Primary health care (PHC) serves as the bedrock for achieving universal health coverage by providing essential and accessible health services that meet the diverse needs of individuals and communities. PHC forms the foundation for equitable health systems, ensuring that everyone can access the care they need without financial hardship. In 2020, similar to numerous other nations, Chile’s PHC centers faced overwhelming challenges due to the surge in COVID-19 cases. To complement the existing in-person PHC delivery infrastructure, the Ministry of Health of Chile, in collaboration with PAHO/WHO and other partners, launched a pilot teletriage initiative in September 2020.[1] Teletriage guides individuals to appropriate care, whether in-person or remote, by remotely assessing, evaluating, and prioritizing their health concerns through telecommunication. Striving to maintain the continuity of PHC services, including for the most remote populations, and relieve pressure on in-person facilities through remote consultation, the initiative proved highly successful, processing over 200 000 requests in its inaugural year. Thanks to its success, Chile enacted a policy in 2022 promoting widespread implementation of the teletriage model. As of May 2023, teletriage has handled more than one million requests. As the teletriage model expands, its success profoundly contributes to the priorities outlined in Chile's government plan, the Country Cooperation Strategy, and the United Nations Sustainable Development Cooperation Framework agreed upon with the Government of Chile.

“With the onset of the pandemic, we faced considerable challenges given the limited infrastructure of our center. High demand, coupled with patients requiring routine checks for chronic conditions meant that we didn't have the capacity to care for everyone in need. That's when the platform came to our rescue, helping us organize and understand the healthcare needs of our population.”

- Dr Carla Bermudez, Dr Arturo Baeza Goñi de San Joaquín Family Health Center

How did Chile, with the support PAHO/WHO, achieve this?

Intellectually co-created by PAHO/WHO, the Ministry of Health, the School of Public Health at the University of Chile, Plataforma 360, and health care staff from two pilot PHC centers, the conceptualization of the teletriage model centered on two key aspects, 1) demand management to optimize the flow of care requests, and 2) triage to prioritize care requests based on urgency and severity. This model was subsequently translated into an algorithm, establishing the groundwork for the teletriage software and platform. The teletriage system enables patients to submit information via an online care request form, with a healthcare professional assessing the request and arranging an appointment, providing flexibility for in-person or remote consultations depending on the patient's condition and consultation complexity. In preparation for a successful launch, PAHO/WHO leveraged its expertise to deliver a comprehensive implementation package along with various tools, encompassing communication materials, a website, a specialized training environment, and a cutting-edge virtual platform.

To trial the teletriage model, PAHO/WHO financed and implemented a pilot project with the South Metropolitan Health Service, providing a valuable opportunity to refine the model and associated tools through real-world application. Pilot evaluations indicated a notable increase in healthcare access and a tangible reduction in workload pressure at PHC centers. The teletriage model’s prioritization of care requests based on individual needs, considering urgency and severity, markedly improved health system efficiency, leading to reduced waiting periods for medical appointments. In its first year, the initiative processed over 200,000 care requests across 12 centers, resolving 14% without requiring a physical visit. The initiative garnered positive feedback, with 64% of patients highly satisfied and 66% preferring it over traditional appointment scheduling. Additionally, 67% intended to continue using it, citing time and monetary savings. As a result of the pilot's success, the teletriage model was embraced as a national policy, with the Ministry of Health leading a nationwide implementation plan in 2022. As of May 2023, the teletriage system has successfully processed one million requests across 76 centers in 29 municipalities. Thirteen percent of these requests were promptly resolved remotely, and an additional 10% were administratively resolved without requiring a physical visit.

“This system has been an invaluable asset to us, and as a team, we can summarize its advantages in four key benefits: it reduces queues and crowds early in the morning, it provides us with a global vision of demand which aids in schedule management, it offers a clear visualization of unaddressed demand, and it serves as a channel for improved communication between users and the health center.”

- Cecilia Acevedo, midwife and triagist, Dr Miguel Ángel Solar de Paine Family Health Center