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1.
Epidemiol Psychiatr Sci ; 29: e101, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32029018

RESUMO

Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries (LMICs), and using exemplars from the front-lines in South Africa; we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. While this approach will promote systems more enabling of scaling up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.


Assuntos
Saúde Global , Política de Saúde , Serviços de Saúde Mental/organização & administração , Saúde Mental , Prestação Integrada de Cuidados de Saúde , Países em Desenvolvimento , Humanos , Qualidade da Assistência à Saúde , África do Sul
4.
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
6.
BMC Public Health ; 19(1): 1448, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684905

RESUMO

BACKGROUND: Very few postpartum women want to become pregnant within the next 2 years, but approximately 60% of postpartum women in low- and middle-income countries are not using contraceptive methods. The World Health Organization recommends that women receive postpartum family planning (PPFP) counseling during antenatal, immediate postpartum, and postnatal services. Our objective was to establish whether PPFP counseling is being provided in antenatal and postnatal care services in SNNPR, Ethiopia and whether receipt of PPFP counseling improved uptake of postpartum family planning use by 6 months postpartum. METHODS: Longitudinal data from the Performance Monitoring for Accountability 2020 - Maternal and Newborn Health study were used. At screening, 329 women were identified as six or more months pregnant; 307 completed the survey at 6 months postpartum. We used weighted parametric survival analysis with Weibull distribution to assess the effect of receipt of postpartum counseling in antenatal and/or postnatal care by 6 weeks postpartum on contraceptive uptake, after adjusting for intention to use family planning, wantedness of the index pregnancy, delivery location, amenorrhea, exclusive breastfeeding, residence, parity, and education. RESULTS: Coverage of PPFP counseling is low; by six-weeks postpartum only 20% of women had received counseling. Women who received counseling in postnatal care only and postnatal care and antenatal care took up contraception at significantly higher rates than women who did not receive any counseling (HR: 3.4, p < .01 and HR: 2.5, p = .01, respectively). There was no difference between women who received PPFP counseling only in ANC and women who did not receive counseling at all. Women who did not want the child at all took up contraception at significantly lower rates than women who wanted the child at that time (HR: 0.3, p = .04). Women who had four or more children took up contraception at significantly lower rates than woman with 1-3 children (HR: 0.3, p = .01). There were no significant differences by delivery location, exclusive breastfeeding, residence, or education. CONCLUSION: Integration of postpartum family planning counseling into postnatal care services is an effective means to increase postpartum contraceptive uptake, but significant gaps in coverage, particularly in the delivery and postnatal period, remain.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde , Serviços de Planejamento Familiar/organização & administração , Serviços de Saúde Materna/organização & administração , Período Pós-Parto/psicologia , Adolescente , Adulto , Etiópia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
7.
Methodist Debakey Cardiovasc J ; 15(3): 234-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687108

RESUMO

Through the generosity of Charles R. Millikan, DMin, vice president for Spiritual Care and Values Integration, an annual award competition was established at Houston Methodist Hospital among the resident staff. To enter the writing competition, residents must submit a poem or essay of 1,000 words or less on the topic, "On Being a Doctor." A committee of seven was selected from Houston Methodist Hospital Education Institute to establish the judging criteria and select the winning entries. The following is the second-place winning entry for 2019; the third-place entry will be published in the next issue of this journal.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Médicos/organização & administração , Carga de Trabalho , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência , Médicos/psicologia , Triagem
8.
BMC Health Serv Res ; 19(1): 795, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690308

RESUMO

BACKGROUND: Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. METHODS: A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. INCLUSION CRITERIA: studies exploring patients' point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. RESULTS: Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. CONCLUSIONS: Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.


Assuntos
Atitude Frente a Saúde , Prestação Integrada de Cuidados de Saúde , Multimorbidade , Idoso , Humanos
9.
Health Serv Res ; 54(6): 1203-1213, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31742687

RESUMO

OBJECTIVE: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. DATA SOURCES: 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. STUDY DESIGN: We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. PRINCIPAL FINDINGS: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. CONCLUSIONS: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais Pediátricos/economia , Medicaid/economia , Medicaid/estatística & dados numéricos , Serviços de Saúde Mental/economia , Atenção Primária à Saúde/economia , Adolescente , Boston , Criança , Pré-Escolar , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
10.
BMC Health Serv Res ; 19(1): 749, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651302

RESUMO

BACKGROUND: An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders. METHODS: This study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not? RESULTS: From baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen's d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen's d = 0.91) and Continuity of Care (p = 0.026, Cohen's d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen's d = 0.51) were found. CONCLUSIONS: Overall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders. TRAIL REGISTRATION: ClinicalTrials.gov, NCT03007940 . Retrospectively registered January 2017.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Comportamento Aditivo , Análise por Conglomerados , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/complicações , Washington
11.
BMC Public Health ; 19(1): 1398, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660915

RESUMO

BACKGROUND: Achieving the Sustainable Development Goal of a 90% reduction in neglected tropical diseases (NTDs) by 2030 requires innovative control strategies. This proof-of-concept study examined the effectiveness of integrating control programs for two NTDs: mass drug administration (MDA) for soil-transmitted helminths in humans and mass dog rabies vaccination (MDRV). METHODS: The study was carried out in 24 Tanzanian villages. The primary goal was to demonstrate the feasibility of integrating community-wide MDA for STH and MDRV for rabies. The objectives were to investigate the popularity, participation and cost and time savings of integrated delivery, and to investigate the reach of the MDA with respect to primary school-aged children and other community members. To implement, we randomly allocated villages for delivery of MDA and MDRV (Arm A), MDA only (Arm B) or MDRV only (Arm C). RESULTS: Community support for the integrated delivery was strong (e.g. 85% of focus group discussions concluded that it would result in people getting "two for one" health treatments). A high proportion of households participated in the integrated Arm A events (81.7% MDA, 80.4% MDRV), and these proportions were similar to those in Arms B and C. These findings suggest that coverage might not be reduced when interventions are integrated. Moreover, in addition to time savings, integrated delivery resulted in a 33% lower cost per deworming dose and a 16% lower cost per rabies vaccination. The median percentage of enrolled primary school children treated by this study was 76%. However, because 37% of the primary school aged children that received deworming treatment were not enrolled in school, we hypothesize that the employed strategy could reach more school-aged children than would be reached through a solely school-based delivery strategy. CONCLUSIONS: Integrated delivery platforms for health interventions can be feasible, popular, cost and time saving. The insights gained could be applicable in areas of sub-Saharan Africa that are remote or underserved by health services. These results indicate the utility of integrated One Health delivery platforms and suggest an important role in the global campaign to reduce the burden of NTDs, especially in hard-to-reach communities. TRIAL REGISTRATION: clinicaltrials.gov NCT03667079 , retrospectively registered 11th September 2018.


Assuntos
Prestação Integrada de Cuidados de Saúde , Doenças do Cão/prevenção & controle , Helmintíase/prevenção & controle , Raiva/prevenção & controle , Solo/parasitologia , Animais , Criança , Redução de Custos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/economia , Cães , Helmintíase/transmissão , Humanos , Administração Massiva de Medicamentos/economia , Vacinação em Massa/economia , Vacinação em Massa/veterinária , Avaliação de Programas e Projetos de Saúde , Raiva/transmissão , Raiva/veterinária , Vacinas Antirrábicas/administração & dosagem , Vacinas Antirrábicas/economia , População Rural , Tanzânia/epidemiologia
12.
J Cardiovasc Med (Hagerstown) ; 20(7): 414-418, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593558

RESUMO

: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.


Assuntos
Técnicas de Imagem Cardíaca/normas , Serviço Hospitalar de Cardiologia/normas , Prestação Integrada de Cuidados de Saúde/normas , Endocardite/diagnóstico por imagem , Endocardite/terapia , Equipe de Assistência ao Paciente/normas , Regionalização/normas , Consenso , Humanos , Comunicação Interdisciplinar , Valor Preditivo dos Testes , Resultado do Tratamento
13.
J Cardiovasc Surg (Torino) ; 60(6): 662-671, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603291

RESUMO

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


Assuntos
Assistência Ambulatorial/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Pé Diabético/terapia , Equipe de Assistência ao Paciente/organização & administração , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Amputação , Comportamento Cooperativo , Pé Diabético/diagnóstico , Feminino , Humanos , Comunicação Interdisciplinar , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Países Baixos , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
14.
BMC Health Serv Res ; 19(1): 682, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31581947

RESUMO

BACKGROUND: Person-centred care (PCC) focusing on personalised goals and care plans derived from "What matters to you?" has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by "What matters to you?" with 2) IC and 3) pro-active care is unknown. METHODS: Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014-2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up. RESULTS: The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months. CONCLUSION: Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT02541474 ), registered Sept 2015.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Múltiplas Afecções Crônicas/terapia , Assistência Centrada no Paciente/métodos , Idoso , Serviço Hospitalar de Emergência , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Morbidade , Noruega , Planejamento de Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Pontuação de Propensão , Estudos Prospectivos , Autocuidado
15.
Med Care ; 57(11): 882-889, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567863

RESUMO

OBJECTIVE: The objective of this study was to assess the potential health and budgetary impacts of implementing a pharmacist-involved team-based hypertension management model in the United States. RESEARCH DESIGN: In 2017, we evaluated a pharmacist-involved team-based care intervention among 3 targeted groups using a microsimulation model designed to estimate cardiovascular event incidence and associated health care spending in a cross-section of individuals representative of the US population: implementing it among patients with: (1) newly diagnosed hypertension; (2) persistently (≥1 year) uncontrolled blood pressure (BP); or (3) treated, yet persistently uncontrolled BP-and report outcomes over 5 and 20 years. We describe the spending thresholds for each intervention strategy to achieve budget neutrality in 5 years from a payer's perspective. RESULTS: Offering this intervention could prevent 22.9-36.8 million person-years of uncontrolled BP and 77,200-230,900 heart attacks and strokes in 5 years (83.8-174.8 million and 393,200-922,900 in 20 years, respectively). Health and economic benefits strongly favored groups 2 and 3. Assuming an intervention cost of $525 per enrollee, the intervention generates 5-year budgetary cost-savings only for Medicare among groups 2 and 3. To achieve budget neutrality in 5 years across all groups, intervention costs per person need to be around $35 for Medicaid, $180 for private insurance, and $335 for Medicare enrollees. CONCLUSIONS: Adopting a pharmacist-involved team-based hypertension model could substantially improve BP control and cardiovascular outcomes in the United States. Net cost-savings among groups 2 and 3 make a compelling case for Medicare, but favorable economics may also be possible for private insurers, particularly if innovations could moderately lower the cost of delivering an effective intervention.


Assuntos
Orçamentos , Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hipertensão/economia , Equipe de Assistência ao Paciente/economia , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/métodos , Humanos , Farmacêuticos/economia , Estados Unidos
16.
Clín. investig. arterioscler. (Ed. impr.) ; 31(5): 222-227, sept.-oct. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-184165

RESUMO

La existencia de una buena coordinación entre los distintos niveles asistenciales constituye un factor fundamental en el desarrollo de una asistencia sanitaria de calidad y eficiente. El médico de atención primaria es fundamental en la prevención secundaria de la enfermedad cardiovascular, y la estrecha colaboración entre atención primaria y cardiología constituye un factor clave en el control de la enfermedad cardiovascular. El proyecto CAPaCERES (Colaboración AP-Cardiología en Cáceres) pretende mejorar la coordinación entre atención primaria y cardiología desde la perspectiva del conocimiento mutuo y la mejora de la comunicación entre los profesionales que la desarrollan, y con ello a mejorar la calidad de la asistencia al paciente crónico con enfermedad cardiovascular


The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease


Assuntos
Humanos , Assistência à Saúde , Atenção Primária à Saúde , Doenças Cardiovasculares/prevenção & controle , Comunicação , Projetos Piloto , Educação Continuada , Prevenção Secundária , Prestação Integrada de Cuidados de Saúde/métodos
18.
Georgian Med News ; (292-293): 32-38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560659

RESUMO

The diseases of social significance are one of the biggest threats of people's health and well-being all over the world and a great burden for the healthcare system and community in general. It is widely known that the consequences of most of such diseases include temporary or permanent loss of working ability and continuous significant investments of money in the prediction, curing, and rehabilitation measures. The increase in the number of individuals with deviant behavior, especially among teenagers and young people, social disadaptation, migration of people, insufficient government funding for healthcare and social sphere concerning prevention of diseases of social significance and diseases linked with social status - all these factors create the background for the further complication of the STIs epidemic situation in Ukraine. It is scientifically proven that raising the quality of help given people with STIs and increasing its accessibility for different social strata, particularly for the representatives of the target groups, is an effective method for decreasing the rate of parenteral hepatitis and HIV infections in society. The aim of the current research is to assess the quality of the specialized help given patients with STIs (on the example of HIV-infected persons) in order to implement the integrated system of medical and social rehabilitation considering the features of the target group. The survey was conducted on the basis of designed questionnaires which included questions regarding the level of education, social status, necessity and frequency of appeals for medical help, particularly for dermatovenereological help, the affordability and comprehensiveness of the latter, the level of satisfaction with the received medical care, the respondent's assessment of quality and modernity of medical equipment. 389 questionaries' served as material for the research. Each questionnaire was composed of 15 questions. The respondents included 201 males and 188 females diagnosed with HIV-infection, who permanently live in Odessa region. Methods of research: analytical, descriptive, and statistical. The majority of HIV-infected respondents received incomplete secondary, complete secondary or vocational secondary education, 10,28% of them (40 respondents) received incomplete or complete higher education, which characterized the cohort of respondents as people with low level of education, social and sexual awareness. 24,16% of respondents (94 persons) were permanently employed; the others - were unemployed due to different reasons, and, consequently, had low social security level. More than half of respondents (220 individuals - 56,56%) were dissatisfied by the quality of dermatovenereological medical help due to the lack of medical equipment. Only 76 respondents (19,54%) were completely satisfied and positively characterized the latter. The necessity of the establishment of the specialized center of dermatovenereological help for HIV-infected patients was pointed out by 226 respondents (58,10%). The vast majority of HIV-infected respondents (80,98%) expresses quite strong opinion regarding the necessity of the establishment of multiprofile health care institution, which would provide the whole spectrum of medical services, taking into consideration the specific features of HIV-infected patients.


Assuntos
Prestação Integrada de Cuidados de Saúde , Infecções por HIV/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Adolescente , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Comportamento Sexual , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Inquéritos e Questionários , Ucrânia , Adulto Jovem
19.
BMC Health Serv Res ; 19(1): 654, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500617

RESUMO

BACKGROUND: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. METHODS: A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. RESULTS: Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. CONCLUSIONS: The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.


Assuntos
Doença Crônica/tendências , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , China , Utilização de Instalações e Serviços , Feminino , Humanos , Renda/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Saúde da População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Saúde da População Urbana/estatística & dados numéricos , Adulto Jovem
20.
Surg Technol Int ; 35: 58-66, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31482534

RESUMO

INTRODUCTION: Comprehensive wound management programs that employ a standardized integrated care bundle (ICB) and advanced wound dressings are generally recognized to decrease healing times and treatment costs. The purpose of this study was to compare wound healing rates and cost efficiencies as measured by nursing-care requirements for patients not on an ICB versus patients on an ICB and using a gentian violet/methylene blue-impregnated (GV/MB) antimicrobial advanced wound dressing. MATERIALS AND METHODS: The comprehensive wound management programs enabled continuous, standardized measurement of each patient's wound episode from admission with a wound to healing and discharge. Data was recorded over 24 months from 2016 to 2018. The variables recorded for each patient included: wound healing time (number of weeks), wound acuity based on the Bates-Jensen Wound Assessment Tool (BWAT), a comorbidity index (using the Charlson Comorbidity Index), and the number of wound dressing changes. The wound dressing changes required a visit by a registered nurse and, therefore, served as an indicator of care delivery costs where the dressing change visit cost was $68 (CAD). RESULTS: A total of 6300 patients (25% of the total study population) were identified as using GV/MB dressings within the context of an ICB. The mean healing time for these patients was accelerated more than 50% versus patients not on an ICB. The average total cost of patient care was reduced by more than 75% from diagnosis to wound healing when patients were on an ICB with GV/MB dressings. These results compared well to patients on ICBs that had other types of advanced dressings. CONCLUSION: The study demonstrates that a comprehensive wound management program based on integrated care bundles in conjunction with GV/MB dressings can be a highly-effective clinical option. The benefits showed significant reductions in healing times and treatment costs.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Bandagens , Violeta Genciana/administração & dosagem , Azul de Metileno/administração & dosagem , Cicatrização , Ferimentos e Lesões/terapia , Bandagens/economia , Bandagens/normas , Doença Crônica , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/normas , Humanos , Administração dos Cuidados ao Paciente/economia , Administração dos Cuidados ao Paciente/normas , Qualidade da Assistência à Saúde , Estudos Retrospectivos
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