and
promoting a more inclusive PHC. In addition, telemedicine enables communities that were previously
disconnected from the formal health system to receive consistent and continuous care, contributing to
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the reduction of regional and social inequalities (Freitas and Silva, 2022).
CONCLUSION
It is concluded that telemedicine has brought a signicant transformation in access to primary
care, offering a new dynamic for primary care, especially after the COVID-19 pandemic. Its incorporation
proved to be not only an emergency response, but also a viable and effective strategy to expand access,
reduce geographical barriers, and optimize resources. Despite the advances, full implementation still
faces challenges, such as the need for investments in infrastructure and training of professionals, as
well as overcoming technological limitations in areas of low connectivity and the necessary care for the
security and privacy of patient data.
The positive results highlight the potential of telemedicine to make primary care more inclusive
and resilient, promoting equity in care and enabling access to populations previously disconnected from
the formal health system. The development of a hybrid model, which combines remote and face-to-face
care, offers a promising prospect for a more integrated and sustainable health system, capable of facing
future health crises more effectively.
In addition, telemedicine drives a more efcient workow, facilitating the screening and
referral of cases that really need face-to-face care, relieving health units and allowing a more rational
use of resources. Strengthening this model requires a systematic approach that considers expanding
quality internet access and investing in remote diagnostic tools, as well as developing clear guidelines
for the ethical and safe use of patient information. In short, telemedicine is a robust and adaptable
solution, with the potential to transform primary care and make health care more accessible, efcient,
and equitable in the long term.
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