Digital health interventions for remote follow-up after mild traumatic brain injury.

BACKGROUND: After a mild traumatic brain injury (mild TBI,) a significant number of patients may experience persistent symptoms and disabilities for months to years. Early identification and timely management of persistent symptoms may help to reduce the long-term impacts of mild TBIs. There is currently no formalised method for identifying patients with persistent symptoms after mild TBI once they are discharged from emergency department. OBJECTIVE: Assess the feasibility of a remote monitoring tool for early identification of persistent symptoms after mild TBI in the outpatient setting using digital tools. METHODS: Electronic surveys were sent to patients with mild TBI who presented to the emergency department at a Major Trauma Centre in England. The surveys were completed at three different timepoints (within days of injury (S1), 1 month (S2), and 3 months (S3) after injury). The indicators used to assess feasibility were engagement, number of eligible patients for follow-up evidence of need for the intervention, and consistency with the literature. Feedback was sought from participants. RESULTS: Of the 200 people invited to participate, 134 (67.0%) completed S1, 115 (57.5%) completed S2, and 95 (47.5%) completed S3. The rates of persistent symptoms ranged from 17.9%-62.6% depending on the criteria used, and we found a significant proportion of the participants experienced morbidity 1 and 3 months after injury. The electronic follow-up tool was deemed an acceptable and user-friendly method for service delivery by participants. CONCLUSION: Using digital tools to monitor and screen mild TBI patients for persistent symptoms is feasible. This could be a scalable, cost-effective, and convenient solution which could improve access to healthcare and reduce healthcare inequalities. This could enable early identification of patients with further medical needs and facilitate timely intervention to improve the clinical workflows, patient satisfaction, and health outcomes for people with persistent morbidities after mild TBIs.

Clinical indicators for recommending continued care to patients with neck pain in chiropractic practice: a cohort study.

BACKGROUND: Chiropractors' clinical indicators for recommending preventive continued care to patients with low back pain include previous pain episodes, a history of long pain duration and improvement after initial treatment. Our objectives were, in a cohort of patients with neck pain, to examine whether these clinical indicators were associated with being recommended continued care beyond 4 weeks, and if so whether this recommendation was dependent of chiropractor characteristics, as well as if the number of clinical indicators influenced this recommendation. METHODS: In this multi-center observational study, 172 patients seeking care for a new episode of neck pain in chiropractic practice in Norway were included between September 2015 and May 2016. The chiropractors treated their patients as per usual, and for this study, baseline data and 4-week follow-up data were used. Patient data included the clinical indicators (1) previous episodes of neck pain, (2) a history of long duration neck pain and (3) improvement four weeks after initial treatment. The recruiting chiropractors were asked at 4-week follow-up if each patient was recommended continued care, defined as care planned beyond the first 4 weeks. Univariate and multivariable logistic regression models investigated the association between clinical indicators and the continued care recommendation, as well as the influence of chiropractor characteristics on this recommendation. Cross tabulations investigated the relationship between the number of indicators present and recommendation of continued care. RESULTS: Long duration of neck pain was the strongest clinical indicator for being recommended continued care 4 weeks after the initial treatment. Chiropractor characteristics were not associated with this recommendation. In patients with all three clinical indicators present, 39% were recommended continued care. When two and one indicators were present, the percentages of those recommended continued care were 25% and 10%, respectively. CONCLUSION: Chiropractors recommended continued care for patients experiencing neck pain based on their history of long pain duration, and this was not influenced by characteristics of the chiropractor. This differs from previous studies of indicators for maintenance care in patients with low back pain.

Resultados en salud tras la implantación de una guía multidisciplinar para la atención a la fractura de cadera / Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures

Antecedentes y objetivo: Evaluar el impacto de la aplicación de una guía clínica multidisciplinar en el proceso de atención a pacientes con fractura de cadera. Material y métodos: Estudio prospectivo pre y postintervención en una Unidad de Ortogeriatría de un hospital de segundo nivel tras implementar una guía clínica multidisciplinar de atención a la fractura de cadera. Se analizan las características basales de los pacientes y las variaciones observadas en las variables de proceso y de desenlace en los 2períodos estudiados (junio del 2015-mayo del 2016 y junio del 2016-mayo del 2017). Resultados: Las características basales de la población fueron similares en el período preintervención (n = 455) y en el período postintervención (n = 456). La edad media de los pacientes fue 84,8 ± 6,8 años y un 70,8% eran mujeres. La aplicación de la guía clínica multidisciplinar produjo una reducción de la estancia media (16,9 días vs. 15,6 días, p = 0,014) y mejoró la prescripción del tratamiento de la osteoporosis (51,6% vs. 88%, p < 0,001), y redujo los episodios de delirio (44% vs. 31,2%, p < 0,001), broncoespasmo (18,3% vs. 12%, p = 0,019), insuficiencia cardíaca (20% vs. 11,5%, p < 0,001) y enfermedad pulmonar obstructiva crónica agudizada (7,9% vs. 3,8%, p = 0,017). Observamos un incremento de las úlceras por presión al alta (2,9% vs. 9%, p = 0,001). No hubo diferencias en la proporción de pacientes operados en menos de 48 h (56% vs. 61,2%, p = 0,64), en reingresos hospitalarios (6,9% vs. 5,9%, p = 0,51) ni en mortalidad (5,0% vs. 7,2%, p = 0,17). Conclusiones: La implantación de una guía clínica multidisciplinar mejoró aspectos del proceso de atención a los pacientes con fractura de cadera (AU)

Background and objectives: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. Materials and methods: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients’ baseline characteristics and the variations observed in care provided and in outcome variables in the 2periods studied (June 2015-May 2016 and June 2016-May 2017). Results: The baseline characteristics of the population were similar in the pre-intervention period (n=455) compared to the post-intervention period (n=456). Patients’ mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs 15.6 days, p=.014); improved osteoporosis treatment prescribing (51.6% vs 88%, p<.001); and reduced episodes of delirium (44% vs 31.2%, p<.001), bronchospasm (18.3% vs 12%, p=.019), heart failure (20% vs 11.5%, p<.001), and COPD exacerbation (7.9% vs 3.8%, p=.017). We observed an increase in pressure ulcers at discharge (2.9 vs 9%, p<.001). There were no differences in the percentage of operations in less than 48hours (56% vs 61.2% p=.64), hospital readmissions (6.9% vs 5.9%, p=.51), or mortality (5.0% vs 7.2%, p=.17). Conclusions:The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture (AU)

Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures.

BACKGROUND AND OBJECTIVES: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. MATERIALS AND METHODS: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017). RESULTS: The baseline characteristics of the population were similar in the pre-intervention period (n = 455) compared to the post-intervention period (n = 456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs. 15.6 days, p= .014); improved osteoporosis treatment prescribing (51.6% vs. 88%, p< .001); and reduced episodes of delirium (44% vs. 31.2%, p < .001), bronchospasm (18.3% vs. 12%, p = .019), heart failure (20% vs. 11.5%, p < .001), and COPD exacerbation (7.9% vs. 3.8%, P = .017). We observed an increase in pressure ulcers at discharge (2.9 vs. 9%, P < .001). There were no differences in the percentage of operations in less than 48 h (56% vs. 61.2% p = .64), hospital readmissions (6.9% vs. 5.9%, p = .51), or mortality (5.0% vs. 7.2%, p = .17). CONCLUSIONS: The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.

Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study.

BACKGROUND: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. OBJECTIVE: This study aimed to assess the impact of the COVID-19 pandemic and the resulting "Stay-at-Home" order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. METHODS: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the "stay-at-home" mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. RESULTS: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. CONCLUSIONS: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research.

Substance use disorder patients' expectations on transition from treatment to post-discharge period.

Aim: There is limited knowledge about how inpatients anticipate factors that facilitate the transition between specialised inpatient treatment for substance use disorder (SUD) and the post-discharge period. This study explores factors that inpatients anticipated would facilitate such a transition period. Method: A focus group study, consisting of four group interviews with individuals in inpatient SUD treatment, was conducted to explore their expectations for the transition and post-discharge period ahead of them. The transcribed interview material was analysed using thematic analysis. Findings: The analytical process led to three themes: "Belonging", "Intrapersonal processes" and "Predictability". Correspondence between inpatients' expectations and the services they are offered in the transition and post-discharge period may serve as proper support for inpatients ahead of a vulnerable phase, such as the transition and post-discharge period. Conclusions: Findings from the current study highlight overarching elements that inpatients envisioned to be facilitating, such as social support, motivation, self-efficacy, self-awareness and predictability in basic elements such as employment, housing and personal finances. Findings from this study and previous ones imply that certain factors appear to facilitate in vulnerable phases, such as service level transitions. These facilitating factors should be taken into consideration and used as steppingstones through the transition and post-discharge period after inpatient SUD treatment.

Reforms in the Portuguese health care sector: Challenges and proposals.

Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.

Effects of continued psychological care toward brain tumor patients and their family members' negative emotions.

PURPOSE: Numerous studies have confirmed that brain tumor patients and their family members frequently exhibit negative emotional reactions, such as anxiety and depression, during diagnosis and treatment of the disease. Family members experience increasing pressure as the year of survival of patient progress. The aim of this study was to investigate the effects of the continued psychological care (CPC) toward the brain tumor patients and their family members' emotions. SUBJECTS AND METHODS: The asynchronous clinical control trial was performed, and 162 brain tumor patients and their family members were divided into the control group and the intervention group. The control group was only performed the telephone follow-up toward the patients. Beside this way, the intervention group was performed the CPC toward the patients and their family member. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to measure the negative emotions of the patients and their family members, and the patients' treatment compliance and the incidence of seizures were compared. RESULTS: The SAS and SDS scores of the intervention group on the 14 days, 28 days and 3 months of the CPC were significantly lower than the control group (P < 0.05); the SAS and SDS scores of the intervention group after the intervention were significantly lower than those at the discharging (P < 0.05), the treatment compliance of the intervention group was significantly higher than the control group (P < 0.05), and the seizure incidence of the intervention group was significantly lower than the control group (P < 0.05). CONCLUSION: The CPC could effectively reduce the anxiety and depression among the brain tumor patients and their family members.

Adolescents with cannabis use disorders: Adaptive treatment for poor responders.

OBJECTIVE: Treatment response as measured by both retention and abstinence attainment rates for adolescents with cannabis use disorders (CUD) has been unsatisfactory. This study tested the hypothesis that adaptive treatment (AT) will improve outcomes for poor responders (PR) to evidence-based practice interventions. METHOD: A total of 161 adolescents, 13-18years of age, diagnosed with DSM-IV CUD, enrolled in this outpatient, randomized, AT study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7) only poor responders (defined as failing to achieve abstinence at week seven for any reason) were randomized into a 10-week AT phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention. Good responders (GR) enrolled only in follow-up assessments starting at the completion of the AT phase (week 17). RESULTS: Eighty adolescents (50%) met the criterion for poor response to treatment. Thirty seven percent of poor responders completed the AT phase and 27% of them achieved abstinence. There was no significant difference in retention and abstinence rates between the AT conditions. Although the majority of GR relapsed by week 17, they significantly differed from PR both for drug use (71% vs. 91%, respectively; p<0.05) and reporting to scheduled assessment on that week (78% vs. 54%, respectively; p<0.01). CONCLUSION: Continuity of care to achieve abstinence among poor responders remains a therapeutic necessity and a research challenge. Examining innovative AT designed interventions including potential integrative approaches should be further studied in order to improve treatment outcomes.

Referral and counter-referral system between secondary and tertiary care facilities in a children's hospital network of Greater Buenos Aires / Sistema de referencia-contrarreferencia entre el segundo y el tercer nivel de salud en una red hospitalaria pediátrica en el conurbano bonaerense

Introduction. Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it. Population and Methods. This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the network's pediatric departments in order to assess the level of knowledge they had about it. Results. A total of1677patients were hospitalized; 83.9% were referred from the network. Of all referrals made, 71.1% were accepted. There were 156 patients (9.4%) who were counter-referred to the referring facility. The survey results showed that 70% of heads of pediatric departments were unaware of the range of services provided by the network. Conclusions. Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.

Introducción. El Hospital El Cruce es un centro de alta complejidad de una red asistencial que funciona desde julio de 2008 y abarca centros sanitarios de cinco municipios del conurbano sur bonaerense. El objetivo del estudio fue describir el sistema de referencia y contrarreferencia a la unidad de cuidados intermedios pediátricos del Hospital de Alta Complejidad en Red El Cruce, y secundariamente identifcar los puntos críticos que podrían conspirar contra la consolidación de la red y analizar el nivel de autoconocimiento sobre ésta. Población y métodos. Estudio observacional, prospectivo, realizado en la unidad de cuidados intermedios pediátricos del Hospital El Cruce, entre julio de 2008 y diciembre de 2010. Se analizaron los indicadores vinculados al ingreso y egreso del paciente. Se realizó una encuesta a todos los jefes de servicios pediátricos de la red para evaluar el nivel de conocimiento sobre ésta. Resultados. Se internaron 1677 pacientes; 83,9% fueron derivados desde la red. Se aceptaron 71,1% de las derivaciones solicitadas. El 9,4% (156 pacientes) fueron contrarreferidos al centro de origen. En la encuesta, 70% de las respuestas de los jefes de servicios pediátricos expresaron desconocimiento del menú prestacional de la red. Conclusiones. El intercambio asistencial se basó predominantemente en la aceptación de pacientes derivados desde centros de segundo nivel de atención hacia el Hospital El Cruce y escasa contrarreferencia hacia los centros derivadores, con una dinámica de funcionamiento radiada. Hubo escaso conocimiento de la disponibilidad de prestaciones de la red.

Apoio matricial: dispositivo para resolução de casos clínicos de saúde mental na Atenção Primária à Saúde / Matrix support: device for resolution of mental health clinical cases at the Primary Health Care / Apoyo matricial: dispositivo para resolución de casos clínicos de salud mental en la Atención Primaria de Salud

O estudo objetivou compreender o apoio matricial como um dispositivo para a resolução de casos clínicos de saúde mental no âmbito da Atenção Primária à Saúde em um estudo qualitativo realizado a partir de um estudo de caso. Os dados foram coletados por meio de observação das práticas de matriciamento e analisados sob a ótica da análise de conteúdo reflexiva. Os resultados apontam para as seguintes categorias: O caminhar da usuária: dilemas e desafios; Compartilhamento de saberes: uma ampliação de olhares? A cortina se abre: passou, mas a dor ficou! e Desfecho: construção coletiva do projeto terapêutico. Evidencia-se que o matriciamento tem potência para sinalizar os caminhos para a construção de um determinado modelo de atenção à saúde que esteja articulado e sinérgico com os princípios e diretrizes do Sistema Único de Saúde.

The study aimed to comprehend the matrix support as a device to resolution of clinical cases of mental health within the Primary Health Care in a qualitative study, carried out from a case study. The data were collected through observation of matrix practices and analyzed under the view of reflective content analysis. The results pointed out to the following categories: The walking of user: dilemmas and challenges; Sharing of knowledge: an expansion of views? The curtain opens itself: It passed but the pain remains! and Results: collective construction of the therapeutic project. It highlights that matrix practices has the power to sign the paths for the construction of a particular model of health care that is articulate and synergistic with the principles and guidelines of the National Health System.

El objetivo del estudio fue comprender el apoyo matricial como un dispositivo para la resolución de casos clínicos de salud mental en el ámbito de la Atención Primaria de Salud en un estudio cualitativo, realizado a partir de un estudio de caso. Los datos fueron recogidos a través de observación de las prácticas de matriciamento y analizados bajo la óptica del análisis de contenido reflexiva. Los resultados apuntan para las categorías: El caminar de la usuaria: dilemas y retos; Compartir saberes: ¿una ampliación de miradas? La cortina se abre: pasó, pero el dolor se ha quedado! e el Resultado: construcción colectiva del proyecto terapéutico. Se evidencia que el matriciamento tiene potencia para señalar caminos para la construcción de un modelo particular de atención de la salud que es articulada y sinérgica con los principios y directrices del Sistema Nacional de Salud.

Referral and counter-referral system between secondary and tertiary care facilities in a childrens hospital network of Greater Buenos Aires / Sistema de referencia-contrarreferencia entre el segundo y el tercer nivel de salud en una red hospitalaria pediátrica en el conurbano bonaerense

Introduction. Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it. Population and Methods. This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the networks pediatric departments in order to assess the level of knowledge they had about it. Results. A total of1677patients were hospitalized; 83.9% were referred from the network. Of all referrals made, 71.1% were accepted. There were 156 patients (9.4%) who were counter-referred to the referring facility. The survey results showed that 70% of heads of pediatric departments were unaware of the range of services provided by the network. Conclusions. Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.(AU)

Introducción. El Hospital El Cruce es un centro de alta complejidad de una red asistencial que funciona desde julio de 2008 y abarca centros sanitarios de cinco municipios del conurbano sur bonaerense. El objetivo del estudio fue describir el sistema de referencia y contrarreferencia a la unidad de cuidados intermedios pediátricos del Hospital de Alta Complejidad en Red El Cruce, y secundariamente identifcar los puntos críticos que podrían conspirar contra la consolidación de la red y analizar el nivel de autoconocimiento sobre ésta. Población y métodos. Estudio observacional, prospectivo, realizado en la unidad de cuidados intermedios pediátricos del Hospital El Cruce, entre julio de 2008 y diciembre de 2010. Se analizaron los indicadores vinculados al ingreso y egreso del paciente. Se realizó una encuesta a todos los jefes de servicios pediátricos de la red para evaluar el nivel de conocimiento sobre ésta. Resultados. Se internaron 1677 pacientes; 83,9% fueron derivados desde la red. Se aceptaron 71,1% de las derivaciones solicitadas. El 9,4% (156 pacientes) fueron contrarreferidos al centro de origen. En la encuesta, 70% de las respuestas de los jefes de servicios pediátricos expresaron desconocimiento del menú prestacional de la red. Conclusiones. El intercambio asistencial se basó predominantemente en la aceptación de pacientes derivados desde centros de segundo nivel de atención hacia el Hospital El Cruce y escasa contrarreferencia hacia los centros derivadores, con una dinámica de funcionamiento radiada. Hubo escaso conocimiento de la disponibilidad de prestaciones de la red.(AU)

Implementação da equipa de cuidados continuados integrados / Implementation of the integrated continuous care team

ste trabalho de projecto ultrapassa o seu sentido tecnicista original, adquirindo uma orientação construtivista e integrada que aponta para a capacidade de agir e reagir de forma pró-activa perante situações mais ou menos complexas, através da mobilização de conhecimentos, atitudes e procedimentos adquiridos no âmbito do Mestrado em Gestão das Organizações ­ Ramo Gestão das Unidades de Saúde (MGO ­ GUS) no sentido de dar resposta a um projecto institucional, designadamente no que se refere à Implementação da Reforma da Saúde no âmbito dos Cuidados de Saúde Primários (CSP), onde se premeia a formação de equipas em cuidados de saúde, como respostas mais efectivas aos problemas de saúde da comunidade. Pois, promove-se a abertura organizacional a novos modelos de cuidados, que incorporam novos paradigmas, orientados para uma intervenção multidisciplinar tendo como enfoque principal as pessoas em situação de dependência funcional, doença terminal, ou em processo de convalescença, com rede de suporte social, cuja situação não requer internamento. Todos os intervenientes neste sector do mercado percebem que a saúde e a sua protecção são um bem económico altamente dispendioso e não gratuito, ainda que frequentemente o seja no momento da utilização dos serviços. Estas premissas estão subjacentes ao objectivo preconizado para este trabalho: Implementação de uma Equipa de Cuidados Continuados Integrados. Para a sua consecução está implícita a necessidade inadiável, na conjectura económica e financeira actual, periodizada através da adaptação às necessidades do cidadão, de forma a garantir o acesso aos cuidados necessários e adequados, no tempo e locais certos, visando assegurar a continuidade dos cuidados, mediante intervenções coordenadas e articuladas entre os diferentes sectores sociais, constituindo uma estratégia que visa maximizar a prestação dos cuidados de saúde comunitários de proximidade, sendo um componente de Inovação no Serviço Nacional de Saúde (SNS). Estes pressupostos conceptuais constituíram-se, em grande medida, norteadores da dimensão praxiológica do trabalho desenvolvido. Assim, foram planeados, desenvolvidos e validados os documentos que servem de suporte à implementação da ECCI, nomeadamente a candidatura, a carta de compromisso, o manual de articulação, o regulamento interno e vários documentos no âmbito da operacionalização, que permitiram a abertura da ECCI Norte. A monitorização e o acompanhamento, enquanto etapa fundamental do processo de controlo, das actividades desenvolvidas, no sentido da mudança se concretizar com o envolvimento de todos, deve também ser progressivamente estudado e adaptado de forma a permitir identificar os principais problemas, virtudes, estabelecer alertas e recomendações no apoio à gestão operacional. Neste sentido, procuramos que este projecto assegurasse uma intervenção marcada pela singularidade, unicidade e congruência interna.

This project work goes beyond its original technicist meaning, gaining an integrated and constructivist orientation pointing out to the ability of acting and reacting in a pro-active way when situations, in some way complex, arise, through the mobilization of knowledge, attitudes and procedures acquired in the Mestrado em Gestão das Organizações ­ Ramo Gestão das Unidades de Saúde (MGO ­ GUS), in the attempt of answering to an institutional project, specially when it comes to Implement the health Reformation in Primary Health Care (CSP), where the formation of health care teams is awarded, considering them as more effective answers to the community's health problems. The organizational opening to new care models is promoted. Care that can incorporate new paradigms, oriented to a multidisciplinary intervention mainly focusing people in functional dependence, terminal illness, or in a recovery process, with a social support web, whose situation does not request admission to the hospital. Every intervenient in this market realize that health and its protection are an economic asset highly expensive and not free, although it's usually free when we use those services. These premises are underlying the main purpose of this work: implementation of an integrated and continued health care team. For that to be possible it's implied the urgent need in nowadays economic and financial forecast periodized through the adaptation to the citizen's needs, in a way that can guarantee the access to necessary and proper health care, in the right timing and right place, ensuring the continuing of the care, with coordinated and articulated interventions with the different social sectors, building a strategy that aims to enlarge the health care providing in communities. This is an innovation component in Serviço Nacional de Saúde (SNS) (National Health Service). These conceptual assumptions were built mainly guided by the praxeological dimension of the developed work. So, one planed, developed and validated documents that support the implementation of the ECCI, namely the application form, the commitment letter, the articulation manual, the internal regulation and several documents about the establishment that allow the opening of ECCI Norte. Monitoring and accompanying while fundamental stage in controlling all the developed activities, so that change can happen with everybody's involvement, should also be progressively studied and adapted, so that it can identify the main virtues and problems, to establish alerts and recommendations in the support of the operational management. In this line of thought, we tried that this project assured an intervention marked by singularity, unity and internal congruence.