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1.
Semergen ; 47(2): 122-130, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-33358090

RESUMO

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Assuntos
/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/ética , Acesso aos Serviços de Saúde/ética , Controle de Infecções/métodos , Atenção Primária à Saúde/ética , Telemedicina/ética , /epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde para Idosos/ética , Serviços de Saúde para Idosos/organização & administração , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/organização & administração , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/organização & administração , Espanha/epidemiologia , Telemedicina/métodos , Telemedicina/organização & administração
2.
Rev. enferm. UERJ ; 28: e35224, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1096015

RESUMO

Objetivo: investigar a atuação dos enfermeiros frente à amamentação cruzada e correlacionar com a atual questão da precarização do trabalho. Método: estudo qualitativo do tipo descritivo com base metodológica de análise do discurso, realizado com seis enfermeiras da Estratégia de Saúde da Família (ESF) por meio de um grupo focal. Resultados: o tema amamentação cruzada é apresentado como um indicador de conflitos ético-profissionais no processo de trabalho, expressando-se nos seguintes aspectos: conhecimento das prescrições de contraindicação, sensação de dificuldade em intervir e transferência à nutriz por qualquer dano à saúde da criança. Considerações finais: no cotejo entre esses resultados e uma organização de trabalho com normas e rotinas institucionalizadas, discutem-se como efeitos da não utilização de técnicas de aconselhamento, a fragilização da autonomia da nutriz, de forma imperceptível, reproduzidas por enfermeiros na assistência.


Objective: to investigate nurses' role related to cross-breastfeeding and to correlate with the current issue of precarious work.Method: descriptive andqualitative study based on methodological discourse analysis, carried out with six nurses from Estratégia de Saúde da Família (ESF) Program through a focus group. Results: cross-breastfeeding topic is presented as an indicator of ethical-professional conflicts in the work process, expressing itself in the following aspects: knowledge of prescriptions of contraindication, feeling of difficulty in intervening and transference to the nursing mother for any harm to the child's health. Final considerations: in the comparison between these results and a work organization with institutionalized norms and routines, we discuss the effects of not using counseling techniques, the fragility of nurses' autonomy, imperceptibly reproduced by nurses in care.


Objetivo: investigar el papel de las enfermeras relacionadas con la lactancia cruzada y su correlación con el tema actual del trabajo precario. Método: estudio descriptivo y cualitativo basado en el análisis metodológico del discurso, realizado con seis enfermeras del Programa Estratégia de Saúse da Familia (ESF) através de un grupo focal. Resultados: el tema de la lactancia cruzada se presenta como un indicador de conflictos ético-profesionales en el proceso de trabajo, expresándose en los siguientes aspectos: conocimiento de prescripciones de contraindicación, sensación de dificultad para intervenir y transferencia a la madre lactante por cualquier daño a la salud del niño Consideraciones finales: en la comparación entre estos resultados y una organización de trabajo con normas y rutinas institucionalizadas, discutimos los efectos de no utilizar técnicas de asesoramiento, la fragilidad de la autonomía de las enfermeras, reproducida imperceptiblemente por las enfermeras bajo cuidado.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/ética , Condições de Trabalho , Aleitamento Materno , Papel do Profissional de Enfermagem , Estratégia Saúde da Família , Contraindicações , Relações Trabalhistas , Brasil , Competência Clínica , Grupos Focais , Pesquisa Qualitativa
4.
Index enferm ; 29(1/2): 46-50, ene.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197426

RESUMO

OBJETIVO PRINCIPAL: Identificar los principales problemas bioéticos suscitados al proporcionar cuidados de enfermería durante la pandemia de Covid-19. METODOLOGÍA: Revisión de la literatura sobre bioética de las pandemias y de las respuestas propuestas por organismos nacionales e internacionales con competencia sobre cuestiones bioéticas. RESULTADOS PRINCIPALES: Se identificaron problemas bioéticos en las siguientes áreas: el autocuidado de la enfermera en un contexto de alta contagiosidad; la priorización en la distribución de recursos insuficientes; y la defensa de los derechos del paciente. CONCLUSIÓN PRINCIPAL: Si bien se pueden obtener algunas respuestas a los mencionados desafíos a partir de las fuentes empleadas en este trabajo, resulta necesario un mayor análisis de cada uno de los problemas bioéticos identificados para hallar las respuestas correctas para el momento actual y en futuros escenarios análogos que puedan presentarse


OBJECTIVE: To identify the main bioethical problems raised by providing nursing care during the Covid-19 pandemic. METHODS: Review of the literature on bioethics of pandemics and the responses offered by national and international organizations with competence on bioethical issues. RESULTS: Bioethical problems were identified in the following areas: nurse self-care in a highly contagious context; prioritization in the distribution of insufficient resources; and the defense of the patient's rights. CONCLUSION: Although some answers to the mentioned challenges have been offered from the sources used in the document, it is necessary to further analyze each of the bioethical problems identified, to find the correct answers for the present moment and in future similar scenarios that may occur


Assuntos
Humanos , Cuidados de Enfermagem/ética , Pandemias/ética , Infecções por Coronavirus/enfermagem , Pneumonia Viral/enfermagem , Relações Enfermeiro-Paciente/ética , Pandemias/prevenção & controle , Direitos do Paciente , Qualidade da Assistência à Saúde/ética
6.
Am J Bioeth ; 20(6): 52-64, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32441594

RESUMO

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N = 196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.


Assuntos
Temas Bioéticos , Família/psicologia , Pacientes Internados/psicologia , Qualidade da Assistência à Saúde/ética , Adulto , Idoso , Tomada de Decisões/ética , Dissidências e Disputas , Conflito Familiar/ética , Feminino , Acesso aos Serviços de Saúde/ética , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente/ética , Pesquisa Qualitativa , Inquéritos e Questionários , Assistência Terminal/ética , Estados Unidos
7.
Cancer ; 126(17): 3896-3899, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32463478

RESUMO

The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision-making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS-CoV-2-positive patients with cancer.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Assistência à Saúde/ética , Pessoal de Saúde/ética , Neoplasias/complicações , Pandemias/ética , Pneumonia Viral/complicações , Qualidade da Assistência à Saúde/ética , Assistência Ambulatorial/ética , Assistência Ambulatorial/organização & administração , Tomada de Decisão Clínica , Infecções por Coronavirus/virologia , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , Humanos , Neoplasias/radioterapia , Segurança do Paciente , Pneumonia Viral/virologia , Qualidade da Assistência à Saúde/organização & administração
8.
Gastroenterol. hepatol. (Ed. impr.) ; 43(5): 233-239, mayo 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192999

RESUMO

INTRODUCCIÓN: Los errores son muy comunes en la práctica clínica diaria; no obstante, pueden prevenirse. Nuestro objetivo fue identificar los errores más frecuentes en el manejo ambulatorio de los pacientes con enfermedad inflamatoria intestinal (EII). MATERIAL Y MÉTODOS: Se incluyeron pacientes consecutivos diagnosticados de EII atendidos en segunda opinión en nuestra Unidad de EII. Se obtuvieron datos sobre las estrategias que habían realizado los médicos que les atendieron previamente, y se compararon con los procedimientos diagnósticos y terapéuticos actualmente recomendados. RESULTADOS: Se incluyeron 74 pacientes. Previamente a la atención en nuestra Unidad, se había interrogado sobre el tabaquismo en el 50% de los pacientes con enfermedad de Crohn, y en el 29% se promocionó el abandono de este. Al diagnóstico de la EII, en el 16% se había evaluado la infección por el virus de la hepatitis B, en el 15% por el virus de la hepatitis C, y en el 7% por la varicela. El 7% de los pacientes había sido vacunado frente a la hepatitis B, mientras que el 3% frente a la gripe, tétanos y neumococo. El 67% y el 37% de los pacientes con indicación de 5-aminosalicitalos e inmunosupresores, respectivamente, los había recibido. DISCUSIÓN: Los errores en el manejo de los pacientes ambulatorios diagnosticados de EII son muy frecuentes y relevantes


INTRODUCTION: Errors are very common in daily clinical practice; however, they can be prevented. Our aim was to identify the most common errors in the outpatient management of inflammatory bowel disease (IBD) patients. MATERIAL AND METHODS: Patients diagnosed with IBD, being treated at our IBD Unit and who were referred for a second opinion were consecutively enrolled. Data on the strategies implemented by their previous physicians were obtained. These strategies were compared with the currently recommended diagnostic and therapeutic procedures. RESULTS: Seventy-four IBD patients were enrolled. Prior to care in our Unit, screening for tobacco use had been performed in 50% of Crohn's disease patients, while smoking cessation counselling had been provided in 29%. At the time of IBD diagnosis, the hepatitis B virus immunization status had been investigated in 16% of the patients, the hepatitis C virus status in 15%, and the varicella status in 7%. Seven percent of the patients had been vaccinated against hepatitis B virus, and 3% against influenza, tetanus and pneumococcus. Sixty-seven percent of the patients with an indication for use of 5-aminosalicylic acid and 37% of those with an indication for immunosuppressants had received the indicated drug. DISCUSSION: Errors in the outpatient management of IBD patients are very common and relevant


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Inflamatórias Intestinais/epidemiologia , Erros Médicos/prevenção & controle , Serviços de Saúde , Estudos Retrospectivos , Estudos Transversais , Inquéritos e Questionários , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/estatística & dados numéricos
10.
Nurs Ethics ; 27(1): 258-272, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30975034

RESUMO

BACKGROUND: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today's hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual's dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses' options to act on the basis of ethical and moral grounds in the individual care situation. AIM: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. METHOD: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. ETHICAL CONSIDERATION: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. RESULTS: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse-patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. CONCLUSION: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses' professional decision-making and forcing them to compromise basic nursing values.


Assuntos
Esgotamento Profissional , Conflito Psicológico , Ética em Enfermagem , Recursos Humanos de Enfermagem no Hospital/ética , Recursos Humanos de Enfermagem no Hospital/psicologia , Carga de Trabalho , Tomada de Decisões/ética , Humanos , Relações Enfermeiro-Paciente , Política Organizacional , Qualidade da Assistência à Saúde/ética , Padrão de Cuidado/ética
11.
Artigo em Espanhol | LILACS | ID: biblio-1146815

RESUMO

Honduras En Honduras y en el resto del mundo se atraviesa un reto de salud pública por la pandemia de la enfermedad COVID-19. Por lo cual, surgió la necesidad de poner en marcha la telesalud, considerando los principios deontológicos y éticos que rigen la profesión médica. Es importante romper paradigmas en la incorporación de las tecnologías de la información y la comunicación en los sistemas de salud. Debemos expandir nuestra visión en beneficio de la salud de las personas, teniendo en cuenta que siempre es y será, apropiado e ineludible cuestionar las innovaciones, para analizar y reflexionar los aspectos éticos y legales sobre su implementación y garantizar que lo implementado represente un beneficio directo para los usuarios. Desde este enfoque se reflexionó sobre la necesidad de implementar una telemedicina ética, humanista, cuyo fin prioritario sea preservar la vida, la confidencialidad, la seguridad de los pacientes, además la calidad y la continuidad de la atención médica...(AU)


Assuntos
Humanos , Telemedicina/ética , Infecções por Coronavirus , Qualidade da Assistência à Saúde/ética , Ética Médica
12.
Rev. cuba. med. trop ; 71(3): e346, sept.-dic. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093574

RESUMO

Introducción: El dengue es un problema que afecta a más de 100 países y pone en situación de riesgo a la mitad de la población mundial. En la evolución de los pacientes, además de los factores biológicos, influyen factores sociales entre los cuales se encuentra la calificación del personal de salud. Objetivo: describir el grado de conocimiento y aceptación que tienen directivos y profesionales del sistema de salud para la atención a enfermos de dengue. Métodos: Se realizó una investigación operativa de tipo cualitativa, en las provincias La Habana, Ciego de Ávila, Cienfuegos y Santiago de Cuba en el período 2014-2017. Se aplicó cuestionario de conocimientos con respecto a las Guías Cubanas para la Atención a Enfermos de Dengue, y se realizaron discusiones grupales para conocer criterios acerca de los aspectos organizativos. Resultados: La mayoría de los encuestados dominó los aspectos fundamentales necesarios para el manejo clínico adecuado de los pacientes y evitar su muerte, aunque existieron diferentes niveles de conocimiento. Los profesionales médicos obtuvieron mayor puntuación que los no médicos. Conclusiones: La apreciación general de los profesionales del Sistema de Salud es que la organización para la atención a pacientes durante epidemias de dengue es correcta y se ejecuta de manera satisfactoria. Ellos tienen los conocimientos indispensables para manejar adecuadamente a los pacientes(AU)


Introduction: Dengue is a problem that affects more than 100 countries and threatens half of the world population. Besides biological factors, the evolution of patients is influenced upon by social factors such as the qualification of the health personnel. Objective: Describe the degree of knowledge and acceptance by managers and professionals from the health system for the care of dengue patients. Methods: A qualitative operational study was conducted in the provinces of Havana, Ciego de Avila, Cienfuegos and Santiago de Cuba in the period 2014-2017. A questionnaire was applied to assess acquaintance with the Cuban Guides for the Care of Dengue Patients, and group discussions were performed to gather criteria about organizational aspects. Results: Most respondents were aware of the main aspects required for the appropriate clinical management of patients and to prevent their death, though varying levels of information were observed. Medical professionals obtained higher scores than non-medical staff. Conclusions: Most Health System professionals consider that implementation of patient care actions during epidemics is appropriate and these are performed in a satisfactory manner. They have the indispensable knowledge required to adequately manage patients(AU)


Assuntos
Humanos , Masculino , Feminino , Qualidade da Assistência à Saúde/ética , Conhecimentos, Atitudes e Prática em Saúde , Dengue/prevenção & controle
13.
J Health Care Poor Underserved ; 30(4S): 91-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31735723

RESUMO

Mainstream bioethics has dealt inadequately with issues of race, gender, and class that intersect and shape the life experiences of vulnerable populations in the U.S., such as Black women in the rural South who have faced bioethical and public health challenges throughout U.S. history. They have suffered from health disparities, challenges to their autonomy, inadequate access to quality health care, biomedical violations, and a healthcare system that has implicit bias and discrimination. Thus, we propose a framework for biomedical and behavioral researchers and organizations who seek to engage, ethically, such vulnerable communities. The goal of this Ethical Community Engagement (ECE) framework is to empower communities, respect autonomy, and address needs of populations that suffer from health disparities. The Tuskegee/Macon County Diabetes Coalition, formed to coordinate and share information promoting healthy living and habits among citizens of this area, is a demonstration of this ECE framework.


Assuntos
Afro-Americanos , Pesquisa Participativa Baseada na Comunidade/ética , Pesquisa Participativa Baseada na Comunidade/organização & administração , Disparidades nos Níveis de Saúde , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/organização & administração , Alabama , Temas Bioéticos , Participação da Comunidade , Pesquisa Participativa Baseada na Comunidade/normas , Feminino , Acesso aos Serviços de Saúde , Humanos , Área Carente de Assistência Médica , Qualidade da Assistência à Saúde/normas , População Rural , Populações Vulneráveis
14.
Lakartidningen ; 1162019 Oct 15.
Artigo em Sueco | MEDLINE | ID: mdl-31613375

RESUMO

This article highlights a special subtype of this dilemma, in which the patient requests a treatment that the physician judges to be substandard. Reasons for and against providing substandard treatment in the name of patient autonomy are presented and discussed. It is suggested that physicians carefully consider the risk of crowding out of other patients if substandard treatment is provided.


Assuntos
Necessidades e Demandas de Serviços de Saúde/ética , Preferência do Paciente , Qualidade da Assistência à Saúde/ética , Beneficência , Ética Médica , Prioridades em Saúde , Humanos , Participação do Paciente , Direitos do Paciente , Autonomia Pessoal , Papel do Médico
16.
AMA J Ethics ; 21(9): E801-805, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31550229

RESUMO

In clinical settings, exploitation of patients who live in poverty can be exacerbated when health professions students' educational goals are overemphasized relative to patients' and communities' needs. Continuity of care relies on health system infrastructure and its capacity to keep patients engaged. Achieving just health care delivery in domestic and international settings requires balancing students', patients', and communities' interests. This article examines how students' interests in learning should be considered relative to patients' and communities' interests in receiving quality care.


Assuntos
Educação Médica/ética , Pobreza/ética , Educação Médica/normas , Humanos , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas , Estudantes de Medicina
17.
Ned Tijdschr Geneeskd ; 1632019 07 23.
Artigo em Holandês | MEDLINE | ID: mdl-31361421

RESUMO

A recent report by the Netherlands Centre for Ethics and Health (CEG) is a valuable contribution to the discussion around patient safety and regulatory pressure in healthcare. The CEG criticizes the recent tendency to make safety the sole and absolute value in healthcare practice. Doing so, not only downplays the dilemmas healthcare professionals are confronted with, but also creates an unnecessary regulatory burden. The report shows how professional practices are more than capable of managing conflicting values (e.g. patient-centred care, efficiency, safety) and argues for giving professionals more space for making compromises. While endorsing their position, in this commentary we propose that the CEG could have gone one step further by emphasizing the need for stimulating resilience in healthcare practices. This can create a platform for a different, more bottom-up and practice-based perspective on rules and accountability. Resilience puts additional demands on the reflexive capabilities of healthcare professionals. However, regulators can develop methods to stimulate such reflexivity.


Assuntos
Assistência à Saúde/ética , Ética Clínica , Pessoal de Saúde/ética , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/ética , Atitude do Pessoal de Saúde , Ética Profissional , Humanos , Países Baixos , Assistência Centrada no Paciente/ética
18.
Nurs Inq ; 26(3): e12299, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31162786

RESUMO

Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when "real-world" cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.


Assuntos
Cuidados de Enfermagem/normas , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/tendências , Gestão de Riscos/normas , Humanos , Motivação , Gestão de Riscos/tendências
19.
J Bioeth Inq ; 16(4): 515-524, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31236758

RESUMO

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment-a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed.


Assuntos
Custo Compartilhado de Seguro/ética , Medicina Estatal/ética , Medicina Estatal/organização & administração , Europa (Continente) , Alocação de Recursos para a Atenção à Saúde/ética , Prioridades em Saúde/ética , Nível de Saúde , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/ética , Humanos , Preferência do Paciente , Segurança do Paciente/economia , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/ética , Medicina Estatal/economia
20.
Int J Qual Health Care ; 31(8): G81-G86, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31066452

RESUMO

OBJECTIVE: This study aims to identify the key issues regarding the ethical oversight of health care improvement activities in Switzerland. DESIGN: Individual semi-structured qualitative interviews, analysed using conventional content analysis. SETTING: Interviews were conducted in Switzerland between July 2017 and February 2018. PARTICIPANTS: A purposive sample of 38 key stakeholders from four different groups: health care improvement researchers and practitioners (n = 19), representatives of clinical trial units (n = 3), clinical ethicists (n = 5), quality heads of university hospitals (n = 5), and cantonal ethics committee members (n = 6). RESULTS: There appears to be widespread uncertainty regarding when certain learning health care activities require ethical review by a research ethics committee in Switzerland. This situation is exacerbated by legislative ambiguity and limited guidance. It was reported that the lack of other oversight mechanisms for activities outside of the Human Research Act is also leading many investigators to submit projects to research ethics committees to avoid barriers to publication. CONCLUSIONS: The continuous, integrated, and dynamic nature of learning health care poses significant challenges to the current regulatory framework. It will be important that more clarification and guidance is provided regarding which activities require ethical review, and that it is considered how the ethical oversight of activities falling outside human research legislation can be strengthened. However, the traditional model of ethical oversight is poorly suited to learning health care and may need to be replaced with new systemic oversight approaches.


Assuntos
Pesquisa sobre Serviços de Saúde/ética , Melhoria de Qualidade/ética , Qualidade da Assistência à Saúde/ética , Comitês de Ética em Pesquisa , Humanos , Pesquisa Qualitativa , Suíça
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