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Am J Manag Care ; 26(12): 502-504, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33315324


The scale of the coronavirus disease 2019 pandemic and its disproportionate impact on vulnerable populations has spurred unprecedented focus on and investment in social determinants of health (SDOH). Although the greater focus on social determinants is laudable and necessary, there is a tendency for health care organizations to implement SDOH programs at scale without rigorous evidence of effect, rather than targeting interventions to specific patients and assessing their impact. This broad, and sometimes blind, application of SDOH interventions can be costly and wasteful. We argue for rejecting the "more is better" mindset and specifically targeting patients who truly need and would substantially benefit from SDOH interventions. Matching interventions to the most appropriate patients involves screening for social needs, developing rigorous evidence of effect, and accompanying policy reform.

/epidemiologia , Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Determinantes Sociais da Saúde/tendências , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/normas , Assistência Integral à Saúde/organização & administração , Política de Saúde , Promoção da Saúde/economia , Promoção da Saúde/normas , Disparidades nos Níveis de Saúde , Humanos
Nutr. hosp ; 37(5): 926-932, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198007


ANTECEDENTES: los adultos mayores presentan enfermedades que pueden repercutir en sus parámetros funcionales, psicológicos y sociales. La Valoración Geriátrica integral (VGI) se utiliza como herramienta de evaluación de estos parámetros a través del uso de instrumentos validados, sencillos y de fácil aplicación. OBJETIVO: determinar el estado de salud de los adultos mayores en un área urbano-marginal de Guayaquil (Ecuador) mediante la VGI, como primer paso para poder establecer un plan de cuidados coordinado en las áreas estudiadas. MATERIAL Y MÉTODOS: estudio transversal de 196 sujetos mayores de 65 años que acuden a un centro de salud comunitario de atención primaria en Guayaquil y a los que se les ha realizado una VGI. RESULTADOS: los participantes tenían una edad media de 70,9 ± 7,1 años. Variables demográficas: el 73 % eran afroecuatorianos, el 69 % tenían instrucción básica y el 57 % no realizaban ninguna actividad física. Evaluación clínica: el 47,4 % presentaban dificultad de visión, el 52 % riesgo nutricional y el 6 % desnutrición. Valoración social: el 13 % tenían deterioro social severo; el 40 % presentaban algún deterioro cognitivo y el 8,2 % tenían depresión; el 46,9 % eran funcionalmente dependientes y el 16,8 % presentaban dinapenia. CONCLUSIONES: la VGI permite identificar los principales problemas de salud de esta población, por lo que se considera una herramienta práctica y fácil de aplicar en los centros de atención primaria de las poblaciones urbano-marginales, como primer paso para mejorar el estado de salud de esta población mayor que en los últimos años está creciendo de forma importante en los países en vías de desarrollo tales como Ecuador

BACKGROUND: older adults suffer from diseases that can affect their functional, psychological and social parameters. The Comprehensive Geriatric Assessment (CGA) is used as an evaluation tool for these parameters through the use of validated, simple and easy-to-apply instruments. OBJECTIVE: to report the health status of older adults who attend a primary care center in an urban-marginal area of Guayaquil (Ecuador) through CGA, as a first step in order to establish a coordinated care plan in the areas studied. MATERIAL AND METHODS: a cross-sectional assessment of 196 aged subjects with a median age of 70.9 years (83 % females) who attended a Primary Care Community Health Center in Guayaquil. Nutritional, social, demographic, functional, and cognitive variables were assessed. RESULTS: participants had a mean age of 70.9 ± 7.1 years. Demographic variables: 73 % were Afro-Ecuadorian, 69 % had basic education, and 57 % performed no physical activity. Clinical assessment: 47.4 % presented with vision impairment, and 37.8 % with hearing problems; 52 % had nutritional risk and 6 % malnutrition. Social valuation: 13 % had severe social deterioration; 40 % had some cognitive impairment, and 8.2 % had depression; 46.9 % were functionally dependent, and 16.8 % had dynapenia. CONCLUSIONS: CGA allows to identify major health problems in this population, which is why it is considered a practical and easy tool to apply in primary care centers in marginal urban populations as a first step to improve health status for this older population, which in recent years is growing significantly in developing countries such as Ecuador

Humanos , Idoso , Assistência Integral à Saúde/organização & administração , Nível de Saúde , Atenção Primária à Saúde , Exercício Físico , Avaliação da Deficiência , Serviços de Saúde para Idosos , Equador/epidemiologia , Estudos Transversais , Serviços de Saúde Comunitária , Inquéritos e Questionários , Atividade Motora
J Stroke Cerebrovasc Dis ; 29(9): 105068, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807471


BACKGROUND AND PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). METHODS: We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). RESULTS: A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 - 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.

Betacoronavirus/patogenicidade , Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Pneumonia Viral/terapia , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Procedimentos Clínicos/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento , Fluxo de Trabalho
J Am Med Dir Assoc ; 21(7): 954-957, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674827


The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.

Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Cuidados Semi-Intensivos/organização & administração , Centros de Atenção Terciária/organização & administração , Idoso , Infecções por Coronavirus/prevenção & controle , Feminino , Geriatria/métodos , Humanos , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Espanha , População Urbana
J Thromb Thrombolysis ; 50(3): 596-603, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32661758


The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to - 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI - 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.

Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Recuperação de Função Fisiológica , Encaminhamento e Consulta/organização & administração , Singapura/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento , Fluxo de Trabalho
Washington; Organización Panamericana de la Salud; jul. 15, 2020. 15 p.
Não convencional em Espanhol | LILACS | ID: biblio-1103391


Ante el incremento de casos y defunciones por COVID-19 en comunidades indígenas en las Américas, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) insta a los Estados Miembros a redoblar esfuerzos para prevenir el avance de la infección en dichas comunidades, así como también para asegurar el acceso a los servicios de atención de salud y fortalecer el manejo adecuado de casos con enfoque intercultural. Al mismo tiempo, la OPS/OMS urge a implementar medidas preventivas para reducir la mortalidad asociada a la COVID-19 en todos los niveles del sistema de salud.

Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Assistência Integral à Saúde/organização & administração , Grupos Populacionais , Pandemias/estatística & dados numéricos , Betacoronavirus , Serviços de Saúde do Indígena/organização & administração , América/epidemiologia
Genebra; World Health Organization; June 1, 2020. 61 p.
Não convencional em Inglês | Coleciona SUS | ID: biblio-1140272


Health systems around the world are being challenged by increasing demand for care of people with COVID-19, compounded by fear, stigma, misinformation and limitations on movement that disrupt the delivery of health care for all conditions. When health systems are overwhelmed and people fail to access needed care, both direct mortality from an outbreak and indirect mortality from preventable and treatable conditions increase dramatically (1, 2, 3). Maintaining population trust in the capacity of the health system to safely meet essential needs and to control infection risk in health facilities is key to ensuring appropriate care-seeking behaviour and adherence to public health advice. Any system's ability to maintain the delivery of essential health services will depend on its baseline burden of disease, the local COVID-19 transmission scenario (classified as no cases, sporadic, clusters or community transmission) and the health system capacity as the pandemic evolves (4). Recent investments in primary health care for universal health coverage provide a critical foundation for adapting to the pandemic context. A well organized and prepared health system has the capacity to maintain equitable access to high-quality essential health services throughout an emergency, limiting direct mortality and avoiding indirect mortality. In the early phases of the COVID-19 outbreak, many health systems have been able to maintain routine service delivery in addition to managing a relatively limited COVID-19 case-load. As demands on systems have surged and health workers themselves have increasingly been affected by COVID-19 infection and the indirect consequences of the pandemic, strategic adaptations have become urgent to ensure that limited public and private sector resources provide the maximum benefit for populations. Countries are making difficult decisions to balance the demands of responding directly to the COVID-19 pandemic with the need to maintain the delivery of other essential health services. Establishing safe and effective patient flow (including screening for COVID-19, triage and targeted referral) remains critical at all levels. Many routine and elective services have been suspended, and existing delivery approaches are being adapted to the evolving pandemic context as the risk­benefit analysis for any given activity changes. When the delivery of essential health services comes under threat, effective governance and coordination mechanisms, and protocols for service prioritisation and adaptation, can mitigate the risk of outright system failure. As the outbreak is brought under control and restrictive public health measures are gradually eased, some adaptations in service delivery may need to be reversed, others continued for a limited time, and yet others that are found to be effective, safe and beneficial can be incorporated into routine post-pandemic practice. The course of the outbreak is likely to wax and wane, and the strategic response will need to be dynamic and calibrated. Decision-makers should anticipate the need to start, stop and restart adaptations. Decisions should be aligned with relevant national and subnational policies and should be re-evaluated at regular intervals. Successful implementation of these strategic shifts will require the active engagement of communities and public and private stakeholders, specific measures to ensure access for socially vulnerable populations, transparency and frequent communication with the public and a high degree of cooperation from individuals.

Humanos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/epidemiologia , Sistemas de Saúde/organização & administração , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/epidemiologia , Assistência Integral à Saúde/organização & administração , Pandemias/prevenção & controle , Monitoramento Epidemiológico , Controle de Doenças Transmissíveis/organização & administração , Doenças não Transmissíveis/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Transtornos Mentais/prevenção & controle
Rev. esp. cardiol. Supl. (Ed. impresa) ; 20(supl.C): 3-12, jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197033


La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva

Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination

Humanos , Equipe de Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Insuficiência Cardíaca/reabilitação , Reabilitação Cardíaca/métodos , Terapia por Exercício/métodos , Consenso , Alta do Paciente/normas , Atenção Primária à Saúde/organização & administração , Assistência Integral à Saúde/organização & administração , Tolerância ao Exercício , Cuidados de Enfermagem/organização & administração
J Cardiovasc Transl Res ; 13(3): 495-505, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32444945


The burgeoning field of cardio-oncology (C-O) is now necessary for the delivery of excellent care for patients with cancer. Many factors have contributed to this increasing population of cancer survivors or those being treated with novel and targeted cancer therapies. There is a tremendous need to provide outstanding cardiovascular (CV) care for these patients; however, current medical literature actually provides a paucity of guidance. C-O therefore provides a novel opportunity for clinical, translational, and basic research to advance patient care. This review aims to be a primer for cardio-oncologists on how to develop a vibrant and comprehensive C-O program, use practical tools to assist in the construction of C-O services, and to proactively incorporate translational and clinical research into the training of future leaders as well as enhance clinical care.

Antineoplásicos/efeitos adversos , Sobreviventes de Câncer , Cardiologia/organização & administração , Assistência Integral à Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Cardiopatias/diagnóstico por imagem , Oncologia/organização & administração , Neoplasias/tratamento farmacológico , Técnicas de Imagem Cardíaca , Cardiotoxicidade , Cardiopatias/induzido quimicamente , Humanos , Valor Preditivo dos Testes , Prognóstico , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Medição de Risco , Fatores de Risco
Rev Infirm ; 69(258): 37-39, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32327060


Caring for people with chronic pain is complex and multifaceted. At the Rothschild Hospital in Paris, the multi-professional team of the pain assessment and treatment service includes a music therapist. On medical orientation and according to the typology of the source pathology, this professional opens to the patients spaces of musical relaxation and awareness that a better well-being is possible.

Dor Crônica/terapia , Assistência Integral à Saúde/organização & administração , Musicoterapia , Humanos , Paris
Acta Diabetol ; 57(9): 1049-1056, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32248347


AIMS: The past 3 decades witnessed the rapid growth of diabetes in China. To better serve large numbers of patients, the Chinese Medical Doctor Association launched metabolic management center (MMC) program which is featured with a one-stop and comprehensive diabetes management mode in 2016. It is worth exploring whether MMC model is better than conventional models in management. METHODS: In this study, 228 patients with type 2 diabetes were recruited, and 193 patients completed the study. Therapeutic effects and health care costs were analyzed. RESULTS AND CONCLUSIONS: Our results showed that decreases in HbA1C and TG/HDL-C values were significantly greater in the MMC group than in the control group. The increase in HDL-C was significantly higher in the MMC group than in the control group. The percentage of patients whose HbA1C lower than 7% was significantly higher in the MMC group. The results of the UKPDS model simulation showed that within 30 years, with the slight increases in treatment costs, the average life expectancy and total QALE of the MMC group are higher than those of the control group by 0.61 and 0.51 year, respectively. Further study showed that the drug intervention in the MMC group was significantly stronger. In addition, the questionnaires revealed that MMC group performed better in diabetes knowledge tests and have higher patient satisfaction rates of medical services. More patients in the MMC group adopted a more favorable diet strategy. These advantages enable MMC to achieve more short-term and long-term benefits in diabetes treatment than conventional mode.

Assistência Integral à Saúde , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/terapia , Autogestão , Padrão de Cuidado , China/epidemiologia , Assistência Integral à Saúde/métodos , Assistência Integral à Saúde/organização & administração , Assistência Integral à Saúde/normas , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Autogestão/economia , Autogestão/métodos , Autogestão/psicologia , Padrão de Cuidado/economia , Padrão de Cuidado/organização & administração , Padrão de Cuidado/normas , Inquéritos e Questionários
Rev. Soc. Esp. Dolor ; 27(2): 97-103, mar.-abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195851


INTRODUCCIÓN: En diciembre de 2014, en el contexto del Plan de Atención del Dolor Crónico del SERGAS, se aplicó la primera experiencia de teleconsultas en unidades de dolor (UD). Se escogió la Estructura Organizativa de Gestión Integrada (EOXI) de Vigo para su aplicación. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo longitudinal retrospectivo de todas las teleconsultas enviadas a la UD en el periodo comprendido entre el 1 de enero de 2015 hasta el 31 de diciembre de 2018. RESULTADOS: Entre enero de 2015 y diciembre de 2018 se han solicitado un total de 2218 teleconsultas. Fueron realizadas desde 42 centros de salud de un total de 42 del EOXI. De las 2218 teleconsultas recibidas, el 49 % fueron preferentes. Respecto a la capacidad de resolución, el 26 % (586) de los pacientes son dados de alta de forma telemática y el 74 % (1632) son citados en la UD. Los tiempos de respuesta medios para el periodo de tiempo estudiado fueron: 21 días para las teleconsultas preferentes y de 22 para las ordinarias. CONCLUSIONES: La teleconsulta contribuye a que se conozca y mejore la coordinación entre diferentes niveles asistenciales, evitando derivaciones innecesarias a consulta presencial, mejorando la accesibilidad del paciente y descongestionando los servicios hospitalarios. Pone de manifiesto la importancia de unos protocolos consensuados de remisión y la necesidad de actualizar la información sobre la cartera de servicios. Permite detectar defectos de comunicación entre Atención Primaria y UD. Permite poner en marcha acciones correctoras

INTRODUCTION: On 2014 the Galician Health Service (SERGAS)starts the first teleconsult experience applied to pain unit, and the Sanitary Area of Vigo was chosen for its pilot implementation. MATERIAL AND METHODS: A retrospective longitudinal descriptive study was undertaken during the lapse time January 2015 to December 2018. RESULTS: In the period of study a total of 2218 teleconsults were requested from the 42 primare care centers of the Sanitary Area.49% of the teleconsults were preferent.26% (586) of the requests were rejected and 74% (1632) were evaluated at the Pain Unit. The mean time for response were: 21 days for preferents and 22 for non-preferents. CONCLUSIONS: Teleconsult allows an improvement in the relationship between specialized and primary care levels. Remarks the importance on consensuated protocols for patient referal. Remarks the need of an updated and well documented portfolio of services. It allows to correct errors of information transmission between assistance levels and implement correction actions

Humanos , Telemedicina/organização & administração , Manejo da Dor/métodos , Consulta Remota/organização & administração , Modelos Organizacionais , Assistência Integral à Saúde/organização & administração , Estratégias de eSaúde , Estudos Retrospectivos
Rev Infirm ; 69(257): 20-22, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32146958


The follow-up of a patient with cystic fibrosis requires specific skills. The implementation of a comprehensive management approach gives convincing results in terms of survivability and quality of life. This is why the Cystic Fibrosis Resource and Competence Centres (CRCMs) bring together multidisciplinary teams in which nurse coordinators play a key role with patients, relatives and other healthcare professionals.

Assistência Integral à Saúde/organização & administração , Fibrose Cística/terapia , Criança , Humanos , Equipe de Assistência ao Paciente/organização & administração
Pharm. pract. (Granada, Internet) ; 18(1): 0-0, ene.-mar. 2020.
Artigo em Inglês | IBECS | ID: ibc-195715


The interrelationship between governmental policies and objectives in primary health care and community pharmacy/pharmacists' strategic plans are of the outmost importance, having significant professional, economic and practical consequences for the future of the pharmacy profession, research, education and health care. Sharing information of the potential and real impact on current and future practice of community pharmacy/pharmacists, be it in product or service, in primary care would benefit many stakeholders. In order to create and focus professional and scientific debate the journal has commissioned key experts to contribute a series of country case studies. The aim of the series is to promulgate and disseminate country-based information on primary health care and community pharmacy/pharmacist

No disponible

Humanos , Atenção Primária à Saúde/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Assistência Integral à Saúde/organização & administração , Política Nacional de Assistência Farmacêutica , Política de Saúde , Estratégias Nacionais
Rev Saude Publica ; 54: 06, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31967275


OBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.

Assistência Integral à Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Brasil , Estudos de Coortes , Assistência Integral à Saúde/organização & administração , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Atenção Primária à Saúde/organização & administração