Strategic and clinical insights from the rapid scale-up of over 200,000 specialty teleconsultations in remote and underserved Brazilian regions

Background: Large-scale provider-to-provider teleconsultation models remain underreported in low- and middle-income countries. Optimal strategies for scaling outpatient telemedicine and evaluating its impact on quality, efficiency, and patient experience are still being investigated. Methods: We conducted a retrospective descriptive implementation study of synchronous, video-based, provider-to-provider teleconsultations coordinated by the Telemedicine Department of Hospital Israelita Albert Einstein, São Paulo, Brazil. We summarized program reach, site implementation, consultation volume, specialty distribution, consultation disposition, no-show rate, schedule utilization, and post-consultation experience indicators. Results: A total of 365 service points were established, offering 12 specialties and performing 201,012 teleconsultations. Schedule occupancy remained at 99.8%. Among consultations, 79% resulted in follow-up within the same specialty, 16% were discharged from specialty care, and 5% were referred elsewhere. Common diagnoses included hypertension (3.9%), autism spectrum disorder (3.7%), joint pain (3.7%), ADHD (3.6%), and generalized anxiety disorder (3.3%). Net Promoter Scores were 91 for physicians and 85 for patients. Conclusion: A centralized, structured, multi-specialty telehealth strategy was feasible across remote locations, sustained high appointment occupancy, and effectively resolved or redirected 95% of cases. Both clinician and patient satisfaction were notably high, supporting the scalability of this model in underserved regions.