ABSTRACT
El sistema de salud se enfrentó a una pandemia mundial provocada por el SARS-CoV-2. Los planes de preparación para emergencias, por lo general, no consideraban cuestiones específicas de rehabilitación para pacientes en sus diferentes niveles de atención, a pesar de que la Organización Mundial de la Salud aconsejó incluir a toda la comunidad médica, además del personal de rehabilitación, lo antes posible. Se realizó una revisión de lo publicado en los últimos cinco años, referenciándose 25 bibliografías. La revisión se hizo con el objetivo de compartir información con la comunidad médica, incluidos profesionales y técnicos dedicados a la rehabilitación, que atendieron pacientes con COVID-19 en los diferentes niveles de atención. Se resumió y analizó la información disponible sobre la COVID-19, basada en una búsqueda de la literatura científica y en la experiencia en el tratamiento de los pacientes con diferentes tipos de discapacidad, para planificar la continuidad asistencial de rehabilitación y orientar las pautas a seguir en las diferentes fases y niveles de atención, aspecto que aún resulta incierto.
The health system faced a global pandemic caused by SARS-CoV-2. Emergency preparedness plans generally did not consider specific rehabilitation issues for patients at their different levels for care, although the World Health Organization advised the inclusion of the entire medical community in addition to rehabilitation staff as soon as possible. A review of what was published in the last five years was carried out, referencing 25 bibliographies. The review was made with the objective of sharing information with the medical community, including professionals and technicians dedicated to rehabilitation, who treated patients with COVID-19 at different levels of care. The available information on COVID-19 was summarized and analyzed, based on a search of the scientific literature and on the experience in the treatment of patients with different levels of disabilities, to plan the continuity of the rehabilitation care and to guide the guidelines to follow in the different phases and levels of care, an aspect that is still uncertain.
ABSTRACT
Este artículo hace una revisión sistemática de la literatura, que aporta elementos para encontrarlas relaciones existentes entre: sistemas, modelos de salud y redes integradas de servicios desalud, con el propósito de evidenciar las condiciones externas que hacen posible la conformacióny la viabilidad de una red de salud. Lo anterior teniendo como premisa fundamental que ladisociación existente entre aseguramiento y prestación de servicios de salud puede ser la causade la fragmentación del sistema, dando como resultado problemas de integralidad y continuidadde la atención al usuario. En esta revisión se obtienen como resultados: que existe una relacióndirecta y en doble vía entre las redes integradas de servicios de salud y los sistemas y modelosde salud, la cual puede constituirse en un elemento atenuador de la problemática planteada; yademás, que el hospital debe adoptar un nuevo papel, como parte integral de la red.Palabras clave: integración vertical y horizontal, niveles de atención, sistemas fragmentados,organizaciones sanitarias integradas (OSI), hospitales...
This paper makes a systematic review of the literature, which provides elements to find therelationships between: systems, health models and integrated networks of health services, withthe purpose of showing the external conditions that make possible the creation and viability ofa healthcare network. This keeping always in mind that the dissociation between insurance anda healthcare provision of services may be the cause of the fragmentation of the system, resultingin problems of integrality and continuity on attention to user. In this review, we obtainedthe following results: that there is a direct relationship in double track between the integratednetworks of health services and the systems and models of health care , which can become anattenuating element of the problem raised, and also that the hospital must adopt a new role, asan integral part of the network...
Este artigo faz revisão sistemática da literatura que aporta elementos para encontrar as relaçõesexistentes entre: sistemas, modelos de saúde e redes integradas de serviços de saúde, com opropósito de evidenciar as condições externas que fazem possível a conformação e viabilidadede uma rede de saúde. Isto tendo como premissa fundamental que a dissociação existente entreseguridade e prestação de serviços de saúde pode ser a causa da fragmentação do sistema,resultando em problemas de integralidade e continuidade da atenção ao usuário. Nesta revisãoobtiveram-se como resultados: que existe relação direta e em mão dupla entre as redes integradasde serviços de saúde e os sistemas e modelos de saúde, a qual pode se constituir emelemento atenuador da problemática esboçada; além, do que o hospital deve adotar um novopapel, como parte integral da rede...
Subject(s)
Delivery of Health Care, Integrated , Health Services , Health Services Administration , Health Systems , Hospital Administration , Hospital CareABSTRACT
<b>Objectives</b>: Despite the increasing utilization of in-home services, the assessment of in-home services used by those that have certified levels of care needs has been limited to the actual changes in individual outcomes. The purpose of the present study was to determine factors affecting how the utilization of in-home services could have sustained and/or improved or deteriorated the care needs levels of frail persons. We also examined the effect of in-home services used in the lower level of care needs subgroup and the higher level of care needs subgroup during a two-year period.<br><b>Subjects and Methods:</b> We used longitudinal data from Izumo City of those individuals with certified levels of care needs to analyze the changes in care need levels in Izumo City between 2002 to 2004. In 2002, 2,651 persons had certified levels of care needs. All permanent residents of care facilities, at care needs level 5 in 2002, those who died since 2002 and people who could not be traced during the two-year follow-up period were excluded. The remaining data from 1,788 frail persons were ultimately analyzed. We arbitrarily divided the changes in care needs levels into two categories: sustained/improved and deteriorated. The care needs levels were also stratified into a lower level of care needs subgroup and a higher level of care needs subgroup at the baseline. Simple statistical analysis and binary logistic regression analysis were used to analyze factors that were thought to be related to in-home service utilization data to predict changes in care needs levels.<br><b>Results:</b> Approximately 63.3% of the respondents had a sustained or improved care needs level, and 36.7% of the respondents showed deteriorated of care needs levels. In the lower level of care needs subgroup, utilization of home help/bathing (OR=2.59) was associated with significant sustained/improved care needs levels. In the higher level of care needs subgroup, day care service (OR=0.90) and short stay services (OR=0.87) were significantly related to deteriorated care needs levels, respectively.<br><b>Conclusions:</b> This study shows that home help/bathing care in the lower level of care needs subgroup was a significant predictor of sustained/improved levels of care needs for frail persons but that short stay services and day care services in the higher level of care needs subgroup have a negative impact on sustained/improved levels of care needs. Our results suggest that utilization of home help services can prevent deterioration of these levels of care needs in frail persons.