Costos de los egresos inoportunos de origen no médico en una clínica de alto nivel de complejidad en Colombia / The costs of nonclinical delayed discharge in a tertiary care clinic in Colombia

Resumen Objetivo: describir los pacientes con egreso inoportuno de origen no médico, sus características sociodemográficas, clínicas y estimar los costos derivados, durante el 01 de junio y el 31 de agosto de 2017, en una institución de salud de alto nivel de complejidad. Material y métodos: estudio observacional, retrospectivo. La definición operativa de egreso inoportuno correspondía a pacientes que desde el punto de vista clínico podían ser dados de alta, pero continuaban ocupando una cama por problemas no médicos. Los datos fueron tomados de las historias clínicas y para el análisis de costo, se tuvieron en cuenta el total de los costos generados por la estancia inapropiada, incluyendo el costo día de hospitalización, insumos, medicamentos y evaluaciones médicas. La perspectiva del costo fue desde el pagador. Resultados: de los 3273 egresos durante el periodo analizado, se presentaron 79 casos de egresos inoportunos (2.4%). La edad media de los pacientes fue de 49 años. El 62% eran del régimen subsidiado; 60.7% eran procedentes de otros departamentos o municipios lejanos. El total de días hospitalización perdidos por esta causa fue de 547, con una media de 6.6 días por paciente. Los servicios más afectados fueron medicina interna y cuidados paliativos. Las principales causas fueron: necesidad de tiquetes para retornar al lugar de procedencia, alta temprana por medicamentos o insumos para el egreso y necesidad de oxígeno. El costo total que se generó por egreso inoportuno fue US$83 935, con un valor promedio de US$1062.47 por paciente. Conclusión: el egreso inoportuno es un problema evidente en la atención. Las principales causas que encontramos fueron problemas sociales y traslados regionales. Además genera un gasto adicional importante de recursos materiales y económicos tanto para las instituciones como para el sistema.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1255).

Abstract Objective: to describe the sociodemographic and clinical characteristics of patients with nonclinical delayed discharge and estimate the resulting costs in a tertiary healthcare facility from June 1 to August 31, 2017. Materials and methods: a retrospective observational study. The working definition of delayed discharge was patients who, from a clinical perspective, could be discharged but who continued to occupy a bed due to nonclinical problems. The data were taken from the medical charts, and the total costs incurred by the inappropriate length of stay were used for the cost analysis, including the cost per inpatient day, supplies, medications and medical assessments, from the payer's cost perspective. Results: of the 3,273 discharges during the study period, there were 79 cases of delayed discharge (2.4%). The mean age of the patients was 49 years. Sixty-two percent had subsidized medical insurance; 60.7% came from other departments or distant towns. The total number of inpatient days lost due to this cause was 547, with a me of 6.6 days per patient. The departments which were most affected were internal medicine and palliative care. The main causes were: the need for tickets to return to their place of origin, early discharge due to medications or discharge supplies and the need for oxygen. The total cost incurred due to delayed discharge was USD 83,935, with an average of USD 1,062.47 per patient. Conclusion: delayed discharge is an evident healthcare problem. The main causes found in this study were social and regional transport issues. Delayed discharge also causes a significant additional expense in material and financial resources for both the institutions and the system.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1255).

Internações por condições sensíveis à atenção primária após a implantação da estratégia saúde da família no município de Petrópolis/RJ / Hospitalizaciones por enfermedades sensibles a la atención primaria después de la implementación del programa de salud de la familia enmunicípio de Petrópolis/RJ / Hospitalizations due to primary care sensitive conditions after family health strategy implementation on Petrópolis/RJ

Objective: To quantify and to compare the hospitalizations sensible to primary care (HSPC) with the brute rate of hospitalizations analyzing its frequency with the family health program (FHP) in Petrópolis/RJ. Methods: After analyzing the national health system data, we extracted the rate of HSPC between 1999-2013. Then we have established the ratio of the hospitalizations and city residents multiplied by a thousand. The Pearson correlation coefficient was applied to obtain the variables correlation. Results: The data presented a reduction of 54.4% in the number of HSPC for the investigated period. Total hospitalizations related to primary care conditions went from 19.9% to 16.5%. The rate of HSPC decreased as the coverage of the FHP increased its coverage. Conclusion: The changes observed are significant and stimulate further investigations regarding the FHP strategy and its potential as an effective way of reducing the HSPC in other regions.

Objetivo: Quantificar as internações por condições sensíveis à atenção primária (ICSAP), comparando-as com a taxa bruta de internações e analisar sua frequência junto à cobertura do Programa Saúde da Família (PSF) em Petrópolis/RJ. Métodos: Após consulta no SIH-SUS, obteve-se a taxa bruta de ICSAP entre 1999-2013. Foi estabelecida a razão entre a soma destas internações e o número de residentes no município, multiplicado por mil. O coeficiente de correlação de Pearson foi utilizado para a análise de correlação entre as variáveis. Resultados: Houve redução de 54,4% nas ICSAP no período estudado. Observamos uma redução das ICSAP sobre o total de internações de 19,9%, para 16,5%. A redução na taxa de ICSAP apresentou forte correlação com o aumento da cobertura do PSF. Conclusão: As mudanças ocorridas são significativas e estimulam o aprofundamento do estudo da eficácia das estratégias como o PSF sobre a redução das ICSAP em diferentes municípios.

Objetivo: Cuantificar hospitalizaciones por enfermedades sensibles a la atención primaria (HESAP), comparándolos con la tasa bruta de hospitalizaciones y analizar su frecuencia por la cobertura del Programa de Salud de la Familia (PSF) en Petrópolis/RJ. Métodos: Previa consulta al SIH-SUS, se obtuvo la tasa bruta de HESAP entre 1999-2013. Se estableció la relación de la suma de estas hospitalizaciones y el número de residentes multiplicado por mil. Se utilizó el coeficiente de correlación de Pearson para análisis de las variables. Resultados: Hubo una reducción del 54,4% en las HESAP. Se ha observado una reducción de la ESAP en el total de ingresos de 19,9% a 16,5%. La reducción de la tasa de HESAP mostró una fuerte correlación con el aumento de la cobertura del PSF. Conclusión: Los significativos resultados estimulan más estudios sobre la eficacia de las estrategias tales como el PSF en la reducción de HESAP en diferentes municipios.

Clinical and Functional Outcome of Percutaneous alcohol septal ablation in Obstructive Hypertrophic Cardiomyopathy / Resultados clínicos y funcionales de la ablación septal percutánea con alcohol en la miocardiopatía hipertrófica obstructiva

background: Percutaneous septal ablation is a therapeutic option for patients with obstructive hypertrophic cardiomyopathy refrac-tory to optimal medical therapy. However, results of initial persistence and long-term safety are still controversial. Objectives: The aim of this study was to report percutaneous alcohol septal ablation technique, clinical and functional outcome, cardiovascular events and its impact on long-term follow-up. Methods: A total of 23 patients were included in the study. Functional class (FC), left ventricular outflow tract gradient before and after the procedure and long-term cardiovascular events were evaluated. results: Median follow-up was 52 months (IR 33-72). All patients were in FC III or IV prior to the procedure, under maximum tolerated medical therapy. The procedure was successful in 91% of cases, with 85% of patients currently in FC I and 15% in FC II. Baseline left ventricular outflow tract gradient decreased from 75 mmHg (95% CI 51-89) to 25 mmHg (95% CI 10-37) (p <0.003) and with Valsalva maneuver from 118 mmHg (95% CI 88-152) to 38 mmHg (95% CI 16-69) (p <0.0002), persisting in the long-term follow-up. During hospitalization, two patients presented with complete atrioventricular block requiring permanent pacemaker implantation. No cardiovascular deaths occurred during follow up. Conclusions: Alcohol septal ablation is a promising option for the treatment of a selected population with hypertrophic obstructive cardiomyopathy, generating sustained clinical and functional improvement with low incidence of events in the long-term follow up.

Brincar e problemas de comportamento de crianças com câncer de classes hospitalares / Playing and behavior problems of children with cancer at a hospital classroom / Jugar y problemas de conducta de niños con cáncer de clases hospitalares

Brincar no hospital traz benefícios à criança e ao tratamento, servindo como uma estratégia de enfrentamento da hospitalização. O objetivo deste estudo foi descrever as preferências lúdicas de crianças com câncer, na classe hospitalar. Participaram 18 crianças (de 6 a 12 anos), avaliadas pelo instrumento computadorizado de avaliação do brincar no hospital (ABHcomp). Os pais responderam à escala comportamental infantil A2 de Rutter (ECI). As brincadeiras preferidas no ABHcomp foram: desenhar, assistir à TV e ler gibi. As crianças apresentaram problemas comportamentais e emocionais (61,1%) na ECI, como dor de cabeça e medo. A alta frequência de problemas indica a importância da assistência psicológica, que pode ser realizada por meio da associação de recursos lúdicos às técnicas psicológicas adequadas às demandas do contexto da doença e da hospitalização. Além disso, o brincar aparece durante o período na classe hospitalar, indicando possíveis benefícios dessa para a brincadeira no hospital e o tratamento dessas crianças.

Playing in the hospital brings benefits to the child and to the treatment. It works as a hospitalization coping strategy. This study aims at describing play choices adopted by children with cancer at hospital classrooms. Eighteen children with cancer aged between 6 and 12 participated in the study. The children were evaluated using the computerized instrument for assessing play in the hospital (APHcomp) and their parents responded to Rutter’s child behavior scale-A2 (CBS). Their favorite play activities identified by the APHcomp were: drawing, watching TV and reading comic books. Presented behavior problems and emotional problems (61.1%) – according to the CBS. Of these, problems such as headache and fear stood out. The high frequency of problems shows the importance of psychological care, which can be provided by associating play activities and psychological techniques that are adequate to the demands in the context of this disease and hospitalization. Besides, to play appear during the hospital classrooms term, which pointed to possible benefits to play in the hospital and to the treatment of these kids.

Jugar en el hospital trae beneficios al menor y al tratamiento, sirviendo como una estrategia de enfrentamiento a la hospitalización. El objetivo de este estudio fue describir las preferencias lúdicas de niños con cáncer, en la clase hospitalar. Participaron 18 niños (6 a 12 años) evaluados por el instrumento computarizado de evaluación del juego en el hospital (EJMcomp). Los padres respondieron a la escala comportamental infantil A2 de Rutter (ECI). Los juegos preferidos en el ABHcomp fueron: dibujar, ver televisión y leer comics. Presentaron problemas conductuales y emocionales (61,1%) en ECI; destacándose problemas como dolor de cabeza y miedo. La alta frecuencia de problemas indica la importancia del apoyo psicológico que puede ser realizada por medio de asociación de recursos lúdicos hacia técnicas psicológicas adecuadas de acuerdo con el contexto de la enfermedad y la hospitalización. Además de eso el jugar aparece en el periodo de clase hospitalar, indicando posibles beneficios de esta para el juego en el hospital y en el tratamiento de esos niños.