ABSTRACT
O objetivo deste trabalho é analisar as trajetórias assistenciais, relativas ao uso e acesso às redes de atenção à saúde (RAS), de usuários diagnosticados, internados e em reabilitação decorrente da COVID-19. Foi realizado estudo avaliativo, qualitativo, com base em entrevistas com usuários, no Município de Niterói, Rio de Janeiro, Brasil. As trajetórias assistenciais, a partir da análise temática, foram reconstituídas em três momentos que expressam as experiências com a rede de saúde e apoio durante a pandemia: medidas de prevenção, apoio e diagnóstico; a experiência da internação; cuidados, reabilitação e apoio pós-COVID-19. Os resultados apontam que a principal fonte de informação sobre a doença foram os telejornais; as medidas preventivas de higienização, as mais adotadas; e a família foi a principal rede de apoio. Não houve tempos de espera para internação no hospital municipal de referência. A internação foi muito bem avaliada em função do acolhimento, cuidado multiprofissional, visitas virtuais e contato diário do médico com os familiares. Identificou-se, porém, "vácuo assistencial" pós-alta, com ausência de seguimento pela atenção primária à saúde (APS) e demais serviços públicos. Foi frequente a busca espontânea por planos populares e pagamento direto para acesso aos serviços especializados no pós-COVID-19, até a implantação do serviço de reabilitação. Em síntese, trajetórias assistenciais solitárias e descontínuas de indivíduos e famílias revelam diversos desafios ao sistema de saúde, entre os quais a garantia de acesso e coordenação dos cuidados pela APS, ampliação da oferta de serviços públicos especializados e de reabilitação em redes, alinhados aos princípios do cuidado humanizado, além da manutenção das medidas de apoio social.
Este artículo tiene por objetivo analizar las trayectorias asistenciales de usuarios diagnosticados, hospitalizados y en rehabilitación por el COVID-19 en cuanto al uso y acceso a las redes de atención a la salud (RAS). Se realizó un estudio cualitativo, evaluativo, a partir de entrevistas con usuarios en el municipio de Niterói, Rio de Janeiro, Brasil. A partir del análisis temático, las trayectorias asistenciales se reconstituyeron en tres momentos que expresan las experiencias con la red de salud y de apoyo durante la pandemia: las medidas de prevención, apoyo y diagnóstico; la experiencia de hospitalización; y los cuidados, rehabilitación y apoyo post-COVID-19. Los resultados muestran que los telediarios fueron la principal fuente de información sobre el COVID-19. Las medidas preventivas más adoptadas fueron las de higiene. La familia fue la principal red de apoyo. No hubo tiempo de espera para el ingreso en el hospital municipal de referencia. La hospitalización fue muy bien evaluada debido a la recepción, atención multidisciplinaria, visitas virtuales y contacto diario del médico con los familiares. Se identificó un "vacío asistencial" posterior al alta, sin seguimiento por parte de la atención primaria de salud (APS) y otros servicios públicos. Hubo una frecuente búsqueda espontánea de planes populares y pago directo para acceder a servicios especializados post-COVID-19 hasta la implementación del servicio de rehabilitación. Por lo tanto, las trayectorias asistenciales solitarias y discontinuas de individuos y familias revelan varios desafíos para el sistema de salud, entre ellos la garantía de acceso y coordinación de la atención por parte de la APS, la ampliación de la oferta de servicios públicos especializados y la rehabilitación en redes, combinada con los principios de cuidado humanizado, además del mantenimiento de las medidas de apoyo social.
This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge "care vacuum" was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.
ABSTRACT
Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.
Subject(s)
Cancer Survivors , Neoplasms , Delivery of Health Care , Female , Humans , Islands , Male , Neoplasms/therapy , Pilot Projects , Saint LuciaABSTRACT
The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.
El impacto sanitario y económico de las enfermedades alérgicas está aumentando rápidamente y se necesitan cambios en las estrategias para su manejo. Su influencia reduce al menos en un tercio la capacidad de desempeño laboral y escolar. Los ICP (Vías Integradas de Atención) de las enfermedades de las vías respiratorias son planes de atención estructurados y multidisciplinarios, que promueven las recomendaciones de las guías en protocolos locales y su aplicación a la práctica clínica. En este documento se presenta un resumen ejecutivo para Argentina, México y España. Se desarrollan las guías ARIA de próxima generación para el tratamiento farmacológico de la rinitis alérgica (RA) utilizando las pautas basadas en GRADE para RA, probadas con evidencia de la vida real proporcionada por tecnología móvil basada en escalas visuales analógicas. Se concluye que en el tratamiento de la RA, los antihistamínicos anti-H1 son menos efectivos que los corticoides intranasales (CINS), que en la rinitis gravelos CINS representan la primera línea de tratamiento, y que la combinación intranasal de CINS + anti-H1 es más eficaz que la monoterapia. Sin embargo, según el estudio MASK observacional en vida real, los pacientes tienen pobre adherencia al tratamiento y frecuentemente se automedican de acuerdo con sus necesidades.
Subject(s)
Delivery of Health Care, Integrated , Rhinitis, Allergic/therapy , Algorithms , Argentina , Critical Pathways , Humans , Mexico , SpainABSTRACT
BACKGROUND: The aim of this study is to analyze and to compare data from 2015, focusing on hospital care for patients with multiple sclerosis from three French regions with different characteristics in terms of prevalence, size and number of multiple sclerosis competencies and resource centers. METHODS: All hospital admissions from the PMSI MCO 2015 database, with a principal or related diagnosis (PD-RD) of G35* ("multiple sclerosis") were extracted. We also extracted chemotherapy treatments administered in hospital, during admissions with a significant associated diagnosis (SAD) of G35*, if the PD or RD was coded Z512 ("non-tumor chemotherapy"). The analyzed regions corresponded to those of 2015, some of which have since merged. RESULTS: There were 95,359 hospital admissions for multiple sclerosis in France in 2015 among a total cohort of 21,102 patients, resulting in a total cost of 54.1m. Patients with MS were managed mainly in the ambulatory setting, which accounted for 88.5 % of all admissions. The Rhône-Alpes region represented 7.6 % of national admissions for MS, 9.6 % of patients, and 14 % of inpatient days, contributing 10.4 % of the national cost of MS care. 58.4 % of stays were managed by the two main multiple sclerosis centers. The Nord-Pas-de-Calais region represented 9.8 % of national admissions, 10 % of patients, 6.6 % of inpatient days, and 9.1 % of the national cost. 29.8 % of stays were managed by the main multiple sclerosis center. The Centre region represented 2.7 % of stays, 2.8 % of patients, 3.1 % of inpatient days, and 2.8 % of the national cost. 28.4 % of stays were managed by the main multiple sclerosis center. CONCLUSION: This study highlights the diversity of multiple sclerosis hospital management and care between these three regions.
Subject(s)
Critical Pathways/statistics & numerical data , Hospitalization/statistics & numerical data , Multiple Sclerosis/epidemiology , Multiple Sclerosis/therapy , Practice Patterns, Physicians' , Adult , Clinical Competence/statistics & numerical data , Critical Pathways/economics , Critical Pathways/organization & administration , Critical Pathways/standards , Databases, Factual , Female , France/epidemiology , Health Resources/economics , Health Resources/organization & administration , Health Resources/standards , Health Resources/statistics & numerical data , Hospitalization/economics , Humans , Male , Martinique/epidemiology , Middle Aged , Multiple Sclerosis/economics , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical dataABSTRACT
Abstract Greater knowlegde of patient history among health professionals leads to improved results. This is how the contemporary and resolutive models of care recommended by the most important national and international health agencies work. Current models of care stem from a time when Brazil was a country of young people and acute diseases. But the desire for a higher quality, more efficient and more cost-effective model of care is not only a Brazilian phenomenon. The whole world is debating the issue, recognizing the need for change and proposing improvements in their health systems. The same thing is occurring here. The theme of this text, as Dr. Martha de Oliveira, director of the Agência Nacional de Saúde Suplementar (National Agency Of Supplementary Health) (ANS) comments below, is in agreement with this movement. We advocate a logic that prioritizes low-intensity interventions and constant monitoring, with the doctor responsible for a portfolio of clients who he or she accompanies throughout the different care settings. The text proposes integrated medical treatment, a flow of educational actions, health promotion, the prevention of preventable diseases, the postponement of illness, early care intervention and rehabilitation from sickness. It is time to change and innovate!
Resumo Sabemos que quanto mais o profissional de saúde conhece o histórico do seu paciente, melhores serão os resultados. É assim que devem funcionar os modelos contemporâneos e resolutivos de cuidado recomendados pelos mais importantes organismos nacionais e internacionais de saúde. Os modelos assistenciais vigentes são do tempo em que o Brasil era um país de jovens e de doenças aguda. A preocupação com um modelo de cuidado de maior qualidade, mais resolutivo e com melhor relação custo efetividade, não é uma preocupação somente brasileira. O mundo todo está debatendo o tema, reconhecendo a necessidade de mudanças e propondo melhorias em seus sistemas de saúde. O mesmo ocorre entre nós, a reflexão deste texto, comentado pela Dra. Martha de Oliveira, diretora da ANS, está em sintonia com esse movimento. Estamos privilegiando a lógica que valoriza as instâncias leves e o monitoramento constante, o médico responsável por uma carteira de clientes e que os acompanha em todas as instâncias de cuidado. Como se vê, o texto propõem um cuidado integrado, um fluxo de ações de educação, promoção da saúde, prevenção de doenças evitáveis, postergação de moléstias, cuidado precoce e reabilitação de agravos. Ë hora de mudar e inovar!