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Gac Sanit ; 36 Suppl 1: S44-S50, 2022.
Article in Spanish | MEDLINE | ID: mdl-35781148


Reflection on three major levers for rebuilding the healthcare system: governance, integration of health and social care and digitalization. Spain has worrying levels of quality of democracy and public confidence in its politicians, and major changes are required in public administration to achieve a better state. Healthcare suffers from a deficient institutional architecture that prevents adequate macrogovernance. There is also a lack of autonomy in the management of public health centers, which hinders competition by comparison, care integration and coordination within and between levels of care. The pandemic has highlighted the value of professionalism and has shown that agile healthcare management is possible, but the challenge is to maintain this flexibility outside state of alarm. Care integration is more necessary as the population ages (albeit healthily), and per capita financing is a powerful tool to achieve it. Digitization concerns practically all areas of healthcare and population health, and will bring with it far-reaching organizational changes, requiring new methods of evaluation that differ according to the degree of intrusiveness in individual health. Telemedicine, sponsored during the pandemic with a view to permanence, induces changes in labor relations, among others. It is necessary to measure the value of digital tools and technologies. Spain has a unique opportunity for its digital transformation, thanks to European funds.

Health Services Administration , Telemedicine , Delivery of Health Care , Humans , Organizations , Public Health
San Salvador; MINSAL; jun. 02, 2022. 66 p. graf.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1372441


La Dirección de Políticas y Gestión de Salud, en adelante DPGS, es la dependencia estratégica del Viceministerio de Gestión y Desarrollo, responsable del desarrollo de la normativa institucional relacionada a la promoción, prevención, identificación, tratamiento y rehabilitación, dentro del modelo de atención integral en salud; así como la creación y seguimiento de políticas, planes, proyectos o estrategias institucionales y aquellas establecidas por el Gobierno Central. En este sentido y para documentar la organización y funcionamiento de la Dirección de Políticas y Gestión de Salud, se establece a continuación el presente manual, el cual incluye la misión y visión, sus objetivos y funciones, así como sus principales relaciones de trabajo

The Directorate of Health Policies and Management, hereinafter DPGS, is the strategic dependency of the Vice Ministry of Management and Development, responsible for the development of institutional regulations related to promotion, prevention, identification, treatment and rehabilitation, within the comprehensive care model in health; as well as the creation and monitoring of policies, plans, projects or institutional strategies and those established by the Central Government. In this sense and to document the organization and operation of the Health Policy and Management Directorate, this manual is established below, which includes the mission and vision, its objectives and functions, as well as its main working relationships

Health Services Administration , Public Health , Health Policy , Organization and Administration , Health Strategies , El Salvador
BMJ Open ; 12(6): e060524, 2022 06 09.
Article in English | MEDLINE | ID: mdl-35680253


INTRODUCTION: Practice-based research networks (PBRNs) are sustained collaborations between healthcare professionals, researchers and members of the community that develop, conduct and report on research relevant to local needs. While PBRNs have traditionally been focused towards primary care practices and their patients, there has been increasing interest in how they may help facilitate healthcare integration. Yet, little is known on the ways in which PBRNs can best integrate with the broader healthcare system, in particular Advanced Health Research and Translation Centres. The overall project aim is to build a sustainable collaboration between a PBRN and an Advanced Health Research and Translation Centre to generate a research platform suitable for planning, undertaking and translating research to improve care across the healthcare continuum. METHODS AND ANALYSIS: We will use a developmental evaluation design. Our iterative approach will be informed by a programme logic model and consists of: preparation work (pre-implementation assessment, literature review, community and stakeholder engagement), adaptation and building for a sustainable collaboration (strategy for recruitment and sustainment of members) and planning for network action (designing and implementing priority initiatives, monitoring and follow-up). ETHICS AND DISSEMINATION: This project was approved by the Monash Health ethics committee (ERM Reference Number: 76281; Monash Health Ref: RES-21-0000-392L) and the Monash University Human Research ethics committee (Reference Number: 29786). Dissemination will take place via various channels, including relevant national and international committees and conferences, peer-reviewed journals and social media. Continuous dissemination to and communication with all participants in this project as well as other relevant stakeholders will help strengthen and sustain the network.

Delivery of Health Care, Integrated , Health Services Administration , Health Facilities , Health Services , Humans , Primary Health Care , Research Design , Research Personnel , Stakeholder Participation
Value Health ; 25(3): 368-373, 2022 03.
Article in English | MEDLINE | ID: mdl-35227447


OBJECTIVES: This study aimed to showcase the potential and key concerns and risks of artificial intelligence (AI) in the health sector, illustrating its application with current examples, and to provide policy guidance for the development, assessment, and adoption of AI technologies to advance policy objectives. METHODS: Nonsystematic scan and analysis of peer-reviewed and gray literature on AI in the health sector, focusing on key insights for policy and governance. RESULTS: The application of AI in the health sector is currently in the early stages. Most applications have not been scaled beyond the research setting. The use in real-world clinical settings is especially nascent, with more evidence in public health, biomedical research, and "back office" administration. Deploying AI in the health sector carries risks and hazards that must be managed proactively by policy makers. For AI to produce positive health and policy outcomes, 5 key areas for policy are proposed, including health data governance, operationalizing AI principles, flexible regulation, skills among health workers and patients, and strategic public investment. CONCLUSIONS: AI is not a panacea, but a tool to address specific problems. Its successful development and adoption require data governance that ensures high-quality data are available and secure; relevant actors can access technical infrastructure and resources; regulatory frameworks promote trustworthy AI products; and health workers and patients have the information and skills to use AI products and services safely, effectively, and efficiently. All of this requires considerable investment and international collaboration.

Artificial Intelligence , Health Care Sector/organization & administration , Health Care Sector/statistics & numerical data , Health Policy , Health Services Administration/statistics & numerical data , Biomedical Research/organization & administration , Critical Pathways , Delivery of Health Care/organization & administration , Efficiency, Organizational , Health Care Sector/economics , Health Care Sector/standards , Health Equity , Humans , Public Health Administration/standards , Public Health Administration/statistics & numerical data , Safety Management
BMJ ; 376: o675, 2022 03 14.
Article in English | MEDLINE | ID: mdl-35288378
Rev. Méd. Inst. Mex. Seguro Soc ; 60(2): 104-106, 24-feb-2022.
Article in Spanish | LILACS | ID: biblio-1367060


La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

Humans , Health Services Administration/history , Hospital Administration/history , Academies and Institutes/history
Healthc Manage Forum ; 35(2): 90-98, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35144506


This provincial case study, one of seven conducted as part of a national research program on healthcare supply chain management during COVID-19, focuses on Alberta. With a history of emergency preparedness, Alberta's unique context, one that includes having an already established, centralized, and digital healthcare supply chain strategy, sets this case apart from the others in terms of pandemic responses. A key challenge navigated by Alberta was the inadequacies of traditional sourcing and procurement approaches to meet surges in product demand, which was overcome by the implementation of unique procurement strategies. Opportunities for Alberta included the integration of supply chain teams into senior leadership structures, which enabled access to data to inform public health decision-making. This case demonstrated how Alberta's healthcare supply chain assets-its supply chain infrastructure, data, and leadership expertise, especially-contributed to resilient supply chain capacity across the province.

COVID-19 , Health Services Administration , Alberta , Delivery of Health Care , Humans , SARS-CoV-2
Porto; s.n; 20220125. il., tab..
Thesis in Portuguese | BDENF - Nursing | ID: biblio-1380429


A gestão dos serviços de saúde atualmente, privilegia o planeamento, a organização e direção, de forma a dar resposta à missão da organização, para além das componentes administrativas, estas ações tornam-se fundamentais no alcance do principal objetivo dos gestores, que é a prestação de cuidados de qualidade e eficientes. Face a estas exigências podemos afirmar que os enfermeiros gestores devem possuir competências de liderança, negociação, comunicação, gestão de recursos humanos, entre outras, para que este seja versátil atendendo às várias dificuldades presentes na instituição, pois muitas das suas decisões diárias e a medio prazo são situacionais, como é o caso de situações de conflitos. O enfermeiro gestor, desempenha o papel de mediador de conflitos, tentando solucioná-los de forma positiva ou até evitá-los quando possível, para que "reine" um clima harmonioso e favorável à prática profissional dentro da instituição. O presente estudo pretende saber se há diferenças entre a perceção das competências dos gestores de um centro hospitalar e a gestão de conflitos, a partir de uma pesquisa descritiva, exploratória e de caráter quantitativo, cujo instrumento de colheita de dados é um questionário de autopreenchimento. A amostra é composta por 37 enfermeiros gestores de um centro hospitalar (enfermeiros gestores e em funções de gestão). Neste estudo, o perfil do enfermeiro gestor é caraterizado na sua maioria, por enfermeiras, com média de idades de 56,22 anos, com 33,92 anos em média de experiência profissional, a exercer cargos de gestão em média há 17,76 anos, com especialidade em Enfermagem Médico-Cirúrgica. Em relação à gestão de conflitos, a estratégia mais expressa é a "Colaboração". Verificamos diferenças significativas na gestão de recursos humanos, desenvolvimento profissional e Intervenção política e assessoria em função da idade dos enfermeiros gestores. Também existem diferenças significativas na gestão de conflitos em função dos anos de gestão. No entanto, não foram encontradas diferenças significativas entre as dimensões das atividades dos enfermeiros gestores e a gestão dos conflitos. Em conclusão, a idade influência as atividades realizadas pelos enfermeiros gestores e os anos de gestão influenciam a gestão dos conflitos.

The management of health services currently privileges planning, organization and direction beyond the administrative components, these actions become fundamental in achieving the main objective of managers, which is the provision of quality and efficient care. Nurse managers must have leadership, negotiation, communication, human resource management skills, among others, that can make them a completer and more versatile manager, given the various difficulties present in the institution, such as conflicts. The nurse manager plays the role of mediator of conflicts, trying to resolve them in a positive way or even avoid them when possible, so that a harmonious and favorable climate for professional practice within the institution "reigns". The present study intends to know if there are differences between the perception of the competences of the managers of a hospital center and the management of conflicts, based on a descriptive, exploratory and quantitative research, whose data collection instrument is a self-completed questionnaire. The sample is composed of 37 nurse managers of a hospital center (managers and nurses in management functions). The profile of the nurse manager is characterized mostly by female nurse managers, with an average age of 56.22 years, with an average of 33.92 years of professional experience, holding management positions on average at 17.76 years, with a specialty in Medical-Surgical Nursing. In relation to conflict management, the "Collaboration" strategy was significantly more pointed out. We found significant differences in human resource management, Political intervention and advice and professional development depending on the age of nurse managers. There are also significant differences in conflict management depending on the years of management. However, no significant differences were found between the dimensions of the activities of nurse managers and conflict management. In conclusion, age influences the activities performed by nurse managers and years of management influence conflict management.

Health Services Administration , Negotiating , Nurse Administrators , Personnel Management , Nurse's Role , Leadership
Health Care Manage Rev ; 47(2): 144-154, 2022.
Article in English | MEDLINE | ID: mdl-33660666


BACKGROUND: Advances in natural language processing and text mining provide a powerful approach to understanding trending themes in the health care management literature. PURPOSE: The aim of this study was to introduce machine learning, particularly text mining and natural language processing, as a viable approach to summarizing a subset of health care management research. The secondary aim of the study was to display the major foci of health care management research and to summarize the literature's evolution trends over a 20-year period. METHODOLOGY/APPROACH: Article abstracts (N = 2,813), from six health care management journals published from 1998 through 2018 were evaluated through latent semantic analysis, topic analysis, and multiple correspondence analysis. RESULTS: Using latent semantic analysis and topic analysis on 2,813 abstracts revealed eight distinct topics. Of the eight, three leadership and transformation, workforce well-being, and delivery of care issues were up-trending, whereas organizational performance, patient-centeredness, technology and innovation, and managerial issues and gender concerns exhibited downward trending. Finance exhibited peaks and troughs throughout the study period. Four journals, Frontiers of Health Services Management, Journal of Healthcare Management, Health Care Management Review, and Advances in Health Care Management, exhibited strong associations with finance, organizational performance, technology and innovation, managerial issues and gender concerns, and workforce well-being. The Journal of Health Management and the Journal of Health Organization and Management were more distant from the other journals and topics, except for delivery of care, and leadership and transformation. CONCLUSION: There was a close association of journals and research topics, and research topics evolved with changes in the health care environment. PRACTICE IMPLICATIONS: As scholars develop research agendas, focus should be on topics important to health care management practitioners for better informed decision-making.

Health Services Administration , Periodicals as Topic , Data Mining , Delivery of Health Care , Humans , Leadership
Rev. baiana enferm ; 36: e45076, 2022.
Article in English | LILACS, BDENF - Nursing | ID: biblio-1376472


Objective: analyzing the management of nursing care in hemotherapy in a university hospital. Method: a descriptive, exploratory study with a qualitative approach conducted with 29 nurses from the University Hospital of Belém, Pará, Brazil. Semi-structured interviews were applied between August/2018 and January/2019. The collected data were submitted to thematic content analysis. Results: coordination of care/supervision and provision of complex care were the most mentioned actions regarding hemotherapy procedures. Team dimensioning, Materials management, Nursing care planning and Evaluation of the results of nursing actions were actions absent in the nurses' statements. Training/education of the team was weakened. Leadership was not explicitly mentioned, but it could be present, albeit in a fragile way. Final considerations: the actions most represented in the nurses' statements were related to the technical competencies acquired in the formative context, while the less mentioned actions were related to the competencies and skills that commonly permeate gaps in formal education.

Objetivo: analizar el manejo de los cuidados de enfermería en hemoterapia en un hospital universitario. Método: se trata de un estudio descriptivo, exploratorio con enfoque cualitativo realizado con 29 enfermeras del Hospital Universitario de Belém, Pará, Brasil. Se aplicaron entrevistas semiestructuradas entre agosto/2018 y enero/2019. Los datos recopilados se sometieron a análisis de contenido temático. Resultados: la coordinación de la atención/supervisión y la prestación de cuidados complejos fueron las acciones más mencionadas con respecto a los procedimientos de hemoterapia. El dimensionamiento del equipo, la gestión de materiales, la planificación de los cuidados de enfermería y la evaluación de los resultados de las acciones de enfermería fueron acciones ausentes en las declaraciones de las enfermeras. La capacitación/educación del equipo se debilitó. El liderazgo no se menciona explícitamente, pero podría estar presente, aunque de una manera frágil. Consideraciones finales: las acciones más representadas en las declaraciones de las enfermeras se relacionaron con las competencias técnicas adquiridas en el contexto formativo, mientras que las acciones menos mencionadas se relacionaron con las competencias y habilidades que comúnmente impregnan las brechas en la educación formal.

Objetivo: analisar a gerência do cuidado de Enfermagem na hemoterapia em um hospital universitário. Método: estudo descritivo, exploratório de abordagem qualitativa, realizado com 29 enfermeiros de Hospital Universitário de Belém, Pará, Brasil. Foram aplicadas entrevistas semiestruturadas entre agosto/2018 e janeiro/2019. Os dados coletados foram submetidos à análise de conteúdo temática. Resultados: Coordenação do cuidado/Supervisão e Prestação do cuidado complexo foram as ações mais mencionadas quanto aos procedimentos hemoterápicos. Dimensionamento da equipe, Gestão de materiais, Planejamento do cuidado de enfermagem e Avaliação dos resultados das ações de enfermagem foram ações ausentes nas falas dos enfermeiros. Treinamento/educação da equipe mostrou-se fragilizado. Já Liderança não foi mencionada explicitamente, mas pôde estar presente, ainda que de forma fragilizada. Considerações finais: as ações mais representadas nas falas dos enfermeiros estavam relacionadas às competências técnicas adquiridas no contexto formativo, enquanto as ações menos mencionadas relacionaram-se às competências e habilidades que comumente permeiam lacunas da educação formal.

Humans , Male , Female , Adult , Middle Aged , Health Services Administration , Hemotherapy Service , Nursing Care , Nursing Service, Hospital/organization & administration
Rev. Esc. Enferm. USP ; 56: e20210481, 2022. tab
Article in English, Portuguese | LILACS, BDENF - Nursing | ID: biblio-1376266


Abstract Objective: To identify the prevalence of adverse events and the critically ill patient's need for care in an intensive care unit. Method: This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered. Results: of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified. Conclusion: The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.

RESUMEN Objetivo: identificar la prevalencia de eventos adversos y la necesidad de cuidado del paciente crítico en una unidad de cuidado intensivo (UCI). Método: estudio transversal, realizado entre enero y marzo de 2020. Los eventos adversos investigados fueron: lesión por presión, extubación oro traqueal accidental, caída, pérdida de acceso venoso central e infección relacionada a la asistencia a la salud. El número de horas necesarias para el cuidado del paciente se midió por la Nursing Activities Score. Las variables independientes categóricas fueron descriptas por frecuencia absoluta y relativa, y las continuas, por tendencia central. La medida de magnitud fue la razón de oportunidad (odds ratio) y se consideró un intervalo de confianza del 95%. Resultados: de los 88 pacientes evaluados, un 52,3% presentaron eventos adversos, los cuales fueron asociados a necesidad de cuidados más intensa, gravedad y tiempo de ingreso más extenso. El Nursing Activities Score medio fue un 51,01% (12 h 24 min), siendo identificado un déficit entre 20% y 30% de personal de enfermería en la unidad. Conclusión: la prevalencia de los eventos adversos en la unidad es alta y el déficit de personal de enfermería en la unidad reveló la necesidad de dimensionamiento adecuado de personal para reducir los daños causados por los cuidados prestados a los pacientes críticos.

RESUMO Objetivo: identificar a prevalência de eventos adversos e a necessidade de cuidado do paciente crítico em uma unidade de terapia intensiva. Método: estudo transversal, realizado de janeiro a março de 2020. Os eventos adversos investigados foram: lesão por pressão, extubação orotraqueal acidental, queda, perda de acesso venoso central e infecção relacionada à assistência à saúde. O número de horas necessárias para o cuidado do paciente foi mensurado pela Nursing Activities Score. As variáveis independentes categóricas foram descritas por frequências absoluta e relativa, e as contínuas, por tendência central. A medida de magnitude foi a razão de chance e considerou-se intervalo de confiança de 95%. Resultados: dos 88 pacientes avaliados, 52,3% apresentaram eventos adversos, os quais foram associados à maior necessidade de cuidados, gravidade e ao maior tempo de internação. O Nursing Activities Score médio foi 51,01% (12 h 24 min), sendo identificado um déficit de 20% a 30% de pessoal de enfermagem na unidade. Conclusão: a prevalência dos eventos adversos na unidade é alta e o déficit de pessoal de enfermagem na unidade revelou a necessidade de dimensionamento adequado de pessoal para reduzir os danos ocasionados pelos cuidados prestados aos pacientes críticos.

Patient Safety , Intensive Care Units , Personnel Management , Health Services Administration , Legislation, Nursing , Nursing Care
Article in English, Portuguese | LILACS, BDENF - Nursing | ID: biblio-1361667


Objetivo: identificar os principais entraves e desafios enfrentados pelo enfermeiro atuante nos serviços de urgência e emergência. Método: trata-se de uma revisão narrativa. Utilizou-se artigos publicados nos últimos cinco anos, disponíveis nas principais bases de dados, em três idiomas, contemplando a temática em seu título, resumo ou assunto. Inicialmente encontrou-se 12.370 arquivos, que ao passarem pelos critérios de exclusão e leitura simplificada culminou na abordagem de 28 artigos. Resultados: dentre os principais achados destacam-se: a grande demanda do serviço, carga horária exaustiva, baixos salários, situações de estresse, eventos adversos, além da falha na comunicação e relação interprofissional. Conclusão: há a prevalência dos entraves nos diversos serviços de urgência e emergência, contudo, são apontadas diversas soluções com potencial de aplicabilidade, na tentativa de gerir os entraves e sanar os desafios identificados

Objective: to identify the main obstacles and challenges faced by nurses working in urgent and emergency services. Method: this is a narrative review. Articles published in the last five years, available in the main databases, in three languages, covering the theme in its title, abstract or subject, were used. Initially, 12,370 files were found, which when passing through the criteria of exclusion and simplified reading culminated in the approach of 28 articles. Results: among the main findings, we highlight: the great demand for the service, exhaustive workload, low wages, stressful situations, adverse events, in addition to the failure in communication and interprofessional relationship. Conclusion: there is a prevalence of obstacles in the various urgency and emergency services, however, several solutions with potential applicability are pointed out, in an attempt to manage the obstacles and solve the identified challenges

Objetivo: identificar los principales obstáculos y desafíos que enfrentan los enfermeros que trabajan en los servicios de urgencias y emergencias. Método: esta es una revisión narrativa. Se utilizaron artículos publicados en los últimos cinco años, disponibles en las principales bases de datos, en tres idiomas, cubriendo el tema en su título, resumen o tema. Inicialmente se encontraron 12.370 expedientes, que al pasar por los criterios de exclusión y lectura simplificada culminaron en el abordaje de 28 artículos. Resultados: entre los principales hallazgos se destacan: la gran demanda del servicio, la carga de trabajo exhaustiva, los bajos salarios, las situaciones estresantes, los eventos adversos, además de fallas en la comunicación y relación interprofesional. Conclusión: existe un predominio de obstáculos en los distintos servicios de urgencia y emergencia, sin embargo, se señalan varias soluciones con potencial aplicabilidad, en un intento de gestionar los obstáculos y resolver los desafíos identificados

Humans , Male , Female , Health Services Administration , Global Health , Emergencies/nursing , Emergency Medical Services
Rev Rene (Online) ; 23: e71282, 2022.
Article in English, Portuguese | LILACS | ID: biblio-1357534


Objetivo: compreender a utilização do tempo dos gestores de enfermagem em unidades de Saúde Mental e Psiquiatria no desempenho das atividades diárias. Métodos: estudo transversal, constituído por 48 gestores de unidades psi-quiátricas públicas e do setor social. Coleta de dados por meio de questionário online que integrava a Escala de Per-cepção do Trabalho dos Gestores em Enfermagem, inclui 43 itens, distribuídos por cinco domínios funcionais dos enfer-meiros gestores. Respostas cotadas em escala tipo Likert: não ocupa tempo; ocupa pouco tempo; ocupa algum tempo; ocupa muito tempo. Resultados: as atividades inerentes às competências prática profissional ética e legal, e gestão de cuidados e de recursos humanos consumiam mais tempo ao gestor comparativamente com intervenção política e asses-soria e desenvolvimento profissional. Conclusão: os gesto-res reconhecem que gerir o tempo implica organização, pla-nejamento do trabalho e estabelecer prioridades nas tarefas a desempenhar. (AU)

Time , Health Services Administration , Mental Health , Nursing , Health Manager
PLoS One ; 16(12): e0260820, 2021.
Article in English | MEDLINE | ID: mdl-34941876


INTRODUCTION: The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services. METHODS: We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics. RESULTS: Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19-146 discounted deaths per 10,000 clients. DISCUSSION: While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

COVID-19/transmission , Health Services Accessibility/trends , Health Services/trends , COVID-19/complications , COVID-19/epidemiology , HIV Infections/complications , HIV Infections/epidemiology , HIV Infections/therapy , HIV-1/pathogenicity , Health Services Administration , Humans , Models, Theoretical , Pandemics/prevention & control , Risk Assessment/methods , SARS-CoV-2/pathogenicity
BMC Public Health ; 21(1): 2061, 2021 11 10.
Article in English | MEDLINE | ID: mdl-34758798


BACKGROUND: Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU). METHODS: The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016. RESULTS: Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs - Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI - 0.276 to 0.449, p = 0.621). No adverse events were reported. CONCLUSION: The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN11841493 , 25/10/2012.

Health Services Administration , Prisoners , Aged , Humans , Male , Middle Aged , Needs Assessment , Prisons , Social Support
São Paulo; SMS; out. 2021. graf; tab; fig.
Non-conventional in Portuguese | LILACS, Coleciona SUS, Sec. Munic. Saúde SP, Sec. Munic. Saúde SP | ID: biblio-1342035
Health Serv Res ; 56(5): 755-765, 2021 10.
Article in English | MEDLINE | ID: mdl-34498259


OBJECTIVE: To assess the prevalence of patient administrative tasks and whether they are associated with delayed and/or foregone care. DATA SOURCE: March 2019 Health Reform Monitoring Survey. STUDY DESIGN: We assess the prevalence of five common patient administrative tasks-scheduling, obtaining information, prior authorizations, resolving billing issues, and resolving premium problems-and associated administrative burden, defined as delayed and/or foregone care. Using multivariate logistic models, we examined the association of demographic characteristics with odds of doing tasks and experiencing burdens. Our outcome variables were five common types of administrative tasks as well as composite measures of any task, any delayed care, any foregone care, and any burden (combined delayed/foregone), respectively. DATA COLLECTION: We developed and administered survey questions to a nationally representative sample of insured, nonelderly adults (n = 4155). PRINCIPAL FINDINGS: The survey completion rate was 62%. Seventy-three percent of respondents reported performing at least one administrative task in the past year. About one in three task-doers, or 24.4% of respondents overall, reported delayed or foregone care due to an administrative task: Adjusted for demographics, disability status had the strongest association with administrative tasks (adjusted odds ratio [OR] 2.91, p < 0.001) and burden (adjusted OR 1.66, p < 0.001). Being a woman was associated with doing administrative tasks (adjusted OR 2.19, p < 0.001). Being a college graduate was associated with performing an administrative task (adjusted OR 2.79, p < 0.001), while higher income was associated with fewer subsequent burdens (adjusted OR 0.55, p < 0.01). CONCLUSIONS: Patients frequently do administrative tasks that can create burdens resulting in delayed/foregone care. The prevalence of delayed/foregone care due to administrative tasks is comparable to similar estimates of cost-related barriers to care. Demographic disparities in burden warrant further attention. Enhancing measurement of patient administrative work and associated burdens may identify opportunities for assessing quality, value, and patient experience.

Health Services Administration , Patients/psychology , Patients/statistics & numerical data , Adolescent , Adult , Appointments and Schedules , Consumer Health Informatics/economics , Consumer Health Informatics/statistics & numerical data , Cost Sharing/economics , Cost Sharing/statistics & numerical data , Female , Health Services Accessibility , Health Status , Humans , Information Seeking Behavior , Male , Middle Aged , Prior Authorization/economics , Prior Authorization/statistics & numerical data , Time Factors , Time-to-Treatment , Young Adult
Salud bienestar colect ; 5(2): 94-122, sept.-dic. 2021.
Article in Spanish | LILACS | ID: biblio-1367189


La literatura técnica suele presentar los Sistemas de Salud (SS) como conjuntos de recursos médicos destinados a atender enfermedades. Un análisis más amplio del tema permite caracterizar los SS como la expresión de sistemas políticos que surgen y cambian en contextos históricos diferentes, al impulso de las condiciones e intereses predominantes. Los sistemas políticos son los mismos sistemas sociales cuando los valoramos desde la perspectiva de las relaciones de poder que se establecen entre sus integrantes. Desde esta perspectiva los SS, sus agentes, discursos y dispositivos, se revelan como componentes de sistemas políticos que determinan, bajo las apariencias el tipo de gestión que se aplica a la comprensión y cuidado de la salud, y configuran "modelos de respuesta social". Este documento, describe los SS como sistemas políticos, con base en las características de la respuesta social preponderante. Se describen cinco tipologías que pueden coexistir tanto de forma sinérgica como contradictoria reflejando las condiciones e intereses predominantes en el grupo: sistemas populares, de beneficencia, de seguridad social, estatales, y privados. Al final se propone que el análisis de los aspectos formales y técnicos es por sí mismo insuficiente para explicar e intervenir la dinámica de los SS.

Technical literature usually presents Health Systems (HS) as sets of medical resources aimed at treating diseases. A broader analysis of the subject allows us to characterize HS as the expression of political systems, which arise and change in different historical contexts, driven by prevailing conditions and interests. Political systems are the same social systems when we value them from the perspective of the power relations established among their members. From this perspective, HS, their agents, discourses, and devices, are revealed as components of political systems that determine, under appearances, the type of management that people applied to understand and care for their health, and configure "models of social response." In this document, the analysis of HS is based on the characteristics of the prevailing social response. We describe five typologies that can coexist, both synergistically and contradictory, reflecting the prevailing conditions and interests in the group: popular, charity, social security, state, and private systems. In the end, it is proposed that the analysis of the formal and technical aspects is by itself insufficient to explain HS and intervene in their dynamics

Humans , Political Systems , Health Services Administration , Health Systems , Private Sector , Social Security , Public Health Systems