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1.
Drug Discov Ther ; 14(4): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32908070

RESUMO

The COVID-19 infection has been a matter of urgency to tackle around the world today, there exist 200 countries around the world and 54 countries in Africa that the COVID-19 infection cases have been confirmed. This situation prompted us to look into the challenges African laboratories are facing in the diagnosis of novel COVID-19 infection. A limited supply of essential laboratory equipment and test kits are some of the challenges faced in combatting the novel virus in Africa. Also, there is inadequate skilled personnel, which might pose a significant danger in case there is a surge in COVID-19 infection cases. The choice of diagnostic method in Africa is limited as there are only two available diagnostic methods being used out of the six methods used globally, thereby reducing the opportunity of supplementary diagnosis, which will further lead to inappropriate diagnosis and affect the accuracy of diagnostic reports. Furthermore, challenges like inadequate power supply, the method used in sample collection, storage and transportation of specimens are also significant as they also pose their respective implication. From the observations, there is an urgent need for more investment into the laboratories for proper, timely, and accurate diagnosis of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Virologia/organização & administração , Betacoronavirus/patogenicidade , Orçamentos , Técnicas de Laboratório Clínico/economia , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Nigéria/epidemiologia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Carga Viral , Virologia/economia , Fluxo de Trabalho
2.
Lancet Glob Health ; 8(11): e1372-e1379, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32918872

RESUMO

BACKGROUND: Since WHO declared the COVID-19 pandemic a Public Health Emergency of International Concern, more than 20 million cases have been reported, as of Aug 24, 2020. This study aimed to identify what the additional health-care costs of a strategic preparedness and response plan (SPRP) would be if current transmission levels are maintained in a status quo scenario, or under scenarios where transmission is increased or decreased by 50%. METHODS: The number of COVID-19 cases was projected for 73 low-income and middle-income countries for each of the three scenarios for both 4-week and 12-week timeframes, starting from June 26, 2020. An input-based approach was used to estimate the additional health-care costs associated with human resources, commodities, and capital inputs that would be accrued in implementing the SPRP. FINDINGS: The total cost estimate for the COVID-19 response in the status quo scenario was US$52·45 billion over 4 weeks, at $8·60 per capita. For the decreased or increased transmission scenarios, the totals were $33·08 billion and $61·92 billion, respectively. Costs would triple under the status quo and increased transmission scenarios at 12 weeks. The costs of the decreased transmission scenario over 12 weeks was equivalent to the cost of the status quo scenario at 4 weeks. By percentage of the overall cost, case management (54%), maintaining essential services (21%), rapid response and case investigation (14%), and infection prevention and control (9%) were the main cost drivers. INTERPRETATION: The sizeable costs of a COVID-19 response in the health sector will escalate, particularly if transmission increases. Instituting early and comprehensive measures to limit the further spread of the virus will conserve resources and sustain the response. FUNDING: WHO, and UK Foreign Commonwealth and Development Office.


Assuntos
Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Previsões , Humanos , Modelos Teóricos , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia
3.
Nat Med ; 26(7): 1005-1008, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32528155
4.
PLoS One ; 15(6): e0233635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542043

RESUMO

INTRODUCTION: Accompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country's goal of Universal Health Coverage by 2030. METHODS: This descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed. RESULTS: Significant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet. CONCLUSIONS: Study results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.


Assuntos
Doença Crônica/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Serviços Urbanos de Saúde/organização & administração , População Urbana/estatística & dados numéricos , Adulto , Bangladesh , Estudos Transversais , Feminino , Geografia , Gastos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/estatística & dados numéricos , Urbanização
5.
Transplantation ; 104(7): 1305-1307, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568998
6.
J Rehabil Med ; 52(6): jrm00073, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32516421

RESUMO

OBJECTIVE: The COVID-19 pandemic has caused significant motor, cognitive, psychological, neurological and cardiological disabilities in many infected patients. Functional rehabilitation of infectious COVID-19 patients has been implemented in the acute care wards and in appropriate, ad hoc, multidisciplinary COVID-19 rehabilitation units. However, because COVID-19 rehabilitation units are a clinical novelty, clinical and organizational benchmarks are not yet available. The aim of this study is to describe the organizational needs and operational costs of such a unit, by comparing its activity, organization, and costs with 2 other functional rehabilitation units, in San Raffaele Hospital, Milan, Italy. METHODS: The 2-month activity of the COVID-19 Rehabilitation Unit at San Raffaele Hospital, Milan, Italy, which was created in response to the emergency need for rehabilitation of COVID-19 patients, was compared with the previous year's activity of the Cardiac Rehabilitation and Motor Rehabilitation Units of the same institute. RESULTS: The COVID-19 Rehabilitation Unit had the same number of care beds as the other units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs. DISCUSSION: The COVID-19 Rehabilitation Unit was twice as expensive as the 2 other units studied. World health systems are organizing to respond to the pandemic by expanding capacity in acute intensive care and sub-intensive care units. This study shows that COVID-19 rehabilitation units must be organized and equiped according to the clinical and rehabilitative needs of patients, following specific measures to prevent the spread of infection amongs patients and workers.


Assuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/reabilitação , Necessidades e Demandas de Serviços de Saúde/economia , Unidades Hospitalares/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/reabilitação , Reabilitação/economia , Betacoronavirus , Infecções por Coronavirus/virologia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Unidades Hospitalares/organização & administração , Humanos , Itália , Pneumonia Viral/virologia , Reabilitação/organização & administração
7.
AAPS PharmSciTech ; 21(5): 153, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: covidwho-343702

RESUMO

The supply of affordable, high-quality pharmaceuticals to US patients has been on a critical path for decades. In and beyond the COVID-19 pandemic, this critical path has become tortuous. To regain reliability, reshoring of the pharmaceutical supply chain to the USA is now a vital national security need. Reshoring the pharmaceutical supply with old know-how and outdated technologies that cause inherent unpredictability and adverse environmental impact will neither provide the security we seek nor will it be competitive and affordable. The challenge at hand is complex akin to redesigning systems, including corporate and public research and development, manufacturing, regulatory, and education ones. The US academic community must be engaged in progressing solutions needed to counter emergencies in the COVID-19 pandemic and in building new methods to reshore the pharmaceutical supply chain beyond the pandemic.


Assuntos
Antivirais/provisão & distribução , Betacoronavirus/efeitos dos fármacos , Defesa Civil/organização & administração , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Pandemias , Pneumonia Viral/terapia , Vacinas Virais/provisão & distribução , Antivirais/economia , Betacoronavirus/patogenicidade , Defesa Civil/economia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Custos de Medicamentos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Determinação de Necessidades de Cuidados de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estados Unidos , Vacinas Virais/economia
8.
J Vasc Surg ; 72(4): 1161-1165, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32360683

RESUMO

The appropriate focus in managing the COVID-19 pandemic in the United States has been addressing access and delivery of care to the population affected by the outbreak. All sectors of the U.S. economy have been significantly affected, including physicians. Physician groups of all specialties and sizes have experienced the financial effects of the pandemic. Hospitals have received billions of dollars to support and enable them to manage emergencies and cover the costs of the disruption. However, many vascular surgeons are under great financial pressure because of the postponement of all nonemergency procedures. The federal government has announced a myriad of programs in the form of grants and loans to reimburse physicians for some of their expenses and loss of revenue. It is more than likely that unless the public health emergency subsides significantly, many practices will experience dire consequences without additional financial assistance. We have attempted to provide a concise listing of such programs and resources available to assist vascular surgeons who are small businesses in accessing these opportunities.


Assuntos
Agendamento de Consultas , Compensação e Reparação , Infecções por Coronavirus/economia , Procedimentos Cirúrgicos Eletivos/economia , Renda , Reembolso de Seguro de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Cirurgiões/economia , Procedimentos Cirúrgicos Vasculares/economia , Compensação e Reparação/legislação & jurisprudência , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Cirúrgicos Eletivos/legislação & jurisprudência , Financiamento Governamental/economia , Financiamento Governamental/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Formulação de Políticas , Cirurgiões/legislação & jurisprudência , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência
9.
AAPS PharmSciTech ; 21(5): 153, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32449007

RESUMO

The supply of affordable, high-quality pharmaceuticals to US patients has been on a critical path for decades. In and beyond the COVID-19 pandemic, this critical path has become tortuous. To regain reliability, reshoring of the pharmaceutical supply chain to the USA is now a vital national security need. Reshoring the pharmaceutical supply with old know-how and outdated technologies that cause inherent unpredictability and adverse environmental impact will neither provide the security we seek nor will it be competitive and affordable. The challenge at hand is complex akin to redesigning systems, including corporate and public research and development, manufacturing, regulatory, and education ones. The US academic community must be engaged in progressing solutions needed to counter emergencies in the COVID-19 pandemic and in building new methods to reshore the pharmaceutical supply chain beyond the pandemic.


Assuntos
Antivirais/provisão & distribução , Betacoronavirus/efeitos dos fármacos , Defesa Civil/organização & administração , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Pandemias , Pneumonia Viral/terapia , Vacinas Virais/provisão & distribução , Antivirais/economia , Betacoronavirus/patogenicidade , Defesa Civil/economia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Custos de Medicamentos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Determinação de Necessidades de Cuidados de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estados Unidos , Vacinas Virais/economia
10.
Phys Ther ; 100(9): 1502-1515, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32386221

RESUMO

OBJECTIVE: Factors predicting physical therapy utilization for lower back pain (LBP) remain unclear, limiting the development of value-based initiatives. The purpose of this study was to identify important factors that impact the number of physical therapist visits per episode of care for US adults with nonspecific LBP. METHODS: This study was a retrospective observational cohort study of a clinical dataset derived from 80 clinics of a single physical therapy provider organization. Research variables were categorized at the individual (patient) level and the organization (therapist, clinic) level. A hierarchical regression model was designed to identify factors influencing the number of physical therapist visits per episode of care. RESULTS: Higher out-of-pocket payments per visit, receipt of "active" physical therapy, longer average visit length, earlier use of physical therapy, and sex of the therapist (male) were found to predict fewer visits per episode of care. Percent change of function, prior receipt of physical therapy by the same provider organization, self-discharge from physical therapy, level of starting function, and therapist certification were found to predict more visits. Of the variance in number of visits, 8.0% was attributable to the health care organization. CONCLUSIONS: Individual factors, such as higher out-of-pocket payment, have a significant impact on reducing visits per episode of care and should be considered when developing value-based initiatives to optimize clinical and utilization outcomes. IMPACT: Payers use consumer-directed healthcare to reduce costs by discouraging utilization of low value services and encouraging use of low-cost providers. LBP is a costly condition for which physical therapy is a high-value treatment. This study shows that non-need factors predict the number of physical therapy visits per episode of care for patients with nonspecific LBP. Insurance benefit plans with lower out-of-pocket payments for physical therapy and higher reimbursement for active physical therapist interventions may facilitate appropriate utilization of high-value treatment for LBP.


Assuntos
Cuidado Periódico , Gastos em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Dor Lombar/reabilitação , Modalidades de Fisioterapia/estatística & dados numéricos , Adulto , Feminino , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Modalidades de Fisioterapia/economia , Análise de Regressão , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
12.
Vascular ; 28(5): 520-529, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32379584

RESUMO

OBJECTIVE: Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. METHODS: We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. RESULTS: Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14-1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17-1.34). Propensity-scored matched analyses confirmed these results. CONCLUSION: Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.


Assuntos
Efeitos Psicossociais da Doença , Pé Diabético/terapia , Custos Hospitalares , Pacientes Internados , Admissão do Paciente/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Pé Diabético/mortalidade , Feminino , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos
13.
Radiology ; 296(3): E141-E144, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32293225

RESUMO

The coronavirus 2019 (COVID-19) pandemic will have a profound impact on radiology practices across the country. Policy measures adopted to slow the transmission of disease are decreasing the demand for imaging independent of COVID-19. Hospital preparations to expand crisis capacity are further diminishing the amount of appropriate medical imaging that can be safely performed. Although economic recessions generally tend to result in decreased health care expenditures, radiology groups have never experienced an economic shock that is simultaneously exacerbated by the need to restrict the availability of imaging. Outpatient-heavy practices will feel the biggest impact of these changes, but all imaging volumes will decrease. Anecdotal experience suggests that radiology practices should anticipate 50%-70% decreases in imaging volume that will last a minimum of 3-4 months, depending on the location of practice and the severity of the COVID-19 pandemic in each region. The Coronavirus Aid, Relief, and Economic Security, or CARES, Act provides multiple means of direct and indirect aid to health care providers and small businesses. The final allocation of this funding is not yet clear, and it is likely that additional congressional action will be necessary to stabilize health care markets. Administrators and practice leaders must be proactive with practice modifications and financial maneuvers that can position them to emerge from this pandemic in the most viable economic position. It is possible that this crisis will have lasting effects on the structure of the radiology field.


Assuntos
Infecções por Coronavirus , Necessidades e Demandas de Serviços de Saúde , Pandemias , Pneumonia Viral , Radiografia , Radiologia , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Radiografia/economia , Radiografia/estatística & dados numéricos , Radiologia/economia , Radiologia/organização & administração
14.
Value Health ; 23(3): 277-286, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197720

RESUMO

The allocation of healthcare resources among competing priorities requires an assessment of the expected costs and health effects of investing resources in the activities and of the opportunity cost of the expenditure. To date, much effort has been devoted to assessing the expected costs and health effects, but there remains an important need to also reflect the consequences of uncertainty in resource allocation decisions and the value of further research to reduce uncertainty. Decision making with uncertainty may turn out to be suboptimal, resulting in health loss. Consequently, there may be value in reducing uncertainty, through the collection of new evidence, to better inform resource decisions. This value can be quantified using value of information (VOI) analysis. This report from the ISPOR VOI Task Force describes methods for computing 4 VOI measures: the expected value of perfect information, expected value of partial perfect information (EVPPI), expected value of sample information (EVSI), and expected net benefit of sampling (ENBS). Several methods exist for computing EVPPI and EVSI, and this report provides guidance on selecting the most appropriate method based on the features of the decision problem. The report provides a number of recommendations for good practice when planning, undertaking, or reviewing VOI analyses. The software needed to compute VOI is discussed, and areas for future research are highlighted.


Assuntos
Técnicas de Apoio para a Decisão , Custos de Cuidados de Saúde , Alocação de Recursos para a Atenção à Saúde/economia , Prioridades em Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Modelos Estatísticos , Determinação de Necessidades de Cuidados de Saúde/economia , Avaliação da Tecnologia Biomédica/economia , Consenso , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Prioridades em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Probabilidade , Avaliação da Tecnologia Biomédica/estatística & dados numéricos , Incerteza
15.
Value Health ; 23(3): 335-342, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197729

RESUMO

OBJECTIVES: Studies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population. METHODS: A study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status. RESULTS: A total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital's case mix significantly increased the probability that the hospital would be in deficit by 2.6%. CONCLUSIONS: Reforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.


Assuntos
Alocação de Recursos para a Atenção à Saúde/economia , Preços Hospitalares , Custos Hospitalares , Hospitalização/economia , Maternidades/economia , Complicações na Gravidez/economia , Complicações na Gravidez/terapia , Classe Social , Orçamentos , Bases de Dados Factuais , Feminino , França , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Recém-Nascido , Tempo de Internação/economia , Masculino , Modelos Econômicos , Determinação de Necessidades de Cuidados de Saúde/economia , Admissão do Paciente/economia , Alta do Paciente/economia , Gravidez , Complicações na Gravidez/diagnóstico , Estudos Retrospectivos , Fatores de Tempo
16.
PLoS One ; 15(2): e0229081, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069323

RESUMO

BACKGROUND AND OBJECTIVES: Myanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation. METHODS: Mixed methods design involving a quantitative component (retrospective study analysing both aggregate and individual patient data from PEN project records; cross-sectional facility survey using a structured checklist) and a descriptive qualitative component. RESULTS: A total of 152,446 individuals were screened between May 2017-December 2018 comprising of current smokers (17.5%), tobacco chewers (26.3%), Body Mass Index ≥25 kg/m2 (30.6%), raised blood pressure i.e. ≥ 140/90 mmHg (35.2%) and raised blood sugar i.e. Random Blood Sugar >200 mg/dl, Fasting Blood Sugar >126 mg/dl (17.1%). Nearly 14.8% of those screened had Cardiovascular Disease (CVD) risk score ≥20%, 34.6% had CVD risk not recorded. Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, CVD risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively. Health facility assessment showed 64% of the sanctioned posts were filled; 90% of those appointed been trained in PEN; key essential medicines for PEN were available in half of the facilities surveyed. Confidence of the health care staff in managing common NCD and perceived benefits of the project were some of the strengths. CONCLUSION: High loss to follow up, poor recording of CVD risk score, lack of essential medicines and equipments were the key challenges identified that need to be addressed before further expansion of PEN project to other townships.


Assuntos
Implementação de Plano de Saúde/organização & administração , Promoção da Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Programas de Rastreamento/organização & administração , Doenças não Transmissíveis/prevenção & controle , Adulto , Estudos Transversais , Medicamentos Essenciais/uso terapêutico , Estudos de Viabilidade , Feminino , Seguimentos , Implementação de Plano de Saúde/economia , Promoção da Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Mianmar/epidemiologia , Doenças não Transmissíveis/economia , Doenças não Transmissíveis/epidemiologia , Educação de Pacientes como Assunto , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estudos Retrospectivos , Fatores de Risco
18.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31888959

RESUMO

CONTEXT: Integrated care models may improve health care for children and young people (CYP) with ongoing conditions. OBJECTIVE: To assess the effects of integrated care on child health, health service use, health care quality, school absenteeism, and costs for CYP with ongoing conditions. DATA SOURCES: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018). STUDY SELECTION: Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome. DATA EXTRACTION: Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care. RESULTS: Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44; P = .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37; P = .57). LIMITATIONS: Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist. CONCLUSIONS: Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.


Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde da Criança , Prestação Integrada de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Qualidade da Assistência à Saúde , Absenteísmo , Adolescente , Serviços de Saúde do Adolescente/economia , Serviços de Saúde do Adolescente/normas , Serviços de Saúde do Adolescente/estatística & dados numéricos , Asma/terapia , Criança , Saúde da Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/normas , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Intervalos de Confiança , Redução de Custos , Análise Custo-Benefício , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
Einstein (Sao Paulo) ; 18: eGS5129, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939526

RESUMO

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


Assuntos
Acesso aos Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Brasil , Cidades , Custos de Cuidados de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Fatores Socioeconômicos
20.
J Surg Res ; 246: 93-99, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562991

RESUMO

BACKGROUND: Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS: A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS: For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS: Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.


Assuntos
Efeitos Psicossociais da Doença , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Doenças do Recém-Nascido/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Pediátricos/economia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/economia , Doenças do Recém-Nascido/epidemiologia , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Operatórios/economia , Taxa de Sobrevida , Uganda/epidemiologia
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