Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the "Suspension of drug without indication" saved R$1,360 while the "Inclusion of required drugs" cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist's role in the evaluation of pharmacotherapy is important for patients' health and represents a positive economic impact.

A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles

ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.

Do acolhimento ao encaminhamento: O atendimento às tentativas de suicídio nos contextos hospitalares / From reception to triage: Care of suicide attempts in hospital emergencies / De la recepción a derivación: Intentos de suicidio en las urgencias hospitalarias

Este estudo teve como objetivo investigar o acolhimento, o atendimento e os encaminhamentos feitos aos usuários atendidos por tentativa de suicídio, em duas urgências e duas emergências hospitalares de um município do Sul do Brasil. De caráter qualitativo, foram entrevistados 16 profissionais de saúde de nível superior, de diferentes categorias profissionais. Os resultados mostraram o predomínio do atendimento ao sexo feminino, as intoxicações como método mais frequente e o uso da tentativa de suicídio como forma de chamar a atenção. Ainda, evidenciou-se a existência de protocolos mínimos de atendimento, que, contudo, apresentam dificuldades nos encaminhamentos pós-alta para a rede de saúde. Ressalta-se, assim, a necessidade de capacitação dos profissionais para lidar com esta demanda bem como de melhor articulação do Sistema de Saúde e outras políticas para acolher os usuários após sua alta.

This study aimed to investigate the reception, care and referrals given to users attended for suicide attempts in two urgency and two emergency services of a city in the south of Brazil. Qualitatively, sixteen health professionals of higher education from different professional categories were interviewed. The results show the predominance of the female sex, intoxication as the most frequent method and the use of the attempted suicide as a way to call attention. The existence of minimum care protocols is perceived. There is, however, a difficulty in post-discharge referrals to other health services. Thus, it highlights the need of capacitation for professionals to deal with this demand and a better articulation between the Health System and other policies to receive users after discharge as well.

Este estudio tuvo como objetivo investigar la recepción, atención y derivación de usuários atendidos por intento de suicidio en dos servicios de emergencia y dos servicios de urgencias de un gran municipio del sur de Brasil. De caracter cualitativo, fueron encuestados dieciséis profesionales de salud de nivel superior, de categorias distintas. Los resultados muestran el predominio del sexo femenino, la intoxicación como método más frecuente y el intento de suicidio como una forma de llamar la atención. También pone de relieve la existencia de protocolos mínimos de atención, sin embargo, al post alta hay dificultades para las derivaciones a la red. Así, destaca la necesidad de capacitar a los profesionales para manejar esta demanda, así como articular mejor el sistema de salud y otras políticas para dar cabida a los usuarios al post alta.

Burnout e sua relação com o clima organizacional em funcionários de um hospital / Burnout and organizational climate relationships in hospital workers

INTRODUÇÃO: Em contextos em que os contatos interpessoais são intensos, os profissionais estão sujeitos a diversas situações de estresse. A síndrome de burnout advém do contato com estressores interpessoais crônicos provenientes do ambiente de trabalho, e seu desenvolvimento é influenciado por alguns aspectos, entre eles, os socioambientais. OBJETIVO: Entender como se dá a interação entre os sintomas da síndrome de burnout e algumas variáveis do clima organizacional no ambiente hospitalar. MÉTODOS: A amostra foi composta por 565 profissionais de um hospital do interior do estado de São Paulo. A idade variou de 18 a 63 anos, sendo 72,2% do sexo feminino. Os dados foram coletados no ambiente hospitalar,no período de outubro a dezembro de 2012, respeitando-se os devidos procedimentos éticos. Para a análise dos dados, foram realizadas as estatísticas descritivas, assim como teste t de Student e correlação de Pearson. RESULTADOS: Os resultados mostraram que o fator exaustão emocional do MBI-HSS teve correlações estatisticamente significativas e negativas com todas as dimensões da CLIMOR, sendo elas moderadas com os fatores comunicação, integração e satisfação (r=-0,45); desenvolvimento profissional e benefícios (r=-0,46); e pontuação total (r=-0,52). As correlações dos fatores despersonalização e realização profissional do MBIHSS foram de magnitudes baixas com todas as dimensões da CLIMOR. CONCLUSÃO: Os dados corroboram a relação entre o clima organizacional e alguns sintomas do burnout. Há necessidade de que novas pesquisas sejam realizadas com delineamento e análises estatísticas mais sofisticadas e, ainda, que tenham grupos equiparados de pessoas com e sem síndrome de burnout.

INTRODUCTION: In contexts in which interpersonal contactsare intense, professionals are subjected to various stresssituations. The burnout disorder comes from contact withchronic interpersonal stressors from the work environment andits development is influenced by some aspects, among them,the social and environmental factors. OBJECTIVE: To understand how is the interaction between the symptoms of burnout andsome variables of organizational climate in the hospital setting. METHOD: The sample consisted of 565 professionals from a hospital in the country region of the state of São Paulo. Theage ranged from 18 to 63, and 72.2% were female. Data were collected in the hospital setting, from 2012 October to 2012 December, following the ethical procedures. Data analysis consisted in descriptive and t-test and Pearson correlation. RESULTS: The results showed that emotional exhaustion factor of the MBI-HSS showed correlations statistically significant and negative with all dimensions of CLIMOR, which were moderatecorrelations with the factors communication, integration and satisfaction (r=-0,45); professional development and benefits (r=-0.46); and total score (r=-0.52). Correlations of factors depersonalization and personal accomplishment of the MBIHSS were low with all dimensions of the CLIMOR. CONCLUSION: The data corroborate the relationship between organizational climate and some symptoms of burnout. There is need forfurther research to be carried out with more sophisticated experimental design and statistical analyzes, and yet, using similar groups of people with and without burnout.

A promoção da saúde de crianças em espaço hospitalar: refletindo sobre a prática fisioterapêutica / Health promotion among children in a hospital setting: reflections on physiotherapy practice / La promoción de la salud de los niños en el espacio hospitalario: reflexión sobre la práctica fisioterapéutica

Analisa-se a inserção da promoção de saúde na prática do profissional fisioterapeuta em ações voltadas para a atenção à saúde integral da criança em um ambiente hospitalar. Estudo de foco qualitativo, baseado na perspectiva hermenêutica-dialética. Para coleta dos dados, utilizaram-se as técnicas de observação participante e entrevista semiestruturada, e análise a partir de princípios do método de interpretação de sentidos. O estudo foi realizado com fisioterapeutas do Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira. Três eixos temáticos sintetizam a discussão dos resultados: a criança como foco da fisioterapia; a promoção da saúde por parte da fisioterapia pediátrica em ambiente hospitalar; e desafios da fisioterapia para a promoção da saúde das crianças. Este estudo aponta para algumas peculiaridades da prática fisioterapêutica, destacando seus limites e possibilidades, voltada para a promoção da saúde...

It was analyzed the place of health promotion in professional physiotherapy practice in relation to actions aimed towards comprehensive child healthcare in hospital settings. This study had a qualitative focus based on a dialectical hermeneutic perspective. The techniques of participant observation and semi-structured interviews were used for data gathering. The principles of the method of interpretation of meanings were used in the analysis. The study was conducted among the physiotherapists at the “Fernandes Figueira” National Institute of Women’s, Children’s and Adolescents’ Health. The discussion on the results was summarized into three thematic strands: children as the focus of physiotherapy; health promotion within the pediatric physiotherapy sector in the hospital setting; and challenges of physiotherapy regarding health promotion among children. The study revealed some peculiarities of physiotherapy practice, emphasizing limits and possibilities with regard to health promotion...

Buscase analizar la inserción de la promoción de la salud en la práctica del fisioterapeuta en la atención para la salud total del niño en un ambiente hospitalario. Estudio fue basado en la hermenéutica-dialéctica. Se utilizaron técnica de observación participante y entrevista semi-estructurada y el análisis a partir de principios del método de interpretación de sentidos. El estudio se realizó con fisioterapeutas del Instituto Nacional de la Salud de la Mujer, del Niño y del Adolescente Fernandes Figueira. Tres ejes temáticos sintetizan la discusión: el niño como enfoque de la fisioterapia, la promoción de la salud por parte de la fisioterapia pediátrica en un ambiente hospitalario y desafíos de la fisioterapia para la promoción de la salud de los niños. Este estudio señala algunas peculiaridades de la práctica fisioterapéutica, destacando límites y posibilidades en la promoción de la salud...

Development of Medical Students Interpersonal Skills and Understanding of the Roles which Non-Faculty Hospital Personnel through an Experience-Based Learning Program / 한국의학교육

Gachon Medical School developed an "Experience-based Sharing Program" as a component of its "Patients, Doctors and Society" course. The program was designed to familiarize preclinical students with the various roles which patients and hospital personnel take on in the hospital setting by directly experiencing these roles and performing the same daily routines that these personnel perform. The unit was organized as a 6-day program for 2nd and 3rd year students during the winter recess. Distinguishing features of the course are that it encouraged (1) the active participation of students in the daily hospital activities which various hospital personnel perform other than providing direct medical care within the hospital setting, (2) non-faculty hospital personnel to function as educational facilitators, (3) the development of medical students interpersonal skills with various groups of hospital staff and patients, and (4) students to engage in self-evaluation by requiring them to report on their experience. We conclude that the program is useful and essential in motivating students to understand the roles of their future coworkers in medical practice, in developing students interpersonal skills with the goal that they will be better doctors, and in encouraging paramedical personnel to be facilitators in educating medical students.

The role of mammography on breast cancer patients in a hospital setting

From Oct. 1, 1983 to May 31, 1988, 6198 mammograms were taken and 443 mastectomies were performed at the Yonsei University Hospital, Seoul, Korea. Of these, 191 cases had preoperative mammography performed prior to surgery (study group) and 252 cases underwent mastectomies without preoperative mammography (control group). There were no significant differences between the two groups in pathological stages, axillary lymph node metastasis and size of the tumor, suggesting that little benefit is derived from the preoperative mammography in the hospital setting. However, there were a number of other findings, including a 14% incidence of multiple foci and localization of non-palpable cancer in 3% of cases, that could help us to make therapeutic plans and strategies for these patients.