ABSTRACT
ANTECEDENTES: El 11 de marzo de 2020, la Organización Mundial de la Salud declaró la enfermedad por coronavirus (COVID-19) como pandemia, cuyos casos y gravedad en Chile han sido elevados. Internacionalmente, los profesionales de la salud han debido adaptar sus actividades laborales hacia pacientes mecánicamente ventilados por agravamiento de los síntomas respiratorios. La terapia respiratoria y terapia física que realizan los kinesiólogos en la unidad de cuidados intensivos (UCI) es fundamental, y existe la urgencia por agrupar datos nacionales que permitan describir la situación y así prepararse para futuros aumentos de la carga asistencial en UCI. OBJETIVO: Describir las modificaciones institucionales, laborales y asistenciales, experimentadas por kinesiólogos que se desempeñan en UCI durante y después de la pandemia COVID-19 en Chile. MÉTODOS: Este es el protocolo de un estudio observacional analítico transversal, el cual recopilará información desde el inicio hasta un año iniciada la pandemia. Se incluirán todas las UCI adulto existentes y las creadas por contingencia COVID-19. Se excluirán aquellas que no hayan recibido pacientes en UCI con COVID-19 confirmado. Se aplicará una encuesta online (REDCap®) al kinesiólogo representante de cada centro, la cual recopilará la información anonimizada principalmente a través de selección múltiple y escala Likert. RESULTADOS ESPERADOS: Se espera identificar un alto porcentaje de modificaciones institucionales en las UCI de Chile, y kinesiólogos que se vieron en la necesidad decambiar sus condiciones laborales y asistenciales durante la pandemia, en comparación al período pre-pandemia;cambios que en un menor porcentaje se mantuvieron en el tiempo.
BACKGROUND: On March 11, 2020, the World Health Organization declared coronavirus disease (COVID-19) as a pandemic, whose cases and severity in Chile have been high. Worldwide, health staffs have adapted their working activities focusing mainly on mechanically ventilated patients due to respiratory decline. Respiratory therapy and physical therapy by physiotherapists in the intensive care unit (ICU) are essential, and national data needs to be collected to describe the pandemic-related context to prepare for future increases in the ICU demand. OBJECTIVE: To describe the institutional, workforce and healthcare modifications experienced by the ICU physiotherapists during and after the COVID-19 pandemic in Chile. METHODS: This is the protocol of a cross-sectional study, which will collect information from the beginning to 1 year after the pandemic begins. All existing adult ICUs and those ICUs created during the pandemic will be included. Those who have not received ICU patients with confirmed COVID-19 will be excluded. An online survey will be applied to the physiotherapists representing each ICU, which will collect the anonymous information mainly through multiple selection-choice and Likert scale.EXPECTED RESULTS: We will be expected to identify a high percentage of institutional modifications in the ICUs in Chile, and that the physiotherapists would need of changing their working and healthcare conditions during the pandemic, compared to the pre-pandemic period; changes that in a smaller percentage would be maintained over time.
Subject(s)
Humans , Pneumonia, Viral , Physical Therapy Modalities/organization & administration , Coronavirus Infections , Critical Care/organization & administration , Physical Therapists/organization & administration , Chile , Cross-Sectional Studies , Surveys and Questionnaires , Physical Therapy Specialty/organization & administration , Pandemics , Intensive Care Units/organization & administrationABSTRACT
Resumo Exploramos, a partir de entrevistas com fisioterapeutas, os argumentos produzidos por estes sobre suas ações e as relações entre uma mudança que vem ocorrendo no perfil de adoecimento em crianças, onde vemos um aumento da prevalência de condições crônicas complexas. De caráter qualitativo, os dados foram gerados com base em duas afirmativas provocadoras de argumentos por parte dos profissionais. A análise dos dados revelou falas que podem ser referidas como resultados de disputas de poder sobre a atuação nesse novo campo de saber. Para se sentir reconhecido e valorizado o fisioterapeuta procura se afirmar através de seu conhecimento e da aproximação com outras categorias profissionais, principalmente a medicina. No entanto, vemos que o profissional utiliza com os familiares e os cuidadores um discurso mais simples, gerando um vínculo de confiança e uma identificação com os mesmos, o que facilita seu atendimento e o acesso à criança. Apontamos a necessidade de o ambiente hospitalar ser reconhecido como espaço de atuação de outras categorias, além de Medicina e Enfermagem, e a valorização da formação em fisioterapia pediátrica.
Abstract Based on interviews with physiotherapists, we explored the arguments produced by them about their actions and the relationships of a change that has been taking place in the profile of illness in children, where an increased prevalence of complex chronic conditions has been observed. Structured in a qualitative approach, data were generated based on two provocative affirmations that generated arguments by the professionals. Data analysis revealed statements that can be referred to as results of power struggles over the performance in this new field of knowledge. Physiotherapists seek to affirm themselves through their knowledge and by approaching other professional categories, especially Medicine, in order to feel recognized and valued. However, we see that these professionals use a simpler discourse with family and caregivers, creating a bond of trust and identification with them, which facilitates their care and access to children. We point out the need for the hospital environment to be recognized as a place for the action of other categories, besides Medicine and Nursing, and the valuation in pediatric physiotherapy.
Subject(s)
Humans , Male , Female , Child , Health Knowledge, Attitudes, Practice , Chronic Disease/therapy , Physical Therapy Modalities , Physical Therapists/organization & administration , Pediatrics/methods , Interviews as Topic , Dissent and DisputesABSTRACT
INTRODUCCIÓN: La Sociedad Europea de Medicina de Cuidados Intensivos recomienda la presencia de un Kinesiólogo con formación especializada, disponible cada cinco camas de alta complejidad, los 7 días de la semana en la Unidad de Cuidados Intensivos (UCI). En Chile se desconoce la adherencia de las UCI adulto a esta recomendación. OBJETIVO: Describir las características administrativas y de cobertura kinésica en las UCI adulto chilenas, y de acuerdo con la adherencia a las recomendaciones internacionales, informar a los tomadores de decisión en salud. MÉTODOS: Estudio observacional transversal, basado en encuesta telefónica. Se incluyeron las UCI adultos de establecimientos de mayor complejidad, clínicas privadas y centros asociados a universidades (n = 74). La proporción de instituciones con disponibilidad de kinesiólogos las 24 horas del día, los siete días de la semana (kinesiólogo 24/7), con un número máximo de cinco pacientes por kinesiólogo y presencia de un kinesiólogo especialista fueron reportados. RESULTADOS: La tasa de respuesta fue del 86,5% (n = 64), principalmente públicas (59%) y de nivel III (83%). El 70% (n = 45) de las UCI adulto chilenas cuentan con kinesiólogo 24/7; correspondiendo el 87% al sector público y el 46% al privado. El 41% de los centros posee un máximo de 5 pacientes por kinesiólogo en día hábil diurno, disminuyendo en fines de semana y horarios nocturnos. Un 23% de las UCIs cuenta con kinesiólogo especialista en intensivo, siendo mayor en el sector privado (31%). CONCLUSIONES: En UCI adulto chilenas, la disponibilidad de kinesiólogos 24/7 es alta, y la prevalencia de especialistas es baja. Estrategias de creación de programas de formación de especialidad podrían contribuir a disminuir la brecha de especialistas.
INTRODUCTION: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. OBJECTIVE: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. METHODS: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. RESULTS: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). CONCLUSIONS: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.
Subject(s)
Humans , Adult , Physical Therapy Modalities/organization & administration , Physical Therapists/organization & administration , Intensive Care Units/organization & administration , Personnel Staffing and Scheduling , Chile , Cross-Sectional Studies , Public Sector/statistics & numerical data , Private Sector/statistics & numerical data , Health Care SurveysABSTRACT
Abstract Many health systems (HS) have adopted novel models of care which have included non-medical prescription (NMP) by physiotherapists. The aim of this study was to verify in the literature the existence of this practice and its possible benefits. A literature review was carried out through search on Science Direct, PubMed, SciELO, Lilacs and Google Scholar, and in the World Confederation for Physical Therapy and Chartered Society of Physiotherapy websites. In recent decades the United Kingdom adopted the NMP for health professionals, followed by Canada. In Australia and New Zealand physiotherapists have acted in the prescription and administration of medications under medical orders, which is the first step into independent prescription. Brazilian physiotherapists cannot prescribe any medication, despite of high demands from patients in the Brazilian HS, shortage of physicians in many regions and bureaucracy in accessing health services. The adoption of NMP by physiotherapists may play an important role in the HS, and it seems to be an inevitable achievement in the next years in Australia and New Zealand. The main benefits include decreasing bureaucracy for assistance, population demands for medication as well as major professional refinement.
Resumo Alguns sistemas de saúde (SS) têm adotado modelos inovadores de assistência que incluem a prescrição não médica (PNM) por fisioterapeutas. Este estudo objetivou verificar na literatura a existência dessa prática e seus possíveis benefícios. Foi realizada revisão da literatura, com buscas na Science Direct, PubMed, SciELO, Lilacs e Google Scholar, e nos sites da World Confederation for Physical Therapy e da Charthered Society of Physiotherapy, entre 2014 e 2015. O Reino Unido adotou a PNM por fisioterapeutas em décadas recentes, exemplo seguido pelo Canadá. Na Austrália e Nova Zelândia, fisioterapeutas têm atuado na prescrição e administração de medicamentos, sob ordens médicas, sendo este o primeiro passo para a prescrição independente. Fisioterapeutas brasileiros não podem prescrever medicamentos, apesar das altas demandas de pacientes, carência de médicos em muitas regiões e burocracia no acesso aos serviços de saúde. A prática da PNM por fisioterapeutas pode preencher um importante papel nos SS, e parece ser uma inevitável realização na Austrália e Nova Zelândia nos próximos anos. Os principais benefícios são a diminuição da burocracia no acesso a medicamentos e demandas populacionais, bem como maior refinamento profissional.
Subject(s)
Humans , Drug Prescriptions , Delivery of Health Care/organization & administration , Physical Therapists/organization & administration , Physicians/organization & administration , Physicians/supply & distribution , Brazil , Physical Therapy Modalities/organization & administration , Professional Role , Prescription Drugs/administration & dosage , Health Services AccessibilityABSTRACT
El presente trabajo denominado "Caracterización de las condiciones laborales del Kinesiólogo y Fisioterapeuta como indicador de salud en tres Instituciones de la Ciudad de San Fernando del Valle de Catamarca, tiene la finalidad de describir, interpretar y reflexionar sobre el trabajo en Instituciones de Salud ya que pueden ser fuentes de enfermedades física como mentales, los profesionales de la salud están expuesto a las llamadas patologías laborales y están más expuesto que otros sectores que poseen contacto directo con los pacientes, y no existe entre ellos conciencia real de sus derechos ni de las medidas de prevención que son responsabilidad del estado, ya que su intervención profesional con personas con distintas patologías, hace más expuesta su salud si no poseen la aparatología, espacios físicos ect. de atención acorde
Summary: The present work called "Characterization of working conditions of physical therapists and physical therapist as an indicator of health in three institutions since they can be sources of physical as mental illnesses, health professionals are exposed to the so-called occupational pathologies and are more exposed to that other sectors that have direct contact with" patients, and not exists among them real awareness of their rights or of preventive measures which are the responsibility of State, since his professional intervention with people with different pathologies, more exposed their health if they do not possess equipment, physical spaces ect consistent attention
Subject(s)
Humans , Occupational Health , Physical Therapists/organization & administration , Physical Therapists/trends , ArgentinaABSTRACT
INTRODUÇÃO: São abordados os históricos da Saúde Pública e da Fisioterapia, tanto no Brasil como em Belém, as representações sociais da Fisioterapia que lhe dão corpo e formatação e a realidade do fisioterapeuta municipal no SUS. O enfoque é dado ao processo de vivência dos fisioterapeutas no SUS, expondo a realidade da entrada da Fisioterapia nos serviços públicos, a partir da visão do fisioterapeuta municipal, participante do processo de municipalização preconizado pelo SUS. OBJETIVO: Esta dissertação analisa o processo de contribuição da Fisioterapia no SUS, a partir de ações mobilizadoras do fisioterapeuta municipal de Belém. MATERIAL E MÉTODO: O estudo foi realizado entrevistando dezoito fisioterapeutas atuantes no município e em posições legais de liderança, fazendo uso de entrevistas semiestruturadas, objetivando analisar suas opiniões acerca da atual conjuntura em que se encontra a Fisioterapia nas Políticas Públicas de Saúde da região. CONCLUSÃO: Conclui-se que o fisioterapeuta, sofre as mesmas dificuldades que muitos profissionais de saúde do município, devido a completa faltade vontade política dos atuais governantes, que só arrastam os problemas para o imediatismo e emergencialismo tardio. Aliado a este aspecto, sobressai a falta de coligação da classe de fisioterapeutas, que só tende a retardar e enfraquecer as possíveis lutas políticas em beneficio próprio, pois seus interesses ainda perpassam por questões individualizadas e desconectadas da necessidade do sistema de saúde vigente do país. Esses fatores se entrelaçam e dificultam a inserção mais contundente da Fisioterapia dentro das Políticas Públicas de Saúde de Belém.
INTRODUCTION: It presents historical issues of Public Health and Physical Therapy areas in Brazil in general and in the city of Belem; social representation issues of the Physical Therapy profession which characterizes its local cultural manifestation and the way physical therapy services are provided in Belem city, and the present conditions physical therapists who work for the Brazilian universal health care system in city health care centers deal with. Focus is given to experiences lived by physical therapists who work for the universal health care system, presenting the real conditions of the onset of physical therapy services in public centers from the perspective of physical therapists who work in city health care centers who participated in the process of municipalization of physical therapy services present in universal health care system.OBJECTIVE: This dissertation thesis analyzes the process of physical therapists Ì contribution to the Brazilian Universal Health Care system focused on advocacy professional actions performed by physical therapists who work at city health care centers. MATERIAL E MÉTODO: In this study, 18 physical therapists who work in city health care centers and who hold leadership positions at their workplaces were interviewed through semi-structured interviews whose goal was analyzing their opinions on the present conjuncture the physical therapy profession deals with concerning health public policies in the North region of Brazil. CONCLUSION: The study reaches the conclusion that the physical therapist faces the same difficulties many other health professionals who work in city health care centers do because of total lack of political will of present government rulers, and this situation just drags problems into immediacy and late emergency actions. Besides this situation, one may highlight lack of physical therapists professional coalition which retards advocacy for the physical therapy profession. The author states that physical therapists act based on individual interests which do not relate to Brazil Ìs health care system needs. All these issues are interconnected and make it difficult for more appropriate implementation of physical therapists Ì intervention in public health policies in the city of Belém.