[Assessment of the Effect of Implementing an Obesity Center of Integrated Responsibility on Hospital Performance in Portugal]. / Avaliação do Efeito da Implementação de um Centro de Responsabilidade Integrado de Obesidade no Desempenho Hospitalar em Portugal.

The continuous increase in the prevalence of obesity has generated growing concern, having become an important challenge at a global level in economic and public health terms. In Portugal, the treatment of obesity presents significant problems in access to health services. In this context, there is a need to implement new management models that offer more effective responses. Centers of integrated responsibility, already implemented in this area, are a cutting-edge approach, and it is important to evaluate their performance and identify recommendations for improving the model. The main objective of this study is to assess the impact of implementing an obesity center of integrated responsibility on hospital performance. This study was conducted using a comprehensive multiple-case study approach, which was predominantly descriptive but also included explanatory elements. The methodological approach is a well-balanced mix of quantitative and qualitative analyses. The study evaluates various hospital performance indicators, encompassing the dimensions of access, production, efficiency, quality, and economic-financial, both before and after the implementation of the new model. The overall results indicate that the implementation of an obesity center of integrated responsibility led to improvements in hospital performance, particularly in the dimensions of access, production, and efficiency. While these findings are promising, the study also identifies areas for potential improvement in the model, such as organizational, functional, and legal aspects, including the method of granting incentives and the funding process. In the analyzed cases, this new organizational model proved to be a solution for improving hospital performance, particularly around obesity. These units can play a fundamental strategic role in the National Health System, contributing to access to specialized treatments, retention of professionals and financial sustainability.

O aumento contínuo na prevalência da obesidade é um desafio ao nível global, em termos económicos e de saúde pública. Em Portugal, o tratamento da obesidade apresenta problemas acentuados no acesso aos serviços de saúde. Neste contexto, surge a necessidade de implementar e avaliar novos modelos de gestão que ofereçam respostas mais eficazes, como os centros de responsabilidade integrados. Este estudo tem como objetivo principal avaliar o impacto da implementação de um centro de responsabilidade integrado de obesidade no desempenho hospitalar. A pesquisa foi conduzida por meio de um estudo de caso múltiplo, predominantemente descritivo, mas com elementos também explanatórios. A abordagem metodológica é mista, combinando análises quantitativas e qualitativas. São avaliados indicadores de desempenho hospitalar, incluídos na dimensão do acesso, produção, eficiência, qualidade e económico-financeira, antes e após a implementação do novo modelo. Em termos globais a implementação de um centro de responsabilidade integrado de obesidade conduziu a melhorias no desempenho hospitalar nas dimensões avaliadas, sobretudo ao nível do acesso, produção e eficiência. Apesar de promissor, este novo modelo poderá beneficiar de um conjunto de melhorias em termos organizacionais, funcionais e jurídico-legais, como por exemplo no método de concessão de incentivos e no processo de financiamento. Nos casos analisados, este novo modelo de organização demonstrou ser uma solução para incrementar o desempenho hospitalar. Estas unidades podem desempenhar um papel estratégico fundamental no Sistema Nacional de Saúde, contribuindo para o acesso a tratamentos especializados, retenção de profissionais e sustentabilidade financeira.

Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design - A population-based study.

INTRODUCTION AND OBJECTIVES: Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. METHODS: The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. CONCLUSIONS: Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.

Clinical, economical and safety impact of ferric carboxymaltose use in Patient Blood Management programme in Portuguese National Health Service hospitals.

Ferric carboxymaltose (FCM) can be used in Patient Blood Management (PBM) to promote the optimization of preoperative haemoglobin (Hb), which aims to minimise the use of allogeneic blood components and improve clinical outcomes, with better cost-effectiveness. This was an observational study conducted in a retrospective and multicentre cohort with adults from elective orthopaedic, cardiac and colorectal surgeries, treated according to local standards of PBM with allogeneic blood product transfusions (ABTs) on demand and with FCM to correct iron deficiency with or without anaemia. In this work, only the first pillar of the PBM model issue by Directorate-General for Health (DGS) was evaluated, which involves optimising Hb in the preoperative period with iron treatment if it's necessary/indicated. Before the implementation of PBM in Portugal, most patients did not undergo preoperative laboratory evaluation with blood count and iron kinetics. Therefore, the existence of Iron Deficiency Anaemia (IDA) or Iron Deficiency (ID) without anaemia was not early detected, and there was no possibility of treating these patients with iron in order to optimise their Hb and/or iron stores. Those patients ended up being treated with ABTs on demand. A total of 405 patients from seven hospitals were included; 108 (26.7%) underwent FCM preoperatively and 197 (48.6%) were transfused with ABTs on demand. In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM, respectively, a decrease from 31.7 to 9.6% in moderate anaemia and no cases of severe anaemia after FCM administration, while 7.7% of patients were severely anaemic before FCM treatment. There were significant differences (p < 0.001) before and after correction of preoperative anaemia and/or iron deficiency with FCM in Hb, serum ferritin and transferrin saturation rate (TS). In the ABT group, there were significant differences between pre- and postoperative Hb levels (p < 0.001). Hb values tended to decrease, with 44.1% of patients moving from mild anaemia before transfusion to moderate anaemia in the postoperative period. Concerning the length of hospital stay, the group administered with ABTs had a longer hospital stay (p < 0.001). Regarding the clinical outcomes of nosocomial infection and mortality, there was no evidence that the rate of infection or mortality differed in each group (p = 0.075 and p = 0.243, respectively). However, there were fewer nosocomial infections in the FCM group (11.9% versus 21.2%) and mortality was higher in the transfusion group (21.2% versus 4.2%). Economic analysis showed that FCM could reduce allogenic blood products consumption and the associated costs. The economic impact of using FCM was around 19%. The preoperative Hb value improved when FMC was used. Patients who received ABTs appeared to have a longer hospital stay. The FCM group reported fewer infections during hospitalisation. The economic results showed savings of around €1000 for each patient with FCM administration. The use of FCM as part of the PBM program had a positive impact on patients' outcomes and on economic results. However, it will be essential to perform studies with a larger sample to obtain more robust and specific results.

Migrant Communities at the Center in Co-design of Health Literacy-Based Innovative Solutions for Non-communicable Diseases Prevention and Risk Reduction: Application of the OPtimising HEalth LIteracy and Access (Ophelia) Process.

The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.

Can Tracking Data Help in Assessing Interpersonal Contact Exposure in Team Sports during the COVID-19 Pandemic?

During the COVID-19 pandemic, the temporary closure of physical activity and sports facilities, and the generalized cancellation or postponement of sports events have a massive impact on social and economic development. In this study, we explored the feasibility of using tracking data from a football match to assess interpersonal contact between individuals by calculating two measures of respiratory exposure. The dynamic tracking positioning of all players and referees during one international football match was analyzed. For each individual, two measures of respiratory exposure were calculated, based on the 2 m interpersonal distance recommendations for contact tracing for COVID-19 control. Overall, individuals spent a median of 0.12 mm:ss (IQR = 0.45 mm:ss) exposed to interpersonal contact of fewer than 2 m from others. The highest value of exposure was observed between two players of opposing teams (6.35 mm:ss). The results suggest that tracking data can be used to assess respiratory exposure to interpersonal contact in team sports, such as football. The measures of exposure calculated can be used to the prompt identification of high-risk contacts of COVID-19 cases during a match or a training session, but also the risk stratification of different sports and physical activities.

Financial Crisis in Portugal: Effects in the Health Care Sector.

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate - composed of the European Commission, the International Monetary Fund, and the European Central Bank - signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens' life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts-related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.

Medicines Compliance and Reimbursement Level in Portugal.

During a severe financial crisis, it is a priority to use scientific evidence to identify factors that enable therapeutic compliance by patients. This study aimed to evaluate a possible association between the number of patients who attended a medical appointment and had medicine prescribed and the number of these same patients who purchased the prescribed medicine and whether the level of reimbursement was a deciding factor. We perform a correlation analysis at primary care centers in Portugal, between 2010 and 2012 (n = 96). We found a moderate to high positive association, which is statistical significant, between the number of the patients with medicines dispensing and medicines reimbursement levels. The correlation coefficient varies from .5 to .63 (P < .01). The compliance increases along with the increase in the reimbursement levels.