RESUMO
Hasta diciembre de 2020, en Argentina el aborto era legal ante determinadas causales. Sin embargo, era común que la implementación de esta legislación se viera entorpecida. El objetivo de esta investigación fue identificar las barreras y los factores facilitadores para la accesibilidad a la interrupción legal de embarazo en una institución del subsistema privado y de la seguridad social. Se realizó una investigación con enfoque cualitativo con entrevistas a profesionales del equipo de salud involucrados en el circuito de atención de interrupción legal de embarazo del Hospital Italiano de Buenos Aires. Los resultados se organizan en cinco ejes temáticos que surgieron luego de un proceso de lectura, interpretación y discusión:1) ausencia de una política institucional explícita, 2) los componentes de la práctica (falta de registro en la historia clínica electrónica, desarrollo de circuitos paralelos para acceder a la medicación: misoprostol), 3) el marco jurídico legal y las causales (falta de leyes claras, diversas interpretaciones en lo que respecta al causal salud), 4) la objeción de conciencia y 5) los aspectos contextuales (movimiento feminista, el proyecto de ley desaprobado en el senado en 2018). A pesar de que el equipo de salud contaba con un marco legal claro, implementar una política institucional interna resulta sumamente necesario. (AU)
Up until December 2020, abortion was legal in Argentina on certain grounds. However, it was common for the implementation of this legislation to be hindered. The purpose of this research was to identify the barriers and facilitating factors for the accessibility to legal abortion in both private and public health care institutions. A qualitative research was carried out with interviews with health professionals involved in the health team at Hospital Italiano de Buenos Aires legal interruption of pregnancy care circuit. The results are organized into five thematic axes that emerged after a process of reading, interpreting and discussing: 1) the absence of an explicit institutional policy, 2) the components of the practice (lack of registration in the electronic health records, development of parallel circuits to access medication: misoprostol), 3) the legal framework and grounds (lack of clear laws, different interpretations regarding health grounds), 4) conscientious objection, and 5) contextual aspects (feminist movement, the bill disapproved in the Senate in 2018). Even though the health teamhad a clear legal framework in place, implementing an internal institutional policy is extremely necessary. (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Política Organizacional , Misoprostol/provisão & distribuição , Aborto Legal/legislação & jurisprudência , Aborto Legal/normas , Ética Clínica , Saúde de Gênero/políticas , Argentina , Sistemas Pré-Pagos de Saúde/normas , Inquéritos Epidemiológicos , Hospitais Privados/normas , Aborto Legal/instrumentação , Pesquisa Qualitativa , AbortoRESUMO
Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table.
Assuntos
Conselho Diretor/tendências , Sistemas Pré-Pagos de Saúde/tendências , Papel do Profissional de Enfermagem/psicologia , Conselho Diretor/organização & administração , Sistemas Pré-Pagos de Saúde/normas , HumanosRESUMO
The quality of healthcare service delivery under the existing health maintenance organisations (HMOs) in Nigeria has been a major concern to enrollees who have contested the value received from their respective HMO accredited hospitals under the program. This paper appraised health maintenance organisations' performance in the Nigerian healthcare service sector capturing enrollees' experience on the issues of access, responsiveness, and quality of healthcare service choice to measure the success or failure of the program since inception. The study adopted survey design with three hundred forty enrollees of ten leading HMOs in Nigeria that operate in different parts of Lagos Metropolis. Data collected were analysed with relevant descriptive and inferential statistics while hypotheses tested were at 0.05 level of significance. Findings revealed that HMO accredited hospitals have not ensured adequate access of enrollees to healthcare services, their responsiveness to enrollees' healthcare requests have not been impressive, and quality of healthcare services to enrollees have also not been excellent. Based on the findings, the study recommends that HMOs and government should improve on monitoring the quality of healthcare service delivery at their accredited hospitals and concluded that the performance of the HMOs in the area of healthcare service delivery is not world class when it comes to access, responsiveness, and quality of service delivery.
Assuntos
Sistemas Pré-Pagos de Saúde/normas , Acreditação , Adolescente , Adulto , Atenção à Saúde/normas , Feminino , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Adulto JovemRESUMO
We investigated the psychometric properties of the simplified Japanese version of the Athens Insomnia Scale (AIS-SJ) using baseline data from the Fukushima Health Management Survey. Data from 22 878 men and 27 669 women aged 16 years and older were analysed (Mage = 52.9 ± 18.6). Participants lived in the Fukushima evacuation zone and experienced the Great East Japan Earthquake. The AIS-SJ was used to assess participants' insomnia symptoms, and its validity was examined by administering the Kessler 6-item Psychological Distress Scale (K6) and assessing education, self-rated health and disaster-related experiences. A confirmatory factor analysis revealed that the two-factor model was a better fit than the one-factor model. The AIS-SJ and its subscales had acceptable reliability (Cronbach's alpha, 0.81). Test of measurement invariance confirmed strict invariance across groups for the participants' characteristics of gender and mental illness history, but not for participants' age. AIS-SJ scores exhibited a near-normal distribution (skewness, 0.45; kurtosis, -0.89). There were significant age differences only among women, and gender differences in AIS-SJ scores with small effect sizes. The AIS-SJ scores had weak-to-moderate correlations with mental illness history, bereavement, experiencing the tsunami, experiencing the nuclear power plant incident, housing damage and losing one's job (polyserial correlations, 0.36, 0.17, 0.13, 0.18, 0.13, and 0.15, respectively), and strong correlations with self-rated health (polyserial correlation, 0.51), psychological distress (rs , 0.60) and post-traumatic stress disorder (rs , 0.60). The AIS-SJ is a useful instrument for assessing community dwellers' insomnia symptoms.
Assuntos
Sistemas Pré-Pagos de Saúde/normas , Psicometria/métodos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
BACKGROUND: It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES: To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA: We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS: We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS' CONCLUSIONS: The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.
Assuntos
Informação de Saúde ao Consumidor/métodos , Hospitais/normas , Disseminação de Informação , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade , Canadá , Tomada de Decisão Clínica , Estudos de Avaliação como Assunto , Sistemas Pré-Pagos de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Medicaid , Inovação Organizacional , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do Tratamento , Estados UnidosRESUMO
PURPOSE: Implementation of the 2013 ACC/AHA cholesterol treatment guideline is likely to vary by statin benefit group. The aim of this study was to document trends in statin use before and after introduction of the ACC/AHA guideline. METHODS: We conducted a retrospective study with annual cohorts from 2009 to 2015 among members of Kaiser Permanente Southern California aged ≥ 21 years. Members were categorized into four mutually exclusive statin benefit groups: atherosclerotic cardiovascular disease (ASCVD), LDL-C ≥ 190 mg/dL in the last year, diabetes (aged 40-75 years), and 10-year ASCVD risk ≥ 7.5% (aged 40-75 years). RESULTS: The cohorts ranged from 1,993,755 members in 2009 to 2,440,429 in 2015. Approximately 5% of patients had ASCVD, 1% had LDL-C ≥ 190 mg/dL, 6% had diabetes, and 10% had a 10-year ASCVD risk ≥ 7.5% each year. Trends in statin use were stable for adults with ASCVD (2009 78%; 2015 80%), recent LDL-C ≥ 190 mg/dL (2009 45%; 2015 44%), and diabetes (2009 74%; 2015 73%), but increased for patients with 10-year ASCVD risk ≥ 7.5% (2009 36%; 2015 47%). High-intensity statin use also increased 142% and 54% among patients with LDL-C ≥ 190 mg/dL and those with ASCVD ≤ 75 years of age, respectively. Moderate-to-high intensity statin utilization increased over 50% among those with a 10-year ASCVD risk ≥ 7.5%. CONCLUSIONS: Statin use increased substantially among patients with 10-year ASCVD risk ≥ 7.5% and use of appropriate statin dosage increased in each of the four statin benefit groups between 2009 and 2015; however, there is room for improvement.
Assuntos
LDL-Colesterol/sangue , Dislipidemias/tratamento farmacológico , Sistemas Pré-Pagos de Saúde/tendências , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Padrões de Prática Médica/tendências , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , California/epidemiologia , Regulação para Baixo , Prescrições de Medicamentos , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Sistemas Pré-Pagos de Saúde/normas , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Implementation of efforts to screen older people for fall risk-and to intervene before falls occur-have been scattershot at best. Ongoing studies of fall prevention called STRIDE (Strategies to Reduce Injuries and Develop Confidence in Elders) might change that. The studies look at whether clinicians can implement a fall-prevention program across rural, urban, and suburban treatment settings.
Assuntos
Prevenção de Acidentes/métodos , Acidentes por Quedas/prevenção & controle , Programas de Rastreamento , Exercício Físico , Sistemas Pré-Pagos de Saúde/normas , Humanos , Medicare , Medicare Part C , Organizações de Prestadores Preferenciais/normas , Estados Unidos , Transtornos da Visão/terapiaRESUMO
PURPOSE: Prescribing practices within a clinical pharmacy cardiac risk service (CPCRS) and their impact on treatment outcomes in patients with atherosclerotic cardiovascular disease (ASCVD) are described. SUMMARY: National healthcare reforms have increased the population of insured patients and placed increased demands on physicians and other providers. Pharmacists are well trained and positioned to aid in patient care by providing expertise in medication management and patient safety that can result in pharmacotherapy optimization and cost savings. Kaiser Permanente Colorado (KPCO), a group-model health maintenance organization with about 675,000 members served by 30 medical offices throughout Colorado, has adopted a collaborative drug therapy management (CDTM) model that enables pharmacist prescribing to improve patient access, patient care, and healthcare cost-effectiveness. Within the CPCRS established by KPCO, qualified pharmacists are permitted to prescribe initial therapy, modify drug regimens, order laboratory tests, and perform follow-up activities within their professional scope of practice. The CPCRS focuses on the long-term management of patients with ASCVD. The primary goals of the CPCRS are to optimize secondary-prevention pharmacotherapy, monitor and ensure medication adherence, assist in the management of risk factors for ASCVD, provide patient education and counseling, and serve as a resource for physicians and other healthcare providers. Working under a CDTM agreement, pharmacists are authorized to prescribe therapies to minimize the risk of future ASCVD events. CONCLUSION: The CPCRS at KPCO has demonstrated successful maintenance of a clinical pharmacy service including pharmacist prescribing under a CDTM model to manage patients with ASCVD.
Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Prescrições de Medicamentos , Equipe de Assistência ao Paciente/tendências , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , Papel Profissional , Doenças Cardiovasculares/epidemiologia , Colorado , Prescrições de Medicamentos/normas , Sistemas Pré-Pagos de Saúde/normas , Sistemas Pré-Pagos de Saúde/tendências , Humanos , Colaboração Intersetorial , Equipe de Assistência ao Paciente/normas , Patient Protection and Affordable Care Act/normas , Patient Protection and Affordable Care Act/tendências , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Fatores de Risco , Estados UnidosRESUMO
UNLABELLED: The objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02299791.
Assuntos
Cardiotônicos/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Complicações do Diabetes/prevenção & controle , Melhoria de Qualidade/organização & administração , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/normas , Aspirina/administração & dosagem , Aspirina/normas , Cardiotônicos/normas , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/etiologia , Complicações do Diabetes/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Sistemas Pré-Pagos de Saúde/organização & administração , Sistemas Pré-Pagos de Saúde/normas , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/normasAssuntos
Assistência Integral à Saúde/normas , Atenção à Saúde/normas , Modelos Organizacionais , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Idoso , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/normas , Assistência Integral à Saúde/organização & administração , Atenção à Saúde/organização & administração , Sistemas Pré-Pagos de Saúde/normas , Médicos Hospitalares , Hospitalização , Humanos , Atenção Primária à Saúde , Risco , Cuidado Transicional/organização & administração , Cuidado Transicional/normasRESUMO
PURPOSE: Advanced imaging is commonly used for staging of early-stage breast cancer, despite recommendations against this practice. The objective of this study was to evaluate and compare use of imaging for staging of breast cancer in two integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was routine or used for diagnostic purposes. METHODS: We identified patients with stages 0 to IIB breast cancer diagnosed between 2010 and 2012. Using KP and IH electronic health records, we identified use of computed tomography, positron emission tomography, or bone scintigraphy 30 days before diagnosis to 30 days postsurgery. We performed chart abstraction on a random sample of patients who received a presurgical imaging test to identify indication. RESULTS: For the sample of 10,010 patients, mean age at diagnosis was 60 years (range, 22 to 99 years); with 21% stage 0, 47% stage I, and 32% stage II. Overall, 15% of patients (n = 1,480) received at least one imaging test during the staging window, 15% at KP and 14% at IH (P = .5). Eight percent of patients received imaging before surgery, and 7% postsurgery. We found significant intraregional variation in imaging use. Chart abstraction (n = 129, 16% of patients who received presurgical imaging) revealed that 48% of presurgical imaging was diagnostic. CONCLUSION: Use of imaging for staging of low-risk breast cancer was similar in both systems, and slightly lower than has been reported in the literature. Approximately half of imaging tests were ordered in response to a sign or symptom.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Prestação Integrada de Cuidados de Saúde/normas , Diagnóstico por Imagem/estatística & dados numéricos , Diagnóstico por Imagem/normas , Fidelidade a Diretrizes/normas , Sistemas Pré-Pagos de Saúde/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Registros Eletrônicos de Saúde , Feminino , Disparidades em Assistência à Saúde/normas , Humanos , Mamografia/normas , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/normas , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Valor Preditivo dos Testes , Sistema de Registros , Fatores de Tempo , Estados Unidos , Adulto JovemRESUMO
Previous research has determined that substance abuse treatment (SAT) is effective under managed care within residential treatment and outpatient treatment, but we have not followed patients after treatment completion. This study examined SAT in both an intensive day treatment and an outpatient treatment program in a large health maintenance organization, with mandatory 12-step participation. We conducted interviews (N = 72) at the beginning, upon completion, and 6 months after completion of treatment. Variables measured were substance use, quality of life, symptoms, functionality, and patient satisfaction as well as Drug Abuse Treatment and Assessment Resources (DATAR) score and treatment completion. Before treatment, DATAR scores were high: 7.68 on a scale of 1-9, indicating serious addictions. Patients showed significant improvement in all variables measured, upon completion of SAT, and additional improvement again 6 months later. Eighty-three percent of subjects completed treatment. Unique advantages of treatment in this setting were discussed, as well as the importance of referral and support from nurses and other healthcare professionals.
Assuntos
Processo de Enfermagem , Pacientes Ambulatoriais , Satisfação do Paciente , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Adolescente , Adulto , California , Feminino , Sistemas Pré-Pagos de Saúde/normas , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Centros de Tratamento de Abuso de Substâncias/normas , Inquéritos e QuestionáriosRESUMO
This study aims at replicating and extending Xiao and Savage's (2008) research to understand the multidimensional aspect of HMOs distinguished by HMOs' consumer-friendliness, and their relationship to consumers' preventive care utilization. This study develops a dynamic model to consider both concurrent and time lagging effects of HMOs' consumer-friendliness. Our data analysis discloses similar relationship patterns as revealed by Xiao and Savage. Additionally, our findings reveal the time-series changes of the influence of HMOs' consumer-friendliness that either the effects of early experienced HMOs' consumer-friendliness wear out totally or HMOs' consumer-friendly characteristics on the concurrent term contain most of the explanatory power.
Assuntos
Comportamento do Consumidor , Sistemas Pré-Pagos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Análise de Variância , Controle de Custos/métodos , Controle de Custos/normas , Sistemas Pré-Pagos de Saúde/economia , Sistemas Pré-Pagos de Saúde/normas , Humanos , Estudos Longitudinais , Medicaid , Modelos Organizacionais , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/organização & administração , Setor Privado , Fatores Socioeconômicos , Estados UnidosAssuntos
Competência Cultural , Diversidade Cultural , Trocas de Seguro de Saúde/estatística & dados numéricos , Sistemas Pré-Pagos de Saúde/normas , Marketing de Serviços de Saúde/normas , Barreiras de Comunicação , Sistemas Pré-Pagos de Saúde/tendências , Humanos , Idioma , Marketing de Serviços de Saúde/tendênciasAssuntos
Derivação Arteriovenosa Cirúrgica/normas , Sistemas Pré-Pagos de Saúde/normas , Falência Renal Crônica/terapia , Garantia da Qualidade dos Cuidados de Saúde , Diálise Renal/normas , Dispositivos de Acesso Vascular/normas , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , California/epidemiologia , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Diálise Renal/estatística & dados numéricos , Dispositivos de Acesso Vascular/estatística & dados numéricosRESUMO
A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter. Higher rates of home visits by physicians and nurses showed a protective dose-response effect on hospitalization-free survival time. The data suggest that regular home visits by physicians and nurses lengthen hospitalization-free survival time among elderly patients enrolled in the program.
Foi realizado estudo de coorte retrospectiva com o objetivo de avaliar o impacto do plano de cuidados do Programa de Atenção Domiciliar da Unimed-BH, modalidade Gerenciamento de Casos (PrGC/AD), sobre o tempo livre de hospitalização entre os pacientes com 60 anos ou mais assistidos pelo programa. Utilizou-se o modelo de Cox para avaliar o efeito do intervalo entre as visitas domiciliares dos profissionais do programa sobre o tempo livre de hospitalização de 2.943 idosos, ajustado por idade, medicamentos em uso, via de alimentação, úlcera de pressão, déficit cognitivo, dependência física, oxigenioterapia, consultas ambulatoriais e hospitalizações no trimestre anterior. Foram fatores de risco para menor tempo livre de hospitalização: o grau de dependência física, alimentação enteral, oxigenioterapia suplementar, úlceras de pressão e hospitalizações no trimestre anterior. Observouse efeito protetor dose-resposta da frequência de visitas médicas e de enfermagem. Os resultados sugerem que visitas domiciliares regulares de médico e enfermeiro aumentam significativamente o tempo livre de hospitalização nos pacientes assistidos pelo PrGC/AD.
Se realizó un estudio de cohorte retrospectivo para evaluar el impacto de un plan de asistencia del Programa de Atención Domiciliaria de Unimed-BH, modalidad de Gestión de Casos (PrGC/AD), sobre el tiempo libre de hospitalización en pacientes con 60 años o más. Se usó el modelo de riesgos proporcionales de Cox para evaluar el efecto del intervalo entre las visitas domiciliarias de los profesionales del programa sobre el tiempo libre de hospitalización de 2.943 ancianos, ajustado por edad, medicamentos usados, vía de alimentación, úlcera por presión, deterioro cognitivo, dependencia física, oxigenoterapia, consultas ambulatorias y hospitalizaciones en el trimestre anterior. Fueron factores de riesgo para un menor tiempo libre de hospitalización: grado de dependencia física, alimentación enteral, oxigenoterapia suplementaria, úlcera por presión y hospitalizaciones en el trimestre anterior. Las frecuencias de visitas médicas y de enfermeros tuvieron un efecto protector dosis-respuesta. Los resultados sugieren que las visitas domiciliarias regulares de médico y enfermero aumentan el tiempo libre de hospitalización en los pacientes asistidos por el PrGC/AD.