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1.
Support Care Cancer ; 28(1): 295-301, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31044305

RESUMO

BACKGROUND: An international panel achieved consensus on 9 need-based and 2 time-based major referral criteria to identify patients appropriate for outpatient palliative care referral. To better understand the operational characteristics of these criteria, we examined the proportion and timing of patients who met these referral criteria at our Supportive Care Clinic. METHODS: We retrieved data on consecutive patients with advanced cancer who were referred to our Supportive Care Clinic between January 1, 2016, and February 18, 2016. We examined the proportion of patients who met each major criteria and its timing. RESULTS: Among 200 patients (mean age 60, 53% female), the median overall survival from outpatient palliative care referral was 14 (95% confidence interval 9.2, 17.5) months. A majority (n = 170, 85%) of patients met at least 1 major criteria; specifically, 28%, 30%, 20%, and 8% met 1, 2, 3, and ≥ 4 criteria, respectively. The most commonly met need-based criteria were severe physical symptoms (n = 140, 70%), emotional symptoms (n = 36, 18%), decision-making needs (n = 26, 13%), and brain/leptomeningeal metastases (n = 25, 13%). For time-based criteria, 54 (27%) were referred within 3 months of diagnosis of advanced cancer and 63 (32%) after progression from ≥ 2 lines of palliative systemic therapy. The median duration from patient first meeting any criterion to palliative care referral was 2.4 (interquartile range 0.1, 8.6) months. CONCLUSIONS: Patients were referred early to our palliative care clinic and a vast majority (85%) of them met at least one major criteria. Standardized referral based on these criteria may facilitate even earlier referral.


Assuntos
Assistência Ambulatorial/organização & administração , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Seleção de Pacientes , Encaminhamento e Consulta/organização & administração , Adulto , Idoso , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Pré-Escolar , Consenso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Pacientes Ambulatoriais , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
2.
Med. infant ; 26(4): 335-345, dic. 2019. Tab
Artigo em Espanhol | LILACS | ID: biblio-1047042

RESUMO

Mediano Riesgo es un servicio de atención ambulatoria del Hospital Garrahan. Se atienden pacientes con enfermedades prolongadas, que han realizado consultas en otros efectores de salud u otros servicios del Hospital, o que requieren segunda opinión o abordaje multidisciplinario. Objetivos: Mensurar el tiempo profesional invertido en la atención como herramienta para ponderar la complejidad de los pacientes. Identificar variables demográficas y del proceso de atención. Material y métodos: Investigación descriptiva, transversal sobre pacientes encuestados entre julio y diciembre de 2017 en el Sector de Mediano Riesgo. Se registraron: variables demográficas, proceso de atención, diagnósticos previos y finales, interconsultas, exámenes complementarios y tiempos de consulta profesional. Se tomó 65 minutos (mediana del tiempo profesional total) como punto de corte para definir dos grupos: tiempo de consulta corto o largo. Se realizó un análisis comparativo entre ambos. Resultados: se encuestaron 400 pacientes. Mediana de edad fue de 67,2 meses; 80,1% procedían de CABA y del GBA; mediana de duración del síntoma fue 4 meses; 25,8% tenía enfermedad de base; 62,5% fueron pacientes derivados (externos e internos); destino a pediatra zonal: 30%; interconsultas: 48,5%; tiempo total profesional: mediana 65 minutos (rango 12-460); diagnósticos simples: 37,2%. Variables con significación estadística para pertenecer al tiempo largo: número de diagnósticos finales, procedencia, diagnósticos no simples y presencia de enfermedad de base. Variables con tendencia a pertenecer a tiempo largo: duración del síntoma mayor de 1 mes, edad menor a 24 meses, patología tumoral, síndromes polimalformativos, abuso sexual infantil y problemas de lenguaje /aprendizaje. Conclusiones: el tiempo de consulta es un factor concurrente para la evaluación de la complejidad del proceso de atención. La identificación de variables que permitan preverlo es información relevante para la organización del sector, o de otros efectores de salud (AU)


The sector of Intermediate Risk is part of the outpatient clinics of Garrahan Hospital. In the sector patients with chronic diseases are seen, that have have consulted at other centers or other departments of the hospital, or that need a second opinion or a multidisciplinary approach. Objectives: To assess the professional time invested in care as a tool to evaluate the complexity of the patients, and to identify demographic variables and the care process. Material and methods: A cross-sectional, descriptive study on patients surveyed between July and December 2017 in the Sector of Intermediate Risk. The following data were recorded: Demographic features, care process, previous and final diagnoses, consultations, complementary studies, duration of the interview. A time of 65 minutes (median total time of the visit) was defined as the cut-off point to define two groups: Those with a long and a short interview. A comparative analysis was performed comparing both groups. Results: 400 patients were surveyed. Median age was 67.2 months; 80.1% were form the city of Buenos Aires and Greater Buenos Aires. Mean symptom duration was 4 months; 25.8% had an underlying disease; 62.5% of the patients was referred (either external or internally); referred by the local pediatrician: 30%; second opinions: 48,5%; total time of the interview: median 65 minutes (range, 12-460); simple diagnoses: 37.2%. Statistically significant variables for a long interview were: number of final diagnoses, place of origin, complicated diagnoses, and presence of underlying disease. Variables with a trend to a long interview were: symptom duration more than one month, age less than 24 months, a diagnosis of a tumor, polymalformation syndromes, sexual abuse, language/learning difficulties. Conclusions: The time of the interview is a concurrent factor for the assessment of the complexity of the care process. Identification of the variables that allow to anticipate these cases is relevant for the organization of the sector or other health care providers (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Equipe de Assistência ao Paciente , Estudos Transversais , Inquéritos e Questionários
3.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185134

RESUMO

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Métodos Epidemiológicos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Estudos Retrospectivos , Fatores de Risco , Análise de Variância
4.
Rev Med Suisse ; 15(669): 1962-1966, 2019 Oct 30.
Artigo em Francês | MEDLINE | ID: mdl-31663695

RESUMO

In ambulatory care, the community pharmacist and the general practitioner most often interact through the dispensing of medicines in pharmacies following a prescription from the physician. However, this interaction can be reinforced by other practices that can increase the quality and safety of care. Interprofessional collaboration is possible through the development of increasing interrelationships, particularly in the sharing of information through dialogue on common objectives that integrate the perspectives of patients and professionals, and through joint decision-making. In this article, interprofessional collaboration between pharmacists and general practitioners is described, as well as data from the literature and some concrete examples from the regular practice of pharmacists and physicians in Unisanté.


Assuntos
Assistência Ambulatorial/organização & administração , Comportamento Cooperativo , Relações Interprofissionais , Farmacêuticos , Médicos , Humanos , Segurança do Paciente
5.
J Cardiovasc Surg (Torino) ; 60(6): 662-671, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603291

RESUMO

BACKGROUND: Recent studies showed no reduction in major amputation rates after introduction of a multidisciplinary team (MDT) approach for the treatment of diabetic foot ulcer. The efficacy of MDTs in the current standard of care is being questioned. This retrospective single-center study evaluated the efficacy of an outpatient MDT approach on limb salvage and ulcer healing in treating diabetic foot ulcers. METHODS: Patients with a diabetic foot ulcer treated before (2015) and after (2017) implementation of an MDT in a single center were compared. The MDT met weekly and consisted of a vascular surgeon, physiatrist, internist, shoe technician, wound care nurse, nurse practitioner, cast technician, and podiatrist. The primary outcome was limb salvage at 1 year. Secondary outcomes were ulcer healing, amputation-free survival, freedom from any amputation, and overall survival. Multivariable Cox regression models were used to assess predictors for major amputation. RESULTS: A vascular surgeon treated 104 patients with 148 ulcers in 2015, and the multidisciplinary team treated 133 patients with 188 ulcers in 2017. Limb salvage (90.9% vs. 95.5%, P=0.050), freedom from any amputation (56.5% vs. 78.0%, P<0.001), and ulcer healing (48.3% vs. 69.2%, P<0.001) were significantly lower in the non-MDT group than in the MDT group. Amputation-free survival and overall survival did not differ significantly between the groups. Predictors for major amputation were University of Texas Wound Classification 3D (hazard ratio, 2.8; 95% confidence interval, 1.17-6.45) and being treated in the non-MDT group (hazard ratio, 3.7; 95% confidence interval, 1.25-11.08). CONCLUSIONS: This retrospective study found an MDT dedicated to diabetic foot care was highly effective in increasing limb salvage and ulcer healing. We advise that such an MDT is an integrated part of the patient's chain-based care.


Assuntos
Assistência Ambulatorial/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Pé Diabético/terapia , Equipe de Assistência ao Paciente/organização & administração , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Amputação , Comportamento Cooperativo , Pé Diabético/diagnóstico , Feminino , Humanos , Comunicação Interdisciplinar , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Países Baixos , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
7.
Br J Nurs ; 28(17): S4-S8, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31556736

RESUMO

This is the final article in a three-part series. Previous articles discussed the patient experience and the enhanced roles of nurses and the multidisciplinary team (MDT) and their role in safety within ambulatory care (AC) at a major London teaching hospital. There is understandably apprehension when starting a new service and embarking on a new healthcare concept. The challenges of starting and maintaining an AC service are multifaceted. Common questions posed to this London teaching hospital concern the challenges of opening and maintaining a new service and the savings it will produce. There are many indirect savings and benefits to an ambulatory service, although the value of a positive patient experience cannot be measured in monetary terms.


Assuntos
Assistência Ambulatorial/organização & administração , Neoplasias/terapia , Pesquisa sobre Serviços de Saúde , Hospitais de Ensino , Humanos , Londres
8.
BMC Health Serv Res ; 19(1): 604, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462280

RESUMO

BACKGROUND: Technology-based self-assessment (TB-SA) benefits patients and providers and has shown feasibility, ease of use, efficiency, and cost savings. A promising TB-SA, the VA eScreening program, has shown promise for the efficient and effective collection of mental and physical health information. To assist adoption of eScreening by healthcare providers, we assessed technology-related as well as individual- and system-level factors that might influence the implementation of eScreening in four diverse VA clinics. METHODS: This was a mixed-method, pre-post, quasi-experimental study originally designed as a quality improvement project. The clinics were selected to represent a range of environments that could potentially benefit from TB-SA and that made use of the variety eScreening functions. Because of limited resources, the implementation strategy consisted of staff education, training, and technical support as needed. Data was collected using pre- and post-implementation interviews or focus groups of leadership and clinical staff, eScreening usage data, and post-implementation surveys. Data was gathered on: 1) usability of eScreening; 2) knowledge about and acceptability and 3) facilitators and barriers to the successful implementation of eScreening. RESULTS: Overall, staff feedback about eScreening was positive. Knowledge about eScreening ranged widely between the clinics. Nearly all staff felt eScreening would fit well into their clinical setting at pre-implementation; however some felt it was a poor fit with emergent cases and older adults at post-implementation. Lack of adequate personnel support and perceived leadership support were barriers to implementation. Adequate training and technical assistance were cited as important facilitators. One clinic fully implemented eScreening, two partially implemented, and one clinic did not implement eScreening as part of normal practice after 6 months as measured by usage data and self-report. Organizational engagement survey scores were higher among clinics with full or partial implementation and low in the clinic that did not implement. CONCLUSIONS: Despite some added work load for some staff and perceived lack of leadership support, eScreening was at least partially implemented in three clinics. The technology itself posed no barriers in any of the settings. An implementation strategy that accounts for increased work burden and includes accountability may help in future eScreening implementation efforts. Note. This abstract was previously published (e.g., Annals of Behavioral Medicine 53: S1-S842, 2019).


Assuntos
Melhoria de Qualidade/organização & administração , Autocuidado/métodos , Telemedicina/organização & administração , Idoso , Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Atitude do Pessoal de Saúde , Tecnologia Biomédica , California , Redução de Custos , Diagnóstico Precoce , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pessoal de Saúde/organização & administração , Implementação de Plano de Saúde , Humanos , Liderança , Inovação Organizacional , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs
9.
Z Rheumatol ; 78(8): 765-773, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31456005

RESUMO

Since April 2018, the new third level care model of outpatient specialist care (ASV) according to §116b of the Social Code Book V (SGBV) has been available for patients with chronic inflammatory rheumatic diseases in Germany. Not only is a multiprofessional cooperation between the disciplines involved in treating rheumatic diseases promoted but also the cooperation between specialized rheumatologists and other specialists in private practice and in hospitals is encouraged. As budget capping limiting services and number of cases do not apply in ASV, a significant improvement of patient care in rheumatology is expected due to an increase in provider capacity. At the end of May 2019, 72 rheumatologists in the first 9 newly approved ASV teams had qualified for this new care concept. Bureaucratic obstacles have so far delayed the implementation of ASV. Difficulties arose in building a team with different specialties, in the process of registration of the teams and the assessment of the registration by certain regional boards responsible for access control. The national associations of rheumatologists, the Professional Association of German Rheumatologists (BDRh), the VRA (Verband der Rheumatologischen Akutkliniken e. V.) and the German Society of Rheumatology (DGRh) campaign for an easier admission of providers to the ASV and for adequate financing of all specialties involved in the ASV. The aim is to realize the chance of the ASV for better rheumatological care nationwide with shorter waiting times for a medical appointment and a better cooperation between specialists.


Assuntos
Assistência Ambulatorial/normas , Reumatologia , Especialização , Assistência Ambulatorial/organização & administração , Alemanha , Humanos , Pacientes Ambulatoriais , Reumatologia/organização & administração , Reumatologia/normas , Resultado do Tratamento
10.
N Z Med J ; 132(1501): 21-32, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31465324

RESUMO

AIM: Outpatient parenteral antimicrobial therapy (OPAT) has become an established option for management infections requiring intravenous therapy. As the uptake of OPAT has increased, the clinical governance has changed and is now managed via virtual clinics and increased use of district nurses in addition to specialist outpatient review. The aim of this study was to report the characteristics, diagnoses, treatment and outcomes of patients managed by the service over 12 months in 2015/6 and compared these features with those of patients treated with OPAT in 1999. METHODS: Cases for 2015/6 were identified from the OPAT service database which records prospectively all information on diagnosis, antibiotic choice and duration of treatment, complications and requirement for review by the ID physicians and OPAT nurses prospectively. The outcomes, complications and readmissions were found by reviewing computerised records of Christchurch Hospital. All results were entered into a Microsoft® Excel database for analysis. Statistical analyses were performed using OpenEpi software. Data for 1999 was taken from an earlier publication. RESULTS: OPAT treatment in 12 months from 1 July 2015 was administered 407 times to 385 patients, which represented a 2.7 times increase in treatment courses than in 1999. The median age was 55 years in 1999 and 61 in 2015/6. There was a substantial increase in the proportion of bone and joint, abdominal and urinary tract infections but a fall in cellulitis and soft tissue infection. The number and proportion of patients treated with broad spectrum agents including piperacillin + tazobactam, ceftriaxone and carbapenems increased from 1% in 1999 to 20% in 2015/6. Unplanned readmission to hospital increased from 15 (10%) in 1999 to 62 patients (15%) in 2015/6. The most common reason for readmission in 2015/6 was for ongoing symptoms or progression of the infection requiring OPAT. Eight patients (2%) required readmission from adverse reactions to antimicrobial therapy. Two patients on palliative care died while on OPAT and 35 (9%) within 12 months of the index admission. CONCLUSION: OPAT use has increased and is used to treat patients with comorbidities, who are older, and with a different case-mix than 1999. Safety has not been compromised but the risk of treatment failure has increased. A better understanding of the reasons for treatment failure would improve patient selection and management with OPAT.


Assuntos
Assistência Ambulatorial , Anti-Infecciosos , Doenças Ósseas Infecciosas/tratamento farmacológico , Supervisão de Enfermagem/organização & administração , Dermatopatias Infecciosas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Assistência ao Convalescente/métodos , Idoso , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/classificação , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Readmissão do Paciente/estatística & dados numéricos , Autoadministração/métodos , Resultado do Tratamento
11.
Am J Health Syst Pharm ; 76(16): 1238-1247, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369113

RESUMO

PURPOSE: The purpose of this study was to identify and describe strategies that have successfully achieved collaboration among physicians and pharmacists providing comprehensive medication management (CMM) to support development of CMM services. METHODS: A 2-phase, mixed-methods approach was employed to identify successful strategies for building pharmacist-physician relationships in primary care clinic settings. Phase I used a qualitative approach to identify strategies deemed successful in building relationships with physicians. An advisory group of pharmacists with experience building CMM practices assisted in the development of minimum criteria characterizing pharmacists as having strong collaborative relationships. Semi-structured interviews were conducted with 10 interviewees meeting established criteria. Researchers coded interview transcripts and identified the resulting strategies. Phase II employed a survey instrument to determine how frequently identified strategies are used and evaluate the relative level of perceived impact of each strategy, which was distributed to a national audience of pharmacists practicing in ambulatory care settings. Responses from pharmacists meeting prespecified criteria were included in the analysis. RESULTS: Thirty-three strategies were identified and grouped into 8 themes. In phase II, 104 survey respondents met defined criteria and were eligible to endorse use of identified strategies and rate their relative influence. CONCLUSIONS: Thirty-three strategies were identified and grouped into 8 themes to aid pharmacists practicing CMM in developing stronger collaborative relationships with physician colleagues. A national sampling found many of these strategies were employed by a majority of pharmacists, who had found them to be influential in creating collaborative relationships.


Assuntos
Assistência Ambulatorial/organização & administração , Relações Interprofissionais , Farmacêuticos/organização & administração , Médicos/organização & administração , Atenção Primária à Saúde/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Humanos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos
12.
Med Care ; 57(8): 648-653, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31299026

RESUMO

OBJECTIVE: The objective of this study was to evaluate the impacts of the implementation of patient cost-sharing for an outpatient visit and prescription drugs for poor and nonable bodied Koreans in 2007. DATA SOURCES/STUDY SETTINGS: Nationally-representative longitudinal data sets (Korea Welfare Panel Study and the Korean Longitudinal Study of Ageing) in 2006, 2008, and 2010. RESEARCH DESIGN: Propensity score matching with difference-in-differences framework exploiting within-person variation in cost-sharing. RESULTS: Decreases in the probability of outpatient visit are offset by increases in the likelihood of hospitalization after the policy change. Cost-sharing also decreases drug adherence by 20%, particularly among chronically-ill persons. CONCLUSION: Because the costs of increased hospitalization among Medical Aid enrollees accrue to the government, the introduction of outpatient cost-sharing does not achieve the goal of cost control.


Assuntos
Assistência Ambulatorial/economia , Custo Compartilhado de Seguro , Pobreza , Idoso , Assistência Ambulatorial/organização & administração , Controle de Custos/economia , Controle de Custos/métodos , Controle de Custos/organização & administração , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/métodos , Custos de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Pontuação de Propensão , República da Coreia
13.
BMC Musculoskelet Disord ; 20(1): 324, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299929

RESUMO

BACKGROUND: Osteoarthritis is the most common form of arthritis, principally affecting the older population. Highly prevalent, disabling diseases such as osteoarthritis strain the capacity of health systems, and can result in unmet need for services. The Joint Clinic was initiated to provide secondary care consultations and access to outpatient services for people with advanced hip or knee osteoarthritis, who were referred by their general practitioner for orthopaedic consultation but not offered an orthopaedic specialist appointment. METHODS: This longitudinal programme evaluation comprised four components: a proof-of-concept evaluation; an implementation evaluation; a process evaluation; and an outcomes evaluation. Interviews and surveys of general practitioners, staff, and patients were conducted pre- and post-implementation. Interviews were transcribed, and thematic analysis was completed. In addition, Joint Clinic patient visits and outcomes were reviewed. RESULTS: One hundred and eleven primary care physicians (GPs) and 66 patients were surveyed, and 28 semi-structured interviews of hospital staff and GPs were conducted. Proof of concept was satisfied. Interim and final implementation evaluations indicated adherence to the concept model, high levels of acceptance of and confidence in the programme and its staff, and timely completion within budget. Process evaluation revealed positive impacts of the programme and positive stakeholder perceptions, with some weaknesses in communication to the outer context of primary care. The Joint Clinic saw a total of 637 patient visits during 2 years of operation. Unmet need was reduced by 90%. Patient and referring physician satisfaction was high. Hospital management confirmed that the programme will continue. CONCLUSIONS: This evaluation indicates that the Joint Clinic concept model is fit for purpose, functioned well within the organisation, and achieved its primary objective of reducing unmet need of secondary care consultation for those suffering advanced hip or knee osteoarthritis.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida
14.
Cien Saude Colet ; 24(6): 2043-2052, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269163

RESUMO

The integration among levels of care is a continuous challenge even in consolidated and high performance health systems. The reform of public health system of Distrito Federal, based on the strengthening of primary health care associated to the reconfiguration of specialized attention (ambulatory and hospital) and of its of urgency and emergence network brought, as a challenge, the need for integration between these levels. Thus, became necessary to create an instrumentto perform the role of gatekeeper, leading to equanimous, transparent and safe access to specialized and hospital care. Thus, the Regulatory Complex in Health of Distrito Federal (CRDF) and its Regulatory Centers (CR) were created to carry out the regulatory process of access to care services, such as hospitalization, ambulatory care (procedures and specialized consultations), elective surgeries, complex procedures, sanitary transport, urgencies and transplants of patients of the Federal District and outside it. This article describes the process of the CRDF implementation and its CRs, aiming to reflect on the potential and challenges of its role as an instrument of integration among the levels of care.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Reforma dos Serviços de Saúde , Acesso aos Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Assistência Ambulatorial/organização & administração , Brasil , Hospitalização , Humanos , Saúde Pública
15.
Cien Saude Colet ; 24(6): 2115-2124, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269170

RESUMO

This article reports on the experience of implementing Health Care Planning (HCP) in the territories of Itapoã, Paranoá and São Sebastião in the East Region of Brazil's Federal District. HCP began at the end of 2016 with Itapoã and was expanded to the other territories in 2018. The results point to a better organised health care network, specifically as regards care for chronic conditions, hypertension and diabetes. The activities involved a series of thematic theory workshops and tutoring workshops carried out in Primary Health Care (PHC) and Specialised Ambulatory Care (SAC) facilities. In PHC, macro-processes (territorialisation, family registration, risk stratification, family risk classification, local diagnosis, care by block of hours, elimination of waiting times, and others) were organised to support meeting certain of the population's demands. In SAC, an Ambulatory Specialities Clinic was set up using the technology of continuous care provided by a multi-professional team to high- and very high-risk hypertensive and diabetic patients stratified in PHC, and care provision is shared. One of the strong points in the integration of PHC and SAC was matrix support provided by SAC professionals in "laboratory units". HCP has been an important management tool for organising health care in the East Region.


Assuntos
Assistência Ambulatorial/organização & administração , Assistência à Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Brasil , Doença Crônica , Diabetes Mellitus/terapia , Humanos , Hipertensão/terapia , Equipe de Assistência ao Paciente/organização & administração
16.
Cien Saude Colet ; 24(6): 2125-2134, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269171

RESUMO

Secondary Outpatient Care (SOC) is a subject seldom studied in the literature, but of great importance for the strengthening of Primary Health Care (PHC) and the structuring of the Health Care Network. After the increase of PHC coverage following the Family Health Strategy (FHS) model, through the "CONVERTE APS" project, the State Health Secretariat of the Federal District (SHS-DF) identified the need to organize this level of care throughout the Federal District. SHS-DF has, as its Health Care Planning basis, the knowledge experienced in one of its regions, in addition to the theoretical framework produced and systematized by the National Council of Health Secretariats (CONASS) in recent years, as well as successful experiences in other regions of Brazil and countries with public health systems. The strategies to be used include the following: diagnosis and organization of facility structures, creation of a regional managerial level for Secondary Care, personnel sizing, development of the legal framework for level of care regulation, creation of technical milestones, regulation of medical and non-medical consultations in health regions and matrix support as an education strategy, but also of connection between levels of care.


Assuntos
Assistência Ambulatorial/organização & administração , Saúde da Família , Atenção Primária à Saúde/organização & administração , Atenção Secundária à Saúde/organização & administração , Brasil , Humanos , Programas Nacionais de Saúde/organização & administração , Saúde Pública , Especialização
18.
Rev Esc Enferm USP ; 53: e03456, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166536

RESUMO

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.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias/tratamento farmacológico , Recursos Humanos de Enfermagem no Hospital/organização & administração , Carga de Trabalho , Adulto , Assistência Ambulatorial/organização & administração , Feminino , Humanos , Masculino , Assistentes de Enfermagem/organização & administração , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Tempo
19.
N Z Med J ; 132(1496): 31-38, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170131

RESUMO

AIMS: Outpatient endoscopy non-attendance leads to diagnostic delay and increasing wait times. We aimed to analyse endoscopy non-attendance rates and factors associated with it at the Canterbury and Auckland District Health Boards during a five-year period. METHODS: Consecutive appointments between April 2012 and March 2017 were assessed. The following procedures were included: gastroscopy, colonoscopy and endoscopic retrograde cholangiopancreatography. Predictors of non-attendance were assessed using univariate and multivariate binary logistic regression. RESULTS: A total of 58,434 appointments were offered (Canterbury-33,697, Auckland-24,737), of which 2,694 (4.6%) were not attended. Maori (OR 3.0, 95%CI 2.63-3.42) and Pacific Peoples (OR 3.1, 95%CI 2.7-3.55) were significantly more likely to miss appointments compared with Europeans. Patients from socioeconomically most deprived areas (NZDep10) had higher rates of non-attendance (OR 2.13, 95%CI 1.72-2.63) compared with NZDep1. Males (OR 1.43, 95%CI 1.32-1.56) and the Auckland District Health Board patients (OR 2.28, 95%CI 2.08-2.50) had higher non-attendance rates. CONCLUSION: Overall, 4.6% patients did not attend endoscopy appointments. Maori, Pacific Peoples and patients from socioeconomically deprived areas had higher non-attendance rates. Targeted interventions for at-risk groups would potentially lessen health inequalities and optimise utilisation of endoscopy resources.


Assuntos
Agendamento de Consultas , Diagnóstico Tardio/estatística & dados numéricos , Endoscopia do Sistema Digestório/métodos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Assistência Ambulatorial/organização & administração , Análise de Variância , Endoscopia do Sistema Digestório/estatística & dados numéricos , Grupos Étnicos , Feminino , Hospitais Públicos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nova Zelândia , Pacientes Ambulatoriais/estatística & dados numéricos , Sistemas de Alerta , Estudos Retrospectivos , Medição de Risco , Fatores Socioeconômicos
20.
G Ital Med Lav Ergon ; 41(2): 132-139, 2019 05.
Artigo em Italiano | MEDLINE | ID: mdl-31170343

RESUMO

SUMMARY: The Complex Ambulatory Macroactivity (MAC, Macroattività Ambulatoriale Complessa) has recently been included among the therapeutic and diagnostic Specialized Rehabilitation services issued by the Lombardy Region health institutes. Within Maugeri Scientific Clinical Institutes, our Occupational Physiatrics and Ergonomics Service is actively involved in the organic redefinition of rehabilitative pathways in the light of functional and patient-centered interpretation, typical of ICF (International Classification of Functioning). The article describes the assumptions, criteria and procedures that support the MAC system, proposing a modeling that can be inserted into the modern and complex system of health services.


Assuntos
Assistência Ambulatorial/organização & administração , Terapia Ocupacional/organização & administração , Reabilitação/organização & administração , Humanos , Classificação Internacional de Doenças , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Modelos Organizacionais
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