RESUMO
BACKGROUND: Little is known about the trend of informal care (unpaid care provided by family or other caregivers) provided to nursing home residents before or during the COVID-19 pandemic. This study assessed this trend during 2010-2021, for all and Medicaid versus non-Medicaid residents. METHODS: Using data from the RAND Health and Retirement Study longitudinal file, our study sample included a total of 2025 resident-years (860 for Medicaid and 1165 for non-Medicaid residents). We fit two-part regression models to determine adjusted trends in average amount of informal care over time, and difference by resident Medicaid status. RESULTS: Informal care received by residents reduced substantially over time, from an average of 39.2 h in the past month of interview in 2010-11 to 23.2 h in 2018-19, and then to 11.2 h in the COVID-19 pandemic (2020-21). The reduced hours were due to both reduced percentages of nursing home residents who received any informal care and reduced hours of care among those who did receive it over time. Multivariable analyses confirmed this trend and similar downward trends for Medicaid versus non-Medicaid residents. Medicaid residents on average received 10.02 fewer hours of informal care per month (95% confidence interval -17.16, -2.87; p = 0.006) than non-Medicaid residents after adjustment for resident characteristics and time trends. CONCLUSION: Informal care provided to nursing home residents during 2010-2021 reduced over time, especially during the COVID-19 pandemic (2020-21). Medicaid residents tended to receive less informal care than non-Medicaid residents.
Assuntos
COVID-19 , Medicaid , Casas de Saúde , Casas de Saúde/estatística & dados numéricos , Humanos , Medicaid/estatística & dados numéricos , Estados Unidos , COVID-19/epidemiologia , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Estudos Longitudinais , SARS-CoV-2 , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Assistência ao Paciente/tendências , Assistência ao Paciente/estatística & dados numéricosRESUMO
Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach. We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents. Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (-110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed. Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.
Assuntos
Objetivos , Estudos de Casos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Inglaterra/epidemiologia , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Estudos de Casos Organizacionais/estatística & dados numéricos , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Distribuição por Idade , Atenção Primária à Saúde/estatística & dados numéricos , Medicina de Emergência/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Apoio Social/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Humanos , Masculino , Feminino , Adulto , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , IdosoRESUMO
Esta pesquisa busca compreender a relação do expressar-se com o cuidado em saúde mental dos usuários de uma Unidade Básica de Saúde (UBS) de um município no Rio Grande do Sul. Como pesquisa qualitativa, os dados foram coletados em entrevistas semiestruturadas. A amostra inicial foi de dez participantes que compareceram a cinco atendimentos psicológicos feitos semanalmente pela estagiária de psicologia, sendo que sete deles permaneceram até o fim devido às faltas aos atendimentos associadas ao tempo reduzido para a realização da coleta de dados. Os resultados indicaram o acompanhamento psicológico como um espaço de escuta associado à livre expressão, proporcionando significados aos usuários, como: percepção de mudanças em seus sentimentos, pensamentos e comportamento, além das dificuldades e melhorias durante o processo. Estes dados trazem um novo significado atribuído pelos usuários sobre a realização dos atendimentos psicológicos, o autoconhecimento, descentralizando a ideia de busca pelo cuidado apenas quando há adoecimento. (AU)
This research aims to understand the relation between self-expression and the mental health care of users from a Basic Health Unit (BHU) located in a city of Rio Grande do Sul. As a qualitative research, the data were collected using semi-structured interviews. The initial sample consisted of ten users that had participated in five psychological consultations done by the psychology intern. However, due to the reduced time for data collection, associated to the absences of some participants, the final number of seven users was reached. The results indicated the psychological follow-up as a listening place, associated with freedom of speech, providing meanings such as: perception of changes in their feelings, thoughts and behavior. Besides that, the difficulties and improvements during the process were also related. These data show the new meanings reported by users aboutgoing to psychological follow-up, like the self-knowledge, decentralizing the idea of seeking mental care only when there is illness. (AU)
Esta investigación busca comprender la relación entre la expresión de sí mismo y la atención a la salud mental de usuarios de una Unidad Básica de Salud (UBS) de un municipio de Rio Grande do Sul. Como investigación cualitativa, los datos fueron colectadosen entrevistas semiestructuradas. La muestra inicial fue compuesta por diez participantes que asistieron a cinco sesiones de terapia hechas por estudiantes de psicología semanalmente, siete de los cuales permanecieron hasta el final por faltas a citas asociadas a la reducción del tiempo de recogida de datos. Los resultados indicaron apoyo psicológico como momento de escucha asociado a la libre expresión, ofreciendo habilidades a los usuarios como: percepción de cambios en sus sentimientos, pensamientos y comportamiento, además de dificultades y mejoras durante el proceso. Estos datos dan nuevo significado atribuido por los usuarios a la prestación de atención psicológica, el autoconocimiento, desconcentrando la idea de buscar atención sólo cuando hay una enfermedad. (AU)
Assuntos
Humanos , Atenção Primária à Saúde , Psicologia/métodos , Autoimagem , Saúde Mental , Assistência ao Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Assistência ao Paciente/psicologiaRESUMO
Importance: The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. Objective: To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. Design, Setting, and Participants: This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. Intervention: Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). Main Outcomes and Measures: Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021. Results: High- and medium-risk model intervention beneficiaries (n = 130â¯578) and standard care control beneficiaries (n = 88â¯286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, -$1.83 per beneficiary per month [90% CI, -$3.97 to -$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, -$16.66 to $20.89]; P = .85). Conclusions and Relevance: The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention. Trial Registration: ClinicalTrials.gov Identifier: NCT04047147.
Assuntos
Medicare , Modelos Cardiovasculares , Infarto do Miocárdio , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Medicare/economia , Medicare/estatística & dados numéricos , Infarto do Miocárdio/economia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Assistência ao Paciente/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Estados Unidos/epidemiologia , Adulto , Pessoa de Meia-Idade , Medição de Risco/economia , Medição de Risco/estatística & dados numéricosRESUMO
BACKGROUND: Informal care is a key element of health care and well-being for society, yet it is scarcely visible and rarely studied in health economic evaluations. This study aims to estimate the time use and cost associated with informal care for cardiovascular diseases, pneumonia and ten different cancers in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico and Peru). METHODS: We carried out an exhaustive literature review on informal caregivers' time use, focusing on the selected diseases. We developed a survey for professional caregivers and conducted expert interviews to validate this data in the local context. We used an indirect estimate through the interpolation of the available data, for those cases in which we do not found reliable information. We used the proxy good method to estimate the monetary value of the use of time of informal care. National household surveys databases were processed to obtain the average wage per hour of a proxy of informal caregiver. Estimates were expressed in 2020 US dollars. RESULTS: The study estimated approximately 1,900 million hours of informal care annually and $ 4,300 million per year in average informal care time cost for these fifteen diseases and eight countries analyzed. Cardiovascular diseases accounted for an informal care burden that ranged from 374 to 555 h per year, while cancers varied from 512 to 1,825 h per year. The informal care time cost share on GDP varied from 0.26% (Mexico) to 1.38% (Brazil), with an average of 0.82% in the studied American countries. Informal care time cost represents between 16 and 44% of the total economic cost (direct medical and informal care cost) associated with health conditions. CONCLUSIONS: The study shows that there is a significant informal care economic burden -frequently overlooked- in different chronic and acute diseases in Latin American countries; and highlights the relevance of including the economic value of informal care in economic evaluations of healthcare.
Assuntos
Cuidadores , Assistência ao Paciente , Humanos , Doenças Cardiovasculares/terapia , Cuidadores/economia , América Latina , Neoplasias/terapia , Custos e Análise de Custo , Pneumonia/terapia , Assistência ao Paciente/economia , Assistência ao Paciente/estatística & dados numéricos , Fatores de TempoRESUMO
Importance: Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days' gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging. Objective: To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity. Design, Setting, and Participants: Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61â¯908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US. Exposures: Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White. Main Outcomes and Measures: Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated. Results: Of 26â¯986â¯716 live births, 61â¯908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], -10.81 [95% CI, -12.75 to -8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, -5.42 [95% CI, -6.36 to -4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, -9.03 [95% CI, -10.07 to -7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment. Conclusions and Relevance: From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.
Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Terapia Intensiva Neonatal , Nascido Vivo , Tomada de Decisão Clínica , Estudos Transversais , Etnicidade/estatística & dados numéricos , Feminino , Viabilidade Fetal , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etnologia , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/tendências , Nascido Vivo/epidemiologia , Nascido Vivo/etnologia , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Assistência ao Paciente/tendências , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
Objective: This study aimed to examine changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders; prevalence of psychiatric disorders among acute care encounters; and change in acute mental health (MH) care encounters by disorder type and, within these categories, by child sociodemographic characteristics before and after statewide COVID-19related school closure orders. Methods: This retrospective, cross-sectional cohort study used the Pediatric Health Information System database to assess percent changes in ED discharges and hospitalizations (N=2,658,474 total encounters) among children ages 317 years in 44 U.S. children's hospitals in 2020 compared with 2019, by using matched data for 36- and 12-calendar-week intervals. Results: Decline in MH ED discharges accounted for about half of the decline in ED discharges and hospitalizations for primary GM disorders (−24.8% vs. −49.1%), and MH hospitalizations declined 3.4 times less (−8.0% vs. −26.8%) in 2020. Suicide attempt or self-injury and depressive disorders accounted for >50% of acute MH care encounters before and after the statewide school closures. The increase in both ED discharges and hospitalizations for suicide attempt or self-injury was 5.1 percentage points (p<0.001). By fall 2020, MH hospitalizations for suicide attempt or self-injury rose by 41.7%, with a 43.8% and 49.2% rise among adolescents and girls, respectively. Conclusions: Suicide or self-injury and depressive disorders drove acute MH care encounters in 44 U.S. children's hospitals after COVID-19related school closures. Research is needed to identify continuing risk indicators (e.g., sociodemographic characteristics, psychiatric disorder types, and social determinants of health) of acute child MH care.
Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Utilização de Instalações e Serviços , Hospitais Pediátricos , Serviços de Saúde Mental , Instituições Acadêmicas , Criança , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Estados Unidos/epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricosAssuntos
Doenças Cardiovasculares/mortalidade , Mortalidade Materna/tendências , Doenças Cardiovasculares/epidemiologia , Humanos , Assistência ao Paciente/normas , Assistência ao Paciente/estatística & dados numéricos , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Estados Unidos/epidemiologiaAssuntos
Pesquisa Biomédica/métodos , COVID-19/prevenção & controle , Neoplasias/terapia , Assistência ao Paciente/métodos , Relatório de Pesquisa , American Cancer Society/organização & administração , Pesquisa Biomédica/estatística & dados numéricos , Pesquisa Biomédica/tendências , COVID-19/epidemiologia , COVID-19/virologia , Humanos , Oncologia/métodos , Oncologia/estatística & dados numéricos , Oncologia/tendências , Neoplasias/diagnóstico , Pandemias/prevenção & controle , Assistência ao Paciente/estatística & dados numéricos , Assistência ao Paciente/tendências , SARS-CoV-2/fisiologia , Estados UnidosRESUMO
Surgery is traditionally a male-dominated field, and gender differences exist despite the growing numbers of female surgeons. A handful of studies have evaluated the condition in Asian societies. We aimed to examine the difference between female and male surgeons in urology, general surgery, and gynecology by analyzing a nationwide, population-based database. We identified surgeons with a clinical experience of six to thirteen years between 1995 to 2013 from the National Health Insurance Research Database. We collected patient numbers and revenue per month in outpatient and inpatient care, as well as monthly numbers of surgeries conducted by female and male surgeons in urology, general surgery, and gynecology, for analysis. Original student's t-test and wilcoxon rank sum test was used to compare the differences between female and male surgeons, and p values less than 0.05 were considered statistically significant. Female urologists and general surgeons had a significantly higher ratio of female patients in Taiwan. Female urologists had patient numbers, revenues, and numbers of surgeries comparable to male urologists. In contrast, female general surgeons had significantly less involvement in outpatient and inpatient care and had low monthly revenues. Female general surgeons contradictorily performed more oncological surgeries per month than males. However, the difference in numbers of oncological surgeries was not significant after excluding breast cancer surgeries. Female gynecologists had a similar amount of outpatients and outpatient revenue but significantly less inpatient care and numbers of surgeries per month. A gender-based gap exists among surgeons in Taiwan. The gap between females and males appeared narrower in urology than in general surgery and gynecology. Management of diseases related to female sex organs, including breast, were more common among female surgeons. Efforts should be made to decrease gender stereotypes, to ensure that patients receive the best care regardless of the sex of the surgeons.
Assuntos
Tomada de Decisão Clínica , Assistência ao Paciente , Padrões de Prática Médica , Cirurgiões , Feminino , Humanos , Pacientes Internados , Masculino , Pacientes Ambulatoriais , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Fatores Sexuais , TaiwanRESUMO
BACKGROUND: Delays in patient flow and a shortage of hospital beds are commonplace in hospitals during periods of increased infection incidence, such as seasonal influenza and the COVID-19 pandemic. The objective of this study was to develop and evaluate the efficacy of machine learning methods at identifying and ranking the real-time readiness of individual patients for discharge, with the goal of improving patient flow within hospitals during periods of crisis. METHODS AND PERFORMANCE: Electronic Health Record data from Oxford University Hospitals was used to train independent models to classify and rank patients' real-time readiness for discharge within 24 hours, for patient subsets according to the nature of their admission (planned or emergency) and the number of days elapsed since their admission. A strategy for the use of the models' inference is proposed, by which the model makes predictions for all patients in hospital and ranks them in order of likelihood of discharge within the following 24 hours. The 20% of patients with the highest ranking are considered as candidates for discharge and would therefore expect to have a further screening by a clinician to confirm whether they are ready for discharge or not. Performance was evaluated in terms of positive predictive value (PPV), i.e., the proportion of these patients who would have been correctly deemed as 'ready for discharge' after having the second screening by a clinician. Performance was high for patients on their first day of admission (PPV = 0.96/0.94 for planned/emergency patients respectively) but dropped for patients further into a longer admission (PPV = 0.66/0.71 for planned/emergency patients still in hospital after 7 days). CONCLUSION: We demonstrate the efficacy of machine learning methods at making operationally focused, next-day discharge readiness predictions for all individual patients in hospital at any given moment and propose a strategy for their use within a decision-support tool during crisis periods.
Assuntos
COVID-19/terapia , Administração Hospitalar/normas , Hospitalização/estatística & dados numéricos , Aprendizado de Máquina , Assistência ao Paciente/estatística & dados numéricos , Alta do Paciente/normas , SARS-CoV-2/fisiologia , COVID-19/virologia , HumanosAssuntos
Atenção à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Internacionalidade , Assistência ao Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comparação Transcultural , Idoso Fragilizado , Hospitais/estatística & dados numéricos , Humanos , Qualidade da Assistência à Saúde , Centros de Reabilitação/economia , Centros de Reabilitação/estatística & dados numéricosRESUMO
Resumen Objetivo: En Costa Rica se observó una disminución en las atenciones en los Servicios de Emergencias al inicio de la pandemia por lo que el objetivo de este estudio es la descripción de este fenómeno, su duración, así como implicaciones en nuestro país. Métodos: Es un estudio descriptivo observacional retrospectivo de las atenciones en los Servicios de Emergencias de los Hospitales pertenecientes a la Caja Costarricense del Seguro Social durante el 1 de enero al 31 de diciembre del 2020. Resultados: Se incluyeron 25 Servicios de Emergencias. Las atenciones durante el periodo de estudio fueron de 1.549.024 millones de visitas y la cantidad de revaloraciones a 4,038,029. El rango de atenciones en los diferentes SEM tuvo un rango de 19070 mil a 122251 mil durante el periodo del estudio. Se observó que 850 707 (54,9%) eran del sexo femenino. La mayor cantidad de pacientes atendidos en los SEM tenían edades entre los 20 a 44 años con 693 379 (44.7%) atenciones, seguido del grupo entre los 45 a 64 años con 328 979 (21.2%). Lo que respecta a la clasificación de la agudeza de los pacientes por medio del sistema de triaje canadiense, un 40% (620 449) fueron catalogados como categoría 3, un 39.8%(616 855) categoría 4, 14%(218 124), 5.3%(82 360) categoría 2 y por último 0.6%(9206) pacientes como categoría 1. Respeto a pacientes con el diagnóstico asociado a SARS CoV-2 se observó que 88 793 en los Servicios de Emergencias tuvieron dichos diagnósticos durante el periodo del estudio. Conclusiones: La tendencia a la baja en las consultas al Servicio de Emergencias en Costa Rica, reproduce las tendencias reportadas en la bibliografía a nivel mundial. La explicación para este fenómeno es multifactorial. Existen una gran cantidad de cambios "estructurales" tanto en los servicios de emergencias como en hospitalización y el sistema de salud en general, que con mucha probabilidad deberán cambiarse de manera definitiva y prioritaria. No solo para la atención de esta pandemia sino con miras a que dichos sistemas se encuentren mejor preparados para próximos eventos infecciosos de cualquier tipo.
Abstract Aim: In Costa Rica, a decrease in the admissions in the emergency departments were observed at the beginning of the pandemic and the objective of this study was to describe this phenomenon, its duration, as well as its implications in our country. Methods: It is a retrospective descriptive observational study of the admissions in the Emergency Departments of the Hospitals belonging to the Costa Rican Social Security from January 1 to December 31, 2020. Results: 25 emergency departments were included. Admissions during the study period was 1,549,024 million visits and the number of re-evaluations to 4,038,029. The range of visits in the different emergency departments were from 19,070,000 to 122,251,000 during the study period. It was observed that 850 707 (54.9%) were female. The lar- gest number of patients treated in the emergency departments were aged between 20 to 44 years with 693,379 (44.7%) visits, followed by the group between 45 to 64 years with 328,979 (21.2%). The acuity of the patients using the Canadian triage system were classified 40% (620,449) as category 3, 39.8% (616,855) as category 4, 14% (218,124), 5.3% (82,360) as category 2 and finally 0.6% (9,206) patients as category 1. In regards of patients with the diagnosis associated with SARS CoV-2, it was observed that 88,793 were seen in the emergency departments with such diagnoses during the study period. Conclusions: The downward trend in consultations to the emergency departments in Costa Rica reproduces the trends reported in the literature worldwide. The explanation for this phenomenon is multifactorial. There are many "structural" changes both in the emergency departments and in hospitalization and the Health System in general, which will most likely have to be changed definitively and as a priority. Not only for the attention of this Pandemic but with a view to future infectious events of any kind.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Emergências , Assistência Ambulatorial , Assistência ao Paciente/estatística & dados numéricos , COVID-19 , Costa RicaRESUMO
Studies show that the burden of caregiving tends to fall on individuals of low socioeconomic status (SES); however, the association between SES and the likelihood of caregiving has not yet been established. We studied the relationship between SES and the likelihood of adults providing long-term care for their parents in Japan, where compulsory public long-term insurance has been implemented. We used the following six comprehensive measures of SES for the analysis: income, financial assets, expenditure, living conditions, housing conditions, and education. We found that for some SES measures the probability of care provision for parents was greater in higher SES categories than in the lowest category, although the results were not systematically related to the order of SES categories or consistent across SES measures. The results did not change even after the difference in the probability of parents' survival according to SES was considered. Overall, we did not find evidence that individuals with lower SES were more likely to provide care to parents than higher-SES individuals. Although a negative association between SES and care burden has been repeatedly reported in terms of care intensity, the caregiving decision could be different in relation to SES. Further research is necessary to generalize the results.
Assuntos
Cuidadores/economia , Assistência ao Paciente/economia , Cuidadores/estatística & dados numéricos , Escolaridade , Feminino , Habitação/economia , Habitação/estatística & dados numéricos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pais , Assistência ao Paciente/métodos , Assistência ao Paciente/mortalidade , Assistência ao Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e QuestionáriosAssuntos
Inibidores da Angiogênese/administração & dosagem , COVID-19/epidemiologia , Atenção à Saúde/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Neovascularização de Coroide/tratamento farmacológico , Bases de Dados Factuais , Retinopatia Diabética/tratamento farmacológico , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/tratamento farmacológico , SARS-CoV-2 , Estados Unidos/epidemiologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/tratamento farmacológicoRESUMO
OBJECTIVES: This report aims to examine income-related inequalities in informal care among older people with functional limitations in China. METHODS: Data are drawn from the 2005, 2008, 2011, and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Erreygers concentration index, concentration index, and horizontal inequity index are used to examine inequalities in informal care. A random effects model is then used to investigate the relationship between household income and informal care. RESULTS: There is no significant association between household income and the probability of receiving informal care. However, we observed a significant positive association between household income and hours of informal care received, indicating that those with higher household income receive more hours of informal care compared to those with lower household income. The degree of this inequality increases as the number of functional limitations increases. DISCUSSION: Lower household income is associated with lower intensity of informal care received, particularly for older people with more functional limitations. Policies are required to support low-income older people with more functional limitations.
Assuntos
Envelhecimento , Cuidadores/estatística & dados numéricos , Pessoas com Deficiência/psicologia , Estado Funcional , Assistência ao Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Renda/estatística & dados numéricos , Longevidade , Estudos Longitudinais , Masculino , Fatores de TempoRESUMO
BACKGROUND: Numerous studies have documented reduced access to patient care due to the COVID-19 pandemic, including access to diagnostic or screening tests, prescription medications, and treatment for an ongoing condition. In the context of clinical management for venous thromboembolism, this could result in suboptimal therapy with warfarin. We aimed to determine the impact of the pandemic on utilization of International Normalized Ratio (INR) testing and the percentage of high and low results. METHODS: INR data from 11 institutions were extracted to compare testing volume and the percentage of INR results ≥3.5 and ≤1.5 between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (January-June 2020, period 2). The analysis was performed for inpatient and outpatient cohorts. RESULTS: Testing volumes showed relatively little change in January and February, followed by a significant decrease in March, April, and May, and then returned to baseline in June. Outpatient testing showed a larger percentage decrease in testing volume compared to inpatient testing. At 10 of the 11 study sites, we observed an increase in the percentage of abnormal high INR results as test volumes decreased, primarily among outpatients. CONCLUSION: The COVID-19 pandemic impacted INR testing among outpatients which may be attributable to several factors. Increased supratherapeutic INR results during the pandemic period when there was reduced laboratory utilization and access to care is concerning because of the risk of adverse bleeding events in this group of patients. This could be mitigated in the future by offering drive-through testing and/or widespread implementation of home INR monitoring.
Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , Coeficiente Internacional Normatizado/métodos , Assistência ao Paciente/estatística & dados numéricos , Assistência ao Paciente/normas , SARS-CoV-2/isolamento & purificação , Tromboembolia Venosa/tratamento farmacológico , Varfarina/uso terapêutico , COVID-19/virologia , Humanos , Tromboembolia Venosa/virologiaRESUMO
BACKGROUND: Current treatments for myelofibrosis (MF) are largely palliative, with the JAK inhibitor ruxolitinib being the breakthrough approved for higher-risk patients by the United States Food and Drug Administration in November 2011. There are limited data on the "real-world" clinical experiences among patients with MF who are treated in the JAK inhibitor era. PATIENTS AND METHODS: We evaluated patterns of care for older patients with MF before and after ruxolitinib approval, using the Surveillance, Epidemiology, and End Results-Medicare database. Treatment patterns were assessed using Medicare part B and D claims. RESULTS: This study included 528 patients diagnosed during 2007 to 2015, with a median age at diagnosis of 76 years. Among 298 patients diagnosed in the ruxolitinib era (2012-2015), 113 (37.9%) were ruxolitinib users. Similar numbers of users started ruxolitinib at 5, 10, 15, or 20 milligrams twice a day (BID). Among 31 patients starting at 5 milligrams BID or less, 48.4% were unable to escalate the dose, and < 11 users could increase the dose to the maximum 25 mg BID. Approximately one-half of ruxolitinib users took hydroxyurea and/or prednisone simultaneously with ruxolitinib. The median time on ruxolitinib was 11.9 months (interquartile range, 4.2-21.7 months). CONCLUSION: It would be important to optimize the use of ruxolitinib and develop new drugs that may be administered together with or after ruxolitinib to accomplish better outcomes in older patients with MF.
Assuntos
Atenção à Saúde/estatística & dados numéricos , Assistência ao Paciente , Padrões de Prática Médica , Mielofibrose Primária/epidemiologia , Fatores Etários , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Atenção à Saúde/métodos , Feminino , Humanos , Masculino , Medicare , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Vigilância da População , Mielofibrose Primária/diagnóstico , Mielofibrose Primária/terapia , Programa de SEER , Estados Unidos/epidemiologiaRESUMO
Scholars are increasingly aware that studies-across many disciplines-cannot be replicated by independent researchers. Here, the authors describe how medical education research may be vulnerable to this "replication crisis," explain how researchers can act together to reduce risks, and discuss the positive steps that can increase confidence in research findings. Medical education research contributes to policy and influences practitioner behavior. Findings that cannot be replicated suggest that the original research was not credible. This risk raises the possibility that unhelpful or even harmful changes to medical education have been implemented as a result of research that appeared defensible but was not. By considering these risk factors, researchers can increase the likelihood that studies are generating credible results. The authors discuss and provide examples of 6 factors that may endanger the replicability of medical education research: (1) small sample sizes, (2) small effect sizes, (3) exploratory designs, (4) flexibility in design choices, analysis strategy, and outcome measures, (5) conflicts of interest, and (6) very active fields with many competing research teams. Importantly, medical education researchers can adopt techniques used successfully elsewhere to improve the rigor of their investigations. Researchers can improve their work through better planning in the development stage, carefully considering design choices, and using sensible data analysis. The wider medical education community can help by encouraging higher levels of collaboration among medical educators, by routinely evaluating existing educational innovations, and by raising the prestige of replication and collaborative medical education research. Medical education journals should adopt new approaches to publishing. As medical education research improves, so too will the quality of medical education and patient care.