Analysis of the costs of teleconsultation for the treatment of diabetes mellitus in the SUS.

OBJECTIVE: To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager's perspective, the article also presents estimates from the patient's perspective, based on the transportation costs associated with each type of consultation. METHOD: Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. RESULTS: Considering only the local SUS manager's perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. CONCLUSION: The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

Analysis of the costs of teleconsultation for the treatment of diabetes mellitus in the SUS / Análise dos custos da teleconsulta para tratamento de diabetes mellitus no SUS

ABSTRACT OBJECTIVE To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager's perspective, the article also presents estimates from the patient's perspective, based on the transportation costs associated with each type of consultation. METHOD Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. RESULTS Considering only the local SUS manager's perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. CONCLUSION The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

RESUMO OBJETIVO Apresentar os resultados da análise de custos para a modalidade de consulta remota (teleconsulta) em comparação à consulta presencial, em pacientes com diabetes do tipo 2, no Sistema Único de Saúde (SUS) brasileiro, na cidade Joinville, Santa Catarina. Para além dos custos, sob a perspectiva do gestor local, o artigo também apresenta estimativas sob perspectiva do paciente, a partir dos custos de transporte associados a cada modalidade de consulta. MÉTODO Foram coletados dados de 246 consultas, remotas e presenciais, entre 2021 e 2023, no contexto de um ensaio clínico randomizado sobre o impacto da teleconsulta realizado na cidade de Joinville, SC. As teleconsultas foram realizadas em Unidades Básicas de Saúde (UBS) e as consultas presenciais no Centro de Saúde Especializada. Para o cálculo dos custos, foi utilizado o método de custos baseado em tempo e atividade (TDABC) e, para o cálculo dos custos relativos aos transportes dos pacientes, foram coletados dados diretamente com os participantes da pesquisa. Foram analisados e comparados descritivamente os custos médios e o tempo de realização de cada modalidade de consulta em diferentes cenários e perspectivas. RESULTADOS Considerando apenas a perspectiva do gestor local do SUS, os custos para a realização da teleconsulta se mostraram 4,5% maiores do que para uma consulta presencial. Contudo, quando considerados os custos de transporte associados a cada paciente, o valor estimado da consulta presencial passa a ser 7,7% maior e, no caso de consultas em outros municípios, 15% maior do que a teleconsulta. CONCLUSÃO Os resultados demonstram que a incorporação da teleconsulta dentro do SUS pode trazer vantagens econômicas, a depender da perspectiva e do cenário considerado, além de ser uma estratégia com potencial para aumentar o acesso à atenção especializada na rede pública.

Drug-Eluting Sandwich Hydrogel Lenses Based on Microchamber Film Drug Encapsulation.

Corticosteroids are widely used as an anti-inflammatory treatment for eye inflammation, but the current methods used in clinical practice for delivery are in the form of eye drops which is usually complicated for patients or ineffective. This results in an increase in the risk of detrimental side effects. In this study, we demonstrated proof-of-concept research for the development of a contact lens-based delivery system. The sandwich hydrogel contact lens consists of a polymer microchamber film made via soft lithography with an encapsulated corticosteroid, in this case, dexamethasone, located inside the contact lens. The developed delivery system showed sustained and controlled release of the drug. The central visual part of the lenses was cleared from the polylactic acid microchamber in order to maintain a clean central aperture similar to the cosmetic-colored hydrogel contact lenses.

[Manaca, sweet potato and yam: possible substitutes of wheat in foods for two ethnic population in Venezuelan Amazon]. / Manaca, batata y ñame: posibles sustitutos del trigo en alimentos para dos etnias del Amazonas venezolano.

In this study, flours from manaca or acai (Euterpe oleracea Mart), sweet potato (Ipomea batatas), and yam (Dioscorea spp.), species grown in the Venezuelan Amazon, were obtained. The proximal composition, water activity (a(w)), Fe, Ca, Zn, Mg, Cu, Na and K content were determined for the flours of manaca, sweet potato and yam. These flours were used as ingredients of products for the inhabitants of the indigenous populations of the Venezuelan Amazon (Piaroa and Hiwi). Two types of products that traditionally contain wheat flour in their formulation (ingredient they know by transculturation) were formulated; an attempt to substitute it totally or partially by the manaca, sweet potato and/or yam flours was made. For the selection of the products to be formulated, the preferences and eating habits of the indigenous communities and ease and simplicity of the preparations to be developed, were considered. The two products formulated were cookies and "small cakes". To decide on the formulation(s) of the final product(s), sensorial evaluations were made in the laboratory and in the indigenous communities Piaroa and Hiwi. High fat content (16%), dietetic fiber (59.7%) and iron (25 mg / 100 g) in manaca or acai flour were remarkable. Two types of cookies and two of "small cakes" were equally accepted by the indigenous communities. Cookies supply a high iron amount (about 24%). The feasibility of substituting the wheat flour by manaca, sweet potato and yam flour in products accepted by two ethnic populations of the Venezuelan Amazon was demonstrated.