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Einstein (Sao Paulo) ; 18: eGS5129, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31939526


OBJECTIVE: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. METHODS: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. RESULTS: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. CONCLUSION: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.

Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Rol Judicial , Brasil , Ciudades , Costos de la Atención en Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Programas Nacionales de Salud/legislación & jurisprudencia , Estudios Retrospectivos , Factores Socioeconómicos
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576910


OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.

Broncodilatadores/economía , Medicamentos Esenciales/provisión & distribución , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Rol Judicial , Enfermedad Pulmonar Obstructiva Crónica/economía , Bromuro de Tiotropio/economía , Brasil , Medicamentos Esenciales/economía , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Programas Nacionales de Salud , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo
PLoS One ; 14(12): e0226133, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31856196


INTRODUCTION: Young people worldwide are often reticent to access family planning services from public health facilities: instead, they choose to get contraception from private, retail pharmacies. In Kenya, certain contraceptives are available in pharmacies: these include injectables, which can be dispensed but not administered, according national guidelines. However, Kenya struggles with enforcement of its pharmacy regulations and addressing illegal activity. Therefore, in this qualitative study, we assessed private pharmacies as an existing source of injectable contraception for young Kenyans (age 18-24), and investigated the perceived quality of service provision. METHODS: This study used: focus group discussions (6) with young community members; in-depth interviews (18) with youth who had purchased contraception from pharmacies; key informant interviews with pharmacy personnel and pharmacy stakeholders (25); and a mystery shopper (visiting 45 pharmacies). RESULTS: The study found that for injectable contraception, private pharmacies had expanded to service provision, and pharmacy personnel's roles had transcended formal or informal training previously received-young people could both purchase and be injected in many pharmacies. Pharmacies were perceived to lack consistent quality or strong regulation, resulting in young clients, pharmacy personnel, and regulators being concerned about illegal activity. Participants' suggestions to improve pharmacy service quality and regulation compliance focused on empowering consumers to demand quality service; strengthening regulatory mechanisms; expanding training opportunities to personnel in private pharmacies; and establishing a quality-based 'brand' for pharmacies. DISCUSSION: Kenya's recent commitments to universal health coverage and interest in revising pharmacy policy provide an opportunity to improve pharmacy quality. Multi-pronged initiatives with both public and private partners are needed to improve pharmacy practice, update and enforce regulations, and educate the public. Additionally, the advent of self-administrable injectables present a new possible role for pharmacies, and could offer young clients a clean, discreet place to self-inject, with pharmacy personnel serving as educators and dispensers.

Anticoncepción/estadística & datos numéricos , Regulación Gubernamental , Farmacéuticos/legislación & jurisprudencia , Adolescente , Anticoncepción/psicología , Servicios de Planificación Familiar/legislación & jurisprudencia , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Grupos Focales , Política de Salud , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Inyecciones , Kenia , Masculino , Calidad de la Atención de Salud , Adulto Joven
Rev. bioét. derecho ; (47): 93-107, nov. 2019.
Artículo en Español | IBECS | ID: ibc-184868


Este artículo tiene como propósito reflexionar sobre la situación de estigma y discriminación que afecta a personas con VIH/SIDA. Esto constituye una vulneración a los derechos fundamentales de estas personas y una barrera en el avance hacia la eliminación de la enfermedad. Ya que estudios realizados en diferentes países dan cuenta que las personas en esta condición se sienten discriminadas por la sociedad, y por los profesionales de la salud. Este es uno de los aspectos que ha dificultado el acceso al tratamiento, su adhesión, y educación para el cambio de conducta en los grupos de riesgo

Aquest article té com a propòsit reflexionar sobre la situació d'estigma i discriminació que afecta a persones amb VIH/SIDA. Això constitueix una vulneració dels drets fonamentals d'aquestes persones i una barrera en l'avanç cap a l'eliminació de la malaltia. Estudis realitzats en diferents països exposen que les persones en aquesta condició se senten discriminades per la societat i pels professionals de la salut. Aquest és un dels aspectes que ha dificultat l'accés al tractament, l'adhesió al mateix, i educació per al canvi de conducta en el grups de risc

This article aims to reflect on the situation of stigma and discrimination affecting people with HIV/AIDS. This constitutes a violation of the fundamental rights of these people and a barrier to progress towards the elimination of the disease. Studies carried out in different countries show that people in this condition feel discriminated against by society and by health professionals. This is one of the aspects that has hindered access to treatment, adherence, and behaviour change education in at-risk groups

Humanos , Ageísmo/ética , Sexismo , Discriminación Social , Estigma Social , Grupos de Riesgo , Relaciones Profesional-Paciente/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Personal de Salud/ética , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Seroprevalencia de VIH , Accesibilidad a los Servicios de Salud/ética , Derechos Humanos
Soins Psychiatr ; 40(324): 18-20, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31623801


"Care is increasingly absent from the pathway of unaccompanied minors". Legal experts of the French ombudsperson work with professionals supporting unaccompanied minors on different levels. They can also have a watchdog role with legislative authorities and judicial bodies. They note in particular increasing difficulty for these youngsters in accessing appropriate care. Interview with Nathalie Lequeux, legal expert and coordinator at the French children's rights centre.

Niño Abandonado , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Menores , Refugiados , Adolescente , Niño , Francia , Humanos
Perspect Biol Med ; 62(3): 489-502, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31495793


While mainstream, establishment medical journals have published opinion pieces condemning conscientious refusals in medical care, American law has consistently and repeatedly supported a right to such refusals. Law has not relied on a particular philosophical basis for health care. Indeed, legal precedents reject any monolithic model, whether based on consumerism or on professional obligations. Law focuses on the coexistence of diverse understandings, motivations, and delivery models. Scholarly approaches tend to ignore the fact that, fundamentally, conscientious objection involves a minority telling the majority that the objector(s) cannot ethically participate according to the majority's preferred model or set of rules. Religious liberty is protected in the US by applying strict scrutiny. Any governmental burden on religious liberty must further a compelling governmental interest and be implemented using the least restrictive means reasonably available. After years of scholarly controversy, strict scrutiny continues to be the law. The moral basis for the legal right of conscientious objection has been affirmed and expanded by Hobby Lobby in 2014, outlined in an Attorney General Memorandum in 2017, and codified in a Final Conscience Rule by the Department of Health and Human Services in May 2019.

Rechazo Conciente al Tratamiento/ética , Libertad , Relaciones Médico-Paciente/ética , Aborto Inducido , Rechazo Conciente al Tratamiento/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Obligaciones Morales , Estados Unidos
Educ Prim Care ; 30(5): 322-323, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31409205


Context: According to the World Health Organisation 'more people are on the move now than ever before with an estimated 1 billion migrants in the world today and 68 million forcibly displaced people'. GPs are on the frontline of healthcare in the UK and have a responsibility to provide free and equitable access for everyone. Aim: The main aim of our work was to assess GP trainees' current experience, knowledge and attitudes towards caring for refugees, asylum seekers and undocumented migrants. Description: 30 final year GP trainees on the Dorset Vocational Training Scheme (VTS) were asked to participate by completing a questionnaire. Outcomes: The results show that GP trainees lack knowledge regarding migrants health needs, rights to care, including whether there is a duty to disclose an illegal immigrant and what to do if a patient could not provide proof of identification. They lacked experience and confidence in caring for this group of patients, with the biggest perceived challenge being language barriers. Conclusions: Education in primary care needs to respond to meet the challenge of population movement (5), and this project highlighted a need to improve education on migrants' rights to care, local support groups, as well as common health problems. In response, we have reviewed our curriculum and introduced an education session on refugee health for all our GP trainees in Dorset.

Médicos Generales/educación , Conocimientos, Actitudes y Práctica en Salud , Refugiados , Migrantes , Adulto , Derechos Civiles , Inglaterra , Femenino , Médicos Generales/psicología , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Lenguaje , Masculino , Investigación Cualitativa , Encuestas y Cuestionarios
Pediatr Cardiol ; 40(8): 1599-1608, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31463514


Travel distance to surgical centers may be increased when coverage restrictions prevent children with congenital heart disease (CHD) from receiving care at out-of-state congenital heart surgery centers. We estimated the minimum travel distance to congenital heart surgery centers among publicly insured infants with time-sensitive CHD surgical needs, under two different scenarios: if they were and were not restricted to in-state centers. Using 2012 Medicaid Analytic eXtract data from 40 states, we identified 4598 infants with CHD that require surgery in the first year of life. We calculated the minimum travel distance between patients' homes and the nearest cardiac surgery center, assuming patients were and were not restricted to in-state centers. We used linear regression to identify demographic predictors of distance under both scenarios. When patients were not restricted to in-state centers, mean minimum travel distance was 43.7 miles, compared to 54.1 miles when they were restricted. For 5.9% of patients, the difference in travel distance under the two scenarios exceeded 50 miles. In six states, the difference in mean minimum travel distance exceeded 20 miles. Under both scenarios, distance was positively predicted by rural status, residence in middle-income zip codes, and white/non-Hispanic or American Indian/Alaskan Native race/ethnicity. For some publicly insured infants with severe CHD, facilitating the receipt of out-of-state care could mitigate access barriers. Existing efforts to regionalize care at fewer centers should be designed to avoid exacerbating access barriers among publicly insured CHD patients.

Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cardiopatías Congénitas/epidemiología , Niño , Preescolar , Bases de Datos Factuales , Femenino , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud , Humanos , Lactante , Recién Nacido , Masculino , Medicaid/estadística & datos numéricos , Viaje , Estados Unidos/epidemiología
Tex Med ; 115(8): 18-19, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31369142


TMA went into this session looking to attack insurer network inadequacy and health plans' use of care-impeding prior authorization demands. On both fronts, medicine scored solid legislative wins that will make it easier for patients and physicians to know who's in network, and provide needed transparency on preauthorization requirements. And on surprise billing, medicine turned what could've been a disastrous bill into something more palatable.

Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Seguro de Salud/legislación & jurisprudencia , Humanos , Autorización Previa/legislación & jurisprudencia , Texas