ABSTRACT
Abstract Physical exercise programs have been carried out in primary health care in Brazil and have provided good results in terms of effectiveness, their economic contribution has not been investigated yet. The aim of the study is to verify the feasibility of brief counseling physical activity intervention and to compare its economic cost and cost-effectiveness with supervised physical exercise intervention in primary care. A multi-arm parallel feasibility trial, with equal randomization [1:1:1] was conducted in Basic Health Units in Brazil. 61 participants were randomized in Brief Counseling Intervention (BCI), Supervised Physical Exercise Intervention (SPEI) and Control Group (CG). Interventions lasted one year. The BCI is more economical than the SPEI, costing around 50% less in the economic comparisons (session cost, annual cost and cost per participant annually). At leisure time, the cost to move one person to the physically active category at 12 months is estimated in R$369.00 for BCI and R$426.21 for the SPEI. The Incremental Cost-effectiveness Ratio (ICER) is R$310.32. The BCI is feasible and more economic, however, the cost effective is not that different. Thus, it is strongly recommended that the two interventions be offered at primary care in Brazil.
Resumo Programas de exercício físico são ofertados na atenção primária à saúde no Brasil, apresentando bons resultados na eficácia, sua contribuição econômica ainda não foi investigada. O objetivo do estudo é verificar a viabilidade de uma intervenção breve de aconselhamento para atividade física, e comparar seu custo econômico e custo-efetividade com a intervenção supervisionada de exercício físico na atenção primária. Um estudo de viabilidade de múltiplos braços paralelos, com igual randomização [1:1:1] foi realizado em Unidades Básicas de Saúde no Brasil. 61 participantes foram randomizados em Intervenção Breve de Aconselhamento (BCI), Intervenção Supervisionada de Exercício Físico (SPEI) e Grupo Controle (CG). As intervenções tiveram duração de 1 ano. BCI é mais econômica que SPEI, custando cerca de 50% menos nas comparações econômicas (custo da sessão, custo anual e custo por participante anualmente). No lazer, o custo de mudança de uma pessoa para a categoria fisicamente ativa aos 12 meses é estimado em R$ 369,00 na BCI e R$ 426,21 na SPEI. O Índice de Custo-Efetividade Incremental (ICER) é de R$ 310,32. BCI é viável e mais econômica; no entanto, o custo-benefício não é tão diferente. Assim, é altamente recomendável que as duas intervenções sejam oferecidas.
Subject(s)
Humans , Primary Health Care , Exercise , Quality of Life , Brazil , Feasibility Studies , Cost-Benefit AnalysisABSTRACT
Introducción: El tabaco es la primera causa de morbimortalidad prevenible en el mundo. En Chile la prevalencia de consumo es 40,6 por ciento, la mayor a nivel continental. El consejo breve o consejería breve (CB) es una intervención simple, efectiva y de bajo costo para el cese de consumo de tabaco, que Atención Primaria en Salud (APS) ha demostrado disminuir en la prevalencia de tabaquismo. Existe escasa información sobre la utilización de CB en APS en Chile. Métodos: Estudio transversal de metodología cuantitativa. Se encuestó a 604 pacientes pertenecientes a 2 centros APS de Santiago, tras haber recibido atención clínica. Los datos fueron analizados con SPSS 21 y calculadora web Graph Pad. Resultados: La prevalencia de tabaquismo entre los encuestados fue de 32,5por ciento, de ellos, el 78,6 por ciento reportó deseo de dejar de fumar. Al 43,7 por ciento de los encuestados se le preguntó respecto al consumo de tabaco en la atención reciente, y del total de fumadores, a 37,1 por ciento se les aconsejó dejar de fumar. Los pacientes fumadores calificaron la recepción de CB como "indiferente", "agradable" o "muy agradable" en un 94,9 por ciento, y en un 90,5 por ciento, entre aquellos que no desean dejar de fumar. Conclusión: El tabaquismo es un problema escasamente abordado en las atenciones clínicas APS, lo que contrasta con la alta prevalencia de consumo nacional y de los pacientes consultantes. La mayoría de los fumadores desea dejar de fumar, y la minoría considera "desagradable" o "muy desagradable" ser aconsejada para cesar el consumo, aun en aquellos fumadores que no quieren dejar de fumar.(AU)
Introduction: Smoking is the leading cause of preventable morbidity and mortality worldwide. In Chile smoking prevalence is 40.6 percent, the highest on the continent. Brief advice or brief counseling (BC) is a simple, effective and inexpensive intervention for tobacco consumption cessation, that has been shown decrease smoking prevalence in Primary Health Care (PHC). There is little information on the use of BC in PHC in Chile. Methods: Cross-sectional study of quantitative methodology. 604 patients were surveyed from 2 PHC centers of Santiago, after receiving clinical care. Data was analyzed with SPSS 21 and Graph Pad web calculator. Results: The smoking prevalence among respondents was 32.5 percent, 78.6 percent of them expressed desire to quit 43.7 percent of respondents were asked about consumption of tobacco in a recent consultation, and a total 36.9 percent of smokers were advised to quit. Smokers patients rated reciving CB as "indifferent", "pleasant" or "very pleasant" in 94,9 percent and 90,5 percent among those who did not want to quit. Conclusion: Smoking is a problem rarely addressed in PHC, this contrasts with the high prevalence of domestic consumption and consulting patients. Most smokers want to quit and only a minority considered "unpleasant" or "very unpleasant" being advised to cease consumption, even in those smokers who do not want to quit.(AU)
Subject(s)
Humans , Male , Female , Tobacco , Counseling , Primary Health Care , Chile , Tobacco Use CessationABSTRACT
Objective:To explore the microanalysis method used to evaluate the solution-focused brief coun-seling (SFBC)interview characteristics of the skilled trainees and novices.Methods:Five skilled SFBC trainees, who had learned and practiced of SFBC for not less than 5 years,and 9 SFBC novices,who had a total of learning of SFBC for no more than 3 months,were recruited.The skilled trainees'5 interview recordings and 9 interview re-cordings of the novices were collected and coded.Then the formulations and questions used in the two groups'inter-views were compared with each other,and the different nature of language (positive,negative or neutral)used by them were also analyzed.Results:The numbers of complex formulations used by skilled trainees were more than the novice's [(4.4 ±2.5)vs.(1.6 ±1.1),P <0.05].And the percentage of opening questions was significant higher than novice's [(0.83 ±0.14)vs.(0.61 ±0.18),P <0.05].The numbers of positive utterances used by the skilled trainees were much more than the novices'[(16.0 ±7.0)vs.(8.7 ±2.4),P <0.05].Conclusion:The microanaly-sis method could be effectively used to distinguish the characteristic differences between the skilled trainees and the novices in their formulations,opening questions and positive utterances,during their respective interviews.And it could be effectively used to evaluate the interview skill levels of the skilled trainees and novices.