Percepções dos profissionais de saúde sobre conceitos de economia clínica e advogado do paciente / Percepciones de profesionales de la salud sobre los conceptos de economía clínica y abogado del paciente / Perceptions of health professionals on concepts clinical economics and patient advocate

Objetivo: compreender a perspectiva dos profissionais de saúde sobre os conceitos de Economia Clínica e Advocacia do Paciente. Método: estudo qualitativo com profissionais de saúde. Os dados foram coletados em junho/2017 a partir da questão: Qual a sua percepção sobre o conceito de Economia Clínica e Advocacia do Paciente? Os dados qualitativos foram analisados pelo Discurso do Sujeito Coletivo. Resultados: os discursos apontaram que se trata de propostas inovadoras, desafiadoras e aplicáveis para a enfermagem e a saúde. O Advogado do Paciente e o conceito de Economia Clínica podem subsidiar as decisões dos gestores da equipe/serviços de saúde. As ideias podem potencializar a integração das equipes, solucionar conflitos, aproximar diferentes categorias profissionais e mitigar os riscos de responsabilidades legais, financeiras e éticas em relação à assistência à saúde. Conclusão: os conceitos foram entendidos como fundamentais e aplicáveis, uma vez que as organizações sobrevivem com adequada gestão humana, financeira e material.

Objetivo: comprender la perspectiva de los profesionales de la salud sobre los conceptos de Economía Clínica y Defensa del Paciente. Método: estudio cualitativo con profesionales de la salud. Los datos fueron recolectados en junio/2017 a partir de la pregunta: ¿Cuál es su percepción del concepto de Economía Clínica y Defensa del Paciente? Los datos cualitativos fueron analizados utilizando el Discurso del Sujeto Colectivo. Resultados: los discursos indicaron que se trata de propuestas innovadoras, desafiantes y aplicables para la enfermería y la salud. El Defensor del Paciente y el concepto de Economía Clínica pueden apoyar las decisiones de los gestores de equipos/servicios de salud. Las ideas pueden mejorar la integración del equipo, resolver conflictos, unir diferentes categorías profesionales y mitigar los riesgos de las responsabilidades legales, financieras y éticas en relación con la atención de la salud. Conclusión: los conceptos fueron entendidos como fundamentales y aplicables, ya que las organizaciones sobreviven con una adecuada gestión humana, financiera y material.

Objective: to understand the perspective of health professionals on the concepts of Clinical Economics and Patient Advocate. Method: a qualitative study with health professionals. Data were collected in June/2017 from the question: What is your perception of the concept of Clinical Economics and Patient Advocate? Qualitative data were analyzed using the Collective Subject Discourse. Results: the speeches pointed out that it deals with innovative, challenging and applicable proposals for nursing and health care. Patient Advocate and the Clinical Economics concept can support the decisions of the health team/service managers. The ideas can enhance the integration of the teams, resolve conflicts, bring together different professional categories and mitigate the risks of legal, financial and ethical responsibilities regarding health care. Conclusion: the concepts was understood as fundamental and applicable, since the organization survive with adequate human, financial and material management.

Relative Impact of the 2012 SSC Guideline Recommendations under the Scope of Numbers Needed to Treat (NNTs).

The surviving sepsis campaign (SSC) guidelines aimed to reduce mortality in severe sepsis and septic shock. The present study was performed to find out which and how many recommendations of the 2012 SSC update were based on significant effects from clinical studies in adult patients with severe sepsis and septic shock, leading to numbers needed to treat (NNTs). Every reference of the SSC 2012 guideline regarding clinical trials in adult patients was screened for absolute risk reduction regarding mortality to calculate NNTs. 17 relevant clinical trials out of 338 were identified. The NNTs ranged between 3.55 to 23.24. Significant reductions of mortality were detected, and items recommended in the SSC guidelines regarding early goal directed therapy (EGDT)/standard operating procedures (SOP)/sepsis bundles, early therapy with antibiotics, combined antibiotic therapy, and use of norepinephrine. Therapy with norepinephrine and the 6h bundles revealed the lowest NNTs. Significant reductions in mortality with restricted or no recommendations regarded therapy with hydrocortisone, therapy with highdose antithrombin III, and enteral feeding with eicosapentaenoic acid, gamma-linolenic acid and antioxidants. In conclusion, only a few recommendations of the 2012 SSC guidelines are based on significant beneficial effects coming from clinical trials in patients with severe sepsis and septic shock. When transferring study results and NNTs, physicians should take into account the own setting and own subgroup of patients. If feasible, costs of additional treatment success may be quantified underlying NNTs.

Surviving Sepsis Campaign Bundles Adherence and Their Limits in Surgical Patients with Septic Shock in an ICU.

Aims: The Surviving Sepsis Campaign (SSC) guidelines aimed to reduce heterogeneity of conventional therapy and mortality. The present study was performed in septic shock to describe the adherence to the 2008 SSC guidelines, confounding factors, and limitations. Study Design: Prospective observational study. Place and Duration of Study: Clinic of Anaesthesiology, University Hospital Medical School, and Clinical Economics at the Institute of History, Philosophy and Ethics in Medicine, University of Ulm, between January 2008 and June 2009. Methodology: The adherence to 36 items of the 6-hour and 24-hour bundles of the 2008 SSC guidelines was investigated in 98 surgical patients with septic shock. Results: The adherence to the 36 items varied between 0% and 95%. Besides the categories “adherent“ and “nonadherent“, additional categories “partially adherent“, “notapplicable“ and “unknown“ were used. None of the single items alone was essential for survival. Patients with septic shock on admission (n=68) had significantly higher SOFA scores (degree of organ dysfunctions) compared to patients developing septic shock in the ICU (n = 30). Conclusion: As many confounders are limiting the adherence to complex guidelines, the complete adherence will hardly be possible in severe diseases such as septic shock. Our results suggest that efforts associated with early diagnosis and active encouragement outside the ICU are necessary to improve applicability and adherence to the SSC guidelines in patients with septic shock in order to reduce the time lag of diagnosis and treatment, which may be reached by focusing on few essential points.

Costs of Additional Treatment Success (COATS) Based on Numbers Needed to Treat (NNT) is a Simplified Calculation Method to Facilitate Physicians Medical Decisions with Regards to Monetary Costs.

Aims: Due to limited resources, to provide a simple and transparent tool for physicians to facilitate budget-related, medical decisions in any patient. Study Design: Comparative study. Methodology: Several articles with topics referring to the 2008 ”Surviving Sepsis Campaign” guidelines in critically ill patients with varying effects on defined clinical endpoints were analyzed regarding the costs of additional treatment success (COATS). A simplified ICER = incremental cost-effectiveness ratio to assess COATS was expressed as the product of the number of patients needed to treat (NNT) and the difference in treatment costs per patient. Results: In publications with significant treatment effects enabling calculation of NNTs, calculating “COATS = NNT x delta costs per patient", mean costs to avoid one additional death or morbidity could be defined. Considering the 95% confidence interval, estimated costs at minimum and maximum to reach distinct clinical endpoints could be expressed. In studies with no significant results, NNTs and COATS were tending to infinity. Conclusion: COATS based on NNT as a simplified ICER is an easy way for the physician at the bedside caring for individual patients to explicitly describe the amount of money which has to be spent to reach definable aims in the clinical setting in one additional patient, such as reduction of mortality or morbidity, or to reassess therapies without significant results. In contrast to COATS, ICER based on quality-adjusted life years may be necessary to perform calculation of the short-term and long-term costs for the community and the adequate allocation of health care resources.