Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country.

BACKGROUND: The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. METHODS: The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. RESULTS: In total, 1144 patients, median age 17 years (range 0-70), 903 (78.9%) with HbSS/HbSß0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSß0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSß0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. DISCUSSION: In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSß0-thalassemia but is dependent on adherence level.

Emergency care necessity for sickle cell disease patients at Rio de Janeiro State Coordinating Blood Bank.

Hemoglobinopathies, in particular sickle cell disease, is the most prevalent group of genetically transmitted diseases in the Brazilian population and should thus be treated as a public health problem. Many of these patients frequently present with complications and require emergency care at the blood bank Coordinator in Rio de Janeiro. This study was developed with the aim of characterizing the emergency assistance required by sickle cell disease patients registered in the blood bank from January 2007 to December 2008. A retrospective study of medical records was made of 78, mostly children, patients from the date of their registration until December 2009. Most attendances (63.7%) were not considered emergency care. The use of specialized services for cases that do not require this level of complexity may saturate the capacity of these centers. However, delay of intervention for complications due to the transportation of patients to specialist centers may lead to deterioration in the clinical condition.

Emergency care necessity for sickle cell disease patients at Rio de Janeiro State Coordinating Blood Bank

Hemoglobinopathies, in particular sickle cell disease, is the most prevalent group of genetically transmitted diseases in the Brazilian population and should thus be treated as a public health problem. Many of these patients frequently present with complications and require emergency care at the blood bank Coordinator in Rio de Janeiro. This study was developed with the aim of characterizing the emergency assistance required by sickle cell disease patients registered in the blood bank from January 2007 to December 2008. A retrospective study of medical records was made of 78, mostly children, patients from the date of their registration until December 2009. Most attendances (63.7 percent) were not considered emergency care. The use of specialized services for cases that do not require this level of complexity may saturate the capacity of these centers. However, delay of intervention for complications due to the transportation of patients to specialist centers may lead to deterioration in the clinical condition.

Os sentimentos dos enfermeiros sobre ser enfermeiro / Nurses’ feelings on be a nurse

Objetivo: descrever os sentimentos dos enfermeiros quanto a sua escolha e prática profissional. Método: estudodescritivo-exploratório realizado com 41 enfermeiros que atuam em um hospital público estadual especializado emHematologia e Hemoterapia do Rio de Janeiro. A coleta de dados foi realizada nos meses de abril e maio de 2008, com aaplicação de um questionário. Resultados: os resultados apontaram que os sentimentos de amor, esperança e satisfaçãosão os motivadores da escolha da profissão e, apesar de se manterem com relação à prática, observa-se que ossentimentos negativos, como desesperança e frustração também estão presentes. Conclusão: os sentimentos motivadoresda escolha profissional reafirmam o caráter humanitário, de amor, doação, satisfação, que se perpetuaram durante aprática profissional. Porém, estes enfermeiros, ao observarem seus pares, enxergam um universo profissional deinsatisfação e frustração. Os enfermeiros repetem o discurso da satisfação e do amor, que minimiza a dor e o sofrimento,porém que permite a conivência com práticas/condições de trabalho inadequadas, remunerações aquém de seu trabalho eespecialização.

Enfermagem em hemoterapia / Nursing hemotherapy

Este livro tem como base a assistência e os avanços técnico-científico e tecnológico em enfermagem. O profissional tem de acompanhar esses avanços, tanto na assistência como no ensino, na pesquisa e na gestão das unidades públicas de saúde. Com Enfermagem em hemoterapia profissionais e estudantes de enfermagem usufruirão de conteúdo técnico sobre hemoterapia, sob o foco da atuação dessa categoria, com uma linguagem de fácil entendimento e de leitura agradável. Desse modo, esperamos poder contribuir para a formação profissional, para aboa utilização do sangue e, acima de tudo, para um atendimento seguro e de qualidade a todos aqueles que confiam sua vida e sua integridade física e emocional aos profissionais de enfermagem