Hybrid Simulation for modelling the impact of implementing Telehealth in the Brazilian Primary Care

Ageing population increases the demand for primary care and long-term care and requires adequacies on social systems, such as healthcare systems. In Brazil, the number of people over 60 years old has been growing at a higher pace than in European countries, such as France and Belgium. In Sao Paulo, the Brazilian state with higher GDP is estimated that in 20 years, 20% of its current 12.3 million people will be over 60 years old. One possible solution to tackle the increase in demand for primary care is the implementation of telehealth for health and teleconsultation. Nonetheless, in developing countries, the effort required in a telemedicine project is likely to be higher in complexity, accuracy, and performance than in developed countries. The use of teleconsultation is not regulated in Brazil; however, this practice was temporally allowed during the Covid-19 pandemic, raising the debate around its sanction. Its adoption might be a potential solution to tackle the future demographic trends (e.g., ageing population) and contribute to the 2030 Agenda for Sustainable Development. In this sense, this research aims to use simulation to evaluate the impacts of telehealth on delivering primary care service offered by public health in a southern region of Sao Paulo city, Brazil. Discrete Event Simulation (DES) and Agent-based Simulation (ABS) are combined in a hybrid model and coded in the commercial software package Simul8. We simulate the primary care offered by the Sao Paulo council, with DES representing the operation of health centres and patients also modelled as agents dictating the demand for health care services. The model supports decision-making around implementing telehealth in public health in Brazil and evaluating a new healthcare delivery impact on patient access to care.