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. 2025 Oct 6;26(1):303.
doi: 10.1186/s12875-025-02989-6.

What are the primary care physicians and cardiologists talking about? a cross-sectional analysis of two telemedicine services in Rio de Janeiro, Brazil

Leonardo Graever  1   2 , Sathya Karunananthan  3 , Rafael Aaron Abitbol  4 , Gabriel Pesce de Castro da Silva  5 , Laís Pimenta Ribeiro Dos Santos  6 , Mariana Borges Dias  7 , Marcelo Machado Melo  5 , Viviane Belídio Pinheiro da Fonseca  5 , Leonardo Cançado Monteiro Savassi  8 , Aurora Felice Castro Issa  5 , Anne Frølich  9 , Maria Kátia Gomes  2 , José Roberto Lapa E Silva  2 , Clare Liddy  10 , Helena Dominguez  11   12
Affiliations

What are the primary care physicians and cardiologists talking about? a cross-sectional analysis of two telemedicine services in Rio de Janeiro, Brazil

Leonardo Graever et al. BMC Prim Care. .

Abstract

Background: Primary care physicians (PCPs) face challenging clinical situations. Telemedicine between PCPs and specialists involving case discussions in cardiology are frequent. Assessing these interactions is essential for identifying knowledge gaps and tailoring support. In Rio de Janeiro, Brazil, two new telemedicine services provide cardiology support for PCPs: one from the Municipal Health Department using WhatsApp (Meta) and one from the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) research project, which uses a web-based platform. This study analysed and compared the use of these two services in terms of their frequency, distribution among city areas, and content of the PCPs’ questions and cardiologists’ answers.

Methods: Cross-sectional study. We described the demographic characteristics of the patients whose cases were discussed and the primary care physicians’ use frequency. We classified the reasons for encounter and discussed diagnoses using the International Classification of Primary Care (ICPC-3), the question types using the Taxonomy of General Clinical Questions domains, and the specialist’s answers using an adapted version of the Champlain eConsult BASE™ research group’s classification.

Results: We analysed the usage data of all interactions (N = 1065) and the detailed content of a random sample (n = 346). The PCPs used the Health Department service more frequently (332/1093, 31%) than the BRAHIT project service (43/1331, 5%). The median answer time was shorter for the Health Department service (19 min) than for the BRAHIT service (two days). Most questions to the health department service were classified within the diagnosis domain, mainly regarding electrocardiography interpretation. The questions asked to the BRAHIT service were more frequently classified into treatment or management domains. The advantages and drawbacks of both models and the contributions of the findings to future implementation projects and continuing medical education opportunities are discussed.

Conclusions: The two types of telemedicine services were adopted differently by the PCPs, with more frequent use and focus on diagnosis in the Health Department WhatsApp (Meta)-based service, compared with less frequent use, more centred on treatment and management topics, in the BRAHIT. Further research using standardised taxonomies for content analysis is needed to inform optimal practices in telemedicine services between providers and guide future initiatives.

Keywords: Cardiovascular disease; Continuing medical education; Low- and middle-income countries; Primary health care; Telemedicine.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study complied with the World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. For this study, a submission to an Institutional Review Board was deemed unnecessary. The conclusion is based on the fact that we analysed data collected from two sources. The first source is secondary data from the BRAHIT project, approved by the National Institute of Cardiology (registration no. 5272), the Health Department of the Rio de Janeiro municipality (no. 5279), and Brazil’s National Ethics Committee (no. 8000) under application number 14894819.5.0000.5272. For this source, the informed consent contemplates secondary analysis without requiring additional individualised permissions. The second source, from the Rio de Janeiro Health Department telemedicine service, contains anonymised, unidentifiable data, whose access was granted upon the researchers'signature of a commitment term for responsible data use. It complies with Brazilian legislation, which waives, in this case, the requirement for the researcher to submit the project to an Institutional Review Board (resolutions 647 of 6/5/2022 and 738 of 1/2/2024 of the National Health Council and the National Research Ethics Committee – CONEP, No. 8000). Consequently, individualised consent to participate is waived and not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participant inclusion and data analysis according to the telemedicine service
Fig. 2
Fig. 2
Proportion of physicians who used each telemedicine service per Rio de Janeiro’s Health Department administrative area. The letters A to J are proxies for the real area’s names
Fig. 3
Fig. 3
Interactions per physician per year according to the Rio de Janeiro’s Health Department administrative area. The letters A to J are proxies for the real area’s names
See this image and copyright information in PMC

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