title: Implementation of a cardiology care program in remote areas in Brazil: influence of governability.
abstract: BACKGROUND
  A telecardiology remote cardiology medical care system was implemented in 82 municipalities of Minas Gerais State, Brazil to support basic network services in the early diagnosis and management of cardiovascular diseases.
  
  
  OBJECTIVE
  To investigate the factors associated with the implementation of this program in the municipalities.
  
  
  METHODS
  This 2006 ecological study involved 393 candidate municipalities to implement the system. The municipalities were divided into two groups: non-random intervention (n = 82) and comparative (n = 311). The social, structure, healthcare needs, and governability indexes of the two groups of municipalities were compared by descriptive and multiple regression analysis using the generalized estimation equation model.
  
  
  RESULTS
  After fitting for other characteristics, participation of the municipalities in the intervention was associated with a higher social responsibility index (OR: 2.44, CI: 1.50-3.96) and lower healthcare needs (OR: 2.29, CI: 1.24-4.22).
  
  
  CONCLUSIONS
  Greater efforts by municipality management was the key to attracting and implementing the remote cardiology intervention, even when fitted for lower healthcare needs, which suggests greater municipal political and social engagement. This translated to improved access to cardiovascular health care for Brazilian rural and remote populations in the intervention municipalities.
authors.affiliation: Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil. clarecicardoso@yahoo.com.br
authors.forename: C S
authors.initials: CS
authors.lastname: Cardoso
authors.forename: A L P
authors.initials: AL
authors.lastname: Ribeiro
authors.forename: R L V
authors.initials: RL
authors.lastname: Castro
authors.forename: C C
authors.initials: CC
authors.lastname: César
authors.forename: W T
authors.initials: WT
authors.lastname: Caiaffa
mesh_terms: D001938:Brazil; D002309:Cardiology / Q000379:methods*; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D009026:Mortality; D019035:Rural Health Services / Q000458:organization & administration*; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000458:organization & administration*