Custos não médicos diretos e indiretos relacionados ao glaucoma primário de ângulo aberto no Brasil / Non-medical direct and indirect costs related to primary open-angle glaucoma in Brazil

RESUMO Objetivo: Identificar os custos não médicos diretos e indiretos em uma população de pacientes portadores de glaucoma primário de ângulo aberto (GPAA) em tratamento no Brasil. Métodos: A pesquisa dos custos neste estudo transversal foi realizada através de entrevista a uma população de pacientes portadores de GPAA em acompanhamento em um centro de referência para o tratamento do glaucoma na cidade de Juiz de Fora - MG. Para avaliação dos custos não médicos diretos, as seguintes variáveis foram investigadas: gasto com transporte, hospedagem, alimentação e acompanhante para cada consulta. Já na análise dos custos indiretos, avaliou-se: recebimento ou não de benefício social por causa do glaucoma (aposentadoria ou auxílio-doença) e qual o valor anual e perda de dias trabalhados pelo paciente e/ou pelo acompanhante. Os valores médios anuais foram calculados para todo o grupo e para cada estágio evolutivo do glaucoma. Resultados: Setenta e sete pacientes foram incluídos nesta análise (GPAA inicial: 26,0%; GPAA moderado: 24,7% e GPAA avançado: 49,3%). A média do custo não médico direto foi (em reais): 587,47; 660,52 e 708,54 para os glaucomas iniciais, moderados e avançados, respectivamente. Já a média do custo indireto foi: 20.156,75 (GPAA inicial); 26.988,16 (moderado) e 27.263,82 (avançado). Conclusão: Os custos não médicos diretos e indiretos relacionados ao GPAA no Brasil foram identificados. Os custos indiretos são superiores aos custos não médicos diretos e ambos tendem a aumentar com o avanço da doença.

ABSTRACT Objective: To identify direct and indirect non-medical costs in a population of patients with primary open-angle glaucoma (POAG) receiving treatment in Brazil. Methods: In this cross-sectional study, we obtained the costs through an interview with a population of patients with POAG at a glaucoma referral clinic in the city of Juiz de Fora - MG. In order to assess the direct non-medical costs, we investigated the following variables transportation expenses, lodging expenses, food and companion expenses for each visit. In the indirect costs analysis, we assessed the following variables: whether or not social benefits were received because of glaucoma (retirement or sickness benefit) and the annual value and loss of days worked by the patient and/or the companion. We calculated the mean annual values for the whole group and for each glaucoma stage. Results: Seventy-seven patients were included in this analysis (initial POAG: 26.0%, moderate POAG: 24.7% and advanced POAG 49.3%). The mean non-medical direct cost was (in reais): 587.47; 660.52 and 708.54 for the initial, moderate and advanced glaucomas, respectively. The mean indirect cost was: 20,156.75 (initial POAG); 26,988.16 (moderate POAG) and 27,263.82 (advanced POAG). Conclusion: We identified the direct and indirect non-medical costs related to POAG in Brazil. Indirect costs are higher than non-medical direct costs and both tend to increase with disease progression.

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia / Costs of oral and nasogastric rehydration compared to intravenous rehydration in children under 5 years of age with diarrhea in Colombia

RESUMEN Objetivo Evaluar los costos de las terapias de rehidratación oral (TRO) y de rehidratación nasogástrica (TRN) comparadas con la terapia de rehidratación endovenosa (TRE) para corregir la deshidratación por diarrea en niños. Metodología Análisis de minimización de costos desde la perspectiva del Sistema de Salud colombiano comparando TRO (seguida de TRN ante falla de la TRO), con la TRE. El horizonte temporal fue la duración de la rehidratación. La medida de efectividad se extrajo de una revisión sistemática de literatura. Para determinar costos, se construyó un caso típico y un árbol de decisiones, a partir de revisión de guías e historias clínicas, validado con expertos. Los costos unitarios se obtuvieron de bases de datos colombianas. Costos fueron calculados en pesos colombianos (COP) y dólares americanos (USD). Se realizaron análisis de sensibilidad de una y dos vías. Resultados La TRO y la TRE son similares en efectividad para prevenir hospitalización y lograr rehidratación. En el caso base, el costo de la TRO fue $91,221COP (40.5 USD) y para TRE $112,944COP (50.14USD), es decir, un ahorro de $21,723 COP (9.64 USD). En los análisis de sensibilidad por regímenes de aseguramiento y complejidad del hospital, la TRO suele ser la estrategia menos costosa. Discusión Ambas intervenciones son similares en efectividad, pero la TRO, seguida de TRN ante falla de la primera resulta menos costosa que la TRE. La TRO es recomendable como primera opción para corregir la deshidratación. Deberían continuarse esfuerzos por implementar TRO y TRN en los servicios de salud en Colombia.(AU)

ABSTRACT Objective To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. Methodology Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. Results ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was $91,221 COP (40.5 USD) and for IRT was $112,944 COP ($50.14 USD), saving $21,723 COP ($9.64 USD) per case. In the sensitivity analyzes by health insurance and hospital level, ORT is often the least costly strategy. Discussion Both interventions are similarly effective, but ORT, followed by NRT when ORT fails, is less costly than IRT. ORT is recommended as the first option to treat dehydration since it is effective and less expensive. Efforts should be continued to implement TRO and NRT in the health services of Colombia.(AU)

Costo-utilidad de intervenciones en pacientes con síndrome del túnel carpiano atendidos en un centro de alta complejidad en Cali, Colombia / Cost-Utility of Interventions in Patients with Carpal Tunnel Syndrome Treated at a Tertiary Center in Cali, Colombia / Custo-utilidade de intervenções em pacientes com síndrome do túnel do carpo atendidos em um centro de atendimento terciário em Cali, Colômbia

Introducción: Aunque existen varios tratamientos para el síndrome de túnel carpiano (STC), no se ha evaluado la eficiencia en Colombia. Objetivo: Determinar la razón de costo-utilidad incremental (RCUI) del tratamiento médico y quirúrgico en pacientes con STC. Materiales y métodos: Se realizó un estudio de costo-utilidad desde la perspectiva social con pacientes mayores de 18 años con diagnóstico de STC quienes recibieron tratamiento médico o quirúrgico. Se calcularon años de vida ajustados a calidad (AVAC) mediante el EQ-5D. Los costos fueron obtenidos del manual tarifario del Instituto de Seguros Sociales para el año 2001+30%.Se extrapoló a largo plazo mediante un modelo de Markov con una tasa de descuento de 3,5%. Se realizó un análisis de sensibilidad probabilístico usando la simulación de Monte Carlo. Resultados: Participaron 53 pacientes: mujeres (71,7%); edad promedio de 55,5 años. El 79% de los pacientes recibió tratamiento médico. La conducta médica más frecuente fue la observación (28 pacientes, 66,7%) y AINES (7 pacientes, 16,6%). El tratamiento médico proporcionó 0,33 AVAC (±0,11) y la cirugía 0,37 (±0,10). El costo total medio en pesos colombianos (COP), del tratamiento médico a los 6 meses y 20 años fue COP 132006 (IC 95%: COP 70255 - 425341) y COP 483440 (IC 95%: COP 104310 - 862570), respectivamente. La cirugía tuvo un costo de COP 1972644 (IC 95 %: COP 981204 -8517065) y COP 979585 (IC 95%: COP 684912 - 1274258). La cirugía fue dominada a los 6 meses. La RCUI a los 20 años fue de COP 1033635/AVAC adicional (IC 95%:COP 840179 - 1235323/AVAC adicional) con un 80% de probabilidad de que la cirugía sea costo útil cuando existe una disposición a pagar de COP 5000000. Conclusión: En el corto plazo el tratamiento médico es más costo útil que la cirugía. En el largo plazo, la cirugía tiene mayor probabilidad de ser costo útil.

Introduction: Although there are several treatments for carpal tunnel syndrome -cts-, the efficiency of these has not yet been evaluated in Colombia. Objective: Determine the incremental cost-utility ratio -icur- of medical and surgical treatment in patients with cts. Material and methods: A cost-utility analysis was conducted from the societal perspective with patients older than 18 years diagnosed with cts who received medical or surgical treatment. Quality-adjusted life-years (-qalys- were calculated using the EQ-5d. Costs were obtained from the iss national tariff 2001+30%.The results were extrapolated to long term figures through a Markov model with a discount rate of 3.5%.A probabilistic sensitivity analysis using Monte Carlo simulation was performed. Results: Fifty-three patients participated, women (71.7%); mean age: 55.5 years. 79% of patients received medical treatment.The most frequent treatment was medical observation (66.7%) and nsaids (16.6%). Medical treatment provided 0.33 qalys (± 0.11) and surgery 0.37 (± 0.10). The average total cost of medical treatment at six months and 20 years was COP 132006 (95% CI: COP 70255-425341) and COP 483440 (95% CI: COP 104310-862570) respectively.The cost of surgery was COP 1972644 (95% CI: COP 981204-8517065) and COP 979585 (95%:COP 684912-1274258). Surgery was dominated by six months. icur at 20 years was COP 1033635/ QALY additional (95% CI: COP 840179- 1235323/additional QALY), with a 80% of probability that surgery be cost-useful when willingness to pay COP 5000000 is achieved. Conclusion: Medical treatment is more cost-effective than surgery in the short term. However, in the long term, surgery is more cost-effective than the medical treatment.

Introdução: ainda que existem vários tratamentos para a síndrome do túnel do carpo (STC) não se tem avaliado a eficiência na Colômbia. Objetivo: Determinar o motivo de custo-utilidade incremental (RCUI) do tratamento médico e cirúrgico em pacientes com STC. Materiais e métodos: realizou-se um estudo de custo utilidade desde a perspectiva social com pacientes maiores de 18 anos com diagnóstico de STC que receberam tratamento médico ou cirúrgico. Calcularam-se anos de vida ajustados à qualidade (AVAC) através do EQ-5D. Os custos foram obtidos a partir do manual tarifário Instituto da Segurança Social para o ano 2001 + 30%. Extrapolou-se a longo prazo mediante um modelo de Markov com uma taxa de desconto de 3,5 %. Realizou-se uma análise de sensibilidade probabilística usando simulação de Monte Carlo. Resultados: Participaram 53 pacientes, mulheres (71,7%); idade média de 55,5 anos. O 79% dos pacientes receberam tratamento médico. A conduta médica mais frequente foi a observação (28 pacientes; 66,7 %) e AINES (7pacientes; 16,6%). O tratamento médico proporcionou 0,33 AVAC (±0,11) e a cirurgia 0,37 (±0,10). O custo total médio, em pesos colombianos (COP) do tratamento médico aos 6 meses e 20 anos foi COP 132006 (IC 95 %: COP 70255 - 425341) e COP 483440 (IC 95%: COP 104310 - 862570) respectivamente. A cirurgia de COP 1972644 (IC 95%: COP 981204 - 8517065) e COP 979585 (IC 95 %: COP 684912 - 1274258). A cirurgia foi dominada aos 6 meses. A RCUI aos 20 anos foi de COP 1033635/AVAC adicional (IC 95%: COP 840179 - 1235323/AVAC adicional) com um 80% de probabilidade que a cirurgia seja custo útil quando existe uma disposição a pagar de COP 5000000. Conclusão: no curto prazo o tratamento médico é mais custo útil que a cirurgia. No longo prazo, a cirurgia tem maior probabilidade de ser custo útil.

Oxigenoterapia domiciliar prolongada: perfil dos usuários e custos / Long term home oxygen therapy: users profile and costs / Oxigenoterapia domiciliaria prolongada: perfil de los usuarios y costos

Estudo exploratório-descritivo, quantitativo, com objetivo de identificar e analisar o perfil dos usuários de oxigenoterapia domiciliar prolongada (ODP), demonstrando o custo mensal da ODP de tais usuários para o município. Foram utilizados dados secundários captados em prontuários, em julho de 2012. A população foi composta por 40 usuários de ODP cadastrados no Serviço de Atenção Domiciliar Norte de Ribeirão Preto-São Paulo. Entre os usuários, 67,5% eram do sexo feminino; 30% tabagistas; 67,5% estavam na faixa de 60 anos ou mais; 62,5% tinham doença pulmonar obstrutiva crônica; 75% mostraram melhora nos níveis de saturação de oxigênio após inicio da ODP; 87,5% utilizavam cateter nasal e 50% usavam concentrador como fonte. O custo mensal somou R$19.410,00. Conclui-se que o perfil dos usuários reflete o envelhecimento da população e o predomínio de doenças crônicas relacionadas ao estilo de vida.

Exploratory-descriptive, quantitative study aiming at identifying and analyzing the profile of users of long term home oxygen therapy (HOT), as well as identifying the monthly cost of the HOT for the city. Secondary data were obtained from medical records, in July, 2012. The population consisted of 40 users registered in HOT North Home Care in Ribeirão Preto, São Paulo, Brazil. Among the users, 67.5% were female; 30% were smokers; 67.5% were 60 years or older; 62.5% hadchronic obstructive pulmonary disease; 75% showed improvement in oxygen saturation levels after initiation of HOT; 87.5% used nasal catheter, and 50% used concentrator as a source. Monthly cost was R$19,410.00. Conclusions show that users' profile mirrors the ageing of the population and the prevalence of chronic diseases related to lifestyle.

Estudio exploratorio, descriptivo y cuantitativo, con el objeto de identificar y analizar el perfil de los usuarios de oxigenoterapia domiciliaria prolongada (ODP), señalando el costo mensual de la ODP de tales usuarios para el municipio. Se emplearon datos secundarios reflejados en historiales, en julio de 2012. El universo lo constituían 40 usuarios de ODP registrados en el Servicio de Atención Domiciliaria Norte de Ribeirão Preto-São Paulo. Entre los usuarios, el 67,5% eran del sexo femenino; 30% tabaquistas; 67,5% tenían 60 años o más; 62,5% tenían enfermedad pulmonar obstructiva crónica; 75% reflejaron mejora en los niveles de saturación de oxígeno tras el inicio de la ODP; 87,5% empleaban catéter nasal y 50% empleaban concentrador como fuente. El costo mensual alcanzó R$19.410,00. Se concluye que el perfil de los usuarios refleja el envejecimiento de la población y el predominio de las enfermedades crónicas relacionadas con el modo de vida.

Análisis de costos de atención de infarto cerebral agudo con o sin fibrilación auricular / Cost analysis of acute stroke care with or without atrial fibrillation

Objetivo. Estimar los costos totales y los componentes del costo de la atención hospitalaria en una serie de pacientes con infarto cerebral agudo (ICA) de gran vaso tratados en el Hospital Universitario San Ignacio, comparando aquellos con y sin fibrilación auricular (FA). Materiales y métodos. Se recogió una muestra secuencial de pacientes mayores de 50 años entre diciembre de 2010 y marzo de 2013. Para un análisis separado, se realizó un pareamiento por edad y NIHSS de ingreso en proporción 1:1 de pacientes con y sin FA. A todos los pacientes se les registró: edad, sexo, NIHSS de ingreso y egreso, Rankin modificado, y puntaje de CHAD2S2 VASC. En cada paciente se cuantificó el uso de recursos intrahospitalarios así como el costo total de la atención durante el evento agudo, calculado en pesos colombianos. Resultados. Se recogió información de 166 pacientes (125 sin y 41 con FA). El costo total promedio de la atención fue de $8.635.419 (DE $12.929.905). Este valor fue de $10.341.065 (DE $15.130.716) para los pacientes con FA y $8.056.718 (DE $12.114.840) para los pacientes sin FA. Conclusiones. A pesar de un costo de tratamiento mayor en pacientes con FA, que son de mayor edad y tienen infartos cerebrales más severos, la diferencia no fue estadísticamente significativa cuando se ajustó por edad y por severidad del compromiso neurológico.

Objective. To estimate the total costs and resource use of hospital care in a series of patients with large vessel ischemic stroke treated at the Hospital Universitario San Ignacio. Material and methods. Prospective convenience sample of all patients 50 years of age or older admitted between December 2010 and March 2013 diagnosed with ischemic stroke. Patients with and without atrial fibrillation (AF) were compared. The following variables were measured: age, sex, admission and discharge NIHSS, modified Rankin, and CHA2DS2 VASC score. We also quantified inpatient resource use and total cost of care during the acute event. Results. We analyzed 166 patients, 125 without non-valvular AF and 41 with non-valvular AF. For a separate analysis, we matched patients with and without AF (37 per group) by age and initial NIHSS, in a 1:1 ratio. The average total cost of care in Colombian pesos (as of February 2012, 1 US$= COP$1,805) for all stroke patients was $8,635,419 (SD $12,929,905). This value was $10,341,065 (SD $15,130,716) for patients with AF and $8,056,718 (SD $12,114,840) for patients without AF. Conclusions. Despite higher treatment cost in patients with AF, these are older and severe strokes. The difference is reduced and does not reach statistical significance, when adjusted for age and stroke severity.

Costeo basado en actividades: una metodología de gestión en tratamientos intensivos / Activity-based costing methodology to manage resources in intensive care units

Background: An accurate estimation of resources use by individual patients is crucial in hospital management. Aim: To measure financial costs of health care actions in intensive care units of two public regional hospitals in Chile. Material and Methods: Prospective follow up of 716 patients admitted to two intensive care units during 2011. The financial costs of health care activities was calculated using the Activity-Based Costing methodology. The main activities recorded were procedures and treatments, monitoring, response to patient needs, patient maintenance and coordination. Results: Activity-Based Costs, including human resources and assorted indirect costs correspond to 81 to 88% of costs per disease in one hospital and 69 to 80% in the other. The costs associated to procedures and treatments are the most significant and are approximately $100,000 (Chilean pesos) per day of hospitalization. The second most significant cost corresponds to coordination activities, which fluctuates between $86,000 and 122,000 (Chilean pesos). Conclusions: There are significant differences in resources use between the two hospitals studied. Therefore cost estimation methodologies should be incorporated in the management of these clinical services.

Costos reales de tratamientos intensivos por paciente y día cama / Real daily costs of patients admitted to public intensive care units

Background: Patient care costs in intensive care units are high and should be considered in medical decision making. Aim: To calculate the real disease related costs for patients admitted to intensive care units of public hospitals. Material and Methods: Using an activity associated costs analysis, the expenses of 716 patients with a mean age of 56 years, mean APACHE score of20 (56% males), admitted to intensive care units of two regional public hospitals, were calculated. Patients were classified according to their underlying disease. Results: The costs per day of hospital stay, in Chilean pesos, were $ 426,265for sepsis, $ 423,300for cardiovascular diseases, $ 418,329 for kidney diseases, $ 404,873 for trauma, $ 398,913 for respiratory diseases, $ 379,455for digestive diseases and $ 371,801 for neurologic disease. Human resources and medications determined up to 85 and 12% of costs, respectively. Patients with sepsis and trauma use 32 and 19% of intensive care unit resources, respectively. Twenty seven percent of resources are invested in patients that eventually died. Conclusions: A real cost benefit analysis should be performed to optimize resource allocation in intensive care units.

La incapacidad temporal en España por algunas enfermedades psiquiátricas. (Trastornos esquizofrénicos, trastorno bipolar y trastornos ansiosos, depresivos y adaptativos) / Sick leaves caused by psychiatric diseases in Spain during 2011

Background: Psychiatric and mood disorders may hamper the efficiency of workers and cause absenteeism. Material and Methods: Revision of sick leaves related to schizophrenia, bipolar diseases, anxiety, depression and adaptive disorders that were granted in Spain in the period January- December 2011. The mean number of days off work for each disease and the costs per each labor day lost were calculated. Results: The total number of labor days lost for schizophrenia, bipolar diseases and mood disorders were 72,831; 899,107 and 3,666,055 days, respectively. The mean duration of sick leaves for the same diagnoses were 84; 100 and 64 days/year respectively. The total indirect costs of sick leaves for psychiatric diseases during 2011 were € 100 million approximately, corresponding to 4% of costs for all diseases. Conclusions: The high costs of absenteeism derived from psychiatric diseases should prompt measures to promote a better adaptation to work environments of people suffering these ailments.

Determinación y análisis de costos reales de tratamientos intensivos por paciente y día cama / Analysis of real costs of intensive treatments per patient and bed/day

El objetivo del trabajo es medir los costos reales asociados a las patologías tratadas en las Unidades de Cuidados Intensivos Adulto de los Hospitales Públicos de la Región del Maule, y compararlos con el costo asignado por Fonasa al día cama para el año 2011. Materiales y métodos: Se trata de un estudio prospectivo, aplicando el Sistema de Costos Basado en Actividades (ABC). Se incluyó 469 pacientes, 222 pacientes de la Unidad de Cuidados Intensivos del Hospital de Curicó y 247 pacientes la Unidad de Cuidados Intensivos del Hospital de Talca entre el 01 de enero y 30 de agosto de 2011, los que de acuerdo a edad y APACHE, representan los niveles de complejidad de pacientes de Unidades de Cuidados Intensivos a nivel nacional. Los pacientes se clasificaron según las patologías: sepsis, cardiovascular, respiratorias, neurológicas, trauma, digestivos, renales y otros. Resultados: Las patologías que presentan mayor mediana de costos por día cama son: sepsis ($362.115), respiratorias ($352.793), trauma ($348.442), renales ($341.928) y cardiovascular ($291.061). La estructura de costos del día cama está conformada principalmente por el costo asociado al recurso humano, cuyo valor máximo asciende a 64 por ciento, seguido del costo asociado a los medicamentos con un valor máximo de 15 por ciento. Los pacientes con sepsis y trauma absorben la mayor proporción de recursos en la Unidad de Cuidados Intensivos en estudio; 35 por ciento y 19 por ciento respectivamente y una proporción significativa de dichos costos es utilizada por pacientes que fallecen (34 por ciento y 19 por ciento) respectivamente. Conclusión: Todas las patologías en estudio tienen desviación desfavorable de costos, con respecto al arancel fijado por Fonasa, que sólo asciende a $192.160, para el año 2011.

The aim of the study is measures the real costs associated with the pathologies treated in the of Intensive Care Unid (ICU) Adults of the Public Hospitals of the region of the Maule, and to compare them with the cost assigned by Fonasa to the bed/day for the year 2011. Materials and methods: it is a question of a market study, applying the Activity-based costing (ABC). There was included 469 patients, 222 patients of the ICU of the Curicó’s Hospital and 247 patients the ICU of the Talca’s Hospital between January 01 and August 30, 2011, which in agreement to age and APACHE II, represent the levels of patients’ complexity of ICU to national level. The patients qualified according to the pathologies: sepsis, cardiovascular, respiratory, neurological, trauma, digestive, renal and others. Results: The pathologies that present major median of costs per day bed are: sepsis ($362.115), respiratory ($352.793),trauma ($348.442), renal ($341.928) and cardiovascular ($291.061). The structure of costs of the day bed is shaped principally by the cost associated with the human resource, which maximum value promotes 64 percent, followed by the cost associated with the medicines with a maximum value of 15 percent. The patients with sepsis and trauma absorbed the major proportion of resources in the ICU in our study; 35 percent and 19 percent respectively and a significant proportion of the abovementioned costs is used by patients who die (34 percent and 19 percent)respectively. Conclusion: All the pathologies in study have unfavorable diversion of costs, with regard to the duty fixed by Fonasa, which only promotes to $192.160, for the year2011.

Aferição do tempo e do custo médio do trabalho da enfermeira na consulta de enfermagem em ambulatório de cardiologia / Time and mean cost rate of a nurse's work in the cardiology outpatients Nursing Consultation

Neste estudo, a autora objetivou caracterizar os atendimentos de consulta de enfermagem segundo os grupos de pacientes de dois programas pré-cirúrgicos (coronária e congênitos), estimar o tempo e o custo médio do trabalho da enfermeira na realização da Consulta de Enfermagem, analisar a existência de associação/correlação entre o tempo, o custo e outras variáveis de interesse. O desenvolvimento da Consulta de Enfermagem seguiu as fases da Sistematização da Assistência (SAE). Para coletar os dados, foram elaborados dois instrumentos: instrumento da consulta para aferição do tempo e planilha para a composição do custo das profissionais. Optou-se por utilizar a média do tempo gasto nesse procedimento, registrando no instrumento de coleta de dados a hora do início e término da consulta. A amostra incluiu 126 pacientes - 44 do Programa de Coronária e 82 do Programa de Congênitos. Para o grupo de coronária foram realizadas consultas novas e de seguimento, e para o grupo de congênitos somente consultas novas. Os resultados alcançados, no programa de coronária, foram: tempo médio de 48,91 minutos para as consultas novas e de 22,14 minutos para as de seguimento, com um custo médio de aproximadamente R$ 18,01 para as consultas novas e R$ 8,15 para as de seguimento. No grupo de congênitos obtivemos média de tempo de consultas novas de 39,02 minutos e um custo médio de R$ 14,37. Os resultados mostram que o tempo médio de consultas novas supera de forma estatisticamente significativa o tempo médio das consultas de seguimento e, consequentemente, os custos. Com o desenvolvimento desse estudo espera-se contribuir para a reflexão das enfermeiras que gerenciam unidades sobre a importância do conhecimento do tempo gasto e o custo recursos e , além disso, conhecer os custos reais d o seu trabalho.

In this study, the author aimed to point out nursing consultation attendance, according to groups of patients from two pre surgical programs (coronary and congenital) to estimate time and nurse's work mean cost in the Nursing Consultation, to analyse the existency of association/correlation among time, cost and other variables of interest. The Nursing Consultation development followed the Assistance Systemization phases (ASP). To collect data, two tools have been elaborated; a consulting tool to rate time and a design to compose the professionals cost. In this procedure, we preferred to use mean time spent to record in the data collecting tool the time showing beginning and ending of the appointment. The sample included 126 patients, 44 from the coronary program and 82 from the congenital. For the coronary group, new appointments and follow up have been performed, for the congenital only new appointments.Results obtained from the coronary program were; mean time of 48.91 minutes for new appointments and 22.14 minutes for follow up, with a mean cost of nearly R$18,01 for new appointment and R$8.15 for follow up. For the congenital we obtained mean time of 39.02 minutes for new appointments and mean cost of R$14.37. Results show that new appointments mean time excells follow up appointments mean time with statiscal significance and consequently costs. By developing this study, we expect to contribute for the reflexion of those nurses who manage their units about the importance of time spent and procedures cost knowledgement in order to improve assistance and resource planning. Moreover, getting to know actual costs of their work.

Análise dos custos dos programas de treinamento e desenvolvimento de pessoal de uma organização hospitalar / Costs analysis of the staff's training and development programs at a hospital institution

Este trabalho teve por objetivo verificar o custo total dos programas de treinamento e desenvolvimento de pessoal de um Centro de Educação Continuada (CEC). Para isso, levantou-se os custos diretos e os custos indiretos relacionados à estrutura do CEC. Pretende-se também, verificar os custos diretos e indiretos dos treinamentos, o custo por participante e os investimentos nos treinamentos desenvolvidos. Como referencial teórico para análise dos custos, utilizou-se o sistema de custeio por absorção. Trata-se de um estudo exploratório descritivo na modalidade de estudo de caso. Foram analisados 7 programas de treinamentos para funcionários, perfazendo 307 treinamentos, desenvolvidos no ano de 1999, pelo CEC de um Hospital de Ensino, no município de São José do Rio Preto. Para a coleta de dados, foram elaborados 2 instrumentos: planilha dos custos dos treinamentos e planilha dos custos da estrutura. Os resultados mostraram que o custo total dos programas foi de R$112.750,24. Os programas terceirizados apresentaram custos maiores que os desenvolvidos internamente, com recursos próprios do hospital. Os dados deste estudo evidenciaram que a média geral do custo hora treinamento foi de R$74,56, o custo do treinamento por participante de R$32,39 e o custo hora participante de R$4,48. Foi também constatado que o investimento total nos referidos treinamentos, durante o ano em estudo foi de R$225.493,84

This study aimed to observe the total costs of the staff's training and development programs from a Continuum Educational Center (CEC). With this purpose, the direct and indirect costs of this Center were investigated such as the relationship between the direct and indirect costs of the investiments, the costs of each participant and the investiments of these trainings. The system of expenditure for alsorption was used as methodology. This is a descripitive, exploratory study in the modality of case study. Seven programs of workers' training, in a total of 307 trainings, developed by the CEC at a school hospital (São José do Rio Preto, SP) in 1999 were analyzed. Data were collected by means of two instruments: spread-sheet of the costs of training and spread-sheet of the costs of the structure. the results showed that the total costs of the programs were R$112.750,24. The programs that had been developed outside the hospital presented greater costs than the ones developed internally with the hospital own resources. The data highlighted that the overall average of costs/hour training was R$75,56, the training cost per participant was R$32,39 and the cost/hour participant was R$4,78. The total investiment of those trainings was R$225.493,84 during this year of study