A two-step planning method to increase accessibility to medium complexity procedures for public secondary healthcare / Um método de planejamento em duas etapas para aumentar a acessibilidade a procedimentos de média complexidade para serviços de saúde pública em cuidados secundários

Abstract The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population's needs. The models consider physicians' propensity for working on a metropolis and the patients' choice on moving the least from their municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.

Resumo A atenção especializada do sistema público de saúde brasileiro é crítica e subfinanciada. Poucos estudos avaliaram o planejamento da atenção secundária em um nível estratégico, portanto ainda há questões em aberto a serem examinadas. Este estudo objetiva determinar a localização de centros médicos e a quantidade de equipamentos com base em um processo de otimização em duas etapas para atender a população. Balanceamos decisões conflitantes de propensão dos médicos em trabalharem em metrópoles e de pacientes em mudarem o mínimo de seus municípios para fornecer a localização dos centros médicos, e equipamentos a esses locais e as horas adicionais de especialistas para atender aos padrões oficiais de demanda. Para a demanda restante, a segunda etapa do modelo de otimização sugere a aquisição de equipamento para os centros médicos eleitos, para atender às necessidades. A localização proposta das unidades de atendimento secundário abrange 834 municípios, correspondendo a 97,77% do estado, com um deslocamento médio de pacientes de 58,73 km (IC95%: 56,18 km - 61,28 km). Em geral, 39 das 77 regiões de saúde devem contratar horas adicionais de especialidades médicas. Pediatria e ginecologia representam a maior lacuna.

Estimating Brazilian states demands for intensive care unit and clinical hospital beds during the COVID-19 pandemic: development of a predictive model

ABSTRACT BACKGROUND: The fragility of healthcare systems worldwide had not been exposed by any pandemic until now. The lack of integrated methods for bed capacity planning compromises the effectiveness of public and private hospitals' services. OBJECTIVES: To estimate the impact of the COVID-19 pandemic on the provision of intensive care unit and clinical beds for Brazilian states, using an integrated model. DESIGN AND SETTING: Experimental study applying healthcare informatics to data on COVID-19 cases from the official electronic platform of the Brazilian Ministry of Health. METHODS: A predictive model based on the historical records of Brazilian states was developed to estimate the need for hospital beds during the COVID-19 pandemic. RESULTS: The proposed model projected in advance that there was a lack of 22,771 hospital beds for Brazilian states, of which 38.95% were ICU beds, and 61.05% were clinical beds. CONCLUSIONS: The proposed approach provides valuable information to help hospital managers anticipate actions for improving healthcare system capacity.

Atención primaria ortopédica y traumatológica: una necesidad en el sistema de salud del Ecuador / Primary care delivery in orthopedics and traumatology: a need for the health system in Ecuador

Introducción: el Modelo de Atención Integral en Salud del Ecuador se orienta al cumplimiento de las políticas nacionales del Plan del Buen Vivir y es uno de los mecanismos que tiene todo ciudadano de acceso a la atención oportuna, pertinente e integral de su salud. Objetivo: describir y analizar la atención médica en el servicio de Ortopedia y Traumatología de la consulta externa del hospital civil de Pasaje durante el 2015 mediante el monitoreo del RDACCA (registro diario automatizado de consultas y atenciones ambulatorias) para conocer su perfil epidemiológico y la pertinencia de enlazar esta especialidad a los centros de atención primaria de salud. Métodos: estudio descriptivo retrospectivo y transversal donde se incluyeron todos los pacientes del año 2015, atendidos en el área de consulta externa de Ortopedia y Traumatología. La información fue obtenida del RDACAA, siendo tabulada según causas de morbilidad más frecuentes, grupos de edades, sexo e interconsultas recibidas. Resultados: el total de pacientes atendidos fue de 2853. La principal entidad nosológica fue el lumbago no especificado y la incidencia de las principales diez causas que originaron la atención especializada representó un 31 por ciento (888 pacientes), de todas las atenciones. Conclusión: la prevalencia de casos vistos revela la necesidad de un servicio de Ortopedia y Traumatología que solucione los problemas ortopédicos y traumatológicos en la atención primaria de salud a través de una coordinación estrecha con los hospitales municipales, lo cual pudiera ser expandible al resto del país(AU)

Introduction: The model of comprehensive health care in Ecuador is oriented towards compliance with the national policies of the Plan of Good Living and is one of the mechanisms that every citizen has access to timely, relevant and comprehensive health care. Objective: To describe and analyze the medical care in the orthopedics and traumatology service of the outpatient clinic of the civil hospital in Pasaje during 2015, through the monitoring of the RDACCA (as it stands for Spanish automated daily record of consultations and outpatient care), in order to know its epidemiological profile and relevance of linking this specialty to primary health care centers. Methods: Retrospective and cross-sectional descriptive study that included all 2015 patients who were treated in the outpatient clinic in the service of orthopedics and traumatology. The information was obtained from the RDACAA, being tabulated according to the most frequent causes of morbidity, age groups, sex, and inter-consultations received. Results: The total number of patients treated was 2853. The main nosological entity was unspecified lumbago and the incidence of the main ten causes of specialized care accounted for 31 percent (888 patients) of all care delivery cases. Conclusion: The prevalence of cases treated reveals the need for a service in orthopedics and traumatology to solve orthopedic and trauma problems in primary health care, through close coordination with municipal hospitals, which could be expandable to the rest of the country(AU)

Cause-of-Death data in public health planning – an overview.

It is well known that more than half of the world’s deaths pass by undocumented as to cause1. Whilst the appropriate focus of health services may well be the care of the living, consistent and reliable cause-of-death data also constitute a crucial and major resource for health planning and prioritization, and their lack in many settings is a major concern towards filling these data gaps 2,3.