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1.
Nursing (Säo Paulo) ; 24(273): 5325-5332, fev.2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1150410

ABSTRACT

O objetivo do estudo foi conhecer com quem os homens comparecem aos serviços de saúde e quem seriam os acompanhantes. O cenário da pesquisa foi um ambulatório localizado na zona sul da cidade de São Paulo e contou com a participação de 51 indivíduos. Tratou-se de um estudo exploratório e descritivo, com abordagem quanti-qualitativa. A coleta dos dados foi feita por meio de um questionário semiestruturado. Os dados numéricos foram organizados em temas, agrupados em tabelas. As informações foram analisadas utilizando-se o método do Discurso do Sujeito Coletivo. Os resultados mostraram que 65% dos homens comparecem sós ao serviço, 27% citaram a esposa, destacando a parceria existente, 4% mencionaram a mãe, denotando vínculo materno, e 4% declararam a presença dos filhos. Constata-se que os homens vêm assumindo o protagonismo nos seus cuidados. Mesmo diante de um trabalho incipiente, vislumbra-se uma possibilidade de mudança.(AU)


The aim of the study was to find out with whom men attend health services and who would be the companions. The research scenario was an outpatient clinic located in the south of the city of São Paulo and had the participation of 51 individuals. It was an exploratory and descriptive study, with a quantitative and qualitative approach. Data collection was performed using a semi-structured questionnaire. The numerical data were organized into themes, grouped in tables. The information was analyzed using the Collective Subject Discourse method. The results showed that 65% of men attend the service alone, 27% mentioned the wife, highlighting the existing partnership, 4% mentioned the mother, denoting a maternal bond, and 4% declared the presence of their children. It appears that men have assumed the leading role in their care. Even in the face of incipient work, there is a possibility of change.(AU)


El objetivo del estudio fue conocer con quiénes acuden los hombres a los servicios de salud y quiénes serían los acompañantes. El escenario de investigación fue un ambulatorio ubicado en el sur de la ciudad de São Paulo y contó con la participación de 51 personas. Fue un estudio exploratorio y descriptivo, con enfoque cuantitativo y cualitativo. La recolección de datos se realizó mediante un cuestionario semiestructurado. Los datos numéricos se organizaron en temas, agrupados en tablas. La información se analizó mediante el método del Discurso Colectivo del Sujeto. Los resultados mostraron que el 65% de los hombres asisten solos al servicio, el 27% mencionó a la esposa, destacando la asociación existente, el 4% mencionó a la madre, denotando vínculo materno, y el 4% declaró la presencia de sus hijos. Parece que los hombres han asumido el papel principal en su cuidado. Incluso ante un trabajo incipiente, existe la posibilidad de cambio.(AU)


Subject(s)
Humans , Male , Referral and Consultation/statistics & numerical data , Health Behavior , Men's Health , Masculinity , Family , Cross-Sectional Studies , Surveys and Questionnaires , Health Services/statistics & numerical data
2.
Dolor ; 31(73): 10-14, ene. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1362741

ABSTRACT

Introducción: El dolor crónico no oncológico (DCNO) es un tema de salud pública con alta prevalencia en Chile. Existe evidencia sobre la necesidad de abordaje multidisciplinario por profesionales capacitados. El año 2013 se crea el policlínico de DCNO por la especialidad de fisiatría, coordinando atención con anestesista para intervencionismo. El Objetivo de este trabajo es conocer las características clínicas de los usuarios en control en policlínico de DCNO. Material y Método: Estudio retrospectivo, descriptivo, observacional. Desde la base de datos de usuarios atendidos entre inicios del 2013 y mayo 2018 de policlínico DCNO del Servicio de Medicina Física y Rehabilitación del HHHA; se recogen variables como: sexo, edad, etnia, previsión, ruralidad, diagnóstico ingreso, intensidad dolor (según NRS), tratamiento farmacológico, entre otras. Para manejo estadístico se utiliza planilla Excel, con pruebas paramétricas (promedio, mínimo, máximo), tablas y gráficos. Resultados: Los usuarios en control en el periodo fueron 125, con un 67,2% de mujeres y una mediana de edad de 55,5 años (mínimo 12, máximo 88). El 58,4% tenía como previsión Fonasa B, 83.2% presenta domicilio urbano, 16% etnia mapuche. El mayor número de ingresos ocurrió el año 2017. Las derivaciones provienen de especialidades médicas (25,6%), quirúrgicas (29,6%), fisiatría (24,8%). Según tipo de dolor, el 49,6% es nociceptivo, 32% neuropático y 18,4% mixto. Al ingreso, la intensidad fue 90% severa y 10% moderada (según NRS). Los principales diagnósticos de ingreso fueron 44,8% patología de columna, 27,2% patología neurológica, 12,8% fibromialgia y 15,2% otras. Al ingreso mayoría de los usuarios usaba paracetamol, tramadol gotas o comprimidos; actualmente 23% recibe metadona, 8% parches buprenorfina, 20% paracetamol, 27,2% tramadol en gotas/comprimidos y 23,2% pregabalina/ gabapentina. En el 51,2% se requirió cambio de terapia; en el 79,7% por analgesia insuficiente y 20,3% por reacción adversa a medicamentos. Se realizó derivación a intervencionismo en 21 usuarios. 15 usuarios fueron dados de alta de policlínico DCNO (12%). Conclusiones: Estos datos servirán para futuras investigaciones y medir impacto de nuestras intervenciones. Se presenta como desafío aumentar recursos de la unidad, demostrar beneficio de atención interdisciplinaria y bajar costos para la institución.


Introduction: Non-oncological chronic pain (NOCP) is a public health issue with high prevalence in Chile. There is evidence of the need for a multidisciplinary approach by trained professionals. In 2013, the NOCP polyclinic was created for the specialty of physiatry, coordinating care with anesthesiologist for interventionism. The objective of this work is to know the clinical characteristics of users in control in NOCP polyclinic. Material and Methods: Retrospective, descriptive, observational study. From the database of users attended between the beginning of 2013 and May 2018, from the NOCP polyclinic of the Physical Medicine and Rehabilitation Service of the HHHA; variables such as: sex, age, ethnicity, foresight, rurality, income diagnosis, pain intensity (according to NRS), and pharmacological treatment, among others are collected. For statistical management Excel spreadsheet isused, with parametric tests (average, minimum, maximum), tables and graphs. Results: The users in control in the period were 125, with 67.2% of women, a median age of 55.5 years (minimum 12, maximum 88). 58.4% had Fonasa B as a forecast, 83.2% have an urban address, 16% Mapuche ethnicity. The highest number of admissions occurred in 2017. The referrals come from medical specialties (25.6%), surgical specialties (29.6%), and physiatry (24.8%). According to type of pain, 49.6% is nociceptive, 32% neuropathic and 18.4% mixed. At admission, the intensity was 90% severe and 10% moderate (according to NRS). The main diagnoses of admission were 44.8% spinal pathology, 27.2% neurological pathology, 12.8% fibromyalgia and 15.2% others. On admission, most users used paracetamol, tramadol drops or tablets; currently 23% receive methadone, 8% patches buprenorphine, 20% paracetamol, 27.2% tramadol in drops / tablets and 23.2% pregabalin / gabapentin. In 51.2%, therapy change was required; in 79.7% due to insufficient analgesia and 20.3% due to adverse drug reaction. A derivation to interventionism was carried out in 21 users. 15 users were discharged from polyclinic DCNO (12%). Conclusions: These data will serve for future research and measure the impact of our interventions. It is a challenge to increase the resources of the unit, demonstrate the benefit of interdisciplinary attention and lower costs for the institution.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Chronic Pain/epidemiology , Patient Discharge/statistics & numerical data , Physical and Rehabilitation Medicine , Referral and Consultation/statistics & numerical data , Chile , Public Health , Prevalence , Retrospective Studies , Age and Sex Distribution , Chronic Pain/drug therapy , Health Services Research
3.
Rev. bras. med. fam. comunidade ; 16(43): 2572, 20210126. tab, graf
Article in Portuguese | LILACS, ColecionaSUS | ID: biblio-1292041

ABSTRACT

Introdução: A iatrogenia é uma causa importante de morbimortalidade, logo, a prevenção quaternária (P4), ação que ceifa a cascata diagnóstica supérflua, foi incluída como exercício de boa prática. A medicina de família e comunidade (MFC) introjeta a P4 na vivência, sendo capaz de usar ciência aliada a habilidades de comunicação para conhecer as pessoas, resolvendo assim cerca de 85% das queixas, o que inclui as de origem vascular. Existe uma alta demanda no Sistema Único de Saúde (SUS) tanto na marcação de exames quanto no encaminhamento para especialistas focais no que tange às queixas circulatórias, mas nem sempre encaminhar é oportuno. Nesse cenário, a MFC funciona como um caminho para a P4. Objetivos: O objetivo do presente estudo foi avaliar as referências para cirurgia vascular e angiologia e as solicitações de ultrassonografia (USG) Doppler de vasos de unidades de saúde da família (USFs) de João Pessoa/PB, analisando as taxas de solicitações por população adulta (>18 anos) adscrita, nas unidades conveniadas ao programa de residência em medicina de família e comunidade (PRMFC) há mais de 1 ano, há menos de 1 ano e naquelas sem convênio com PRMFC, sob o olhar crítico da P4. Métodos: Trata-se de um estudo transversal a partir de dados fornecidos pela Central de Regulação da Secretaria Municipal de Saúde de João Pessoa (SMS/JP), entre janeiro de 2017 e agosto de 2018. Para realização dos cálculos de correlação entre as variáveis estudadas, utilizou-se o teste de Kruskall-Wallis através do software SPSS 21.0. Resultados: O número total de pedidos de exames em análise foi de 3.918, oriundos de 90 USF, que somam uma população adscrita maior de 18 anos de 332.819 pessoas. Solicitou-se 1 Doppler a cada 85 habitantes adultos. Os resultados do estudo sugerem que os médicos residentes solicitam mais exames que os médicos não residentes, mas por outro lado apresentam menor taxa de encaminhamento aos especialistas. Conclusões: Estes achados podem sugerir que os médicos residentes encaminham menos, o que pode estar relacionado ao aumento da resolubilidade da atenção primária à saúde (APS) e ao ensino da P4 sob orientação de um médico de família e comunidade preceptor. Entretanto, novos delineamentos de pesquisa são necessários para melhor elucidar esta hipótese.


Introduction: Iatrogenesis is an important cause of morbimortality and quaternary prevention (P4), an action that reduces the superfluous diagnostic cascade, was included as an exercise of good practice. Family practice projects P4 into practice, being able to use science combined with communication skills to know people, solving about 85% of complaints, including vascular discomforts. There is a high demand at Sistema Único de Saúde (SUS) both in scheduling exams and referrals to focal specialists with regard to circulatory complaints, but referring is not always appropriate. In this scenario, family practice works as a pathway to P4. Objectives: The aim of the present study was to evaluate the referrals for vascular surgery/angiologist and requests for Doppler ultrasonography (USG) of vessels from family health units (USF) in João Pessoa, PB, analyzing the rates of requests per registered adult population (>18-years-old) in the units affiliated to the family practice medical residency program (FPMRP) for more than a year, less than a year and in the non-affiliated ones, under P4's critical view. Methods: This is a cross-sectional study of data provided by the Regulation Center of the Municipal Health Department of João Pessoa, between January 2017 and August 2018. To perform the correlation calculations between the studied variables, Kruskall-Wallis' correlation test was used through the SPSS 21.0 software. Results: The total number of exam requests under analysis was 3,918, from 90 USF, which add up to an enrolled population over 18-years-old of 332,819 people. For every 85 adult inhabitants, one Doppler exam was requested. Data suggest that the resident doctors request more exams than the non-residents, but on the other hand they have lower rates of referrals to focal experts. Conclusions: These findings may suggest that resident physicians refer less, which may be related to the increase in the resolution of primary care and the teaching of P4 under the guidance of a family practice preceptor. However, new research designs are considered to better elucidate this hypothesis.


Introducción: La iatrogenia es una causa importante de morbilidad y mortalidad, por lo que se incluyó como ejercicio de buena práctica la prevención cuaternaria (P4), una acción que corta la cascada diagnóstica superflua. La medicina familiar y comunitaria (MFC) introduce la P4 en la práctica, siendo capaz de utilizar la ciencia aliada a las habilidades de comunicación para conocer a las personas, resolviendo así alrededor del 85% de las quejas, lo que incluye las quejas vasculares. En el Sistema Único de Salud (SUS) brasileño hay una gran demanda, tanto para programar exámenes como para derivar a los especialistas focales las dolencias circulatorias, pero la derivación no siempre es oportuna. En este escenario, la CBM funciona como una vía hacia la P4. Objetivo: El objetivo del presente estudio fue evaluar las referencias de cirugía vascular y angiología y las solicitudes de ultrasonografía Doppler (USG) de vasos de las unidades de salud de la familia (USF) de João Pessoa/PB, analizando las tasas de solicitudes por población adulta (>18 años) asignada, en las unidades asociadas al programa de residencia en medicina de la familia y de la comunidad (CFMRP) por más de 1 año, por menos de 1 año y en las que no tienen convenio con el CFMRP, bajo la visión crítica del P4. Métodos: Se trata de un estudio transversal de datos proporcionados por la Central de Regulación de la Secretaría Municipal de Salud de João Pessoa (SMS/JP), entre enero de 2017 y agosto de 2018. Se utilizó la prueba de Kruskall-Wallis para realizar los cálculos de correlación entre las variables estudiadas mediante el programa informático SPSS 21.0. Resultados: El número total de solicitudes de pruebas analizadas fue de 3.918, procedentes de 90 USF, que suman una población asignada mayor de 18 años de 332.819 personas. Se solicitó un Doppler por cada 85 habitantes adultos. Los resultados sugieren que los médicos residentes solicitan más pruebas que los no residentes, pero por otro lado tienen una tasa de derivación a especialistas más baja. Conclusiones: Estos resultados pueden sugerir que los médicos residentes derivan menos, lo que puede estar relacionado con la mayor resolutividad de la Atención Primaria de Salud (APS) y la enseñanza de la P4 bajo la dirección de un médico de familia y un preceptor comunitario. Sin embargo, se necesitan nuevos diseños de investigación para dilucidar mejor esta hipótesis.


Subject(s)
Humans , Adolescent , Adult , Primary Health Care , Referral and Consultation/statistics & numerical data , Vascular Surgical Procedures/statistics & numerical data , Ultrasonography, Doppler/statistics & numerical data , Quaternary Prevention , Internship and Residency , Cross-Sectional Studies
4.
Clin. biomed. res ; 41(4): 283-290, 2021. tab, graf
Article in English | LILACS | ID: biblio-1349336

ABSTRACT

Introduction: Oral lesions are present in approximately 30% of the population worldwide. Although the mouth is an anatomical region that can be easily accessed for direct visual examination, most dentists of dental surgeons have reported difficulties in the diagnosis and management of oral diseases. The primary aim of this study was to assess the completeness of referral forms of the patients referred by dentists from the primary care basic health units to an Oral Medicine service. The secondary aim was to analyze if the complexity of the cases justify the referral to a specialist. Methods: Data from 131 referral forms of patients referred from June 2014 to April 2016 were retrieved from the records. The referral's completeness analysis comprised two stages. Stage 1 mainly comprised patient and applicant's information. In the Stage 2, the documents were scored according to amount of information, including the description of the lesion characteristics and the procedures required for the patients' diagnosis and management. The referral was considered justifiable if some procedures not available at primary care were required for diagnosis or treatment. Results: Five (9.8%) referral forms were considered well filled. Diagnosis agreement was 71.4%. Regarding the need of referral, 40,6% of the cases (n = 50) could be settle at the primary care. Conclusion: In conclusion, few referral forms had high-quality information and the many cases could be managed at primary care health services. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Referral and Consultation/statistics & numerical data , Oral Medicine , Primary Health Care , Mouth/physiopathology
5.
Esc. Anna Nery Rev. Enferm ; 25(2): e20200249, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1133831

ABSTRACT

Resumo Objetivos identificar a prevalência de adesão e não adesão à consulta puerperal, assim como facilitadores e barreiras, entre puérperas assistidas em um hospital de ensino. Método estudo de coorte prospectivo, realizado com 121 puérperas, no período de agosto a dezembro de 2019, nas dependências de um hospital de ensino do interior de Minas Gerais. Resultados a prevalência de adesão à consulta puerperal foi de 34,7%. Observou-se, como facilitador, o acolhimento da equipe durante o pré-natal e/ou parto. Citaram-se como barreiras: esquecimento; intercorrências com o RN e/ou puerperais; dificuldade de transporte e distância entre o serviço e a residência. Foram associados à adesão: puérperas com maior escolaridade, que realizaram todo ou parte do pré-natal na instituição, que tiveram a gestação classificada como alto risco, que apresentaram doenças prévias durante a gestação, primigestas e as que tiveram parto cesáreo. Conclusões e implicações para a prática os dados apresentados possibilitaram delinear um perfil das puérperas que aderiram ou não à consulta puerperal, desvelando fatores facilitadores e barreiras, assim como fatores associados à maior adesão. Faz-se necessário repensar a assistência ao puerpério, uma vez que a consulta é uma estratégia de prevenção de morte materna.


Resumen Objetivos identificar la prevalencia de adherencia y no adherencia a la consulta puerperal, así como facilitadores y barreras, entre las mujeres puerperales atendidas en un hospital universitario. Método estudio de cohorte prospectivo, realizado con 121 madres, de agosto a diciembre de 2019, en las instalaciones de un hospital universitario en el interior de Minas Gerais. Resultados La prevalencia de adherencia a la consulta puerperal fue del 34,7%. La bienvenida del equipo durante el prenatal y/o parto se observó como un facilitador. Se mencionaron las siguientes barreras: olvido, complicaciones con el recién nacido y/o puerperal, dificultad en el transporte y la distancia entre el servicio y la residencia. Los siguientes se asociaron con la adherencia: mujeres puerperales con educación superior, que realizaron todo o parte de la atención prenatal en la institución, que tuvieron un embarazo clasificado como de alto riesgo, que tuvieron enfermedades previas durante el embarazo, primigestas y quienes tuvieron un parto por cesárea. Conclusiones e implicaciones para la práctica Los datos presentados permitieron esbozar un perfil de las mujeres puerperales que se adhirieron o no a la consulta puerperal, revelando factores y barreras facilitadoras, así como factores asociados con una mayor adherencia. Es necesario repensar la asistencia al puerperio, ya que la consulta es una estrategia para prevenir la muerte materna.


Abstract Objectives to identify the prevalence of adherence and non-adherence to postpartum consultation, as well as facilitators and barriers, among postpartum women assisted in a teaching hospital. Method a prospective cohort study, conducted with 121 postpartum women, from August to December 2019, assisted in a teaching hospital in the inland of Minas Gerais. Results the prevalence of adherence to postpartum consultation was 34.7%. The reception of the health team during the prenatal and/or birth was observed as a facilitator. The mentioned barriers were the following: forgetfulness, complications with themselves and/or the newborn, transportation difficulty and distance between the service and residence. The factors associated with adherence were the following: postpartum women with higher education, who performed all or part of the prenatal care at the institution, who had pregnancy classified as high risk, who had previous diseases during pregnancy, primigravidae, and who had cesarean delivery. Conclusions and implications for the practice the submitted data made it possible to delineate a profile of the postpartum women who adhered or not to the postpartum return, identifying facilitators and barriers as well as factors associated with greater adherence. It is necessary to rethink assistance to the postpartum period, since consultation is the one of the strategies to prevent maternal death.


Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Referral and Consultation/statistics & numerical data , Postpartum Period , Treatment Adherence and Compliance , Socioeconomic Factors , Prevalence , Cohort Studies
6.
Arq. neuropsiquiatr ; 78(8): 494-500, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131736

ABSTRACT

ABSTRACT Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.


RESUMO Introdução: Mais de um terço dos pacientes com COVID-19 apresentam sintomas neurológicos que variam de anosmia a AVC e encefalopatia. Além disso, doenças neurológicas prévias podem exigir tratamento especial e estar associadas a piores desfechos. Não obstante, o papel dos neurologistas na COVID-19 é provavelmente pouco reconhecido. Objetivo: O objetivo deste estudo foi relatar os motivos para solicitar consultas neurológicas por clínicos e intensivistas em um hospital dedicado à COVID-19. Métodos: Estudo retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil, um centro dedicado à COVID-19 com 900 leitos (incluindo 300 leitos para unidades de terapia intensiva). O diagnóstico de COVID-19 foi confirmado por SARS-CoV-2-RT-PCR em swabs nasais. Todas as interconsultas de neurologia hospitalar entre 23 de março e 23 de maio de 2020 foram analisadas. Os neurologistas realizaram o exame neurológico, avaliaram todos os dados disponíveis para diagnosticar a patologia neurológica e solicitaram exames adicionais conforme necessidade. Diagnósticos difíceis foram estabelecidos em reuniões de consenso. Após o diagnóstico, os neurologistas participaram da condução dos casos. Resultados: Foram solicitadas consultas neurológicas para 89 de 1.208 (7,4%) em pacientes internados por COVID-19 durante o período. Os principais diagnósticos neurológicos incluíram: encefalopatia (44,4%), acidente vascular cerebral (16,7%), doenças neurológicas prévias (9,0%), crises epilépticas (9,0%), transtornos neuromusculares (5,6%), outras lesões encefálicas agudas (3,4%) e outros sintomas leves inespecíficos (11,2%). Conclusões: A maioria das consultas neurológicas em um hospital dedicado à COVID-19 foi solicitada para condições graves que poderiam afetar o desfecho clínico. Os médicos na linha de frente devem ser capazes de reconhecer sintomas neurológicos. Os neurologistas são membros importantes da equipe médica no atendimento hospitalar à COVID-19.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Referral and Consultation/statistics & numerical data , Coronavirus Infections/diagnosis , Pandemics , Nervous System Diseases/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Brazil/epidemiology , Retrospective Studies , Coronavirus Infections , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Betacoronavirus , Hospital Bed Capacity , Hospitals, University , Nervous System Diseases/diagnosis , Nervous System Diseases/therapy , Neurology
7.
Ciênc. Saúde Colet ; 25(4): 1389-1400, abr. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1089536

ABSTRACT

Resumo Na Atenção Primária à Saúde (APS) acesso e integralidade são fortemente influenciados pela coordenação do cuidado, que por sua vez recebe impacto positivo da articulação de ações de telessaúde para a telerregulação da assistência. Criamos uma metodologia de telerregulação (Projeto RegulaSUS) baseada em protocolos específicos firmemente alicerçados em evidências. A partir de dados do sistema de regulação e do TelessaúdeRS exploramos os efeitos do RegulaSUS na APS e no acesso ao cuidado especializado. A metodologia foi capaz de criar protocolos abrangentes, com expressiva redução média da fila de consultas especializadas de 30% em 360 dias. Reduziu o tempo de espera na marcação de consultas em especialidades clínicas (mediana de 66 dias), mas não em cirúrgicas. Tempos de espera nos casos mantidos em fila variaram de forma inversa, aumentado em especialidades clínicas e diminuindo em cirúrgicas. O uso de teleconsultorias espontâneas aumentou com a exposição dos profissionais ao RegulaSUS. A intervenção tem potencial na integração de sistemas de saúde, principalmente em países de baixa e média renda, e faz com que a telessaúde atue como metasserviço, construindo redes eficientes, qualificadas e equânimes.


Abstract In Primary Health Care (PHC), access, and integrality are strongly influenced by the coordination of care, which in turn receives a positive impact from the articulation of telehealth actions for teleregulation of care. We created a teleregulation method (RegulaSUS Project) based on specific protocols firmly grounded in scientific evidence. From data of the regulatory system and TelessaúdeRS, we explored the effects of RegulaSUS on PHC and access to specialized care. This method set comprehensive protocols, with a significant mean reduction of 30% in the specialized visits queue over 360 days. It reduced waiting time for medical clinical visits (median of 66 days) but not for surgical appointments. Waiting times for queued cases varied inversely, increasing for clinical and declining for surgical specialties. The use of teleconsultations unrelated to regulation increased with the exposure of professionals to RegulaSUS. The intervention evidence potentiality in the integration of health systems, mainly among low- and middle-income countries, and makes telehealth act as a meta-service, building efficient, qualified, and equitable networks.


Subject(s)
Humans , Primary Health Care/organization & administration , Telemedicine/organization & administration , Health Services Accessibility/organization & administration , Appointments and Schedules , Primary Health Care/statistics & numerical data , Referral and Consultation/organization & administration , Referral and Consultation/statistics & numerical data , Time Factors , Brazil , Waiting Lists , Telemedicine/statistics & numerical data , Capacity Building , Data Analysis , Health Services Accessibility/statistics & numerical data
8.
Rev. bras. ginecol. obstet ; 42(3): 140-145, Mar. 2020. tab
Article in English | LILACS | ID: biblio-1098862

ABSTRACT

Abstract Objective To describe the referral for colposcopy in a Hospital in Brazil and the relative frequency of patients who benefited from it, considering the correct indications for the examination and its final diagnoses. Methods A retrospective study was performed in the colposcopy service database of the Hospital Universitário de Taubaté, Taubaté, state of São Paulo, Brazil. The frequency validated in the analysis of the medical records of women referred for clinical indication or cytological alteration, attended from March 2015 to March 2017. The population selected and analyzed included 256 results that were correlated to the cytological, clinical data and the result of the colposcopy. Results Of the women referred, 45% presented out of the age of screening according to the guidelines of cervical cancer screening, 8.6% being adolescents and young adults < 25 years old, and 36.4% of the patients being ≥ 65 years old. A total of 50% of the patients had no indication of colposcopy, that is, normal cytologies, benign changes, ectopia, cervicitis, atypical squamous cells of indeterminate significance (ASC-US) and low-grade intraepithelial lesion (LSIL) without persistence and normal clinical appearance. A total of 39.84% who underwent colposcopy had high-grade lesion or cancer results, thus benefiting from the adequate referral. Conclusion Most (60.16%) of the patients referred to the colposcopy service did not benefit from the referral for results without changes, such as negative colposcopies, histologies with no cervical intraepithelial neoplasm (CIN) or only CIN 1, or were out of the age for screening. These findings therefore demonstrate a significant number of unnecessary and inadequate referrals.


Resumo Objetivo Descrever os encaminhamentos para colposcopia em um hospital no Brasil e a frequência relativa dos pacientes que foram beneficiados, considerando as indicações corretas para o exame e seus diagnósticos finais. Métodos Foi realizado um estudo retrospectivo no banco de dados do serviço de colposcopia do Hospital Universitário de Taubaté, Taubaté, SP, Brasil. A frequência validou em análise de prontuários de mulheres encaminhadas por indicação clínica ou alteração citológica, atendidas no período de março de 2015 a março de 2017. A população selecionada e analisada incluiu 256 resultados que estavam correlacionadas aos dados citológicos, clínicos e com o resultado da colposcopia. Resultados Das mulheres encaminhadas, 45% apresentaram-se fora da idade de rastreamento conforme as diretrizes de rastreio de câncer de colo uterino, sendo que 8,6% eram adolescentes e adultas jovens < 25 anos de idade e 36,4% das pacientes tinham idade ≥ 65 anos. Um total de 50% das pacientes não possuía indicação de colposcopia, ou seja, citologias normais, de alterações benignas, ectopia, cervicite, células escamosas atípicas de significado indeterminado (ASC-US) e lesão intraepitelial escamosa de baixo grau (LSIL) sem persistência e aspecto clínico normal. Um total de 39,84% das pacientes que realizaram a colposcopia tiveram resultados de lesão de alto grau ou câncer e, dessa forma, se beneficiaram com o encaminhamento adequado. Conclusão A maioria (60,16%) das pacientes encaminhadas para o serviço de colposcopia não se beneficiou com o encaminhamento, por resultados sem alterações como colposcopias negativas, histologias com ausência de neoplasia intraepitelial cervical (NIC) ou apenas NIC 1, ou estavam fora da idade de rastreamento. Esses achados demonstram, portanto, significativo número de encaminhamentos desnecessários e inadequados.


Subject(s)
Humans , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Referral and Consultation/statistics & numerical data , Uterine Cervical Neoplasms/pathology , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/statistics & numerical data , Brazil , Women's Health Services , Medical Records , Retrospective Studies , Age Factors , Hospitals , Middle Aged
9.
Article in English | LILACS | ID: biblio-1057197

ABSTRACT

ABSTRACT Objective: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. Methods: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. Results: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. Conclusions: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.


RESUMO Objetivo: Identificar a forma mais efetiva de contato, como possibilidade de intervenção, para diminuir o absenteísmo em consultas de crianças com suspeita ou com tuberculose pulmonar. Métodos: Ensaio clínico randomizado com coleta de dados prospectiva, entre março de 2017 e fevereiro de 2018. Os pacientes foram aleatorizados em três grupos para relembrar a consulta: contato telefônico; mensagens curtas (SMS) ou WhatsApp; e nenhuma intervenção. Amostra de conveniência, com nível de significância de 5%. Resultados: Incluídas 78 crianças, mediana de idade quatro anos (zero a 14); 59,0% em tratamento para infecção latente e 6,4% com tuberculose ativa; 74,4% moravam em Curitiba, Paraná; 62,8% residiam com ambos os pais; 38,5% dos pais possuíam emprego formal e 47,4% das mães eram do lar; 50,8% dos pais e 55,7% das mães possuíam mais de nove anos de estudo; em 78,2% das famílias a renda per capita foi de até 0,5 salário mínimo; 27,3% estavam inscritas em programas sociais; e 28,2% residiam em casa cedida. Foram 238 intervenções: 85 (35,7%) por contato telefônico, 78 (32,8%) por mensagem de texto (WhatsApp 97,2%) e 75 (31,5%) sem nenhum contato adicional. Nas características sociodemográficas e culturais estudadas não houve diferença estatística. O absenteísmo foi de 24,0% e o abandono, de 16,7%. Lembrar o responsável previamente à consulta, independente da intervenção (p=0,021) e especificamente por mensagem por WhatsApp (p=0,032) foi associado ao não absenteísmo, porém não associado ao abandono. Conclusões: O uso de novas ferramentas, como o aplicativo WhatsApp, pode reduzir o absenteísmo, diminuir a possibilidade de abandono no seguimento e melhorar o desfecho do tratamento de crianças com tuberculose, seja a infecção ou a doença.


Subject(s)
Referral and Consultation/statistics & numerical data , Technology/instrumentation , Tuberculosis, Pulmonary/epidemiology , Parents , Appointments and Schedules , Referral and Consultation/trends , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Brazil/epidemiology , Prospective Studies , Treatment Refusal/psychology , Treatment Refusal/statistics & numerical data , Absenteeism , Mobile Applications/standards
10.
Einstein (Säo Paulo) ; 18: eAO4620, 2020. tab
Article in English | LILACS | ID: biblio-1039737

ABSTRACT

ABSTRACT Objective To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. Methods This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. Results The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. Conclusion This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.


RESUMO Objetivo Verificar a ocorrência de resistência a fármacos antituberculose e a associação com características sociodemográficas e clínicas de pacientes de um hospital referência. Métodos Estudo transversal, com dados de pacientes que tiveram a cultura de micobactérias identificada e o respectivo perfil de sensibilidade aos antimicrobianos definido (junho de 2014 a fevereiro de 2016). Foram realizados a análise estatística descritiva e o teste exato de Fisher, para comparação de proporções. Resultados O estudo envolveu 104 pacientes, e todos tiveram resultados para Mycobacterium tuberculosis . A baciloscopia atingiu alta positividade (93,3%), e 15 pacientes (14,4%) apresentaram linhagens resistentes, sendo 6 (5,6%) multirresistentes. As características sociodemográficas e clínicas não foram associadas à resistência. Conclusão A pesquisa permitiu conhecer melhor o perfil dos pacientes com tuberculose e constitui ferramenta para elaboração de políticas públicas específicas. Os pacientes diagnosticados com tuberculose resistente devem ser submetidos à maior supervisão.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Referral and Consultation/statistics & numerical data , Tuberculosis, Multidrug-Resistant/epidemiology , Brazil/epidemiology , Microbial Sensitivity Tests , Demography , Prevalence , Cross-Sectional Studies , Tuberculosis, Multidrug-Resistant/microbiology , Sex Distribution , Age Distribution , Middle Aged , Mycobacterium tuberculosis/isolation & purification
11.
Rev. saúde pública (Online) ; 54: 18, 2020. tab, graf
Article in English | LILACS | ID: biblio-1058882

ABSTRACT

ABSTRACT OBJECTIVE This study aimed to identify the treatment demands coming from primary health care units and, based on that, the demand for referrals to medical specialties in reference services. This study is justified by the scarcity of scientific literature on the subject. METHODS This is a cross-sectional study using secondary data on the treatments and referrals made by the primary health care units, throughout 2014, in a municipality of the State of São Paulo, Brazil. The total population treated in 2014 was considered, resulting in 411,177 treatments. RESULTS Out of all treatments performed, the percentage of referrals was of 4.42%, showing that 95,58% of the problems did not need to be referred to another service. A number of 8,897 referrals were made, to 6,850 users, who were mostly women (60.74%). The mean of referrals per patient was 1.3 (min. 1 and max. 8), and 1,604 patients (23.5%) were referred at least twice. CONCLUSIONS Primary health care services have been responsible for a large number of treatments, whereas the demand for referrals has decreased, suggesting that such services have established themselves as a gateway to the health system and achieved the expected solvability, although the waiting time for some specialties is very long.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Primary Health Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Waiting Lists , Health Services Needs and Demand/statistics & numerical data , Specialization , Brazil , Cross-Sectional Studies , Middle Aged
12.
Esc. Anna Nery Rev. Enferm ; 24(2): e20190086, 2020. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1056157

ABSTRACT

RESUMO Objetivo Avaliar a associação entre as características maternas e o acompanhamento dos atendimentos no Banco de Leite Humano (BLH) à puérpera e ao recém-nascido internado. Método Pesquisa transversal, quantitativa, realizada em uma maternidade pública da Região Sul do Brasil nos meses de Julho a Dezembro de 2017. Utilizado um formulário estruturado para coleta dos dados. Para as análises, testes de associação de Qui-quadrado ou Exato de Fisher. Resultados Ao total, 316 mães fizeram parte do estudo. Os motivos principais para encaminhamento ao BLH foram perda de peso do recém-nascido e dificuldade na pega. Foram encontradas associações estatisticamente significativas entre o acompanhamento do banco de leite humano e as variáveis idade materna (18-23 anos: 58,1%; 24-29 anos: 63,8%; 30-35 anos: 78,9%; 36-41 anos: 71,8% e 42-47 anos: 85,7%; p=0,036), raça/cor materna (parda: 47,2%; branca: 68,9%; preta: 77,8%; p=0,031), tipo de parto (normal: 61,0%; cesárea: 75,2%; p=0,011). Conclusão e Implicações para Prática As mães com idade mais avançada, de raça/cor preta e com filhos nascidos de parto cesárea foram as que fizeram maiores procuras e acompanhamentos ao banco de leite humano da maternidade. Os resultados encontrados poderão contribuir para o planejamento, monitoramento e elaboração de estratégias para ações em aleitamento materno.


RESUMEN Objetivo Evaluar la asociación entre las características maternas con el seguimiento de las atenciones en el Banco de Leche Humana (BLH) a la puérpera y al recién nacido internado. Método Investigación transversal, cuantitativa, realizada en una maternidad pública de la Región Sur de Brasil entre julio y diciembre de 2017. Utilizado formulario estructurado para recolección de datos. Para los análisis, test de asociación de Qui-Cuadrado o Exacto de Fisher. Resultados Al total, 316 madres formaron parte del estudio. Los motivos principales para el encaminamiento al BLH fueron la pérdida de peso del recién nacido y la dificultad en el agarre. Se encontraron asociaciones estadísticamente significativas entre el seguimiento del BLH y las variables edad materna (18-23 años: 58,1%; 24-29 años: 63,8%; 30-35 años: 78,9%; 36-41años; 71,8% e 42-47años: 85,7%; p=0,036), raza/color materna (parda: 47,2%; blanca: 68,9%; negra: 77,8%; p=0,031), tipo de parto (normal:61,0%; cesárea:75,2%; p=0,011). Conclusión e Implicaciones para la Práctica Madres con edad avanzada, raza/color negra y con hijos nacidos de parto por cesárea, hicieron mayores búsquedas y acompañamientos al BLH de la maternidad. Los resultados encontrados pueden contribuir a la planificación, monitoreo y elaboración de nuevas estrategias para acciones en lactancia materna.


ABSTRACT Objective To evaluate the association between maternal characteristics and assistance services provided by a Human Milk Bank (HMB) to women in the puerperal period and their hospitalized newborns. Methods A quantitative cross-sectional study conducted at a public maternity in southern Brazil between July and December of 2017. It was used a structured form for data collection. The statistical analysis was conducted using Chi-Square for association or Fisher's Exact test. Results In total, 316 mothers were part of this study. The main reasons were weight loss of the newborn and difficulty in handling. Statistically significant associations were found between follow up services from HMB and mother's age (18-23 years old: 58.1%; 24-29: 63.8%; 30-35: 78.9%; 36-41: 71.8%, and 42-47: 85.7%; p = 0.036), mother's race/color (brown: 47.2%; white: 68.9%; black: 77.8%; p = 0.031), and type of delivery (normal: 61,0%; caesarean section: 75.2%; p = 0.011). Conclusion and implications for practice Mothers of older age, who were black and with children born by cesarean section were the ones who sought more often and had most follow-ups at the HMB of the maternity. The results found may contribute to the planning, monitoring and elaboration of strategies for breastfeeding actions.


Subject(s)
Humans , Female , Infant, Newborn , Adult , Young Adult , Milk Banks , Postpartum Period , Referral and Consultation/statistics & numerical data , Breast Feeding , Cross-Sectional Studies , Mother-Child Relations
13.
Rev. bras. epidemiol ; 23: e200020, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1092600

ABSTRACT

RESUMO: Introdução: A vinculação é um passo fundamental para o cuidado contínuo da infecção pelo vírus da imunodeficiência humana (HIV/aids), sendo essencial para proporcionar o acesso à terapia antirretroviral, bem como ao cuidado integral. Metodologia: Estudo transversal, com pessoas vivendo com HIV (PVHIV), idade ≥ 18 anos, vinculadas entre janeiro e dezembro de 2015, em um serviço de referência para assistência ambulatorial e hospitalar especializada em HIV/aids em Belo Horizonte (MG). O tempo de vinculação foi definido como o tempo do diagnóstico até a vinculação ao serviço. Considerou-se vinculação oportuna quando esse tempo foi menor ou igual a 90 dias. Os dados foram coletados por meio de prontuários clínicos. Realizou-se análise de regressão logística com intervalo de confiança de 95% (IC95%). Resultados: Entre os 208 pacientes, a maioria era do sexo masculino (77,8%) com idade média de 39 anos. Cerca de 45% apresentaram condições definidoras de aids na vinculação. O tempo de vinculação apresentou média de 138 ± 397 dias, e a vinculação oportuna ocorreu para 76,9% dos pacientes. As variáveis associadas com a vinculação oportuna foram: ter idade ≥ 48 anos (odds ratio - OR = 8,50; IC95% 1,53 - 47,28), estar trabalhando (OR = 3,69; IC95% 1,33 - 10,25) no momento da vinculação e apresentar contagem de linfócitos T CD4 (LT CD4+) ≤ 200 células/mm3 no momento do diagnóstico de HIV (OR = 4,84; IC95% 1,54 - 15,18). Observou-se proporção importante de vinculação oportuna entre as PVHA, porém com diagnóstico tardio. Conclusão: Intervenções devem ser direcionadas para pessoas mais jovens e com maior contagem de LT CD4+, visando uma melhor prestação de cuidados contínuos em HIV.


ABSTRACT: Introduction: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. Methodology: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. Results: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. Conclusion: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Referral and Consultation/statistics & numerical data , HIV Infections/drug therapy , Continuity of Patient Care/statistics & numerical data , Anti-HIV Agents/therapeutic use , Time-to-Treatment/statistics & numerical data , Health Services/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Time Factors , Brazil/epidemiology , HIV Infections/diagnosis , HIV Infections/epidemiology , Cross-Sectional Studies , CD4 Lymphocyte Count , Antiretroviral Therapy, Highly Active , Delayed Diagnosis , Middle Aged
14.
Kinesiologia ; 39(1): 14-20, 2020. tab
Article in Spanish | LILACS | ID: biblio-1123338

ABSTRACT

OBJETIVO: Determinar las razones de la escasa derivación, acceso, y adherencia a programas de ejercicio supervisado (PES) en pacientes con claudicación intermitente (CI) y la costo-efectividad de estos programas a nivel Internacional. MÉTODOS: Se utilizaron las fuentes de datos de PubMed y ScienceDirect. Se incluyeron revisiones con acceso completo, publicados desde el año 2010, que incluían como mínimo 3 artículos de tipo cuantitativo. RESULTADOS: Se incluyeron 5 Revisiones asociadas a los resultados del ejercicio supervisado, su costo-efectividad, la baja derivación y adherencia a PES de los pacientes con CI. En cuanto a la costo-efectividad los resultados indican que los PES fueron rentables con un ICER de £711 a £1.608 por QALY ganado al compararlos con ejercicio no supervisado, y al compararlos con la cirugía de revascularización (CR) no hay diferencia significativa en QALY ganados, sin embargo, el costo por QALY fue €381.694 más alto para la CR. Por otro lado, las principales razones de la subutilización de los PES, es que los pacientes se resisten a asistir, ya que involucra un esfuerzo y responsabilidad, además de tener problemas de reembolso, teniendo baja adherencia. Sumado a esto, el interés personal de los médicos por realizar intervenciones que involucran pago por servicio produce una baja derivación (45% de cirujanos en Europa refieren menos del 50% de sus pacientes). CONCLUSIÓN: Las principales dificultades para adoptar los PES serían una carencia en la destinación de recursos, falta de centros, dificultad de traslado, falta de tiempo, o de interés por parte de los pacientes, además de incentivos financieros a otras alternativas de tratamiento por sobre PES lo que limita su derivación.


OBJECTIVE: To determine the reasons for the limited derivation, access and adherence to supervised exercise programs (SEP) in patients with intermittent claudication (IC) and the cost-effectiveness of these programs internationally. METHODS: PubMed and ScienceDirect databases were searched. Revisions with full access, published since 2010, which included at least 3 quantitative type articles. RESULTS: 5 reviews were included, these were associated with the results of the supervised exercise, its cost-effectiveness, the low referral and adherence to programs of patients with IC. Regarding cost-effectiveness, the results indicated that SEP were more cost-effective with an ICER of £711 to £1.608 per QALY gained when compared with unsupervised exercise, and that when compared with revascularization surgery (RC) there was no significant difference in QALYs, however the cost per QALY was € 381.694 higher for the RC. On the other hand, the main reasons for the underutilization of SEP are that patients are reluctant to attend, since it involves effort and responsibility, in addition to having reimbursement problems, therefore having low adherence. Added to this, the personal interest of doctors in performing interventions that involve payment for service produce a low referral (45% of surgeons in Europe refer less than 50% of their patients) CONCLUSION: The main difficulties in adopting the SEP would be a lack in the allocation of resources, lack of centers, difficulty of transportation, lack of time or lack of interest from patients, in addition to financial incentives to other treatment alternatives over SEP, which limits their referral.


Subject(s)
Humans , Directly Observed Therapy/economics , Directly Observed Therapy/statistics & numerical data , Exercise Therapy/economics , Intermittent Claudication/therapy , Referral and Consultation/statistics & numerical data , Patient Compliance , Cost-Benefit Analysis , Exercise Therapy/methods , Exercise Therapy/statistics & numerical data , Treatment Adherence and Compliance , Health Services Misuse , Intermittent Claudication/rehabilitation
15.
Säo Paulo med. j ; 137(6): 491-497, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1094526

ABSTRACT

ABSTRACT BACKGROUND: Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available. OBJECTIVE: To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit. DESIGN AND SETTING: Cross-sectional study at a tertiary-level university hospital. METHODS: Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria. RESULTS: Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01). CONCLUSIONS: There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cholangitis/diagnosis , Jaundice, Obstructive/diagnosis , Tertiary Care Centers , Hospitals, University , Patient Admission/statistics & numerical data , Referral and Consultation/statistics & numerical data , Bilirubin/analysis , Brazil/epidemiology , Patient Acceptance of Health Care , Drainage , Cholangitis/surgery , Cholangitis/epidemiology , Acute Disease , Cross-Sectional Studies , Retrospective Studies , Sensitivity and Specificity , Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Jaundice, Obstructive/surgery , Jaundice, Obstructive/epidemiology , Data Accuracy
16.
Med. infant ; 26(4): 335-345, dic. 2019. Tab
Article in Spanish | LILACS | ID: biblio-1047042

ABSTRACT

Mediano Riesgo es un servicio de atención ambulatoria del Hospital Garrahan. Se atienden pacientes con enfermedades prolongadas, que han realizado consultas en otros efectores de salud u otros servicios del Hospital, o que requieren segunda opinión o abordaje multidisciplinario. Objetivos: Mensurar el tiempo profesional invertido en la atención como herramienta para ponderar la complejidad de los pacientes. Identificar variables demográficas y del proceso de atención. Material y métodos: Investigación descriptiva, transversal sobre pacientes encuestados entre julio y diciembre de 2017 en el Sector de Mediano Riesgo. Se registraron: variables demográficas, proceso de atención, diagnósticos previos y finales, interconsultas, exámenes complementarios y tiempos de consulta profesional. Se tomó 65 minutos (mediana del tiempo profesional total) como punto de corte para definir dos grupos: tiempo de consulta corto o largo. Se realizó un análisis comparativo entre ambos. Resultados: se encuestaron 400 pacientes. Mediana de edad fue de 67,2 meses; 80,1% procedían de CABA y del GBA; mediana de duración del síntoma fue 4 meses; 25,8% tenía enfermedad de base; 62,5% fueron pacientes derivados (externos e internos); destino a pediatra zonal: 30%; interconsultas: 48,5%; tiempo total profesional: mediana 65 minutos (rango 12-460); diagnósticos simples: 37,2%. Variables con significación estadística para pertenecer al tiempo largo: número de diagnósticos finales, procedencia, diagnósticos no simples y presencia de enfermedad de base. Variables con tendencia a pertenecer a tiempo largo: duración del síntoma mayor de 1 mes, edad menor a 24 meses, patología tumoral, síndromes polimalformativos, abuso sexual infantil y problemas de lenguaje /aprendizaje. Conclusiones: el tiempo de consulta es un factor concurrente para la evaluación de la complejidad del proceso de atención. La identificación de variables que permitan preverlo es información relevante para la organización del sector, o de otros efectores de salud (AU)


The sector of Intermediate Risk is part of the outpatient clinics of Garrahan Hospital. In the sector patients with chronic diseases are seen, that have have consulted at other centers or other departments of the hospital, or that need a second opinion or a multidisciplinary approach. Objectives: To assess the professional time invested in care as a tool to evaluate the complexity of the patients, and to identify demographic variables and the care process. Material and methods: A cross-sectional, descriptive study on patients surveyed between July and December 2017 in the Sector of Intermediate Risk. The following data were recorded: Demographic features, care process, previous and final diagnoses, consultations, complementary studies, duration of the interview. A time of 65 minutes (median total time of the visit) was defined as the cut-off point to define two groups: Those with a long and a short interview. A comparative analysis was performed comparing both groups. Results: 400 patients were surveyed. Median age was 67.2 months; 80.1% were form the city of Buenos Aires and Greater Buenos Aires. Mean symptom duration was 4 months; 25.8% had an underlying disease; 62.5% of the patients was referred (either external or internally); referred by the local pediatrician: 30%; second opinions: 48,5%; total time of the interview: median 65 minutes (range, 12-460); simple diagnoses: 37.2%. Statistically significant variables for a long interview were: number of final diagnoses, place of origin, complicated diagnoses, and presence of underlying disease. Variables with a trend to a long interview were: symptom duration more than one month, age less than 24 months, a diagnosis of a tumor, polymalformation syndromes, sexual abuse, language/learning difficulties. Conclusions: The time of the interview is a concurrent factor for the assessment of the complexity of the care process. Identification of the variables that allow to anticipate these cases is relevant for the organization of the sector or other health care providers (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Referral and Consultation/statistics & numerical data , Time Factors , Ambulatory Care/organization & administration , Ambulatory Care/statistics & numerical data , Patient Care Team , Cross-Sectional Studies , Surveys and Questionnaires
17.
Medicina (B.Aires) ; 79(5): 337-344, oct. 2019. graf, tab
Article in Spanish | LILACS | ID: biblio-1056728

ABSTRACT

Las recomendaciones internacionales apuntan a la integración temprana de cuidados paliativos (CP) en cáncer a través de la atención simultánea y del entrenamiento de los equipos primarios. La Unidad de CP del Hospital General de Agudos E. Tornú realiza interconsultas para pacientes internados en el hospital y brinda capacitación a los equipos tratantes. El perfil de las interconsultas realizadas podría brindar información importante sobre las características de la intervención de CP dentro de la institución. El objetivo de este estudio fue analizar retrospectivamente las interconsultas de primera vez de pacientes con cáncer realizadas a lo largo de 2 años, con foco en la temporalidad, la identificación de problemas por parte del equipo tratante y del equipo de interconsulta de CP, y la prontitud de respuesta y capacidad pronóstica de este último. La población atendida en interconsulta (168 casos) estuvo constituida principalmente por pacientes con enfermedad avanzada, deterioro del estado general, sin posibilidad de tratamiento oncológico y diagnóstico reciente. En aproximadamente 25% de los casos se encontraron indicios de intervención temprana y participación del equipo de CP en la toma de decisiones. Se discute la oportunidad de la intervención de CP y se señalan áreas con necesidad de mejora, como la identificación de síntomas no físicos y el pronóstico, a ser tenidas cuenta en las futuras actividades asistenciales y educativas.


The international recommendations point to the early integration of palliative care (PC) in cancer through simultaneous care and training of primary teams. The PC Unit of the Hospital General de Agudos E. Tornú conducts interconsultations for hospitalized patients in the hospital and provides training to the treatment teams. The profile of the interconsultations carried out could provide important information about the characteristics of the PC intervention within the institution. The objective of this study was to retrospectively analyze the first-time interconsultations of cancer patients carried out over 2 years, focusing on temporality, identification of problems by the treating team and the PC interconsultation team, the promptness of response and the prognostic capacity of the latter. In the period, 168 interconsultations were carried out. Most patients had advanced disease, poor performance status, no possibility of oncological treatment and recent diagnosis. In approximately 25% of the cases, evidence of early intervention and participation of the pc team in decision making was found. The opportunity of PC intervention is discussed and areas needing improvement are indicated, such as the identification of non-physical symptoms and prognosis, to be considered in future care and educational activities.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Palliative Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Hospitals, General/statistics & numerical data , Neoplasms/therapy , Argentina , Time Factors , Retrospective Studies , Hospitalization , Medical Oncology/statistics & numerical data , Neoplasms/mortality
18.
Rev. méd. Chile ; 147(10): 1229-1238, oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058589

ABSTRACT

Background: Free-text imposes a challenge in health data analysis since the lack of structure makes the extraction and integration of information difficult, particularly in the case of massive data. An appropriate machine-interpretation of electronic health records in Chile can unleash knowledge contained in large volumes of clinical texts, expanding clinical management and national research capabilities. Aim: To illustrate the use of a weighted frequency algorithm to find keywords. This finding was carried out in the diagnostic suspicion field of the Chilean specialty consultation waiting list, for diseases not covered by the Chilean Explicit Health Guarantees plan. Material and Methods: The waiting lists for a first specialty consultation for the period 2008-2018 were obtained from 17 out of 29 Chilean health services, and total of 2,592,925 diagnostic suspicions were identified. A natural language processing technique called Term Frequency-Inverse Document Frequency was used for the retrieval of diagnostic suspicion keywords. Results: For each specialty, four key words with the highest weighted frequency were determined. Word clouds showing words weighted by their importance were created to obtain a visual representation. These are available at cimt.uchile.cl/lechile/. Conclusions: The algorithm allowed to summarize unstructured clinical free-text data, improving its usefulness and accessibility.


Subject(s)
Humans , Natural Language Processing , Electronic Data Processing/methods , Medical Records , Information Storage and Retrieval/methods , Diagnostic Techniques and Procedures , Data Mining/methods , Referral and Consultation/statistics & numerical data , Time Factors , Medical Informatics Computing , Chile , Reproducibility of Results , Medicine
19.
Arq. bras. cardiol ; 112(4): 402-407, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001282

ABSTRACT

Abstract Background: Studies have shown the benefits of rapid reperfusion therapy in acute myocardial infarction. However, there are still delays during transport of patients to primary angioplasty. Objective: To evaluate whether there is a difference in total ischemic time between patients transferred from other hospitals compared to self-referred patients in our institution. Methods: Historical cohort study including patients with acute myocardial infarction treated between April 2014 and September 2015. Patients were divided into transferred patients (group A) and self-referred patients (group B). Clinical characteristics of the patients were obtained from our electronic database and the transfer time was estimated based on the time the e-mail requesting patient's transference was received by the emergency department. Results: The sample included 621 patients, 215 in group A and 406 in group B. Population characteristics were similar in both groups. Time from symptom onset to arrival at the emergency department was significantly longer in group A (385 minutes vs. 307 minutes for group B, p < 0.001) with a transfer delay of 147 minutes. There was a significant relationship between the travel distance and increased transport time (R = 0.55, p < 0.001). However, no difference in mortality was found between the groups. Conclusion: In patients transferred from other cities for treatment of infarction, transfer time was longer than that recommended, especially in longer travel distances.


Resumo Fundamento: Estudos mostram o benefício da terapia de reperfusão rápida no infarto agudo do miocárdio. No entanto, ainda ocorrem atrasos durante o transporte de pacientes para angioplastia primária. Objetivo: Definir se existe uma diferença no tempo total de isquemia entre pacientes transferidos de outro hospital comparados aos que procuram o serviço espontaneamente. Método: Estudo de coorte histórico, incluindo pacientes atendidos com infarto entre abril de 2014 e setembro de 2015. Os pacientes foram divididos em pacientes transferidos (grupo A) e por demanda espontânea (grupo B). As características clínicas dos pacientes foram retiradas do banco de dados de infarto e o tempo de transferência foi estimado tendo como base o correio eletrônico de acordo com o horário de contato. O nível de significância adotado foi um p < 0,05%. Resultados: A amostra incluiu 621 pacientes, 215 no grupo A e 406 no grupo B. As características populacionais foram semelhantes nos dois grupos. O delta T foi significativamente maior no grupo de pacientes transferidos (385 minutos vs. 307 minutos para o grupo B, p < 0,001) com um atraso decorrente do transporte de 147 minutos. Houve relação significativa da distância de transferência e aumento do tempo de transporte (R = 0,55; p < 0,001). Entretanto, não houve diferença na mortalidade entre os grupos. Conclusão: Pacientes transferidos de outras cidades para tratamento de infarto tem Delta T de transferência acima do recomendado, com tempo ainda mais longo quanto maior a distância a ser percorrida.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Referral and Consultation/statistics & numerical data , Patient Transfer/statistics & numerical data , Angioplasty/methods , ST Elevation Myocardial Infarction/therapy , Time Factors , Brazil , Risk Factors , Cohort Studies , Angioplasty/mortality , Statistics, Nonparametric , ST Elevation Myocardial Infarction/mortality , Geography
20.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(1): 63-70, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1013124

ABSTRACT

Abstract Objectives: to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil. Methods: a prospective cohort study based on data collected in two time points, the first 48h and after the 42nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%. Results: of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 st tercile PR= 2.01; CI95%= 1.21-3.33 - 2 nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16). Conclusions: puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.


Resumo Objetivos: identificar a frequência da não realização das consultas de puerpério e fatores associados em mulheres residentes de um município de médio porte no Brasil. Métodos: estudo de coorte prospectiva através da coleta de dados em dois momentos, nas primeiras 48h e após o 42º dia pós-parto. Para a análise dos dados, utilizou-se o teste qui-quadrado para comparar proporções e, para a análise ajustada, Regressão de Poisson obedecendo ao modelo hierárquico pré-determinado. O nível de significância adotado foi de 5%. Resultados: das 572 mulheres incluídas no estudo, 24,8% não realizaram consulta de puerpério. Os fatores associados a não realização da consulta de puerpério foram: menor renda (1º tercil RP= 2,01 IC95%= 1,21-3,33 - 2º tercil RP= 1,94 IC95%= 1,17-3,20), escolaridade (≤ 8 anos RP= 2,00 IC95%= 1,24-3,24); mulheres que apresentaram alguma comorbidade durante a gestação (RP 1,45; IC95%= 1,01-2,09), realizaram o pré-natal em serviço público (RP= 1,74; IC95%= 1,18-2,58) e que não usaram método anticoncepcional (RP= 3,10; IC95%= 1,86-5,16). Conclusões: a revisão puerperal não parece estar sendo valorizada no pré-natal, principalmente no sistema público de saúde. Foi identificada uma importante iniquidade na prestação desse serviço, pois as mulheres de menor renda, escolaridade e mais expostas a uma gravidez recorrente foram as que menos retornaram à consulta puerperal.


Subject(s)
Humans , Female , Pregnancy , Referral and Consultation/statistics & numerical data , Cohort Studies , Postpartum Period , Health Status Disparities , Maternal-Child Health Services , Primary Health Care , Unified Health System , Brazil
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