Gerenciamento de doença crônica: equívoco para o grupo etário dos idosos / Chronic disease management: mistaken approach in the elderly / Gerenciamiento de enfermedad crónica: equivocación para el grupo etario de los ancianos

Alterações nos estilos de vida (mudanças dos hábitos alimentares, aumento do sedentarismo e estresse) e maior expectativa de vida aumentam a incidência das doenças crônicas não transmissíveis, principais causas de óbito e incapacidade no Brasil. Sua gestão passou a ser considerada importante pelos gestores na busca de intervenções e estratégias para reduzir custos, diminuir hospitalizações e combater agravos. Mas a maior parte dos programas de atendimento foca exclusivamente na doença, e isso é um erro. Modelos que funcionem de modo integrado e deem conta das necessidades dos pacientes serão mais efetivos. O objetivo deste artigo foi contribuir para a discussão de políticas e estratégias que permitam a indução de modelos de atenção ao idoso com ênfase em projetos preventivos e resolutivos.

Lifestyle changes, including unhealthy eating habits and high rates of physical inactivity and stress, along with an increase in life expectancy have been accompanied by increasing rates of chronic non-communicable diseases. Chronic diseases are the main causes of death and disability in Brazil. Chronic disease management is one of the most important challenges facing health managers who are constantly seeking interventions and strategies to reduce costs and hospital admissions and to prevent other conditions. However, most existing models of health care have focused exclusively on disease, but it is a mistaken approach. An integrated approach is required to effectively meet patient needs. The purpose of this article was to further discuss policies and strategies for the development of new models of care for the elderly with an emphasis on prevention and resolution actions.

Alteraciones en los estilos de vida (cambios de los hábitos alimenticios, aumento del sedentarismo y estrés) y mayor expectativa de vida aumentan la incidencia de las enfermedades crónicas no transmisibles, principales causas de óbito e incapacidad en Brasil. Su gestión pasó a ser considerada importante por los gestores en la búsqueda de intervenciones y estrategias para reducir costos, disminuir hospitalizaciones y combatir agravios. Sin embargo, la mayor parte de los programas de atención se enfoca exclusivamente en la enfermedad, y esto es un error. Modelos que funcionen de modo integrado y tomen en cuenta las necesidades de los pacientes serán más efectivos. El objetivo de este artículo fue contribuir para la discusión de políticas y estrategias que permitan la inducción de modelos de atención al anciano haciendo énfasis en proyectos preventivos y resolutivos.

La última reforma del sistema general de seguridad social en salud Colombiano / The latest reform of the Colombian healthcare-related social security system

Objetivo El propósito de este ensayo es explorar y analizar los cambios y oportunidades generados con la reforma del sistema de salud colombiano, a partir de la ley 1438 del 2011. Métodos Para lograrlo se revisan documentalmente algunos temas pendientes desde la reforma introducida por la ley 100 de 1993 y los compara con la norma del 2011; también se contrastan con algunas estrategias de la salud pública inoperantes en la etapa de la reforma, bajo condiciones del modelo de mercado. Resultados Se discute esta segunda fase de la reforma en relación con el alcance del derecho a la salud, el acceso y la equidad global. Se reconoce el avance en temas importantes, como la igualación de los paquetes de beneficios, la atención primaria en salud, las redes integradas de servicios de salud, pero se discute su inoperancia para modificar aspectos medulares del sistema, como la sostenibilidad financiera y la lógica económica que se imponen sobre las estrategias mencionadas las cuales ven cercenada su capacidad de respuesta, en aras de mantener incólume el modelo de la ley 100 de 1993. Conclusión Finalmente, se esbozan los puntos cruciales necesarios a una gran reforma estructural del sistema de salud colombiano que se base en el derecho a la salud y en la equidad.

Objective This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system. Methods Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage. Results This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact. Conclusion The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.

Integrated Child Development Services (ICDS) scheme: a program for holistic development of children in India.

The Integrated Child Development Services (ICDS) scheme is the largest program for promotion of maternal and child health and nutrition not only in India but in the whole world. The scheme was launched in 1975 in pursuance of the National Policy for Children. The scheme has expanded in the last twenty-seven years form 33 projects to 5171 blocks. ICDS is a multi-sectoral program and involves several government departments. The program services are coordinated at the village, block, district, state and central government levels. The primary responsibility for the implementation of the program lies with the Department of Women & Child Development at the Centre and nodal department at the states, which may be Social Welfare, Rural Development, Tribal Welfare or Health Department or an independent Department. The beneficiaries are children below 6 years, pregnant and lactating women and women in the age group of 15 to 44 yrs. The beneficiaries of ICDS are to a large extent identical with those under the Maternal and Child Health Program. The program provides an integrated approach for converging all the basic services for improved childcare, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. ICDS program is the reflection of the Government of India to effectively improve the nutrition and health status of underprivileged section of the population through direct intervention mechanism. The program covers 27.6 million beneficiaries with supplementary nutrition. The program services and beneficiaries has essentially remained the same since 1975. Recently a review of the scheme was held, sponsored by Government of India, which suggested modifications in the health and nutrition component of ICDS scheme to improve the program implementation and efficiency.

Adopting integrated management of childhood illness module at local level in Bangladesh: implications for recurrent costs.

This study estimated the recurrent cost implications of adopting Integrated Management of Childhood Illness (IMCI) at the first-level healthcare facilities in Bangladesh. Data on illnesses of children who sought care either from community health workers (CHWs) or from paramedics over a four-month period were collected in a rural community. A total of 5,505 children sought care. About 75% of symptoms mentioned by mothers were directly related to illnesses that are targeted in the IMCI. Cough and fever represented 64% of all reported complaints. Referral of patients to higher facilities varied from 3% for the paramedics to 77% for the CHWs. Had the IMCI module been followed, proportion of children needing referral should have been around 8%. Significant differences were observed between IMCI-recommended drug treatment and current practice followed by the paramedics. Adoption of IMCI should save about US$ 7 million on drugs alone for the whole country. Proper implementation of IMCI will require employment of additional health workers that will cost about US$ 2.7 million. If the current level of healthcare use is assumed, introduction of IMCI in Bangladesh will save over US$ 4 million.