Optimizing Brazil Health Care with telemedicine (BRAHIT)


Start date: 1 March, 2019 End date: 31 December, 2024 Project type: Research projects in countries with targeted development cooperation (earlier Window 2) Project code: 18-M03-KU Countries: Brazil Thematic areas: Health, Lead institution: University of Copenhagen (UCPH), Denmark Partner institutions: Ministry of Health, Instituto Nacional de Cardiologia, Brazil Federal University of Ouro Preto (UFOP), Brazil Region Hovedstaden, Bispebjerg Hospital, Denmark Project website: go to website (the site might be inactive) Project coordinator: Helena Dominguez Total grant: 4,848,030 DKK

Project summary

In BRAHIT we test in a pragmatic clinical trial, the hypothesis that a novel collaboration model across health sectors in Brazil can improve the quality of the management of patients with heart failure.

Health resources are scarce in Brazil, posing a constant pressure on specialists, such as cardiologists. Stable patients who have undergone highly complex procedures in a tertiary hospital are discharged to outpatient treatment at primary care. Both the population and cardiologists are reluctant to accept transfer to sometimes less skilled primary care. We propose in BRAHIT an enhanced collaboration that is also tangible for the patients, which can ease transfer of patients from cardiologists to primary care. Despite a more homogenous primary care, Denmark also faces a collaboration gap across sectors, and social inequality. Hence, Denmark can profit from adopting positive research results in BRAHIT.

BRAHIT involves the Brazilian Ministry of Health with participants from the National Institute of Cardiology hospital (INC), primary care and homecare in Rio de Janeiro. Thus, BRAHIT supports the ongoing Strategic Sector Cooperation (SSC) between Denmark and Brazil.

BRAHIT is relevant for SDG targets 3.8.1, 9.5 and 10.2, addressing social inequality, quality of healthcare and improvement of the use of Health data.

BRAHIT uses telemedicine and will outline a platform for data exchange, supported by the Danish company Trifork ApS. Furthermore, BRAHIT will run in parallel with an ongoing Danish project (REAFEL) supported by the Ministry of Higher Education and Science (Innovationsfonden), that targets population at risk for atrial fibrillation, which can provoke strokes. BRAHIT and REAFEL target thus different populations, in different countries, yet addressing comparable problems of social inequality and cross-sectorial gaps. Therefore, we can learn from the BRAHIT and REAFEL trials, while establishing evidence-based strategies that can persist beyond the project and be globalized to other clinical conditions.


Midterm report
The main objective is to provide state-of-the-art quality of care to vulnerable patients with heart failure (HF), in primary care (PC), with remote support from cardiologists.
Rearding outputs, there has been conducted a pilot study with 64 patients with HF, from 24 Primary care clinics that received remote support from cardiologists from INC hospital. Preliminary results show that adhesion to guidelines was improve.

A web platform has been created for data exchange across sectors on HF that can be incorporated as a quality database in the Municipality of Rio de Janeiro (ongoing discussion), a a national model for HF monitoring.
A first module for online course for management of HF in PC is completed and two more modules for standard and complex HF cases is under development.
A cluster-randomization trial protocol has been published and currently ongoing, projected to include 800 patients, expected to end in spring 2024.

Films for patient education have been developed by the Danish company Visikon and are currently delivered to patients at the PC clinics or at the patients home by Community Agents using mobile phones. These films are now also in use in Denmark.
A double ph.d. program is ongoing between the University of Copenhagen and Federal University of Rio de Janeiro and we have created a long-lasting Danish-Brazilian Academic Network (DANBRA) which incorporates scientists from UFRJ, UFOP and Fiocruz from Brazil and UCPH, SDU and the Copenhagen Trial Unit.

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