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1.
; OPAS.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46939

RESUMO

Os Objetivos de Desenvolvimento Sustentável (ODS) foram fixados em 2015 pela Organização das Nações Unidas como um plano de ação para as pessoas, para o planeta e para a prosperidade. Trata-se de uma agenda de ação até 2030, com 17 Objetivos e 169 metas construídas sobre o legado dos Objetivos de Desenvolvimento do Milênio (ODM).


Assuntos
Desenvolvimento Sustentável , Planejamento em Saúde , Promoção da Saúde
2.
Lancet Psychiatry ; 7(1): 78-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31474568

RESUMO

Integration of services into primary health care for people with common mental disorders is considered a key strategy to improve access to mental health care in low-income and middle-income countries, yet services at the primary care level are largely unavailable. We did a systematic review to understand the barriers and facilitators in the implementation of mental health programmes. We searched five databases and included studies published between Jan 1, 1990, and Sept 1, 2017, that used qualitative methods to assess the implementation of programmes for adults with common mental disorders at primary health-care settings in low-income and middle-income countries. The Critical Appraisal Skills Programme Qualitative Checklist was used to assess the quality of eligible papers. We used the so-called best fit framework approach to synthesise findings according to the Consolidated Framework for Implementation Research. We identified 24 papers for inclusion. These papers described the implementation of nine programmes in 11 countries. Key factors included: the extent to which an organisation is ready for implementation; the attributes, knowledge, and beliefs of providers; complex service user needs; adaptability and perceived advantage of interventions; and the processes of planning and evaluating the implementation. Evidence on implementation of mental health programmes in low-income and middle-income countries is scarce. Synthesising results according to the Consolidated Framework for Implementation Research helped to identify key areas for future action, including investment in primary health-care strengthening, capacity building for health providers, and increased support to address the social needs of service users.


Assuntos
Prestação Integrada de Cuidados de Saúde , Planejamento em Saúde , Transtornos Mentais , Serviços de Saúde Mental , Atenção Primária à Saúde , Adulto , Países em Desenvolvimento , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Pobreza
3.
Rev. Esc. Enferm. USP ; 53: e03509, Jan.-Dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020390

RESUMO

RESUMO Objetivo Analisar o resultado do desempenho dos Núcleos Ampliados de Saúde da Família do estado de São Paulo, na dimensão Organização do Processo de Trabalho, na Avaliação do PMAQ-AB, segundo o Índice Paulista de Responsabilidade Social. Método Estudo transversal, descritivo, exploratório, com abordagem quantitativa, baseado nos dados do 2º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Foram analisadas por frequência simples 149 equipes, de 47 municípios, distribuídas em cinco agrupamentos, de acordo com o Índice Paulista de Responsabilidade Social. Resultados As equipes do agrupamento quatro (municípios com baixa riqueza e indicadores sociais intermediários) alcançaram desempenho satisfatório e muito satisfatório (90,9%). As equipes dos municípios do agrupamento dois (alto índice de riqueza e indicadores sociais insatisfatórios) tiveram pior desempenho; as equipes do município de São Paulo obtiveram o maior percentual de desempenho satisfatório e muito satisfatório (95,8%). Conclusão As equipes do município de São Paulo (alto índice de riqueza e indicadores sociais insatisfatórios) e as equipes dos municípios do agrupamento quatro (baixa riqueza e indicadores sociais intermediários) foram as que alcançaram melhor desempenho.


RESUMEN Objetivo Analizar el resultado del desempeño de los Núcleos Ampliados de Salud de la Familia del Estado de São Paulo, en la dimensión Organización del Proceso de Trabajo, en la Evaluación del PMAQ-AB, según el Índice Paulista de Responsabilidad Social. Método Estudio transversal, descriptivo, exploratorio, con abordaje cuantitativo, basado en los datos del 2º ciclo del Programa Nacional de Mejoría del Acceso y la Calidad de la Atención Básica. Fueron analizadas por frecuencia simple 149 equipos, de 47 municipios, distribuidas en cinco agrupaciones, según el Índice Paulista de Responsabilidad Social. Resultados Los equipos de la agrupación cuatro (municipios con baja riqueza e indicadores sociales intermedios) alcanzaron desempeño satisfactorio y muy satisfactorio (90,9%). Los equipos de los municipios de la agrupación dos (alto índice de riqueza e indicadores sociales insatisfactorios) tuvieron peor desempeño; los equipos del municipio de São Paulo obtuvieron el mayor porcentual de desempeño satisfactorio y muy satisfactorio (95,8%). Conclusión Los equipos del municipio de São Paulo (alto índice de riqueza e indicadores sociales insatisfactorios) y los equipos de los municipios de la agrupación cuatro (baja riqueza e indicadores sociales intermedios) fueron las que alcanzaron mejor desempeño.


ABSTRACT Objective To analyze the performance of the Expanded Family Health Centers in the state of São Paulo in the Work Process Organization dimension in evaluating the PMAQ-AB , according to the Paulista Social Responsibility Index. A cross-sectional, descriptive, exploratory study with a quantitative approach based on data from the 2ndcycle of the National Program for Improving Access and Quality in Primary Care ( PMAQ-AB ). There were 149 teams from 47 municipalities distributed in five groups analyzed by simple frequency, according to the Paulista Social Responsibility Index. The teams from group four (municipalities of low wealth and intermediate social indicators) achieved satisfactory and very satisfactory performance (90.9%). The teams from the group two municipalities (high wealth index and unsatisfactory social indicators) had worse performance; the teams from the municipality of São Paulo obtained the highest percentage of satisfactory and very satisfactory performance (95.8%). Conclusion The teams from the municipality of São Paulo (high wealth index and unsatisfactory social indicators) and the teams from the municipalities of group four (low wealth and intermediate social indicators) were those that achieved better performance.


Assuntos
Qualidade da Assistência à Saúde , Enfermagem de Atenção Primária , Planejamento em Saúde , Equipe de Assistência ao Paciente , Avaliação em Saúde , Estudos Transversais , Administração em Saúde
4.
Metas enferm ; 22(9): 5-14, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185037

RESUMO

Objetivo: identificar y conocer las políticas alimentarias elaboradas por las comunidades y ciudades autónomas en el territorio español. Método: se realizó una investigación documental. La población de estudio fueron las políticas alimentarias de las comunidades autónomas (CC.AA.), Ceuta y Melilla. Se incluyeron planes de salud y programas nutricionales (integrales o infanto-juveniles) publicados en las páginas web de las administraciones públicas regionales (periodo 2006-2018). Se efectuaron diferentes estrategias de búsqueda para identificar los planes y programas procedentes de administraciones públicas a través de las URL descritas. Se elaboró un checklist ad hoc en función del instrumento TREND para valorar la presencia de seis ítems: objetivos, población, descripción de acciones, método, evaluación de las acciones y difusión de los resultados. Resultados: se obtuvieron 38 planes y programas relacionados con las políticas alimentarias, correspondientes a las 17 CC.AA. y a la ciudad autónoma de Ceuta. El 47,4% (n= 18) fueron planes de salud, uno por CC.AA., incluida Ceuta; el 36,8% (n= 14) fueron programas nutricionales integrales y el 15,8% (n= 6) se trataba de programas de obesidad infanto-juvenil. Todos cumplían los cuatro primeros criterios valorados. Sin embargo, no estaban presentes los criterios cinco y seis en algunos programas. Conclusión: todas las CC.AA. tenían plan de salud y también la ciudad autónoma de Ceuta. Andalucía es la región que más políticas ha desarrollado para afrontar la obesidad como problema de salud. País Vasco, Aragón, Canarias, Castilla-La Mancha, Cataluña y Galicia también han elaborado varios programas para tratar este problema. El abordaje de la alimentación saludable y la obesidad en España es heterogéneo en el ámbito regional


Objective: to identify and understand the food policies conducted by the autonomous communities and cities in the Spanish territory. Method: a documentary research was conducted. The study population was the food policies by the autonomous communities (AACC), Ceuta and Melilla; it included the healthcare plans and nutrition programs (comprehensive or child and youth) published in the websites of regional authorities (period 2006-2018). Different search strategies were used to identify the plans and programs from public authorities through the URLs described. An ad hoc checklist was created based on the TREND tool to assess the presence of six items: objectives, population, description of actions, method, evaluation of actions, and dissemination of results. Results: thirty-eight (38) plans and programs associated with food policies were retrieved, corresponding to the 17 AACCs and the autonomous city of Ceuta; 47.4% (n=18) of these were healthcare plans, one per AACC, including Ceuta; 36.8% (n= 14) were comprehensive nutrition programs, and 15.8% (n= 6) were programs on child-youth obesity. All of them met the first four criteria assessed; however, criteria five and six were not present in some programs. Conclusion: all AACCs have healthcare plans, as well as the autonomous city of Ceuta. Andalusia is the region that has developed more policies to address obesity as a health problem. The Basque Country, Aragon, the Canary Islands, Castille-La Mancha, Catalonia and Galicia have also prepared some programs to deal with this problem. In Spain, healthy eating and obesity are addressed heterogeneously in the regional setting


Assuntos
Humanos , Dieta Saudável , Política Nutricional , Obesidade/prevenção & controle , Promoção da Saúde/organização & administração , Pesquisa Participativa Baseada na Comunidade , Enfermagem em Saúde Pública , Obesidade/epidemiologia , Saúde Global , Planejamento em Saúde/organização & administração
5.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1155-1160, out.-dez. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1021976

RESUMO

Objetivo: Analisar as tendências temporais e o perfil epidemiológico das principais causas de mortalidade em residentes do município de Lagarto, Sergipe, entre 2006 a 2015. Métodos: Estudo epidemiológico, descritivo e de série histórica, através de dados secundários dos óbitos notificados no Sistema de Informação de Mortalidade (SIM). A análise das tendências temporais foi realizada pelo Programa Joinpoint Regression obtendo-se a variação percentual anual (APC) das taxas de mortalidade por meio da regressão Possion. Resultados: Foram notificados 5.586 óbitos, com predomínio do sexo masculino e idosos, 58% e 59,61% respectivamente. Observou-se um aumento da taxa de mortalidade geral de 1,58% ao ano (IC95%: 0,5 a 2,6; p=0,01). Somente as taxas de mortalidade infantil (TMI) e de seus componentes apresentaram tendências decrescentes. Conclusão: Apesar da tendência decrescente das TMI, as mesmas requerem ações especializada, bem como para a redução da mortalidade por doenças crônicas


Objective: The study's purpose has been to analyze the temporal trends and the epidemiological profile of the main causes of mortality in residents of the Lagarto City, Sergipe State, between 2006 and 2015. Methods: This is an epidemiological, descriptive and historical series study, through secondary data on deaths reported in Sistema de Informação de Mortalidade (SIM) [Mortality Information System]. The analysis of temporal trends was performed by the Joinpoint Regression Program, obtaining the Annual Percentage Change (APC) of mortality rates through Possion Regression. Results: 5,586 deaths were reported, with men predominating 58% and the elderly people 59.61%. There was an increase in the overall mortality rate of 1.58% per year (95% CI 0.5 to 2.6, p = 0.01). Only Infant Mortality Rates (IMR) and their components showed declining trends. Conclusion: Despite the decreasing tendency of the IMR, they require specialized actions, as well as the reduction of mortality due to chronic diseases


Objetivo: Analizar las tendencias temporales y el perfil epidemiológico de las principales causas de mortalidad en residentes de la ciudad de Lagarto, Sergipe, entre 2006 y 2015. Método: series epidemiológicas, descriptivas e históricas, a través de datos secundarios sobre muertes relatadas en la Mortalidad Información SIM). El análisis fue realizado por el Programa de Regresión del Joinpoint, obteniendo Variaciones de las tasas de mortalidad a través de la Posibilidad de regresión. Resultados: 5.586 muertes fueron reportadas, con predominio de hombres 58% y ancianos 59.61%. Se observó un aumento en la tasa de mortalidad global del 1,58% anual (IC 95%: 0,5 a 2,6, p = 0,01). Sólo las tasas de mortalidad infantil (IMR) y sus componentes presentaron tendencias en declive. Conclusión: A pesar de la tendencia decreciente del IMR, ellos requieren acciones especializadas, así como la reducción de la mortalidad por enfermedades crónicas


Assuntos
Humanos , Perfil de Saúde , Indicadores de Morbimortalidade , Mortalidade , Brasil , Inquéritos Epidemiológicos , Planejamento em Saúde
6.
BMC Health Serv Res ; 19(1): 670, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533710

RESUMO

BACKGROUND: Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran. METHODS: Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis. RESULTS: The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise. CONCLUSIONS: Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Formulação de Políticas , Atenção Primária à Saúde/organização & administração , Programas Governamentais , Humanos , Irã (Geográfico) , Programas Nacionais de Saúde/organização & administração , Política , Cobertura Universal do Seguro de Saúde/organização & administração
7.
Artigo em Inglês | MEDLINE | ID: mdl-31487789

RESUMO

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: "Co-benefits" to health help underpin greenhouse gas reduction strategies, while safeguarding health-particularly of the most vulnerable-is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health's role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts-governance, implementation and adjustment-that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.


Assuntos
Mudança Climática , Política Ambiental , Política de Saúde , Saúde Pública , Planejamento em Saúde , Estados Unidos
8.
BMC Public Health ; 19(1): 1195, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470819

RESUMO

BACKGROUND: Since pre-exposure prophylaxis (PrEP) is mainly prescribed to high-risk uninfected individuals, consistent condom use (CCU) continues to be recommended as an inexpensive, feasible, practical and acceptable way to prevent the general population from acquiring and transmitting HIV through sexual intercourse. The objective of this cross-sectional study was to compare the relative importance of various determinants of CCU among sexually experienced undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use. METHOD: From September 10, 2018, to January 9, 2019, an anonymous self-administered online questionnaire was voluntarily completed by 12,750 participants distributed across 30 provinces in mainland China (except for Tibet). The present analysis was restricted to 2054 sexually experienced undergraduates. Pearson's chi-square test and Logistic regression models were chosen to analyze the factors associated with CCU. RESULTS: The overall rate of CCU was 61.3% [95% confidence interval (CI) = 59.2-63.4%]. CCU was inequitably distributed since enabling factors exerted greater effects than predisposing and need variables. Compared with heterosexual men, heterosexual women [adjusted odds ratio (AOR) = 0.78, 95% confidence interval (CI):0.64-0.96)], non-heterosexuals men (AOR = 0.64, 95% CI:0.45-0.92) and women (AOR = 0.68, 95% CI:0.47-0.99) were less prone to using condoms consistently. Those with more resources [i.e., higher levels of self- efficacy for condom use (AOR = 2.86, 95% CI:2.35-3.49) and being knowledgeable of the national AIDS policy (AOR = 1.50, 95% CI:1.23-1.82)], and those with lower need for condoms [i.e., late initiation of sexual activity (AOR = 1.34, 95% CI:1.09-1.64) and single sexual partner (AOR = 1.68,95% CI:1.21-2.33)] were more likely to be consistent condom users. CONCLUSIONS: In order to increase consistency of condom use and simultaneously reduce the remaining inequities, a comprehensive intervention measure should be taken to target heterosexual women, non-heterosexual men and women, and those with higher need for condoms, improve their condom use self- efficacy and raise their awareness of the national AIDS policy.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Comportamento Sexual/estatística & dados numéricos , Estudantes/psicologia , Adolescente , China/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Planejamento em Saúde , Humanos , Masculino , Modelos Psicológicos , Fatores Socioeconômicos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
9.
Nature ; 572(7770): 439, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31431746
10.
BMC Health Serv Res ; 19(1): 608, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464609

RESUMO

BACKGROUND: Demand for gastrointestinal endoscopy in Australia is increasing as a result of the expanding national bowel cancer screening program and a growing, ageing population. More services are required to meet demand and ensure patients are seen within clinically recommended timeframes. METHODS: A discrete event simulation model was developed to project endoscopy waiting list outcomes for two large metropolitan health services encompassing 8 public hospitals in Australia. The model applied routinely collected health service data to forecast the impacts of future endoscopic demand over 5 years and to identify the level of service activity required to address patient waiting times and meet key policy targets. The approach incorporated evidence from the literature to produce estimates of cost-effectiveness by showing longer term costs and Quality Adjusted Life Years (QALYs) associated with service expansion. RESULTS: The modelling revealed that doing nothing would lead to the number of patients waiting longer than clinically recommended doubling across each health service within 5 years. A 38% overall increase in the number of monthly procedures available was required to meet and maintain a target of 95-98% of patients being seen within clinically recommended timeframes to the year 2021. This was projected to cost the funder approximately $140 million in additional activity over a 5 year period. Due to improved patient outcomes associated with timely intervention, it was estimated that the increased activity would generate over 22,000 additional QALYs across the two health services. This translated to an incremental cost-effectiveness ratio of $6467 and $5974 per QALY for each health service respectively. CONCLUSIONS: Discrete event simulation modelling provided a rational, data based approach that allowed decision makers to quantify the future demand for endoscopy services and identify cost-effective strategies to meet community needs.


Assuntos
Endoscopia Gastrointestinal/estatística & dados numéricos , Planejamento em Saúde/métodos , Austrália , Análise Custo-Benefício , Tomada de Decisões , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Endoscopia Gastrointestinal/economia , Hospitais Públicos/economia , Hospitais Públicos/estatística & dados numéricos , Humanos , Neoplasias Intestinais/diagnóstico , Modelos Estatísticos , Anos de Vida Ajustados por Qualidade de Vida , Listas de Espera
11.
Artigo em Inglês | MEDLINE | ID: mdl-31349585

RESUMO

The frequency of extreme heat events, such as the summer of 2003 in Europe, and their corresponding consequences for human beings are expected to increase under a warmer climate. The joint collaboration of institutional agencies and multidisciplinary approaches is essential for a successful development of heat-health warning systems and action plans which can reduce the impacts of extreme heat on the population. The present work constitutes a state-of-the-art review of 16 European heat-health warning systems and heat-health action plans, based on the existing literature, web search (over the National Meteorological Services websites) and questionnaires. The aim of this study is to pave the way for future heat-health warning systems, such as the one currently under development in the framework of the Horizon 2020 HEAT-SHIELD project. Some aspects are highlighted among the variety of examined European warning systems. The meteorological variables that trigger the warnings should present a clear link with the impact under consideration and should be chosen depending on the purpose and target of the warnings. Setting long-term planning actions as well as pre-alert levels might prevent and reduce damages due to heat. Finally, education and communication are key elements of the success of a warning system.


Assuntos
Planejamento em Desastres/métodos , Calor Extremo/efeitos adversos , Planejamento em Saúde/métodos , Transtornos de Estresse por Calor/diagnóstico , Transtornos de Estresse por Calor/epidemiologia , Temperatura Alta/efeitos adversos , Europa (Continente) , Humanos
12.
Workplace Health Saf ; 67(8): 439-440, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31313647

RESUMO

Occupational health nurses can ensure that gig workers are aware of health and safety requirements, receive appropriate training for the job, and use appropriate personal protective equipment.


Assuntos
Planejamento em Saúde/métodos , Saúde do Trabalhador/tendências , Planejamento em Saúde/tendências , Humanos , Guias de Prática Clínica como Assunto , Estados Unidos , United States Occupational Safety and Health Administration/organização & administração , Recursos Humanos/legislação & jurisprudência
13.
Afr J AIDS Res ; 18(2): 138-147, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282299

RESUMO

The contribution of civil society organisations (CSOs) to national HIV/AIDS responses in sub-Saharan African countries, with Global Health Initiatives' (GHIs) funding channelled through National AIDS Commissions (NACs), is well researched. Less well understood are the governance models and funding mechanisms being used to successfully engage CSOs in the HIV/AIDS response. Using data from government, donor, CSO and documentary sources, this article characterises the organisational principles and practices and unique funding models adopted by the Ghana AIDS Commission (GAC) to effectively and efficiently engage CSOs in the HIV/AIDS response. It found four major governance principles and practices that target: 1) strategic planning for service delivery; 2) focussed expressions of interest; 3) competitive tendering and contracting for service delivery; and 4) adoption of results-based management. It also identified three predominant funding models that illustrate the application of these guiding principles to harness the inherent strengths of CSOs to more effectively respond to HIV/AIDS, namely: 1) direct funding of locally-based CSOs; 2) funding international and national NGOs to engage local CSOs in partnership; and 3) funding umbrella organisations. These findings are significant for Ghana but they may also have relevance for other low- or middle-income countries (LMICs) that have limited experience delivering HIV/AIDS services through state-civil society partnerships, as well as broader debates on the role of donors, governments and CSOs working in partnership to fight HIV/AIDS.


Assuntos
Saúde Global/legislação & jurisprudência , Infecções por HIV/economia , Planejamento em Saúde/organização & administração , Gana , Governo , Infecções por HIV/tratamento farmacológico , Planejamento em Saúde/economia , Planejamento em Saúde/legislação & jurisprudência , Financiamento da Assistência à Saúde , Humanos , Organizações , Parcerias Público-Privadas/organização & administração
15.
Aten. prim. (Barc., Ed. impr.) ; 51(6): 359-366, jun.-jul. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185716

RESUMO

Objetivo: Describir el uso de dispositivos sanitarios de las personas con cronicidad avanzada, cuantificando y caracterizando el coste de dicho consumo para sugerir mejoras en los modelos de atención. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con cronicidad avanzada. Emplazamiento: Tres equipos de atención primaria (EAP) de Osona, Cataluña. Participantes: Un total de 224 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática. Mediciones principales: Edad, sexo, tipo de domicilio, trayectoria final de vida; uso, tipo y coste de los recursos en atención primaria, urgencias, por equipos de paliativos o de hospitalización (en agudos o atención intermedia). Resultados: Se realizaron una media de 1,1 ingresos al año (estancia media = 6 días), el 74% en hospitales de atención intermedia. El 93,4% del tiempo los pacientes vivieron en la comunidad, realizando un contacto semanal con el EAP (45,1% en domicilio). El coste medio diario fue 19,4euros, siendo los principales capítulos la hospitalización de atención intermedia (36,5%), la actividad EAP (29,4%) y los ingresos en agudos (28,6%). Los determinantes de menor coste serían la trayectoria fragilidad/demencia (p < 0,001), vivir en una residencia (p < 0,001) y el sobreenvejecimiento (p < 0,001). Hay ciertas diferencias en el comportamiento de los EAP en el coste global y en recursos comunitarios (p < 0,05). Conclusiones: Los consumos en hospitalización intermedia y atención primaria son más relevantes que las estancias en centros de agudos. Los contextos residencial y domiciliario son importantes para atender con efectividad y eficiencia, especialmente cuando los EAP se preparan para ello


Objective: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. Design: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. Location: Three primary care teams (EAP) of Osona, Cataluña. Participants: 224 people identified as advanced patients through a systematic population strategy. Main measurements: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). Results: Patients made an average of 1.1 admissions per year (average stay = 6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4 euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p < 0.001), living in a nursing-home facility (p < 0.001) and over-aging (p < 0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p < 0.05). Conclusions: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it


Assuntos
Humanos , Doença Crônica/economia , Equipamentos e Provisões/economia , Estudos de Coortes , Modelos de Assistência à Saúde , Atenção Primária à Saúde/economia , Recursos em Saúde/economia , Estudos Prospectivos , Análise de Variância , Planejamento em Saúde/economia , Recursos em Saúde/estatística & dados numéricos
16.
Artigo em Inglês | PAHO-IRIS | ID: phr-51394

RESUMO

[ABSTRACT]. Objective. Patient safety is challenging for health systems around the world, particularly in low- and middleincome countries such as Guatemala. The goal of this report is to summarize a strategic planning process for a national patient safety plan in Guatemala. Methods. This strategic planning process involved multiple stakeholders, including representatives of the Guatemala Ministry of Health and Social Assistance, medical leadership from across the public health system, and academic experts from Guatemala and the United States of America. We used mixed methods (quantitative and qualitative surveys) and a nominal group technique at a national symposium to prioritize patient safety challenges across Guatemala, and subsequent meetings to develop a national patient safety plan. Results. This national patient safety plan outlines four domains to advance patient safety across the public hospital system over a five-year period in Guatemala: leadership and governance, training and awareness, safety culture, and outcome metrics. For each domain, we developed a set of goals, activities, outputs, and benchmarks to be overseen by the Ministry of Health. Conclusions. With this national patient safety plan, Guatemala has made a long-term commitment to improving patient safety across the public hospital system of Guatemala. Future efforts will require its extension to all levels of the Guatemalan health system.


[RESUMEN]. Objetivo. La seguridad del paciente constituye un reto para los sistemas de salud de todo el mundo, particularmente en los países de ingresos medianos y bajos como Guatemala. El objetivo del presente informe es resumir el proceso de planificación estratégica para elaborar un plan nacional sobre seguridad del paciente en Guatemala. Métodos. En el proceso de planificación estratégica participaron varios interesados directos, entre los cuales se encontraron representantes del Ministerio de Salud Pública y Asistencia Social de Guatemala, autoridades médicas de todo el sistema de salud pública, así como expertos académicos de Guatemala y Estados Unidos de América. Para establecer las prioridades en cuanto a los retos que deben abordarse en Guatemala en materia de seguridad del paciente se utilizó un método mixto (encuestas cuantitativas y cualitativas) y la técnica de grupo nominal en un simposio nacional, y posteriormente se realizaron reuniones para elaborar un plan nacional sobre la seguridad del paciente. Resultados. En el plan nacional sobre la seguridad del paciente se presentan cuatro ámbitos en los cuales se puede impulsar la seguridad del paciente en todos los hospitales públicos de Guatemala en un período de cinco años: liderazgo y gobernanza, capacitación y concientización, cultura de seguridad y métodos para medir los resultados. Se creó un conjunto de metas, actividades, resultados y puntos de referencia para cada ámbito, que estarán bajo la supervisión del Ministerio de Salud. Conclusiones. Con este plan nacional sobre la seguridad del paciente, Guatemala ha adquirido el compromiso a largo plazo de mejorar la seguridad del paciente en los hospitales públicos del país. Las iniciativas que se emprendan en el futuro requerirán que se extienda a todos los niveles del sistema de salud guatemalteco.


[RESUMO]. Objetivo. A segurança do paciente representa um desafio aos sistemas de saúde em todo o mundo, sobretudo nos países de baixa e média renda como a Guatemala. O presente tem o objetivo de descrever sucintamente o processo de planejamento estratégico para um plano nacional de segurança do paciente na Guatemala. Métodos. Este processo de planejamento estratégico contou com a participação de diversos interessados diretos, como representantes do Ministério da Saúde e Assistência Social da Guatemala, autoridades médicas da área de saúde pública e especialistas acadêmicos da Guatemala e dos Estados Unidos. Métodos combinados (pesquisas quantitativas e qualitativas) e técnica de grupo nominal foram usados em um simpósio nacional para priorizar os desafios em segurança do paciente na Guatemala e reuniões subsequentes foram realizadas para elaborar o plano nacional de segurança do paciente. Resultados. No plano nacional de segurança do paciente, são definidos quatro domínios para fazer avançar o processo de segurança do paciente no sistema hospitalar público em um período de cinco anos: liderança e governança; capacitação e conscientização; cultura de segurança e métricas para mensuração dos resultados. Um conjunto de metas, atividades, resultados e parâmetros de referência foi elaborado para cada domínio, a ser supervisado pelo Ministério da Saúde. Conclusões. Com este plano nacional de segurança do paciente, a Guatemala assumiu um compromisso de longo prazo de melhorar a segurança do paciente no sistema hospitalar público. Esforços devem ser empreendidos para expandir o plano a todos os níveis do sistema de saúde da Guatemala.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde , Segurança do Paciente , Erros Médicos , Planejamento em Saúde , Guatemala , Garantia da Qualidade dos Cuidados de Saúde , Segurança do Paciente , Erros Médicos , Planejamento em Saúde , Garantia da Qualidade dos Cuidados de Saúde , Segurança do Paciente , Erros Médicos , Planejamento em Saúde
17.
Health Res Policy Syst ; 17(1): 55, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159828

RESUMO

BACKGROUND: The notion of 'fact-free politics' is debated in Europe and the United States of America and has particular relevance for the use of evidence to underpin health and healthcare policies. To better understand how evidence on health and healthcare is used in the national policy-making process in the Netherlands, we explore how different statistics are used in various policy debates on health and healthcare in the Dutch government and parliament. METHODS: We chose eight ongoing policy debates as case studies representing the subject categories of morbidity, lifestyle, healthcare expenditure and healthcare outcomes, including (1) breast cancer screening rates, prevalence and incidence, (2) dementia prevalence and incidence, (3) prevalence of alcohol use by pregnant women, (4) mobility and school sports participation in children, (5) costs of smoking, (6) Dutch national healthcare expenditure, (7) hospital mortality rates, and (8) bedsore prevalence. Using selected keywords for each policy debate case, we performed a document search to identify documentation of the debates (2014-2016) on the websites of the Dutch government and parliament. We retrieved 163 documents and examined the policy debate cases through a content analyses approach. RESULTS: Sources of the statistics used in policy debates were primarily government funded. We identified two distinct functions, i.e. rhetorical and managerial use of statistics. The function of the debate is rhetorical when the specific statistic is used for agenda-setting or to convince the reader of the importance of a topic. The function of the debate is managerial when statistics determine planning, monitoring or evaluation of policy. When evaluating a specific policy, applied statistics were mostly the result of routine or standardised data collection. When policy-makers use statistics for a managerial function, the policy debate mirrors terms derived from scientific debates. CONCLUSION: While statistics used for rhetorical functions do not seem to invite critical reflection, when the function of the debate is managerial, i.e. to plan, monitor or evaluate healthcare, their construction does receive attention. Considering the current role of statistics in rhetorical and managerial debates, there is a need to be cautious of too much leniency towards the technocratic process in exchange for the democratic debate.


Assuntos
Coleta de Dados , Assistência à Saúde , Medicina Baseada em Evidências/estatística & dados numéricos , Governo , Planejamento em Saúde/estatística & dados numéricos , Política de Saúde , Formulação de Políticas , Pessoal Administrativo , Criança , Comunicação , Dissidências e Disputas , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Países Baixos , Saúde da População , Gravidez , Estatística como Assunto
18.
Lakartidningen ; 1162019 Feb 26.
Artigo em Sueco | MEDLINE | ID: mdl-31192421

RESUMO

Climate change will affect society in many areas, including healthcare.This article aims to explain the health aspects of climate change and how healthcare can play an important role. Rising temperatures affect health through direct effects such as increased heat (especially in tropical countries) and through indirect effects such as deteriorating air quality and changing panorama of infectious diseases. Particularly vulnerable to the effects are small children, elderly and those with severe chronic diseases. In the pursuit of a health care that can resist these effects, action plans based on simple measures that focus on vulnerable groups have been shown to greatly reduce the health impact. Healthcare also has an important role in the work on climate adaptation in Sweden by providing expertise in societal planning and preventive health work. Finally, knowledge among healthcare professionals and students about the health impact of climate change needs to be continuously updated.


Assuntos
Mudança Climática , Assistência à Saúde , Idoso , Poluição do Ar/efeitos adversos , Criança , Pré-Escolar , Doença Crônica , Doenças Transmissíveis/epidemiologia , Calor Extremo/efeitos adversos , Planejamento em Saúde , Humanos , Lactente , Serviços Preventivos de Saúde , Desenvolvimento Sustentável , Suécia , Populações Vulneráveis
19.
Health Res Policy Syst ; 17(1): 57, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170988

RESUMO

BACKGROUND: In a decentralised health system, district health managers are tasked with planning for health service delivery, which should be evidence based. However, planning in low-income countries such as Uganda has been described as ad hoc. A systematic approach to the planning process using district-specific evidence was introduced to district health managers in Uganda. However, little is known about how the use of district-specific evidence informs the planning process. In this study, we investigate how the use of this evidence affects decision-making in the planning process and how stakeholders in the planning process perceived the use of evidence. METHODS: A convergent parallel mixed-methods study design was used, where quantitative data was collected from district health annual work plans for the financial years 2012/2013, 2013/2014, 2014/2015 and 2015/2016 as well as from bottleneck analysis reports for 2012, 2013, 2014 and 2015. Qualitative data was collected through semi-structured interviews with key informants from the two study districts. RESULTS: District managers reported that they were able to produce more robust district annual work plans when they used the systematic approach of using district-specific evidence. Approximately half of the prioritised activities in the annual work plans were evidence based. Procurement and logistics, training, and support supervision activities were the most prioritised activities. Between 4% and 5.5% of the total planned expenditure was for child survival, of which 47% to 94% was from donor and other partner contributions. CONCLUSION: District-specific evidence and a structured process for its use to prioritise activities and make decisions in the planning process at the district level helped systematise the planning process. However, the reported limited decision and fiscal space, inadequate funding and high dependency on donor funding did not always allow for the use of district-specific evidence in the planning process.


Assuntos
Tomada de Decisões , Assistência à Saúde , Países em Desenvolvimento , Programas Governamentais , Planejamento em Saúde , Política , Pessoal Administrativo , Criança , Humanos , Pobreza , Pesquisa Médica Translacional , Uganda , Trabalho
20.
Nat Commun ; 10(1): 2374, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31147545

RESUMO

For dengue fever and other seasonal epidemics we show how the stability of the preceding inter-outbreak period can predict subsequent total outbreak magnitude, and that a feasible stability metric can be computed from incidence data alone. As an observable of a dynamical system, incidence data contains information about the underlying mechanisms: climatic drivers, changing serotype pools, the ecology of the vector populations, and evolving viral strains. We present mathematical arguments to suggest a connection between stability measured in incidence data during the inter-outbreak period and the size of the effective susceptible population. The method is illustrated with an analysis of dengue incidence in San Juan, Puerto Rico, where forecasts can be made as early as three to four months ahead of an outbreak. These results have immediate significance for public health planning, and can be used in combination with existing forecasting methods and more comprehensive dengue models.


Assuntos
Dengue/epidemiologia , Epidemias/estatística & dados numéricos , Planejamento em Saúde , Saúde Pública , Estações do Ano , Suscetibilidade a Doenças , Ecologia , Previsões , Humanos , Incidência , Modelos Estatísticos , Mosquitos Vetores , Porto Rico
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