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1.
Rev Lat Am Enfermagem ; 27: e3217, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31826159

RESUMO

OBJECTIVE: to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety. METHODS: cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio. RESULTS: the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04). CONCLUSION: polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.


Assuntos
Doença Crônica/tratamento farmacológico , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil , Doença Crônica/classificação , Comorbidade , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
2.
Acta Med Port ; 32(7-8): 488-498, 2019 Aug 01.
Artigo em Português | MEDLINE | ID: mdl-31445528

RESUMO

INTRODUCTION: Due to epidemiological change, interest in complex chronic conditions has been increasing within the pediatric health system. As such, we aim to evaluate hospital inpatient care in the National Health Service (mainland Portugal) by pediatric patients (0 - 17 years) with complex chronic conditions. MATERIAL AND METHODS: Observational longitudinal retrospective epidemiological study using anonymized administrative data. We selected hospitalizations within the pediatric age limit, 2011 - 2015; healthy newborns and radiotherapy outpatients were excluded. A descriptive analysis of the admissions with complex chronic conditions was analysed by number of complex chronic conditions categories and by complex chronic conditions categories. Non-parametric tests were applied to length of stay, expense, and mortality. RESULTS: Out of 419 927 admissions, 64 918 (15.5%) contained at least one complex chronic conditions code. These admissions due to complex chronic conditions represented 29.8% of hospital days, 39.4% of expense and 87.2% of deaths. Compared to those without complex chronic conditions, expense was double (median €1467 vs €745) and mortality 40 times higher (2.4% vs 0.06%). Of these, 46% were planned (no complex chronic conditions 23.2%); 64.8% occurred in group III - IV hospitals (no complex chronic conditions 27.1%). Malignant was the most frequent category (23.0%); neonatal had the highest median length of stay (12 days, 6 - 41), median expense (€3568,929 - 24 602), and number of deaths (43.5% of total). DISCUSSION: As in other developed countries where the number of pediatric admissions is decreasing, in mainland Portugal we found an increase in the proportion of complex chronic conditions admissions, which are longer, costlier and deadlier (trends intensified in the presence of two or more complex chronic conditions categories). CONCLUSION: Complex chronic conditions are relevant in the activity and costs regarding pediatric hospitalizations in mainland Portugal. Recognizing this and integrating pediatric palliative care from the moment of diagnosis are essential to promote appropriate hospital use, through the development of effective and sustainable alternatives that meet the needs of children, families, and healthcare professionals.


Assuntos
Doença Crônica/epidemiologia , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Doença Crônica/classificação , Doença Crônica/economia , Doença Crônica/mortalidade , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitais/classificação , Humanos , Lactente , Recém-Nascido , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Cuidados Paliativos , Portugal/epidemiologia , Estudos Retrospectivos , Medicina Estatal/economia , Medicina Estatal/estatística & dados numéricos , Estatísticas não Paramétricas
4.
Cad Saude Publica ; 35(4): e00230518, 2019 05 02.
Artigo em Português | MEDLINE | ID: mdl-31066781

RESUMO

This study aimed to estimate the prevalence of influenza vaccination in elderly Brazilians with specific chronic diseases. The sample included individuals 60 years or older (n = 23,815) participating in the National Health Survey (PNS) in 2013. The study estimated the prevalence rates for influenza vaccination and the respective 95% confidence intervals (95%CI). The associations were verified with the chi-square test (Rao-Scott) with 5% significance. Prevalence of influenza vaccination in the elderly was 73.1% (95%CI: 72.0-74.1), and there was no significant difference in prevalence rates between men and women (p = 0.237). Statistically significant differences were observed in prevalence rates for elderly that reported arterial hypertension, 75% (p < 0.001), diabetes mellitus, 76.5% (p = 0.009), cardiac disease, 79.2% (p < 0.001), and lung disease or chronic obstructive pulmonary disease (COPD), 87% (p = 0.001). The results showed low prevalence of vaccination in elderly with some specific chronic diseases for whom there is formal recommendation to receive the vaccine, suggesting the need for a vaccination campaign to extrapolate the age cutoff (elderly) and better targeting to these specific subgroups.


Assuntos
Doença Crônica/prevenção & controle , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Brasil/epidemiologia , Doença Crônica/classificação , Doença Crônica/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência
5.
Rev Saude Publica ; 53: 26, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30942268

RESUMO

OBJECTIVE: To determine Vulnerable Elders Survey (VES-13) and WHOQOL-bref cutoff points to detect poor quality of life (QoL) in older individuals. METHODS: This is a cross-sectional study, performed in all primary health care units in Samambaia, DF, Brazil. The data were collected from August 2016 to May 2017. The sample size of 466 older individuals treated in primary health care was obtained considering a 5% margin of error, 95% confidence level, 50% prevalence, and 20% possible losses, in a population of 13,259 older individuals. The subjects answered the VES-13 and WHOQOL-bref questionnaires. They were divided into 3 subgroups: poorQoL (older individuals with self-reported very poor or poor QoL AND very dissatisfied or dissatisfied with their health), goodQoL (very good or good QoL AND very satisfied or satisfied with Health) and indeterminateQoL (NOT belonging to poorQoL or goodQoL subgroups). A receiver-operating characteristic (ROC) curve was performed with poorQoL (case) versus goodQoL (control) to determine the cutoff score in VES-13 and WHOQOL-bref. A diagnostic test using these cutoffs was carried out in all older individuals (n = 466). RESULTS: The VES-13 and WHOQOL-bref cutoff points to detect poorQoL were ≥ 2 and < 60, respectively. The area under ROC curve of VES-13 and WHOQOL-bref was 0.741 (CI95% 0.659-0.823; p < 0.001) and 0.934 (CI95% 0.881-0.987; p < 0.001), respectively. In diagnostic tests, VES-13 showed 84% sensitivity and 98.2% negative predictive value, and WHOQOL-bref, 88% sensitivity and 99% negative predictive value. CONCLUSIONS: VES-13 score ≥ 2 and WHOQOL-bref score < 60 adequately detected poorQoL in patients treated in primary health care. Our data suggest that older individuals with these scores require special treatment such as geriatrics collaborative care to improve this scenario, considering QoL impact on mortality.


Assuntos
Qualidade de Vida/psicologia , Inquéritos e Questionários , Triagem/métodos , Idoso , Brasil , Doença Crônica/classificação , Doença Crônica/psicologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Psicometria , Curva ROC , Sensibilidade e Especificidade , Fatores Socioeconômicos , Organização Mundial da Saúde
6.
Rev Bras Epidemiol ; 22: e190030, 2019 Apr 01.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30942336

RESUMO

OBJECTIVE: Objective: To analyze the mortality trends for Chronic Noncommunicable Diseases (NCDs) in the period 2000-2013 and its probability of death until 2025. METHOD: time series analysis of mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory disease, with correction for ill-defined causes and underreporting of deaths and calculation of probability of death. RESULTS: There was an average decline of 2.5% per year in all four major NCDs in Brazil. There was a decline in all regions and federal units. The reduced likelihood of death by 30% in 2000 to 26.1% in 2013 and expected decline to 20.5% in 2025. CONCLUSION: From the trend of reduction is expected to reach Brazil reducing overall goal 25% by 2025.


Assuntos
Doença Crônica/mortalidade , Mortalidade Prematura/tendências , Doenças não Transmissíveis/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Doença Crônica/classificação , Estudos Epidemiológicos , Feminino , Carga Global da Doença , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Rev Bras Epidemiol ; 22: e190023, 2019 Mar 21.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30916145

RESUMO

INTRODUCTION: Regular physical activity (PA) generates several health benefits. This study aimed to analyze the predictors of moderate PA (MPA) and vigorous PA (VPA) separately, as well as some health outcomes related to each intensity. METHOD: A population-based, cross-sectional study, with adults and the elderly in the urban area of the city of Rio Grande, RS, Brazil. PA was collected through the leisure section of the International Physical Activity Questionnaire (IPAQ). The cutoff points used for MPA and VPA were, respectively, 150min/wk and 75min/wk. The health conditions analyzed were: obesity, stress, hypertension, diabetes, depression and self-perception of health. RESULTS: A total of 1,290 individuals participated in the study, with a mean age of 46.0 years (SD = 17.3); 14.3% (95%CI 11.7 - 16.8) were classified as active for MPA, and 14.6% (95%CI 12.1 - 17.1) for VPA. Male gender, higher schooling, more favorable perception of the neighborhood and more hours of sleep were associated with higher prevalence of MPA. Males, aged 20 to 39 years, white skin color, absence of smoking, higher schooling and higher index of assets were associated with higher prevalence of VPA. Regarding health outcomes, MPA conferred protection for stress, while VPA was a protective factor for obesity, hypertension, and diabetes. CONCLUSIONS: It was observed that both the predictors and the health outcomes differed according to the intensity of the PA.


Assuntos
Doença Crônica , Exercício , Atividade Motora , Adolescente , Adulto , Fatores Etários , Brasil , Doença Crônica/classificação , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , População Urbana , Adulto Jovem
8.
Theor Med Bioeth ; 40(1): 1-19, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30826976

RESUMO

Jerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construe harmful in his harmful dysfunction analysis (HDA). Recently, Neil Feit has argued that classic puzzles involved in analyzing harm render Wakefield's HDA better off without harm as a necessary condition. Whether or not one conceives of harm as comparative or non-comparative, the concern is that the HDA forces people to classify as mere dysfunction what they know to be a disorder. For instance, one can conceive of cases where simultaneous disorders prevent each other from being, in any traditional sense, actually harmful; in such cases, according to the HDA, neither would be a disorder. I argue that the sense of harm that Wakefield should employ in the HDA is dispositional, similar to the sense of harm used when describing a vile of poison: "Be careful! That's poison. It's harmful." I call this harm in the damage sense. Using this sense of harm enables the HDA to avoid Feit's arguments, and thus it should be preferred to other senses when analyzing harmful dysfunction.


Assuntos
Doença Crônica/classificação , Doença Crônica/psicologia , Humanos , Teoria Psicológica
9.
Gac. sanit. (Barc., Ed. impr.) ; 33(1): 60-65, ene.-feb. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183628

RESUMO

Objetivo: Comparar la concordancia de los pesos de complejidad entre los estratificadores Clinical Risk Groups (CRG) y los grupos de morbilidad ajustada (GMA), determinar cuál de ellos es el mejor predictor de ingreso hospitalario y optimizar el método para seleccionar el 0,5% de pacientes de más alta complejidad que se incluirán en un protocolo de intervención. Método: Estudio analítico transversal en 18 zonas de salud de Canarias, con una población a estudio de 385.049 personas, usando variables sociodemográficas procedentes de la tarjeta sanitaria, los diagnósticos y el uso de los recursos asistenciales obtenidos de la historia electrónica de salud de atención primaria (HSAP) y del conjunto mínimo básico de datos hospitalario, el estado funcional registrado en la HSAP y los fármacos prescritos en el sistema de receta electrónica. A partir de esos datos se estimó la concordancia entre estratificadores, se evaluó la capacidad de cada estratificador para predecir ingresos y se construyeron modelos para optimizar la predicción. Resultados: La concordancia entre los pesos de complejidad de los estratificadores fue fuerte (rho = 0,735) y la concordancia entre categorías de complejidad fue moderada (Kappa ponderado = 0,515). El peso de complejidad GMA predice el ingreso hospitalario mejor que el del CRG (área bajo la curva [AUC]: 0,696 [0,695-0,697] vs. 0,692 [0,691-0,693]). Se añadieron otras variables predictivas al peso GMA, obteniendo la mejor AUC (0,708 [0,707-0,708]) el modelo compuesto por GMA, sexo, edad, escalas de Pfeiffer y Barthel, existencia de reingreso y número de grupos terapéuticos prescritos. Conclusiones: Se constató una fuerte concordancia entre estratificadores y una mayor capacidad predictiva de los ingresos por parte de los GMA, que puede aumentarse añadiendo otras dimensiones


Objective: To compare the concordance of complexity weights between Clinical Risk Groups (CRG) and Adjusted Morbidity Groups (AMG). To determine which one is the best predictor of patient admission. To optimise the method used to select the 0.5% of patients of higher complexity that will be included in an intervention protocol. Method: Cross-sectional analytical study in 18 Canary Island health areas, 385,049 citizens were enrolled, using sociodemographic variables from health cards; diagnoses and use of healthcare resources obtained from primary health care electronic records (PCHR) and the basic minimum set of hospital data; the functional status recorded in the PCHR, and the drugs prescribed through the electronic prescription system. The correlation between stratifiers was estimated from these data. The ability of each stratifier to predict patient admissions was evaluated and prediction optimisation models were constructed. Results: Concordance between weights complexity stratifiers was strong (rho = 0.735) and the correlation between categories of complexity was moderate (weighted kappa = 0.515). AMG complexity weight predicts better patient admission than CRG (AUC: 0.696 [0.695-0.697] versus 0.692 [0.691-0.693]). Other predictive variables were added to the AMG weight, obtaining the best AUC (0.708 [0.707-0.708]) the model composed by AMG, sex, age, Pfeiffer and Barthel scales, re-admissions and number of prescribed therapeutic groups. Conclusions: strong concordance was found between stratifiers, and higher predictive capacity for admission from AMG, which can be increased by adding other dimensions


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Seleção de Pacientes , Alocação de Recursos para a Atenção à Saúde/métodos , Risco Ajustado/métodos , Doença Crônica/classificação , Estudos Transversais , Índice de Gravidade de Doença , Hospitalização/estatística & dados numéricos , Admissão do Paciente/normas
10.
Braz. J. Pharm. Sci. (Online) ; 55: e18341, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039058

RESUMO

The adherence to therapy associated with the socio-demographic variables and the habits of patients with hypertension and/or diabetes mellitus were investigated in this study. The registration forms of 105 patients in the Hiperdia program in the municipality of Campina Grande-PB were used as a data collection instrument, applying the Morisky-Green test (MGT) and Batalla test (BT) to assess compliance treatment. For the MGT, there was a prevalence of non-adherent individuals (76.2%) and the type of predominant behavior was unintentional. The internal consistency of the responses obtained through the MGT presented good reliability, according to the value of 0.69 obtained by Cronbach's alpha. For the BT, there was a predominance of adherence (68.6%) and the alpha value was 0.80, showing a high reliability level. It was found that a diet lacking in salt is a strong impact variable for determining the adherence to the BT. Given the representativity of the tests, there is a need to amend the interferences that facilitate the low adherence to drug treatment. The results of this study can be used to construct strategies that will address these difficulties and optimize the adherence level and quality of life of patients.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus/tratamento farmacológico , Cooperação e Adesão ao Tratamento , Hipertensão/tratamento farmacológico , Conscientização/classificação , Doença Crônica/classificação , Avaliação de Resultados da Assistência ao Paciente
11.
AMA J Ethics ; 20(12): E1195-1200, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30585584

RESUMO

Addressing the question of how medicine should engage with people who consider their clinical disease condition to be importantly constitutive of their identity, this article focuses on one group-advocates for the fat acceptance (FA) or body positivity movement in American society. Drawing on philosophical analysis, I try to show that FA and physician communities represent different traditions within the larger culture and that whether obesity should be considered a disease is a culture battle. I argue that diseases (medical) and illnesses (cultural) are 2 different designations of clinical symptoms and that both disease and illness designations can change over time or be uncertain.


Assuntos
Doença Crônica/classificação , Características Culturais , Doença/classificação , Obesidade/classificação , Obesidade/psicologia , Terminologia como Assunto , Humanos , Estados Unidos
12.
J Wound Care ; 27(11): 790-796, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30398932

RESUMO

OBJECTIVE: Wound assessment is an essential part of wound management and has traditionally focused on the wound bed. The Triangle of Wound Assessment (Triangle) is a new assessment tool that includes a holistic evaluation of the patient with a wound. The aim of this pilot study was to describe the use of the Triangle in our clinical practice in Spain. METHODS: Prospective, consecutive patients, male and female, over 18 years old, with wounds of any aetiology and duration, who attended the centres involved in the study, were recruited between May and June 2017. The TWA was used during the first presentation, to assess the wound bed, edge and periwound skin. The study's expert panel met to discuss the results collected by the assessment, as well as the advantages and disadvantages of the system. RESULTS: We recruited 90 patients. Non-viable tissue (necrotic/sloughy) was recorded in 57.8% of the patients, elevated exudate (medium/high) in 52.2%. Approximately 25% of the patients had signs or symptoms of local infection. Maceration was the most prevalent issue recorded on the wound edge and periwound skin assessment, affecting 31.1% and 30.0% of the patients, respectively. The presence of hyperkeratosis was high for the study population as the main aeitologies of the wounds identified here were DFU. CONCLUSIONS: The implementation of Triangle Wound Assessment could help in the holistic approach to patient care by focusing on more than local wound care, identifying barriers to achieving wound healing and evaluating wound response and patient compliance.


Assuntos
Doença Crônica/classificação , Técnicas e Procedimentos Diagnósticos/normas , Guias de Prática Clínica como Assunto , Ferimentos e Lesões/classificação , Ferimentos e Lesões/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
13.
BMJ Open ; 8(6): e020874, 2018 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-29961016

RESUMO

OBJECTIVES: Sickness absence has been used as a central indicator of work disability, but has mainly been examined in single diseases, with limited follow-up time. This study identified the risk of long-term sickness absence (LTSA) of 32 chronic disease groups in the first year after diagnosis and the subsequent years. SETTING: We identified chronic disease groups prevalent in the work force (26 physical and 6 mental conditions) requiring all levels of care (primary, secondary, tertiary), by national registers of diagnoses from all hospital visits and prescribed medicine in Denmark from 1994 to 2011. PARTICIPANTS: A general population sample within the working age range (18-59 years) was drawn by Statistics Denmark. Participants not working before and during the follow-up period were excluded. A total of 102 746 participants were included. PRIMARY AND SECONDARY OUTCOME MEASURES: HRs of transitions from work to LTSA of each of the chronic conditions were estimated in Cox proportional hazards models for repeated events-distinguishing between risk within the first (<1 year) and subsequent years of diagnosis (≥1 year) and an HR ratio (HRR): HR ≥1 year divided by HR <1 year. RESULTS: Almost all the conditions were associated with significantly increased risks of LTSA over time. The risks were generally more increased in men than in women. Three main patterns of LTSA were identified across diseases: strong decreases of LTSA from the first to subsequent years (eg, stroke in men <1 year: HR=7.55, 95% CI 6.45 to 8.85; ≥1 year HR=1.43, 95% CI 1.20 to 1.74; HRR=0.23). Moderate or small decreases in LTSA (HRR between 0.46 and 0.76). No changes (HRR between 0.92 and 0.95) or increases in elevated risks of LTSA over time (HRR between 1.02 and 1.16). CONCLUSIONS: The 32 chronic diseases were associated with three different risk patterns of LTSA over time. These patterns implicate different strategies for managing work disability over time.


Assuntos
Doença Crônica/epidemiologia , Licença Médica/estatística & dados numéricos , Adulto , Distribuição por Idade , Doença Crônica/classificação , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores de Risco , Distribuição por Sexo , Licença Médica/tendências , Adulto Jovem
14.
Pflege ; 31(5): 237-244, 2018.
Artigo em Alemão | MEDLINE | ID: mdl-29860915

RESUMO

Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. BACKGROUND: Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. AIM: We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. METHODS: In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. RESULTS: The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. CONCLUSIONS: Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.


Assuntos
Doença Aguda/enfermagem , Doença Crônica/enfermagem , Competência Clínica , Hospitais Gerais , Cuidados de Enfermagem/métodos , Diagnóstico de Enfermagem/métodos , Recursos Humanos de Enfermagem no Hospital , Doença Aguda/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/classificação , Comunicação , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Clínicas , Relações Enfermeiro-Paciente , Prognóstico , Incerteza
16.
Adv Ther ; 35(5): 671-685, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29725982

RESUMO

INTRODUCTION: Patients with mental and physical health conditions are complex to treat and often use multiple medications. It is unclear how adherence to one medication predicts adherence to others. A predictive relationship could permit less expensive adherence monitoring if overall adherence could be predicted through tracking a single medication. METHODS: To test this hypothesis, we examined whether patients with multiple mental and physical illnesses have similar adherence trajectories across medications. Specifically, we conducted a retrospective cohort analysis using health insurance claims data for enrollees who were diagnosed with a serious mental illness, initiated an atypical antipsychotic, as well as an SSRI (to treat serious mental illness), biguanides (to treat type 2 diabetes), or an ACE inhibitor (to treat hypertension). Using group-based trajectory modeling, we estimated adherence patterns based on monthly estimates of the proportion of days covered with each medication. We measured the predictive value of the atypical antipsychotic trajectories to adherence predictions based on patient characteristics and assessed their relative strength with the R-squared goodness of fit metric. RESULTS: Within our sample of 431,591 patients, four trajectory groups were observed: non-adherent, gradual discontinuation, stop-start, and adherent. The accuracy of atypical antipsychotic adherence for predicting adherence to ACE inhibitors, biguanides, and SSRIs was 44.5, 44.5, and 49.6%, respectively (all p < 0.001 vs. random). We also found that information on patient adherence patterns to atypical antipsychotics was a better predictor of patient adherence to these three medications than would be the case using patient demographic and clinical characteristics alone. CONCLUSION: Among patients with multiple chronic mental and physical illnesses, patterns of atypical antipsychotic adherence were useful predictors of adherence patterns to a patient's adherence to ACE inhibitors, biguanides, and SSRIs. FUNDING: Otsuka Pharmaceutical Development & Commercialization, Inc.


Assuntos
Anti-Hipertensivos/uso terapêutico , Antipsicóticos/uso terapêutico , Doença Crônica , Adesão à Medicação/estatística & dados numéricos , Transtornos Mentais , Adulto , Doença Crônica/classificação , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Doença Crônica/terapia , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Transtornos Mentais/classificação , Transtornos Mentais/epidemiologia , Transtornos Mentais/fisiopatologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Estados Unidos/epidemiologia
19.
Eur J Intern Med ; 54: 13-16, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29514743

RESUMO

BACKGROUND: The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). METHODS: All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. RESULTS: A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. CONCLUSIONS: ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity.


Assuntos
Doença Crônica/classificação , Doença Crônica/epidemiologia , Grupos Diagnósticos Relacionados , Custos de Cuidados de Saúde/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica/economia , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Sistema de Registros , Risco Ajustado , Distribuição por Sexo , Adulto Jovem
20.
BMJ Open ; 8(2): e018292, 2018 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-29431619

RESUMO

OBJECTIVES: To investigate the prevalence of multimorbidity in adults with intellectual disabilities with and without Down syndrome. DESIGN: Large, population-based cross-sectional study. SETTING: The geographical area of one Health Board, Scotland. PARTICIPANTS: All adults (aged 16+ years) known to general practitioners to have intellectual disabilities and adults receiving services provided or paid by intellectual disabilities health or social work services. 1023/1562 potential participants took part (65.5%); 562 (54.9%) men and 461 (45.1%) women, aged 43.9 years (16-83 years). 186 had Down syndrome and 837 did not. MAIN OUTCOME MEASURES: The prevalence of International Statistical Classification of Diseases, 10th revision, physical health conditions and multimorbidity detected at a comprehensive health assessment. RESULTS: The mean number of physical health conditions/participant was 11.04, and 98.7% had multimorbidity. The most prevalent conditions are painful and/or disabling and, in some cases, life threatening. The five most prevalent were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differs from that seen in the general population and is spread across the entire adult life course. The extent of multimorbidity in the adults with Down syndrome was similar to that of the adults without Down syndrome, while the prevalence of individual conditions differed. CONCLUSIONS: This robustly designed study with a large population found an extremely high prevalence of multimorbidity in adults with intellectual disabilities across the entire adult life course. This increases complexity of medical management that secondary healthcare services and medical education are not yet geared towards, as these tend to focus on single conditions. This is in addition to complexity due to limitations in communication and understanding. As the physical conditions within their multimorbidity also differ from that seen in the older general population, urgent attention is needed to develop the care pathways and guidelines that are required to inform and so improve their healthcare.


Assuntos
Doença Crônica/epidemiologia , Síndrome de Down/epidemiologia , Nível de Saúde , Deficiência Intelectual/epidemiologia , Multimorbidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/classificação , Estudos Transversais , Feminino , Humanos , Deficiência Intelectual/classificação , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Escócia , Índice de Gravidade de Doença , Adulto Jovem
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