Demandas urgentes en atención primaria. Comparativa antes y durante la pandemia / Urgent demands in primary care. Comparative before and during the pandemic

Objetivos: Conocer el porcentaje de situaciones verdaderamente urgentes que acuden al centro de salud basándose en el Triángulo de Evaluación Pediátrica. Como objetivo secundario también se ha analizado la presión asistencial comparando ambos periodos del estudio. Material y métodos: revisión de los triajes en 2 periodos de tiempo diferenciados, su clasifica-ción y motivos de consulta, así como edad, sexo del niño/a. Resultados: En el primer periodo estudiado de enero-febrero de 2020 las consultas urgentes supusieron un 31,5% del total, siendo el 95,91% de las mismas clasificadas como “no urgentes”. En el segundo periodo de enero-febrero de 2021, las citas urgentes fueron un 5,2% del total, contando con un porcentaje de “no urgentes” del 78,9%. La disminución de la demanda urgente entre ambos tramos ha sido del 26,3%. A destacar que durante el periodo pandémico disminuyó también la consulta programada. Conclusiones: El triaje por parte de enfermería se muestra útil para valorar la llegada de pacien-tes de manera urgente. Así mismo, la mayoría de demandas referidas como urgentes desde el punto de vista de los padres/madres/tutores, no lo son desde el punto de vista clínico. (AU)

Objectives: To know the percentage of truly urgent situations that come to the primary care center based on the Pediatric Evaluation Triangle. As a secondary objective, healthcare pressure was also analyzed by comparing both periods of the study. Material and methods: review of triages in 2 different periods of time, their classification and reasons for de-mand, as well as age and sex of the children. Results: In the first period studied f rom January-Febru-ary 2020, urgent consultations accounted for 31.5% of the total, with 95.91% of them classified as “non-urgent”. In the second period of January-February 2021, urgent ap-pointments were 5.2% of the total, with a percentage of “non-urgent” of 78.9%. The decrease in urgent demand between both sections has been 26.3%. It should be noted that during the pandemic period the scheduled consultation also decreased. Conclusions: Triage by nursing staff is useful to assess the arrival of patients urgently. Likewise, the majority of demands referred to as urgent f rom the point of view of the parents / guardians are not so f rom the clinical view. (AU)

Codificar para gestionar / Coding for Management

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Nursing interventions in adult psychiatric outpatient care. Making nursing visible using the Nursing Interventions Classification.

AIM: To describe and to clarify the work of nurses in psychiatric outpatient care using a standardized nursing terminology and to describe the potential benefits and challenges in the use of the terminology. DESIGN: A qualitative study of ethnographically grounded fieldwork in four adult outpatient units located in three major cities in Finland. METHODS: A two-phase ethnographically oriented study, consisting of observations and focus group interviews in four psychiatric outpatient care units (in January-March 2018). During this process, the identified nursing interventions were mapped into the Nursing Interventions Classification. RESULTS: We identified 93 different nursing interventions, covering all seven domains. Categories describing potential benefits and challenges were as follows: giving words to nurses' work and the challenge of overlapping interventions. CONCLUSION: Our findings indicate that the Nursing Interventions Classification is a suitable means to describe nursing in the psychiatric outpatient care setting. Our findings support the theory that describing nurses' work using a nursing terminology can make nursing visible and further empower nurses and help them to structure their work. The lack of other professionals, especially physicians, has led to nurses taking over new tasks officially and unofficially and we suggest that the issue needs to be studied further. IMPACT: Nurses' role in the psychiatric outpatient care has been described as invisible and difficult to describe. Our findings suggest that a nursing terminology can make nursing visible, not only from the perspective of patient health records but is also a way to conceptualize nurses' work.

Antibiotic Prescribing Patterns for Sinusitis Within a Direct-to-Consumer Virtual Urgent Care.

Background:Direct-to-consumer virtual visits are increasingly popular across both for-profit and nonprofit healthcare systems.Introduction:Virtual visits offer a convenient affordable way for patients to obtain medical care for simple conditions such as sinusitis and uncomplicated urinary tract infections. However, virtual visits have been associated with increased antibiotic utilization when compared with traditional in-person care.Methods:In this retrospective cohort study, antibiotic utilization for acute sinusitis was compared between patients treated through a direct-to-consumer virtual urgent care versus a matched cohort treated through traditional urgent care.Results:Fifty-seven patients were treated for acute sinusitis within the virtual care cohort, whereas 100 patients were treated in the traditional care arm. Antibiotic utilization for acute sinusitis was lower when care was delivered virtually using live-interactive video (67%) than when using traditional urgent care (92%) (p < 0.001). When care was delivered virtually, age, gender, and care delivery modality (telephone vs. video) were not associated with antibiotic utilization for acute sinusitis.Discussion:Concerns have been raised that care delivered virtually does not meet expected quality standards when compared with traditional care. Antibiotic utilization has been used as an example of this quality gap. In this study, we demonstrate that antibiotic utilization was lower in a virtual care cohort than when care was delivered by emergency medicine physicians based in an academic setting. This suggests that awareness and sensitivity to prescribing guidelines may be more important than care delivery modality as it relates to antibiotic utilization.Conclusions:It is possible to deliver care virtually for acute sinusitis without increasing antibiotic utilization.

Dimensioning of nursing staff in outpatient chemotherapy: application of the Workload Indicators of Staffing Need / Dimensionamiento de profesionales enfermeros en quimioterapia ambulatoria: aplicación del método Workload Indicators of Staffing Need / Dimensionamento de profissionais de enfermagem em quimioterapia ambulatorial: aplicação do método Workload Indicators of Staffing Need

ABSTRACT Objective: To apply the method developed by the World Health Organization, called Workload Indicators of Staffing Need for dimensioning the nursing staff for the care of cancer patients in a Chemotherapy outpatient clinic. Method: This is a quantitative, observational, documentary field study with an intentional sample. Prospective data were collected through the work sampling method. Results: Seventeen nurses and 12 nursing technicians participated in the study. A total of 3,727 observations were performed and were obtained the mean times and the relative working time of 23 nurses' interventions and 18 nursing technicians' interventions. The interventions corresponded to 88.5% of the relative working time of nurses and 83.9% of nursing technicians. Personal activities accounted for 8.2% of the relative working time of nurses and 7.9% of nursing technicians. The reliability test resulted in 86.3% concordance. Conclusion: The similarity between the staff required according to the method studied and the current staff showed that the Workload Indicators of Staffing Need has great potential and applicability for dimensioning nursing professionals safely.

RESUMEN Objetivo: Aplicar el método elaborado por la Organización Mundial de la Salud, denominado Workload Indicators of Staffing Need, a fin de dimensionar al equipo de enfermería para el cuidado a pacientes oncológicos en Ambulatorio de Quimioterapia. Método: Se trata de una investigación de campo observacional y documental, con abordaje cuantitativo y muestra intencional. Los datos prospectivos fueron recogidos mediante la técnica de muestreo del trabajo. Resultados: Participaron en la investigación 17 enfermeros y 12 técnicos de enfermería. Fueron realizadas 3.727 observaciones, obteniéndose tiempos medios y ocupación relativa de 23 intervenciones de enfermeros y 18 intervenciones de técnicos de enfermería. Las intervenciones correspondieron al 88,5% de la ocupación relativa de los enfermeros y el 83,9% de los técnicos de enfermería. La actividad personal fue responsable del 8,2% de la ocupación relativa de los enfermeros y el 7,9% de los técnicos de enfermería. La prueba de confiabilidad resultó en el 86,3% de concordancia. Conclusión: La semejanza entre el cuadro proyectado por el método estudiado y el existente evidenció que el Workload Indicators of Staffing Need tiene gran potencial y aplicabilidad para dimensionar a los profesionales enfermeros con seguridad.

RESUMO Objetivo: Aplicar o método elaborado pela Organização Mundial da Saúde, denominado Workload Indicators of Staffing Need, para dimensionar a equipe de enfermagem para o cuidado de pacientes oncológicos em Ambulatório de Quimioterapia. Método: Trata-se de uma pesquisa de campo observacional e documental, com abordagem quantitativa e amostra intencional. Os dados prospectivos foram coletados por meio da técnica amostragem do trabalho. Resultados: Participaram da pesquisa 17 enfermeiros e 12 técnicos de enfermagem. Foram realizadas 3.727 observações, sendo obtidos tempos médios e ocupação relativa de 23 intervenções de enfermeiros e 18 intervenções de técnicos de enfermagem. As intervenções corresponderam a 88,5% da ocupação relativa dos enfermeiros e 83,9% dos técnicos de enfermagem. A atividade pessoal foi responsável por 8,2% da ocupação relativa dos enfermeiros e 7,9% dos técnicos de enfermagem. O teste de confiabilidade resultou em 86,3% de concordância. Conclusão: A semelhança entre o quadro projetado pelo método estudado e o existente evidenciou que o Workload Indicators of Staffing Need tem grande potencial e aplicabilidade para dimensionar os profissionais de enfermagem com segurança.

Accuracy and Completeness of Clinical Coding Using ICD-10 for Ambulatory Visits.

This study describes a simulation of diagnostic coding using an EHR. Twenty-three ambulatory clinicians were asked to enter appropriate codes for six standardized scenarios with two different EHRs. Their interactions with the query interface were analyzed for patterns and variations in search strategies and the resulting sets of entered codes for accuracy and completeness. Just over a half of entered codes were appropriate for a given scenario and about a quarter were omitted. Crohn's disease and diabetes scenarios had the highest rate of inappropriate coding and code variation. The omission rate was higher for secondary than for primary visit diagnoses. Codes for immunization, dialysis dependence and nicotine dependence were the most often omitted. We also found a high rate of variation in the search terms used to query the EHR for the same diagnoses. Changes to the training of clinicians and improved design of EHR query modules may lower the rate of inappropriate and omitted codes.

Síndrome de apnea/hipopnea obstructiva ligado al sueño REM: ¿un diagnóstico olvidado? Posible vía de infradiagnóstico del síndrome de apnea/hipopnea obstructiva del sueño / ‘REM-related OSA’: a forgotten diagnostic? Possible path to under-diagnosing sleep apnea

Introducción. Recientemente se han propugnado criterios restrictivos para definir el síndrome de apnea/hipopnea obstructiva ligado al sueño REM y persisten interrogantes sobre su trascendencia nosológica y manejo clínico. Objetivo. Evaluar los criterios definitorios de la apnea del sueño REM, su relación con la comorbilidad cardiometabólica y los aspectos relacionados con su diagnóstico. Pacientes y métodos. Estudio observacional retrospectivo sobre datos clínicos y polisomnográficos de pacientes ambulatorios. Se incluyó a 525 pacientes mayores de 18 años que tenían un índice apnea/hipopnea (IAH) por hora de sueño ≥ 5 (total, o parcial en REM o no REM). Resultados. Se han configurado subgrupos ‘dependientes de la fase’ utilizando un criterio basado en la ‘proporción ≥ 2’ y otro ‘estricto’ basado en uno de los IAH parciales ≥ 5 frente al otro IAH < 5 (en REM o en no REM). En el subgrupo ‘apnea del sueño REM estricto’, la mitad de los pacientes muestra un IAH global < 5 y menos gravedad en los parámetros respiratorios, pero sin menores porcentajes de comorbilidad. Con los criterios diagnósticos actuales quedarían excluidos del diagnóstico de síndrome de apnea/hipopnea obstructiva del sueño (SAHOS). Conclusiones. Aplicar un criterio estricto para detectar apnea del sueño REM permite filtrar formas muy leves de SAHOS asociadas a comorbilidad cardiometabólica en porcentajes no diferentes significativamente de otras formas más graves. Para evitar el infradiagnóstico del SAHOS sería oportuno revisar los criterios diagnósticos actuales y las indicaciones de las técnicas reducidas (AU)

Introduction. Restrictive criteria are proposed to define the disorder ‘REM-related OSA’ disorder, and questions remain about its nosological transcendence and clinical management. Aim. To evaluate the criteria proposed to define ‘REM-related OSA’, its relationship with cardio-metabolic comorbidity, and aspects related to it diagnostic. Patients and methods. Retrospective observational study of clinical and polysomnographic data from outpatients. 525 patients over 18 years old who had an Apnea Hypopnea Index (AHI) ≥ 5 (total, or partial, in REM and/or NREM) were included. Results. ‘Phase-dependent’ subgroups were formed using a criterion based on the ‘ratio ≥ 2’ and another ‘strict’ criterion based on a partial AHI ≥ 5 compared to another partial AHI <5 (in REM or in NREM). In the ‘strict REM-related OSA’ subgroup, half of the patients showed an overall AHI < 5, with less severity in the respiratory parameters, but with lower comorbidity percentages. With the current diagnostic criteria, these patients would be excluded from the sleep apnea diagnosis. Conclusions. The application of the strict criterion to detect ‘REM-related OSA’ makes it possible to filter milder forms of sleep apnea associated with percentages of cardiovascular and/or metabolic comorbidity that are not significantly different from other more severe forms of sleep apnea. To avoid under-diagnosis, it would be advisable to review the sleep apnea diagnostic criteria and the indications of the reduced sleep apnea diagnostic techniques (AU)

Rotura de un aneurisma gigante de arteria hepática / Ruptured giant hepatic artery aneurysm

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La Unidad de Neonatología del Hospital Universitario Miguel Servet en la actualidad. Nuevos retos / Neonatology Unit of the Hospital Universitario Miguel Servet at present: new challenges

La presente revisión resume las características de la actual Unidad de Neonatología del Hospital Universitario Miguel Servet en Zaragoza. La Unidad de Neonatología es una unidad de nivel IIIB de acuerdo con la clasificación del Comité de Estandares y la Junta Directiva de la Sociedad Espñola de Neonatología de 2013, siendo la unidad neonatal de referencia de la Cornunidad Autónoma de Aragón. En una primera aproximación, se describen la misión, visión y valores, seguido de una resña estructural y de la cartera de servicios de la Unidad de Neonatología. La actividad asistencia de la Unidad de Neonatología se presenta teniendo en cuenta tanto la hospitalización neonatal como el seguimiento ambulatorio en el área de consultas externas. La actividad docente e investigadora son otros aspectos importantes a considerar en la actual Unidad de Neonatología. Finalmente se revisan los retos de la Unidad de Neonatología para los proximos afios (AU)

This review summarizes the characteristics of the current Neonatology Unit of the Universitary Hospital Miguel Servet in Zaragoza. The Neonatology Unit is a type IIIB unit according to the classification of the Standards Committee and the Board of the Spanish Society of Neonatology in 2013, being the reference neonatal unit for the Autonomous Community of Aragon. In a first approximation, the mission, vision and values are described, followed by a structural review and all the services that de Neonatology Unit provides. The health care activity of the Neonatology Unit is presented taking care of neonatal hospitalization and its subsequent follow-up out patient clinic. The teaching and investigation activity is another important aspect to consider in the current Neonatology Unit. Finally, the challenges of the Neonatology Unit for the next years are been reviewed (AU)

Comparison of a predictive algorithm with receptionist triage for priority public dental care.

OBJECTIVE: To determine the clinical validity and accuracy of an empirically derived triage model when compared with traditional priority assessment by receptionists. BACKGROUND: The use of predictive models to support evidence-based delivery of health care is increasing. Predictive models assist in predicting priority of need or treatment planning for patients and facilitate transparent and consistent decision-making. A predictive model for determining priority of need for dental care was evaluated against a reference standard dentist assessment and traditional receptionist assessment. METHODS: We sampled 310 patients seeking dental care. Participants were selected from people requesting care at two community dental clinics and who agreed to answer eight questions. Receptionists recorded their judgements of participant priority into three categories: care needed <48 h, 2-7 days or 8+ days. The 'reference standard' priority was determined by dental officers using the same categories. Model coefficients generated a predicted probability of requiring care. Sensitivity (Se), specificity (Sp), and predictive (PPV and NPV) and area under the curve (AUC) values were computed for two thresholds, <48 h versus 2+ days and <2-7 days versus 8+ days. RESULTS: At <48-h threshold, the model PPV was higher and NPV lower than receptionists in predicting patients not needing care. At the 2- to 7-day threshold, the model also performed better than receptionists in predicting those needing care for 2-7 days. AUC statistics show the model performed better than the traditional receptionist method. CONCLUSIONS: The predictive model outperformed traditional receptionist screening in predicting priority of care.

A description of injuries in men and women while serving in Afghanistan.

Musculoskeletal injuries (MSIs) are the most common cause of ambulatory visits in the deployed setting. Research done on deployed populations have focused mostly on men. The purpose of this retrospective cohort study was to describe physical demands and MSIs among male and female soldiers in a Brigade Combat Team during a 12-month deployment to Afghanistan. Data on occupational tasks and injuries were collected from the infantry and brigade support battalions. Out of 57 women, 22 had MSIs (39%) and for the 536 men, 120 (22%) had MSIs resulting in limited duty. The average limited duty was 7.5 and 13 days/injury for women and men, respectively. The most commonly injured body region for the men was the low back (32%) and the low back (22%) and foot and ankle (22%) for women. The activity associated with MSI for women was physical training (25%) and for men it was contact with the enemy (23%). Physically demanding duties, more distance walked, and heavier average load and objects lifted all increased the risk of injury in women. Only lifting heavier weights increased the risk in men. The women appear to have less tolerance to physically demanding work such than their male counterparts.

[Ambulatory care-sensitive conditions: an international overview with conclusions for a German catalogue]. / Ambulant-sensitive Krankenhausfälle: Eine inter-nationale Übersicht mit Schlussfolgerungen für einen deutschen Katalog.

OBJECTIVE: Ambulatory care-sensitive conditions (ACSC) foster to quality measurement in the ambulatory sector. The objective of this review is to provide an overview of existing catalogues of ACSC and to derive insights that support the plan-ned development of an ACSC catalogue for Germany. METHODS: This article attempts to systemise the discussion on ACSC by delimiting the term from the related concepts of avoidable hospitalisations and avoidable diseases. Based on that, this article develops a definition of ACSC that is valid for the German context, makes a suggestion for the compilation of adequate diagnoses, and proposes how to apply an ACSC catalogue that is specific to Germany. An overview of nine central -articles describing the elaboration of ACSC catalogues in other countries and a first view of the diagnoses they comprise serve as a guidance. RESULTS AND CONCLUSION: The composition of an ACSC catalogue, that is adapted to the German context, is required to account for the local specifics of the German health-care system in order to ensure validity of the quality indicator. Such an outcome indicator for the ambulatory sector may mean a step towards a more outcome-oriented provision of care and may help ensure the quality of the German health-care system.

[Customer orientation in ambulant medicine]. / Kundenorientierung in der ambulanten Medizin.

BACKGROUND: Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. METHOD: Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. RESULTS: The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. DISCUSSION: The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. CONCLUSION: Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of customer orientation, especially the changing relevance of ethical responsibility. An enlargement or comparison with other control samples (n>20, other medical subfields, structurally weak areas) could be illuminating. The results of this qualitative study can be used to develop quantitative inquiries.

[Access to medium and high-complexity procedures in the Brazilian Unified National Health System: a matter of judicialization]. / Acesso aos procedimentos de média e alta complexidade no Sistema Único de Saúde: uma questão de judicialização.

Lawsuits in healthcare have increased exponentially in Brazil. However, the judicialization of healthcare procedures has not been sufficiently discussed, although such a discussion could broaden the scope of healthcare assessment. This study aimed to analyze the use of court action to ensure access to outpatient and hospital procedures from 1999 to 2009 in the State of Minas Gerais, Brazil. This was a retrospective descriptive study. Procedures were classified according to the Brazilian Unified National Health System (SUS) and the Table on Unified Terminology for Private Healthcare. Coverage by the SUS was 93.5%. The largest proportions of beneficiaries of such lawsuits lived in the Central and Western regions of the country (26.4% and 24%, respectively). The most common procedures involved in such cases were clinical admissions, admission to intensive care, and cardiovascular surgery. The study highlights the emerging need for access to medium and high-complexity procedures through extensive rules for coverage.

Patients' involvement in e-health services quality assessment: a system for the automatic interpretation of SMS-based patients' feedback.

PURPOSE: Effective communication between patients and health services providers is a key aspect for optimizing and maintaining these services. This work describes a system for the automatic evaluation of users' perception of the quality of SmsCup, a reminder system for outpatient visits based on short message service (SMS). The final purpose is the creation of a closed-loop control system for the outpatient service, where patients' complaints and comments represent a feedback that can be used for a better implementation of the service itself. METHODS: SmsCup was adopted since about eight years by an Italian healthcare organization, with very good results in reducing the no-show (missing visits) phenomenon. During these years, a number of citizens, even if not required, sent a message back, with comments about the service. The automatic interpretation of the content of those SMS may be useful for monitoring and improving service performances.Yet, due to the complex nature of SMS language, their interpretation represents an ongoing challenge. The proposed system uses conditional random fields as the information extraction method for classifying messages into several semantic categories. The categories refer to appreciation of the service or complaints of various types. Then, the system analyzes the extracted content and provides feedback to the service providers, making them learning and acting on this basis. RESULTS: At each step, the content of the messages reveals the actual state of the service as well as the efficacy of corrective actions previously undertaken. Our evaluations showed that: (i) the SMS classification system has achieved good overall performance with an average F1-measure and an overall accuracy of about 92%; (ii) the notification of the patients' feedbacks to service providers showed a positive impact on service functioning. CONCLUSIONS: Our study proposed an interactive patient-centered system for continuous monitoring of the service quality. It has demonstrated the feasibility of a tool for the analysis and notification of the patients' feedback on their service experiences, which would support a more regular access to the service.

[Analysis of ambulatory coding quality in Saxony and Thuringia using AOK PLUS billing data - utilisation of the qualifying character "Z" in the documentation of diagnoses]. / Analyse der ambulanten Kodierqualität in Sachsen und Thüringen anhand von Leistungsdaten der AOK PLUS - die Verwendung des Zusatzkennzeichens "Z" in der Diagnosedokumentation.

As a part of the health care reform 2007 the German risk structure compensation scheme was extended so as to connect the financial cash flow towards the payers to morbidity information from ambulatory care. Within this context, morbidity information consists of prescriptions as well as coded ambulatory diagnoses. Accordingly, a high quality of coding is essential for a morbidity compatible allocation of funds. The aim of this study was to evaluate coding quality via qualifying characters as well as to identify future challenges. It focuses on diagnoses which are qualified as "assured" or "post-treatment" from about 350 million diagnoses of about 11 k practitioners' treatment of 2.7 million AOK PLUS insurants in Saxony and Thuringia during the years 2007-2010. The practitioners' documented diagnoses were aggregated within several groups according to the code of specialisation which is attached to the practitioner's 9-digit lifelong identification number (LANR). As a result, the number of "assured" diagnoses generally rose from year to year. Furthermore, diagnoses marked as "assumption" or "exclusion" remain constant over time. We identified a lack of diagnosis coding precision regarding the condition after certain medical events. In particular, general practitioners tend to use diagnosis codes qualified as "post-treatment" instead of using correct "assured" diagnoses qualified for conditions after certain events. Consequently, we expect adverse effects evaluating the cost of diseases as only "assured" diagnoses are considered within the risk transfer compensation scheme.

Acesso aos procedimentos de media e alta complexidade no Sistema Unico de Saude: uma questao de judicializacao / Access to medium and high-complexity procedures in the Brazilian Unified National Health System: a matter of judicialization / El acceso a los procedimientos de media y alta complejidad en el Sistema Unico de Salud de Brasil: una cuestion de legalizacion

Os processos judiciais na área da saúde têm crescido de forma exponencial. A judicialização de procedimentos, no entanto, ainda não foi discutida e pode ampliar o escopo de avaliação da atenção à saúde. O objetivo deste estudo é investigar as ações judiciais para acesso a procedimentos ambulatoriais e hospitalares do Estado de Minas Gerais, Brasil, no período de 1999 a 2009. É um estudo descritivo retrospectivo. Os procedimentos foram classificados pela Tabela Unificada do SUS e pela Tabela de Terminologia Unificada da Saúde Suplementar. Observou-se cobertura pelo SUS de 93,6%. A residência dos beneficiários localiza-se, principalmente, nas macrorregiões Centro (26,4%) e Oeste (24%). Os procedimentos mais solicitados foram internações em leitos comuns, Centro de Terapia Intensiva e cirurgias do aparelho circulatório. Este estudo aponta para as necessidades emergentes de acesso aos procedimentos de média e alta complexidade, mediante uma extensa cobertura normativa.

Lawsuits in healthcare have increased exponentially in Brazil. However, the judicialization of healthcare procedures has not been sufficiently discussed, although such a discussion could broaden the scope of healthcare assessment. This study aimed to analyze the use of court action to ensure access to outpatient and hospital procedures from 1999 to 2009 in the State of Minas Gerais, Brazil. This was a retrospective descriptive study. Procedures were classified according to the Brazilian Unified National Health System (SUS) and the Table on Unified Terminology for Private Healthcare. Coverage by the SUS was 93.5%. The largest proportions of beneficiaries of such lawsuits lived in the Central and Western regions of the country (26.4% and 24%, respectively). The most common procedures involved in such cases were clinical admissions, admission to intensive care, and cardiovascular surgery. The study highlights the emerging need for access to medium and high-complexity procedures through extensive rules for coverage.

Las demandas en materia de salud han crecido de manera exponencial. La judicialización de los procedimientos, sin embargo, aún no se ha discutido y podría ampliar el alcance de la evaluación de la atención sanitaria. El objetivo de este estudio es investigar los procedimientos judiciales para el acceso a la atención ambulatoria y hospitalaria del Estado de Minas Gerais, Brasil, durante el período 1999-2009. Se trata de un estudio descriptivo retrospectivo. Los procedimientos fueron clasificados por la Tabla SUS Unificada y la Mesa de Terminología Unificada de Seguros de Salud. Se observó una cobertura de un 93,6% en el SUS. La estancia de los beneficiarios estaba ubicada principalmente en el macro-centro (26,4%) y zona occidental (24%). Los procedimientos más solicitados son las admisiones para las camas de hospital, en la unidad de cuidados intensivos y cirugía del aparato circulatorio. Este estudio apunta a las nuevas necesidades de acceso, a los procedimientos de media y alta complejidad, a través de amplias normas de cobertura.