Women's preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project.

BACKGROUND: In 2015, a quality improvement project called "Adequate Childbirth Project" (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women's preference for vaginal birth (VB) at the end of pregnancy. METHODS: Evaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women's preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women's preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram. RESULTS: Four thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99-3.24) and multiparous women (OR 1.44 95% CI 0.97-2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22-24.50) and in multiparous women (OR 53.11 95% CI 37.31-75.60). CONCLUSIONS: The PPA had a positive effect on women's preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.

Cesarean rates have been increasing worldwide and constitute the most frequent type of childbirth in Brazil since 2009. In 2015, a quality improvement project was implemented in Brazilian private hospitals, with the objective of reducing medically unnecessary cesarean sections and increasing the number of vaginal births. This project, called "Adequate Childbirth Project" (PPA), has four components, one of which is directed at women and families, aiming to increase their participation in decision-making processes related to childbirth. In this study, we assessed whether this program contributed to increased preference for vaginal birth at the end of pregnancy. In previous studies in Brazil, we saw that women who maintained preference for vaginal birth throughout pregnancy were those who had the lowest proportion of cesarean sections. We found that the PPA increased preference for vaginal birth by almost three times in primiparous women. Among women with previous births, this increase was smaller. In this group of women, having a previous cesarean section was an important factor for not wanting a vaginal birth, and this is a very common condition in Brazil. For all women, having preference for vaginal birth at the beginning of pregnancy was the main factor in wanting this type of birth at the end of pregnancy. The results demonstrate the importance of educational activities that disseminate information about the benefits of vaginal birth, increasing the preference of women for this type of childbirth, in addition to supporting them throughout pregnancy, so that they feel empowered in their choice.

Mortalidade por Covid-19 em hospitais públicos e privados de Florianópolis/SC / Covid-19 mortality in public and private hospitals of Florianópolis/SC

Introdução: O acesso ao tratamento hospitalar adequado é importante para amenizar o impacto causado pelas questões socioeconômicas, auxiliando no combate às iniquidades em saúde. Objetivo: Analisar a diferença da atenção hospitalar pública e privada na mortalidade por Covid-19 em Florianópolis/SC. Métodos: Coorte histórica com dados de pacientes confirmados para Covid-19 entre 22 de fevereiro de 2020 e 09 de novembro de 2020. Utilizou-se abordagem de dupla-robustez. Na primeira etapa, parearam-se indivíduos notificados em hospitais públicos e privados por algoritmo genético. A seguir, estimou-se a probabilidade de óbito em hospitais públicos e privados, por meio de regressão logística. Analisou-se, então, a diferença entre as densidades de probabilidade de óbito dos dois tipos hospitalares. Resultados: Analisaram-se 2.497 pessoas, 1.244 de hospitais públicos e 1.253 de privados. A diferença entre a probabilidade condicional de óbito assumindo que todos os pacientes fossem notificados em hospitais públicos ou que todos fossem notificados em hospitais privados foi de -0,0002 (IC 95% -0,0013; 0,0005). Conclusão: A probabilidade de óbito por Covid-19 mostrou-se semelhante entre pacientes de hospitais públicos e privados.

Introduction: Access to adequate hospital treatment is important to alleviate the impact of socioeconomic issues, helping in the fight against health inequities. Objective: To analyze differences between public and private hospital care regarding COVID-19 mortality in Florianópolis/SC. Methods: This is a historical cohort study with data from patients who had a COVID-19 diagnosis confirmed between February 22, 2020 and November 9, 2020. We used a doubly robust approach. In the first stage, we paired individuals reported by public and private hospitals through a genetics algorithm. Subsequently, we estimated the probability of death in public and private hospitals using a logistic regression. We then analyzed the difference between probability densities of death in both hospital types. Results: This study analyzed 2,497 people, 1,244 public hospitals, and 1,253 private institutions. The difference between conditional probabilities of death assuming that all patients were reported by public hospitals or that all of them were reported by private hospitals was -0.0002 (95%CI -0.0013; 0.0005). Conclusion: The probability of death due to COVID-19 was shown to be similar between patients of public or private hospitals.

Effects of enhanced recovery after surgery practices on postoperative recovery and length of stay after unilateral primary total hip or knee arthroplasty in a private hospital.

INTRODUCTION: Enhanced recovery after surgery (ERAS) practices improve postoperative recovery and reduce postoperative length of stay (LOS) in patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our study investigated whether these promising results could be reproduced in a private hospital setting. METHODS: In total, 228 patients were included in the study cohort: the conventional group comprised 117 patients from 2012 to 2014, while the ERAS group comprised 111 patients from 2017 to 2018. All patients had undergone unilateral primary THA or TKA at a private hospital in Hong Kong. The outcome was postoperative LOS; factors affecting LOS were also investigated. RESULTS: No significant differences were found in any baseline parameters between the two groups of patients. The mean LOS was significantly shorter in the ERAS group than in the conventional group (3.28 ± 1.04 vs 5.16 ± 2.06 days, P<0.001). Moreover, a significantly greater proportion of patients could be discharged on or before postoperative day 3 in the ERAS group, compared with the conventional group (77.5% vs 13.7%, P<0.001). A significant difference in LOS was observed between general ward and private ward patients (3.06 ± 0.59 vs 3.66 ± 1.46 days, P=0.003). Sex, age, and nature of surgery (TKA vs THA) did not have significant effects on LOS. CONCLUSIONS: The ERAS practices yielded a significant improvement in postoperative LOS, compared to conventional practices, among patients who underwent unilateral primary THA or TKA in a private hospital.

Review and analysis of policies for private hospitals during the 13th Five-Year Plan period in China / 中华医院管理杂志

During the 13th Five-Year Plan period, China issued a series of policies for private hospitals, which made an important impact on the running of medical institutions by social forces. One hundred and sixty-one policy documents for private hospitals were sorted out from January 2016 to January 2020, national policies and measures in terms of access approval, comprehensive supervision, fiscal and taxation support, supporting policies, talent development, open innovation, and resource sharing were being reviewed. It found that the characteristics of China′s policies were consistent in content, comprehensive in coverage, and supported the development of traditional Chinese and Western medicine.From 2016 to 2020, the total number of private medical institutions in China maintained growth, however, there were some practical problems, such as insufficient professional and technical capacity, low coordination development with public healthcare, and incomplete supervision and evaluation system. Therefore, during the 14th Five-Year Plan period, we should realize the transformation from private hospital management to modern governance, integrate private hospital development policies, optimize the system of approval and access, standardize the supervision and evaluation system, enhance the sharing of development resources, strengthen the construction of professionals, adhere to the concept of fairness, openness, and innovation, so as to promote the sustainable development of private hospitals.

Anticoagulation Therapy in Patients with Non-valvular Atrial Fibrillation in a Private Setting in Brazil: A Real-World Study / Terapia de Anticoagulação em Pacientes com Fibrilação Atrial não Valvar em Ambiente de Cuidado de Saúde Privado no Brasil: Um Estudo de Mundo Real

Abstract Background: The safety and effectiveness of warfarin depend on anticoagulation control quality. Observational studies associate poor control with increased morbidity, mortality and healthcare costs. Objectives: To develop a profile of non-valvular atrial fibrillation (NVAF) patients treated with warfarin in a Brazilian private ambulatory and hospital setting, evaluate the quality of anticoagulation control, and its association with clinical and economic outcomes. Methods: This retrospective study, through a private health insurance dataset in Brazil, identified NVAF patients treated with warfarin between 01 MAY 2014 to 30 APRIL 2016, described their anticoagulation management, and quantified disease-related costs. Data on demographics, clinical history, concomitant medication and time in therapeutic range (TTR) of international normalized ratio (INR) values were retrieved. Patients were grouped into TTR quartiles, with good control defined as TTR ≥ 65% (Rosendaal method). Major bleeds and all-cause direct medical costs were calculated and compared between good and poor control subgroups. P-values < 0.05 were considered statistically significant. Results: The analysis included 1220 patients (median follow-up: 1.5 years; IQR: 0.5-2.0). On average, each patient received 0.95 monthly INR measurements (mean INR: 2.60 ± 0.88, with 26.1% of values < 2 and 24.8% > 3), (median TTR: 58%; IQR: 47-68%), (mean TTR: 56.6% ± 18.9%). Only 31% of patients were well-controlled (mean TTR: 78% ± 10%), with 1.6% having major bleeds within median follow-up, and direct medical costs per member per year (PMPY) of R$25,352(± R$ 37,762). Poorly controlled patients (69%) were associated with 3.3 times more major bleeds (5.3% vs. 1.6%; p < 0.01) and 40% higher costs (R$35,384 vs. R$25,352; p < 0.01). Conclusions: More than 60% of the patients were below the desired target and the associated costs were higher.

Resumo Fundamento: A segurança e a eficácia da varfarina dependem da qualidade do controle da anticoagulação. Estudos observacionais associam controle deficiente com aumento de morbidade, mortalidade e custos com saúde. Objetivos: Desenvolver um perfil de pacientes com fibrilação atrial não valvar (FANV) tratados com varfarina em ambiente ambulatorial e hospitalar privado brasileiro, avaliar a qualidade do controle da anticoagulação e sua associação com resultados clínicos e econômicos. Métodos: Este estudo retrospectivo, por meio de um conjunto de dados de seguros privados de saúde no Brasil, identificou pacientes com FANV tratados com varfarina entre 01 de maio de 2014 a 30 de abril de 2016, descreveu seu manejo da anticoagulação e quantificou os custos relacionados à doença. Foram recuperados dados demográficos, histórico clínico, medicação concomitante e tempo na faixa terapêutica (TTR) dos valores da razão normalizada internacional (RNI). Os pacientes foram agrupados em quartis de TTR, com um bom controle sendo definido como TTR ≥65% (método de Rosendaal). Sangramentos maiores e custos médicos diretos por todas as causas foram calculados e comparados entre subgrupos de controle bons e ruins. Valores de p < 0,05 foram considerados estatisticamente significantes. Resultados: A análise incluiu 1220 pacientes (mediana de seguimento: 1,5 anos; IIQ: 0,5-2,0). Em média, cada paciente recebeu 0,95 medidas mensais de RNI (RNI média: 2,60 ± 0,88, com 26,1% dos valores < 2 e 24,8% > 3), (mediana de TTR: 58%; IIQ: 47-68%), (TTR médio: 56,6% ± 18,9%). Apenas 31% dos pacientes estavam bem controlados (TTR médio: 78% ± 10%), com 1,6% apresentando grandes sangramentos na mediana do seguimento e custos médicos diretos por membro por ano (PMPY) de R$25.352 (± R$37.762). Pacientes com controle abaixo do ideal (69%) foram associados a 3,3 vezes mais sangramentos graves (5,3% vs. 1,6%; p <0,01) e custos 40% maiores (R$35.384 vs. R$25.352; p < 0,01). Conclusões: Mais de 60% dos pacientes estavam abaixo da meta desejada e os custos associados foram significativamente maiores nesta população.

Avaliação do ambiente da prática profissional da enfermagem em instituições de saúde / Evaluación del ambiente de la práctica profesional de enfermería en instituciones de salud / Evaluation of the professional practice environment of nursing in health institutions

Resumo Objetiv Avaliar o ambiente hospitalar onde a enfermagem exerce sua prática comparando hospitais públicos e privados e descrever as características que receberam avaliação desfavorável (≤ 2,5 pontos) na percepção dos profissionais. Métodos Estudo comparativo e transversal realizado em cinco hospitais (dois públicos - A e B e três privados - C, D e E) de um município do interior do estado de São Paulo, com 1773 profissionais de enfermagem. Os instrumentos utilizados foram: ficha para caracterização da amostra e a versão brasileira da Practice Environment Scale. Na análise dos dados, foram utilizadas estatísticas descritivas e inferenciais. Para comparar os hospitais foi utilizado o teste Kruskall Wallis, seguido pelo pós-teste de Dunn e a regressão multinomial. Resultados Na comparação dos hospitais, os hospitais D e E alcançaram médias superiores aos demais e diferenças significantes (p<0,0001) foram obtidas com relação às cinco subescalas do instrumento utilizado. Na regressão multinomial, o hospital D obteve 5,8; o E 5,2; o C 3,0 e o A 2,7 chances de possuir um ambiente mais favorável, quando comparados ao hospital B. Os itens com nota inferior a 2,5 foram associados, especialmente, a falta de oportunidade de desenvolvimento, reconhecimento, gestão participativa e dimensionamento adequado. Conclusão Os hospitais privados apresentaram melhor desempenho quando comparados aos públicos e as características que receberam pior avaliação estavam relacionadas à participação dos enfermeiros nos assuntos hospitalares, fundamentos voltados para a qualidade, suporte dos gestores à equipe e adequação de recursos.

Resumen Objetivo evaluar el ambiente hospitalario donde la enfermería ejerce su práctica comparando hospitales públicos y privados y describir las características que recibieron evaluación desfavorable (≤ 2,5 puntos) según la percepción de los profesionales. Métodos estudio comparativo y transversal realizado en cinco hospitales (dos públicos: A y B; tres privados: C, D y E) de un municipio del interior del estado de São Paulo, con 1.773 profesionales de enfermería. Los instrumentos utilizados fueron: ficha para caracterización de la muestra y la versión brasileña de la Practice Environment Scale. En el análisis de los datos, se utilizaron estadísticas descriptivas e inferenciales. Para comparar los hospitales, se utilizó la prueba Kruskall Wallis, seguida de la prueba posterior de Dunn y la regresión multinomial. Resultados en la comparación de los hospitales, los hospitales D y E alcanzaron promedios superiores a los demás y se obtuvieron diferencias significativas (p<0,0001) con relación a las cinco subescalas del instrumento utilizado. En la regresión multinomial, el hospital D obtuvo 5,8; el E 5,2; el C 3,0 y el A 2,7 chances de poseer un ambiente más favorable, al compararlos con el hospital B. Los ítems con nota inferior a 2,5 fueron asociados, especialmente, a la falta de oportunidad de crecimiento, reconocimiento, gestión participativa y dimensionamiento adecuado. Conclusión los hospitales privados presentaron mejor desempeño al compararlos con los públicos y las características que recibieron peor evaluación estaban relacionadas con la participación de los enfermeros en los asuntos hospitalarios, fundamentos orientados a la calidad, apoyo de los gestores al equipo y adecuación de recursos.

Abstract Objective To evaluate the hospital environment where nursing performs its practice comparing public and private hospitals and describing the characteristics that received unfavorable evaluation (≤ 2.5 points) in the professionals' perception. Methods A comparative and cross-sectional study was conducted in five hospitals (two public hospitals - A and B; and three private ones - C, D and E) from a city in the countryside of the state of São Paulo, with a total of 1773 nursing professionals. The instruments used were: data sheet for characterization of the sample and the Brazilian version of the Practice Environment Scale. In the data analysis, we used descriptive and inferential statistics. To compare the hospitals, we used the Kruskall Wallis test, followed by the Dunn post-test and the multinomial regression. Results In the comparison of hospitals, D and E hospitals reached mean above the others and significant differences (p<0.0001) were obtained in relation to the five subscales of the instrument used. In the multinomial regression, hospital D obtained 5.8; hospital E 5.2; hospital C 3.0 and hospital A 2.7 chances of having a more favorable environment when compared to hospital B. Items with a score lower than 2.5 were associated, especially, lack of opportunity for development, recognition, participatory management and proper sizing. Conclusion Private hospitals showed better performance when compared to the public ones, and the characteristics that received the worst evaluation were related to the participation of nurses in hospital affairs based on quality, support of the managers to the team and adequacy of resources.

Quality of Intra-Hospital Nutritional Counseling in Patients with STEMI in the Public and Private Health Networks of Sergipe: The VICTIM Register / Qualidade da Orientação Nutricional Intra-hospitalar em Pacientes com IAMcSST das Redes Pública e Privada de Saúde em Sergipe: Registro (VICTIM)

Abstract Background: Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored. Objective: To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe. Methods: A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted. Results: A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001). Conclusion: The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

Resumo Fundamento: A adequação dos hábitos alimentares faz parte das recomendações pós-infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMcSST); contudo, tem sido pouco explorada a qualidade da orientação nutricional intra-hospitalar nos diferentes serviços de saúde. Objetivo: Avaliar a qualidade da orientação nutricional intra-hospitalar entre pacientes com IAMcSST nas redes de saúde pública e privada em Sergipe. Métodos: Estudo transversal, com dados do Registro Via Crucis para o Tratamento do Infarto do Miocárdio (VICTIM), realizado de abril a novembro de 2017 com indivíduos com idade ≥ 18 anos, diagnosticados com IAMcSST em um hospital público e três privados. Analisaram-se a ocorrência de orientação nutricional e a sua qualidade com base nas diretrizes atuais e por meio de aplicação de questionários, sendo adotado nível de significância de 0,05. Resultados: Foram avaliados 188 voluntários, sendo 80,3% do serviço público. Dentre os entrevistados, 57,6% da rede pública e 70,3% da privada receberam orientação nutricional intra-hospitalar (p = 0,191). O registro dessa prática em prontuário foi menor no serviço público (2,6% versus 37,8%; p < 0,001). Verificou-se o predomínio das orientações restritivas, sobretudo de sal e gorduras, 52,3% e 70,3% no público e no privado, respectivamente (p = 0,064). Quanto à inserção de alimentos cardioprotetores, pacientes da rede privada foram mais beneficiados, principalmente quanto ao consumo de frutas e verduras/legumes (48,6% versus 13,2%, p < 0,001). Entre aqueles que receberam orientação, o conhecimento nutricional foi maior no sistema privado (68,2% versus 26,3%, p < 0,001). Conclusão: A orientação nutricional intra-hospitalar para o IAMcSST em Sergipe apresenta baixa qualidade em ambos os serviços de saúde, sobretudo no público.

Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network - VICTIM Register / Disparidades no Uso de Stents Farmacológicos para Pacientes Diabéticos com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Assistidos na Rede Pública versus Privada - Registro VICTIM

Abstract Background: Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives: To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods: This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results: A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions: The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

Resumo Fundamento: A angioplastia primária (AP) com colocação de stent, seja ele convencional ou farmacológico, representa a principal estratégia no tratamento do infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Os pacientes diabéticos, entretanto, representam população especial no IAMCSST, com altas taxas de reestenose e desfechos clínicos desfavoráveis, devendo-se indicar o uso de stents farmacológicos (SF), nível de evidência A e classe de indicação II, para redução destes danos. Objetivo: Avaliar a taxa de uso de SF em pacientes com IAMCSST e no subgrupo dos diabéticos assistidos na rede pública versus privada de saúde em Sergipe. Métodos: Trata-se de um estudo populacional, transversal, com abordagem quantitativa, que utilizou os dados do Registro VICTIM. Estes foram coletados nos quatro únicos hospitais com capacidade para realizar AP em Sergipe, no período de dezembro de 2014 a março de 2017. Em todas as hipóteses testadas, o nível de significância adotado foi de 5% (p < 0,05). Resultados: Foram avaliados 707 pacientes diagnosticados com IAMCSST, dos quais 589 foram atendidos pelo SUS e 118 pela rede privada. O uso de SF na AP foi menor no SUS em comparação com a rede privada, tanto no total da amostra (10,5% vs 82,4%; p < 0,001) quanto no subgrupo dos pacientes diabéticos (8,7% vs 90,6%; p < 0,001), respectivamente. Conclusões: O estudo revela disparidade no uso de SF durante a realização de AP entre a rede pública e privada, tanto na amostra total quanto no subgrupo dos diabéticos, com menores taxas para usuários do SUS, demonstrando os desafios que necessitam ser vencidos para se atingir melhorias na qualidade dos serviços prestados.

Current development of private hospitals in Guangxi under the background of China's ongoing healthcare reform:analysis and countermeasures / 中华医院管理杂志

Objective To analyze the status quo and countermeasures of the development of Guangxi's private hospitals during the ongoing healthcare reform. Methods With the background of the healthcare reform, the current situation of private hospitals was analyzed based on data changes of the development of such hospitals in Guangxi during the 2011 -2015 period, for the purpose of proposing measures such as multiple supervision mechanism. Results During this period,74 private hospitals were founded in Guangxi. They have added 7 395 hospitals beds, served 1.41 million outpatient/emergency visits, and 220. 9 thousand inpatients, with 5 939 employees hired in the meantime. Given these achievements,development of these hospitals tended to be imbalanced and poorly regulated.Conclusions The healthcare reform has encouraged private involvement in medical practice and the growth of private hospitals in the region. In view of the problems as mentioned above, multiple supervision appears an effective solution.

Nurse work environment: comparison between private and public hospitals / Ambiente de trabalho do enfermeiro: comparação entre hospitais privados e público

ABSTRACT Objective To compare the characteristics of the work environment that enable the professional practice of nurses in private and public organizations. Methods A quantitative, exploratory, cross-section study, carried out in four health organizations - one public and three private, with 188 registered nurses. Participants answered the Brazilian version of the Nursing Work Index − Revised, which aims to evaluate the presence of characteristics that favor the development of nursing activities through 15 items distributed into three subscales: autonomy, control over the practice setting and relationships with physicians. The measurement scale used is Likert, and lower scores represent better evaluation of the environment, i.e. , more favorable characteristics are present to assist the development of nursing activities. Results The means of the responses of participants of private hospitals were smaller in all subscales of the instrument, as compared to those from public hospitals. Conclusion The environment of private hospitals showed more favorable characteristics to the professional practice of registered nurses than the public hospital environment.

RESUMO Objetivo Comparar as características do ambiente de trabalho que favorecem a prática profissional do enfermeiro em instituições privadas e pública. Métodos Estudo quantitativo, exploratório, transversal, realizado em quatro instituições de saúde, sendo uma pública e três privadas, com 188 enfermeiros. Os participantes responderam a versão brasileira do Nursing Work Index − Revised , que tem por objetivo avaliar a presença de características que favorecem o desenvolvimento das atividades do enfermeiro por meio de 15 itens distribuídos em três subescalas: autonomia, controle sobre o ambiente de trabalho e relações entre médicos. A escala de medida utilizada é do tipo Likert e menores pontuações representam melhor avaliação do ambiente, ou seja, mais características favoráveis estão presentes para auxiliar o desenvolvimento das atividades da enfermagem. Resultados As médias das respostas dos participantes dos hospitais privados foram menores em todas as subescalas do instrumento, quando comparadas às do hospital público. Conclusão Os ambientes dos hospitais privados demonstraram possuir mais características favoráveis à prática profissional do enfermeiro do que o ambiente do hospital público.

Factors influencing the missed nursing care in patients from a private hospital / Fatores que influenciam o cuidado de enfermagem omitido em pacientes de um hospital particular / Factores que influyen en el cuidado de enfermería perdido en pacientes de un hospital privado

ABSTRACT Objective: to determine the factors that influence the missed nursing care in hospitalized patients. Methods: descriptive correlational study developed at a private hospital in Mexico. To identify the missed nursing care and related factors, the MISSCARE survey was used, which measures the care missed and associated factors. The care missed and the factors were grouped in global and dimension rates. For the analysis, descriptive statistics, Spearman's correlation and simple linear regression were used. Approval for the study was obtained from the ethics committee. Results: the participants were 71 nurses from emergency, intensive care and inpatient services. The global missed care index corresponded to M=7.45 (SD=10.74); the highest missed care index was found in the dimension basic care interventions (M=13.02, SD=17.60). The main factor contributing to the care missed was human resources (M=56.13, SD=21.38). The factors related to the care missed were human resources (rs=0.408, p<0.001) and communication (rs=0.418, p<0.001). Conclusions: the nursing care missed is mainly due to the human resource factor; these study findings will permit the strengthening of nursing care continuity.

RESUMO Objetivo: determinar os fatores que influenciam o cuidado de enfermagem omitido em pacientes hospitalizados. Método: estudo descritivo correlacional, desenvolvido em um hospital particular do México. Para identificar o cuidado omitido e fatores relacionados, utilizou-se o instrumento MISSCARE, que mede o cuidado omitido e os fatores associados. O cuidado omitido e os fatores foram agrupados em índices globais e por dimensões. Para fins de análise, foi utilizada estatística descritiva, correlação de Spearman e regressão linear simples. O estudo recebeu aprovação de comité de ética. Resultados: participaram 71 enfermeiras dos serviços de urgências, terapia intensiva e hospitalização. O índice global de cuidado omitido mostrou um coeficiente M=7,45 (DE=10,74); o índice com maior cuidado omitido correspondeu à dimensão de intervenções de cuidado básico (M=13,02, DE=17,60). O principal fator que contribuiu ao cuidado omitido foi o de recursos humanos (M=56,13, DE=21,38). Os fatores relacionados ao cuidado omitido foram os recursos humanos (rs=0,408, p<0,001) e comunicação (rs=0,418, p<0,001). Conclusões: o cuidado omitido de enfermagem atribui-se principalmente ao fator de recursos humanos; com base nos resultados deste estudo pode-se fortalecer a continuidade do cuidado de enfermagem.

RESUMEN Objetivo: determinar los factores que influyen en el cuidado de enfermería perdido en pacientes hospitalizados. Método: estudio descriptivo correlacional, se realizó en un hospital privado de México. Para identificar el cuidado perdido y factores relacionados se utilizó el instrumento MISSCARE que mide el cuidado perdido y los factores asociados. El cuidado perdido y los factores se agruparon en índices globales y por dimensiones. Para el análisis se utilizó estadística descriptiva, correlación de Spearman y regresión lineal simple. El estudio fue aprobado por el comité de ética. Resultados: participaron 71 enfermeras de los servicios de urgencias, terapia intensiva y hospitalización. El índice global de cuidado perdido mostró una M=7,45 (DE=10,74); el índice con mayor cuidado perdido correspondió a la dimensión de intervenciones de cuidado básico (M=13,02, DE=17,60). El principal factor que contribuyó en el cuidado perdido, fue el de recursos humanos (M=56,13, DE=21,38). Los factores relacionados con el cuidado perdido fueron los de recursos humanos (rs=0,408, p<0,001) y comunicación (rs=0,418, p<0,001). Conclusiones: el cuidado perdido de enfermería se atribuye principalmente al factor de recurso humano; los hallazgos de este estudio permitirán fortalecer la continuidad en el cuidado de enfermería.

O impacto do tipo de hospital e tipo de parto sobre a idade gestacional ao nascer no Município de São Paulo, 2013-2014 / The impact of the type of hospital and delivery on the gestational age in São Paulo city, 2013-2014

RESUMO: Introdução: Foi observado que em muitos países, nos últimos anos, houve redução da proporção de nascimentos com 40 semanas e desvio à esquerda da curva de distribuição da idade gestacional (IG), quando comparada ao padrão esperado. Objetivo: Estudar o padrão de distribuição da idade gestacional nos nascimentos do Município de São Paulo (MSP) e sua relação com o tipo de hospital e tipo de parto. Métodos: Foram extraídos dados do Sistema de Informações sobre Nascidos Vivos (SINASC) de 2013 e 2014 e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Os dados são apresentados segundo nascimentos nas redes SUS e não SUS, tipo de parto e IG, com padronização segundo a idade da mãe. Resultados: Houve um desvio à esquerda da IG para o total de nascimentos e entre os nascidos na rede não SUS, e foi mais acentuado entre nascimentos por cesárea. A mediana de IG na rede SUS foi 39 semanas e na rede não SUS, 38 semanas. A proporção de nascimentos pré-termo (9,5%) é semelhante nas duas redes, porém com proporção mais elevada de nascimentos muito pré-termo (<32 semanas) na rede SUS e (34-36) pré-termo tardios na rede não SUS. Conclusão: A mudança na distribuição da idade gestacional ao nascer no MSP está relacionada ao tipo de hospital em que ocorrem os nascimentos e à alta frequência de cesáreas na rede privada.

ABSTRACT: Introduction: There was a left-shift on the distribution curve of gestational age (GA) and a reduction of the proportion of live births of 40 weeks, when compared to the expected standard in many countries. Objective: To study the distribution of gestational age births in São Paulo city (SP) and its relationship with the type of hospital and delivery. Methods: Data were extracted from Live Birth Information System (SINASC) linked to the National Database of Health Establishments (CNES) in 2013 and 2014. Data are presented according to birth in public (SUS) and private (non SUS) hospitals, type of delivery and gestational age, standardized according to the mother's age. Results: There was a left-shift in GA curve for total births which was more pronounced among cesarean births and private hospitals. The median GA of public hospitals was 39 weeks, while in the private hospitals, 38 weeks. The proportion of preterm births (9,5%) was similar in public and private hospitals, but among public hospital there was a higher proportion of very preterm births (<32 weeks), while (34-36) in private hospitals late preterm and early term were more frequent. Conclusions: The change in the distribution of gestational age in SP is related to the type of hospital and the proportion of cesarean sections in private hospitals.

Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals / Comparação entre padrões de tromboprofilaxia na artroplastia em hospitais público e privado

Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system.Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization).Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively.Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.

Objetivo Comparar a terapia para profilaxia de tromboembolismo venoso e os custos de pacientes submetidos à artroplastia total de joelho e de quadril dentro do sistema de saúde brasileiro.Métodos Estudo retrospectivo com pacientes submetidos à artroplastia no ano de 2010, em um hospital público e dois hospitais privados no Estado de São Paulo, por meio da revisão de prontuários. Os custos foram estimados com base na utilização de recursos em saúde durante a hospitalização. Análise descritiva de frequência e média (desvio padrão), de acordo com o tipo de atendimento em saúde (público ou privado).Resultados Um total de 215 pacientes foram avaliados, sendo 56,3% submetidos à cirurgia de joelho e 43,7% à cirurgia de quadril. Cerca de 88% e 98% dos pacientes provenientes do serviço público e privado de saúde, respectivamente, receberam algum tipo de profilaxia para tromboembolismo, sendo a enoxaparina o medicamento mais utilizado em ambos sistemas. O custo total da profilaxia foi de R$ 1.873,01 (R$ 26,38 por paciente) no serviço público e R$ 21.559,73 (R$ 163,33 por paciente) no serviço privado. Para os indivíduos com tromboembolismo, o custo médio da internação foi de R$ 6.210,80 e R$ 43.792,59 por paciente atendido nos serviços de saúde público e privado, respectivamente.Conclusão A profilaxia em pacientes submetidos à artroplastia é mais utilizada em pacientes do serviço de saúde privado do que público, apesar dos altos custos em ambos os serviços. Os pacientes com tromboembolismo tiveram um custo maior do que aqueles apenas com profilaxia, mostrando que a prevenção está associada a um maior custo-benefício.

Tendência temporal da via de parto de acordo com a fonte de financiamento / Time trend of the rates of cesarean and vaginal delivery according to the source of financing

OBJETIVO: Analisar a tendência temporal das taxas das vias de parto de acordo com a fonte de financiamento. MÉTODOS: Trata-se de um estudo ecológico de séries temporais de análise das taxas das vias de parto de acordo com a fonte de financiamento, no município de Maringá, Paraná, de 2002 a 2012. Para coleta de dados foram utilizadas as informações disponíveis no Sistema de Informações sobre Nascidos Vivos e no Sistema de Informações Hospitalares do Sistema Único de Saúde (SUS). Para todas as taxas das vias de parto foram calculadas as médias móveis, para suavizar as oscilações aleatórias da série, feitos diagramas de dispersão entre os coeficientes e os anos de estudo, e a partir da relação funcional observada foram estimados modelos de regressão polinomial, com nível de significância de p<0,05. RESULTADOS: No decorrer dos 11 anos do estudo ocorreram 48.220 nascimentos. Desses, 77,1% foram parto cesáreo e apenas 22,9% parto vaginal. Os partos financiados pelo SUS totalizaram 22.366 procedimentos e desses, 54,6% foram cesáreas. A análise da tendência foi significativa para todos os modelos de regressão, evidenciando tendência ascendente para parto cesáreo e decrescente para parto vaginal nos dois tipos de financiamento. Observa-se que as taxas de cesárea não SUS foram sempre superiores a 90,0% e mais frequentes do que as cesáreas SUS, mesmo com o aumento de 36,0% dessas ao longo do período estudado. CONCLUSÃO: Pela análise de tendência, as cesáreas continuarão aumentando nos dois financiamentos de saúde se não forem implantadas novas ações e estratégias de redução envolvendo as características socioculturais, demográficas e obstétrica das mulheres, a formação ...

PURPOSE: To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing. METHODS: This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05. RESULTS: Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period. CONCLUSION: Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery. .

Public and private hospital nurses' perceptions of the ethical climate in their work settings, sari city, 2011.

BACKGROUND: Nurses' perceptions of ethical climate patterns have certain undeniable effects on hospitals. There is little evidence of possible differences in this element between public and private hospitals and contributing factors. OBJECTIVES: This study investigated whether the perceptions of the ethical climate in nurses' working in public hospitals differ from that of nurses in private hospitals, and which factors may affect nurses' perceptions. MATERIALS AND METHODS: A cross-sectional study of randomly selected registered nurses (n = 235), working in four public hospitals affiliated to Mazandaran University of Medical Sciences, and three private hospitals, was conducted in Sari City, Iran. A self-administered questionnaire, containing demographic characteristics and the Hospital Ethical Climate Survey (HECS), were used to assess registered nurses' perceptions of public and private hospitals ethical climate. An independent t-test and one-way ANOVA were used to analyze the data. RESULTS: Across the five factors of HECS, the highest and lowest mean scores pertained to managers and physicians, respectively, in both public and private hospitals. Nurses who had a conditional employment situation and those working in pediatric intensive care units showed significantly more positive perceptions of the ethical work climate when compared to their peers (P < 0.05). Although the mean score of ethical work climate in private hospitals (3.82 ± 0.61) was higher than that in public hospitals (3.76 ± 0.54), no significant difference was found (P = 0.44). CONCLUSIONS: Hospital managers need to discover better ways to promote safety and health programs for their staff according to nurses' area of work and their type of units. They should also encourage greater levels of participation in safety-enhancing initiatives in the hospital's ethical climate, especially in the areas of nurses' perceptions of their physician colleagues, and for nurses with a conditional employment situation.

Comparação entre a concentração sérica de alfa-tocoferol de puérperas assistidas em maternidades públicas e privadas no Nordeste do Brasil / Comparison between the serum concentration of alpha-tocopherol in puerperal women assisted in public and private maternities in Northeastern Brazil

OBJETIVO: Comparar a concentração de alfa-tocoferol no soro entre puérperas atendidas em maternidades das redes pública e privada da cidade de Natal (RN), Brasil. MÉTODOS: Participaram do estudo 209 puérperas, sendo 96 mulheres provenientes da rede privada e 113, da rede pública, entre 24 e 48 horas pós-parto. Foram incluídas no estudo parturientes com idade a partir de 12 anos, sem patologias associadas à gestação, que tiveram concepto único sem má-formação. Mulheres descompensadas clinicamente e com gestação múltipla foram excluídas. Amostras de 5 mL de sangue de cada participante foram coletadas no período de jejum, antes da primeira refeição do dia. A concentração de alfa-tocoferol no soro (µg/dL) foi determinada por cromatografia líquida de alta eficiência (CLAE). A diferença estatística entre as médias foi testada utilizando o teste t de Student. RESULTADOS: As médias da concentração de alfa-tocoferol nas puérperas da rede pública e da rede privada, respectivamente, foram 1.115,7±341,4 μg/dL e 1.355,7±397,6 μg/dL, tendo sido observada diferença estatisticamente significante (p=0,000687). Para avaliação individual da concentração de vitamina E, a deficiência foi identificada quando alfa-tocoferol <11,6 μmol/L ou <499,6 µg/dL. As puérperas da rede pública tiveram um percentual de 5,3% (n=6) de deficiência, enquanto nas participantes da rede privada tal carência não foi encontrada. Todavia, baixas concentrações (alfa-tocoferol entre 11,6-16,2 μmol/L ou 499,6-697,7 µg/dL) ocorreram tanto na rede pública como na privada: 9,7% (n=11) e 4,2% (n=4), respectivamente. CONCLUSÃO: Esses resultados destacam que as mulheres assistidas ...

PURPOSE: To compare the concentration of serum alpha-tocopherol during the postpartum period in women admitted to public and private hospitals in Natal (RN), Brazil. METHODS: The study included 209 women in the postpartum period, 96 of them from private hospitals and 113 from public hospitals, studied between 24 and 48 hours postpartum. Inclusion criteria were: mothers aged 12 years or more, without diseases associated with pregnancy, who had given birth to a singleton with no malformations. Clinically decompensated women with multiple fetuses were excluded. A 5 mL blood sample was obtained from each participant under fasting conditions, before the first meal of the day. The concentration of alpha-tocopherol in serum (µg/dL) was determined by high performance liquid chromatography (HPLC). The statistical difference between means was tested by the Student's t-test. RESULTS: The mean concentration of alpha-tocopherol was 1.115.7 µg/dL in puerperae from the public network and 1.355.7±397.6 µg/dL in puerperae from the privte network , with a significant difference between groups (p=0.000687). Vitamin E concentration was determined individually and an alpha-tocopherol level <11.6 µmol/L or <499.6 µg/dL was considered to indicate deficiency. Vitamin E deficiency was detected in 5.3% of puerperae from the public network (n=6), whereas no deficiency was detected among women from the private network. However, low concentrations of alpha-tocopherol (11.6 to 16.2 µmol/L or 499.6 to 697.7 µg/dL) was detected in both groups, i.e., in 9.7% of the women from the public network (n=11) and in 4.2% for the women from the private network (n=4). CONCLUSION: These results highlight that women assisted in the public sector were more vulnerable to developing low concentrations of alpha-tocopherol than women assisted in the private sector. .

Escore Prognóstico para Síndrome Coronariana Aguda em Hospital Terciário Privado / Prognostic Score for Acute Coronary Syndrome in a Private Terciary Hospital

Fundamento: Os modelos prognósticos disponíveis para Síndrome Coronariana Aguda (SCA) podem ter limitações de performance, por terem sido elaborados há vários anos, ou problemas de aplicabilidade. Objetivos: Elaborar escores para predição de eventos desfavoráveis em 30 dias e 6 meses, em pacientes com SCA, com ou sem Supradesnivelamento de ST (SST), atendida em hospital privado terciário. Métodos: Coorte prospectiva de pacientes consecutivos com SCA admitidos entre agosto/2009 a junho/2012. O desfecho primário composto foi a ocorrência de óbito, infarto ou reinfarto, Acidente Vascular Cerebral (AVC), parada cardiorrespiratória e sangramento maior. As variáveis preditoras foram selecionadas de dados clínicos, laboratoriais, eletrocardiográficos e da terapêutica. O modelo final foi obtido por meio de regressão logística e submetido a validação interna, utilizando-se bootstraping. Resultados: Incluímos 760 pacientes, 132 com SCA com SST e 628 sem SST. A idade média foi 63,2 ± 11,7 anos, sendo 583 homens (76,7%). O modelo final para eventos em 30 dias contém cinco preditores: idade ≥ 70 anos, antecedente de neoplasia, Fração de Ejeção do Ventrículo Esquerdo (FEVE) < 40%, troponinaI > 12,4 ng/mL e trombólise. Na validação interna, o modelo mostrou ter boa performance com área sob a curva de 0,71.Os preditores do modelo para 6 meses são: antecedente de neoplasia, FEVE < 40%, trombólise, troponina I > 14,3 ng/mL, creatinina > 1,2 mg/dL, antecedente de doença pulmonar obstrutiva crônica e hemoglobina < 13,5 g/dL. Na validação interna, o modelo apresentou boa performance com área sob a curva de 0,69. Conclusões: Desenvolvemos escores de fácil utilização e boa performance ...

Background: Available predictive models for acute coronary syndromes (ACS) have limitations as they have been elaborated some years ago or limitations with applicability. Objectives: To develop scores for predicting adverse events in 30 days and 6 months in ST-segment elevation and non-ST-segment elevation ACS patients admitted to private tertiary hospital. Methods: Prospective cohort of ACS patients admitted between August, 2009 and June, 2012. Our primary composite outcome for both the 30-day and 6-month models was death from any cause, myocardial infarction or re-infarction, cerebrovascular accident (CVA), cardiac arrest and major bleeding. Predicting variables were selected for clinical, laboratory, electrocardiographic and therapeutic data. The final model was obtained with multiple logistic regression and submitted to internal validation with bootstrap analysis. Results: We considered 760 patients for the development sample, of which 132 had ST-segment elevation ACS and 628 non-ST-segment elevation ACS. The mean age was 63.2 ± 11.7 years, and 583 were men (76.7%). The final model to predict 30-day events is comprised by five independent variables: age ≥ 70 years, history of cancer, left ventricular ejection fraction (LVEF) < 40%, troponin I > 12.4 ng /ml and chemical thrombolysis. In the internal validation, the model showed good discrimination with C-statistic of 0.71. The predictors in the 6-month event final model are: history of cancer, LVEF < 40%, chemical thrombolysis, troponin I >14.3 ng/ml, serum creatinine>1.2 mg/dl, history of chronic obstructive pulmonary disease and hemoglobin < 13.5 g/dl. In the internal validation, the model had good performance with C-statistic of 0.69. Conclusion: We have developed easy to apply scores for predicting 30-day and 6-month adverse events in patients with ST-elevation and non-ST-elevation ACS. .

Carga de trabalho de enfermagem em unidades de terapia intensiva publicas e privadas / Nursing workload in public and private intensive care units

OBJETIVO: Comparar pacientes de unidades de terapia intensiva públicas e privadas segundo carga de trabalho e intervenções de enfermagem. MÉTODOS: Estudo comparativo, tipo coorte retrospectivo, com 600 pacientes internados em 4 unidades de terapia intensiva localizadas em São Paulo. A carga de trabalho e as intervenções de enfermagem foram identificadas pelo Nursing Activities Score nas primeiras e últimas 24 horas de permanência do paciente na unidade de terapia intensiva. Os testes do qui-quadrado de Pearson, exato de Fisher, t de Student e Mann-Whitney foram utilizados na comparação dos grupos. RESULTADOS: A média do Nursing Activities Score calculado na admissão da unidades de terapia intensiva foi 61,9 e, na saída, de 52,8. Diferenças significativas foram encontradas entre os pacientes admitidos nas unidades de terapia intensiva públicas e privadas em relação ao Nursing Activities Score médio na admissão e em 12 das 23 intervenções de enfermagem realizadas nas primeiras 24 horas de internação na unidade crítica. Os pacientes internados nas unidades de terapia intensiva públicas apresentaram maior valor médio do escore e, em geral, tiveram maior frequência de intervenções, exceto àquelas relacionadas a "cuidados com drenos", "mobilização e posicionamento", e "hiperalimentação intravenosa". Os grupos também diferiram em relação à evolução do Nursing Activities Score entre admissão e saída da unidade de terapia intensiva na casuística total e entre os sobreviventes. CONCLUSÃO: Pacientes internados em unidades de terapia intensiva públicas e privadas apresentam particularidades em relação à demanda de cuidados requerida e tal achado pode subsidiar os gestores na busca de um adequado ...

OBJECTIVE: This study sought to compare patients at public and private intensive care units according to the nursing workload and interventions provided. METHODS: This retrospective, comparative cohort study included 600 patients admitted to 4 intensive care units in São Paulo. The nursing workload and interventions were assessed using the Nursing Activities Score during the first and last 24 hours of the patient's stay at the intensive care unit. Pearson's chi-square test, Fisher's exact test, the Mann-Whitney test, and Student's t test were used to compare the patient groups. RESULTS: The average Nursing Activities Score upon admission to the intensive care unit was 61.9, with a score of 52.8 upon discharge. Significant differences were found among the patients at public and private intensive care units relative to the average Nursing Activities Score upon admission, as well as for 12 out of 23 nursing interventions performed during the first 24 hours of stay at the intensive care units. The patients at the public intensive care units exhibited a higher average score and overall more frequent nursing interventions, with the exception of those involved in the "care of drains", "mobilization and positioning", and "intravenous hyperalimentation". The groups also differed with regard to the evolution of the Nursing Activities Score among the total case series as well as the groups of survivors from the time of admission to discharge from the intensive care unit. CONCLUSION: Patients admitted to public and private intensive care units exhibit differences in their nursing care demands, which may help managers with nursing manpower planning. .