An Intersectoral Approach to Hypertension Care: Solutions for Improving Blood Pressure Control in São Paulo, Brazil.

BACKGROUND: Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and a major public health issue worldwide. In Brazil, it affects approximately 52.5% of the adult population. We describe the solutions package and the impact of a population health initiative in São Paulo city, following the CARDIO4Cities approach for the management of cardiovascular risk. METHODS: Using a design thinking approach, interventions were developed with a coalition of local and international stakeholders to address needs of patients, healthcare professionals, and the health system. The resulting solution package was checked to comply with guidelines for non-communicable disease and hypertension management. Clinical impact was measured by extracting the hypertension cascade of care-monitored, diagnosis, treatment, and control-from medical records. RESULTS: Under the leadership of the municipal health authorities, nine solutions were piloted and scaled across the city. Solutions conform with local and international best-practices. Between October 2017 and December 2021, 11,406 patient records were analyzed. Results showed a 40% increase in monitored patients (patients with at least one blood pressure, BP, measurement); reduced proportions of patients diagnosed among those with available BP measurements (72%-53%) and treated among diagnosed (93%-85%); and an improvement in controlled patients among those receiving treatment (16%-27%). CONCLUSIONS: The solution package described in this study was correlated with increased BP control. The implementation methodology and results add to the body of real-world evidence supporting population health implementation science in Brazil and beyond.

Economic study in surgical patients of a new model of nutrition therapy integrating hospital and home vs the conventional hospital model.

BACKGROUND: Dehospitalization is a trend in the health sector justified by humanitarian and socials aspects for the patient and relatives. From the financing institutions' perspective, whether government or third party, the positive results arise from an optimization of hospital bed use and favorable cost-benefit ratio. The "integrated home-hospital" model was created with the purpose of optimization of resources without detriment to the patients' nutritional care. The objective of this study was an economic evaluation regarding nutrition therapy of the integrated hospital-home model in comparison with an exclusively hospital model. METHODS: A retrospective controlled study, paired (age, sex, disease, and surgical procedure), was performed on 56 digestive surgery patients divided into 2 groups: study (SG; n = 30) and control (CG; n = 26). The data collected included total expenses with hospitalization, nutritional benefits, minimization cost analysis, cost-effectiveness ratio analysis, cost-benefit ratio analysis, hospital length of stay, and hospital-bed optimization. RESULTS: The patients from the SG achieved the same nutritional benefits as those in the CG, but with expenses 3 times lower (median Brazil Reals (R)$3237.18 vs R$8647.93; p < .05). The new model resulted in economic benefit to the institution, as shown by the cost-effectiveness ratio, mainly resulting from the savings of the days of hospitalization avoided. The cost-benefit ratio showed an important savings per patient for the institution (US $3100). CONCLUSIONS: The home-hospital model also reduced length of hospital stay 2.7 times and optimized the hospital bed usage, as it promoted higher hospital-bed rotation (3 times greater).

Costs of patients under nutritional therapy: from prescription to discharge.

PURPOSE OF REVIEW: This review will discuss the financial cost of the decisions taken regarding the nutritional therapy of hospitalized patients compared with those treated at home. To facilitate comprehension, the authors present a concise introduction to the general concepts of economic health studies, including a glossary of technical terms. RECENT FINDINGS: From a revision of the literature, economic aspects are underscored involving the cost of malnutrition, the maintenance of work in a nutritional support team, the use of nutritional therapy in home-care programmes, and in the use of nutritional therapy as a prophylactic action against surgical complications. SUMMARY: Hospital malnutrition burdens the system financially by provoking a higher rate of surgical complications, mortality and longer hospital stays. Investment in nutritional therapy provides economic returns. The cost of the creation and maintenance of the nutritional support team is easily offset by the resources generated by the team itself. Nutritional therapy in home-care is highly advantageous. In Brazilian trials, groups of surgical patients receiving nutritional therapy within the integrated hospital-home model demonstrated a cost 2.6 times less than the conventional group (exclusively intra-hospital treatment). The adoption of preoperative immunomodulatory nutritional therapy in patients undergoing elective surgery as a prophylactic against postoperative surgical complications presented a 2.24 times reduction in the total treatment cost. The search for the ideal model of nutritional therapy is based on the binomial of quality and cost. The prescription of nutritional therapy has a favourable impact on financial and resource-generating aspects of the institution, when practised by properly trained groups.

Acompanhamento nutricional de pacientes em radioterapia / Nutritional assistance to patients during radiotherapy

With the aim of assessing the possible benefits of nutritional therapy, 140 patients were prospectively studied during radiotherapy of the head and neck (81) and esophageal cancer (19). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 +/- 45 days. Tube feeding was the primary modality in 50.7 of the population, and oral regimens in the remaining 49.3, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100, and a lymphocyte count diminished along this period (1933 +/- 1033 vs 1265 +/- 688, p. 0.001). A subjective improvement was reported by 84 of the population, and total calorie intake, that was below 60 of estimated needs in 100 of the cases initially, significantly improved to just 40 inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21 of the patients, taste changes in 79, xerostomy in 81, anorexia in 66 and odinophagia in 59. In the individuals selected for enteral feeding, side-effects were represented by technical problems (20) and gastrointestinal disorders (13). All patients completed the nutritional support program and there was no mortality in this series. It is concluded that; 1) Early nutritional support during radiotherapy was able to maintain or improve the nutritional status; 2) Tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; 3) Reduction of total lymphocytes could not be prevented by the mentioned therapy; 4) Complications of enteral alimentation were mild and affected a small proportion of the population; 5) Troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of food; 6) The compliance to the therapeutic plan was excellent and can be attributed to the efforts of the multidisciplinary team as well as to the help of the specialized home alimentation unit (PROSNED): Diet therapy. Cancer. Nutritional assessment. Radiotherapy. Nutritional support.

Anemia ferropriva na nutricao enteral: correlacao com o posicionamento da sonda / Iron-deficiency anemia during enteral nutrition: correlation with tube position

A alimentacao enteral e um procedimento amplamente utilizado na reabilitacao e manutencao nutricional de pacientes pre-operatorios com afeccoes esofagicas. Numa avaliacao prospectiva de 61 enfermos, com afeccoes benigas (n=38) e malignas (n=23), administrou-se uma dieta polimetrica comercial na proporcao de 40kcal/kg/dia, no minimo, durante duas semanas. A preparacao liquida era administrada mediante tecnica em bolo pelos proprios pacientes, atraves de sonda nasogastrica (n=25) ou naso-duodenal (n=36)...

Niveis de assistencia em nutricao / The levels of assistance in the nutritial care

A atuacao do nutricionista na area hospitalar e diversificada, abrangendo atividades de planejamento, producao de refeicoes, assistencia, ensino e pesquisa. Objetivando proporcionar ao nutricionista um instrumento de trabalho seguro em assistencia de nutricao, foi estabelecido o atendimento por niveis de acordo com o grau de acoes necessarios do nutricionista no atendimento de cada caso, aplicado a dieta e ao tratamento do doente. A classificacao do atendimento por niveis de assistencia, possibilita ainda a padronizacao dos procedimentos, a mensuracao do tempo dispendido neste atendimento e o estabelecimento de padroes de qualidade em assistencia de nutricao. Esta categorizacao do atendimento de nutricao mostra-se vantajosa nao so o profissional, para a equipe multidisciplinar e para o servico de nutricao como principalmente benefica para o paciente.

Avaliacao do grau de satisfacao dos usuarios do I.C.H.C - PAMB com relacao ao atendimento prestado / Evaluation of the ambulatory facilities regarding signs

Atraves de uma amostra de 1346 pacientes, correspondente a 3 por cento do atendimento mensal do I.C.H.C.-PAMB no primeiro semestre de 1992, os autores aferem o grau de satisfacao da populacao assistida. O inquerito aborda o desempenho dos multiplos profissionais que atuam junto aos pacientes, assim como avalia as dependencias dos ambulatorios quanto a sinalizacao, a higiene, a organizacao geral dos servicos, etc. Os parametros mensurados, em especial no que se refere aos profissionais da saude, mostram que e muito bom seu conceito entre os usuarios do I.C.H.C-PAMB.

Atualizaçäo em dietas enterais poliméricas no Brasil: I / Up-to-dating in polymeric enteral diets in Brazil: I

Devido ao rápido crescimento de fórmulas enterais industrializadas no mercado brasileiro, tornou-se cada vez mais difícil a seleçäo da melhor fórmula para indicaçäo adequada do suporte nutricional enteral. A análise das características inerentes a cada dieta industrializada disponível e o total conhecimento destas pelos profissionais que atuam nesta área é fundamental para a escolha da fórmula enteral mais adequada. Os autores estudaram dez dietas poliméricas nutricionalmente completas, todas isentas de lactose, as quais foram avaliadas segundo diferentes parâmetros de seleçäo e de dietas: fontes de nutrientes, densidade calórica, complexidade molecular, osmolaridade, forma de apresentaçäo e via de administraçäo