# Telehealth as a Strategy to Expand Access in Brazil’s Unified Health System: Analysis of São Paulo State’s Experience Across the Three Levels of Health Care

## TL;DR

This study shows how telehealth can expand healthcare access in Brazil by analyzing its implementation in São Paulo across different care levels.

## Contribution

The study provides empirical evidence on telehealth implementation in Brazil’s public health system across primary, secondary, and tertiary care.

## Key findings

- Telehealth was implemented in 52 facilities across São Paulo with 19,053 primary teleconsultations and 4,178 ICU discussions.
- High patient satisfaction scores (NPS 97 for primary care) indicate successful telehealth adoption.
- Telehealth proved feasible even at limited scale, improving access and coverage in public health.

## Abstract

The COVID-19 pandemic accelerated the adoption of telehealth as a key strategy within Brazil’s Unified Health System. In São Paulo State, digital health initiatives have been developed to implement telehealth-based care models across all 3 levels of health care.

The aim of this study is to describe the implementation process of the telehealth model in public health facilities to a lesser extent.

This descriptive study reports on the implementation of telehealth services at the primary, secondary, and tertiary levels of health care in São Paulo State. Thirty primary health units, 4 specialty care outpatient clinics, and 18 hospitals were selected by the institutions participating in the project based on technical, health care, and infrastructure criteria. Teleconsultations were conducted through the institutional teleconferencing platform, ensuring data security and privacy. Data were collected through REDCap (Research Electronic Data Capture) between April and December 2024, including operational metrics and satisfaction scores (Net Promoter Score [NPS]). All participating health care facilities signed a term of adherence and data sharing agreement. Patients received care only after being informed and after signing a consent and adherence term for telehealth form.

Telehealth was implemented in 52 health care facilities across 47 municipalities in São Paulo State. A total of 19,053 teleconsultations were conducted in primary health units (NPS 97) and 218 in specialty care outpatient clinics (NPS 74), and 4178 intensive care unit case discussions were held (NPS 86).

The findings suggest that telehealth is a feasible strategy across all levels of health care, even when implemented at a limited scale, contributing to expanded access and service coverage.