Impact analysis of regulatory regime options for integrated health care provider networks in the Philippines

Background@#The enactment of the Philippine Universal Health Care (UHC) Act mandates the formation of Integrated Health Care Provider Networks (IHCPN), linking hospitals and health facilities, which includes government and privately-owned primary care providers. While hospitals and some health facilities are already under government regulation, primary care providers have not been subjected to formal licensing requirements. In this changing service delivery model, the possible impact of three regulatory policy options being considered need to be assessed according to the goal of ensuring that health services remain affordable and are of high quality.@*Methodology@#A multi-method approach to regulatory impact analysis (RIA) systematically assessed three regulatory options: 1) one Department of Health (DOH) license per hospital and health facility (status quo); 2) one DOH license for all public hospitals and health facilities within an IHCPN and another for individual private hospitals and health facilities; and 3) one DOH license per individual hospital and health facility, and one DOH certification issued to individual hospitals and health facilities as part of an IHCPN. Information from literature, documents, focus group discussions, and cost analyses were triangulated.@*Results@#Regulators are faced with two main risks: there is no standard for networked health care delivery that could provide a foundation for regulation, and provider participation is voluntary, which could lower the interest of private providers to integrate. The three regulatory options considered these risks. Option 1 requires the least change in regulatory policy, but is expected to increase costs to regulators due to the expansion of licensing and enforcement work covering primary care providers. Option 2 requires the most change in regulatory policy, but may be the least expensive to enforce, especially if all facilities join a network. This can also be preferred in a setting with existing interlocal health zones, and participation in the network by private providers poses the most challenge. Option 3 is a tiered regulatory set up that projects the highest cost to regulators as a result of both establishing new certification standards and guidelines on top of a wider scope for enforcement.@*Conclusion@#This is the first RIA conducted for the Philippine health system, with challenges similar to those experienced in developing countries. Across the three pre-determined regulatory models, the least costly option may not be the easiest to mount and enforce. Implementability appears to be a stronger consideration which seems to be hinged to the option requiring incremental rather than large form of changes.

Look into their eyes and save their vision: role of primary health care provider in early diagnosis of retinoblastoma

Childhood cancer is not amenable to preventive or screening strategies. The most effective strategy to reduce the cancer burden and improve outcomes, is to focus on early, correct diagnosis followed by evidence-based therapy. When diagnosed early, they are responsive to appropriate therapy and increases survival rates, thereby reducing the need for intensive treatment and reduces the expenditure per child. Retinoblastoma is the most common intra ocular malignancy and is one of the most curable cancers in children. If diagnosed early and treated optimally, not only they are completely cured but a vast majority can have ocular salvage and retain vision. Lack of awareness among general population, diagnostic delays, delays in referral to proper treatment centre, compounded by socio economic factors attributes to the poor outcome in such children. We report a case of 2 years 10 months old girl child whose initial presentation of leukocoria was missed and later presented with advanced retinoblastoma with CNS metastasis.

Silver lining: a ray of hope through strength-based approach in the health care setting

The strength-based approach challenges the traditional deficit model applied in psychosocial care practice, which takes an all-encompassing perspective. Creating a comprehensive portrait of each person's life and working in a multidisciplinary team collectively analyses the full capabilities and circumstances of individuals or families. This paper employs case illustrations to demonstrate how psychosocial care providers can do assessments and interventions based on a strength-based approach to improve the quality of life of patients and their families. The study adopted cases from the case file and derived how strength-based approaches can be utilized for the patients referred for psychosocial assessment and designing psychosocial care plan in the tertiary care hospital. The case illustrations depict practice through strength-based approach. The assessments were conducted, plans were made, and interventions focused on the strengths in various domains. The result portrayed strength of each case on innate, acquired/learned, supportive strengths in personal, family, social and health domains of life. The analysis of the strengths of the patient allowed to develop a tailor-made intervention plan, and these interventions have resulted in empowerment and recovery. The strength-based approach is one of the approaches which came differently from the deficit models of psychosocial practice. In India, the practice of a strength-based approach for interventions in various fields is in its infancy. The legislations in India have provisions that support a strength-based approach.

Análise de custo-efetividade de um painel genético no câncer de mama precoce na saúde suplementar brasileira / Cost-effectiveness analysis of a genetic panel in early breast cancer in Brazilian supplementary health

Objetivo: Avaliar o custo-efetividade do uso de um painel genético de 21 genes em pacientes adultas diagnosticadas com câncer de mama em estádio inicial em uma operadora de saúde com mais de 500.000 vidas. Métodos: Foi utilizada uma coorte prospectiva seguida de um estudo de custo-efetividade entre os pacientes que utilizaram Oncotype DX® em 2020. Calcularam-se as despesas totais de cada esquema de quimioterapia (QT), somando-se os custos dos produtos e taxas de infusão. Resultados: Das 35 pacientes que utilizaram o teste de 21 genes no período avaliado, 60% (n = 21) não necessitaram de QT. Quando aplicadas simulações, houve custo evitado de R$ -1.945.448,88 (custos incrementais potenciais de R$ -6.488.207,56 até R$ 443.485,26, dependendo do esquema de QT escolhido). Conclusão: A inserção do teste de 21 genes na jornada do tratamento de câncer de mama na saúde suplementar evidenciou significativa relevância, pois contribuiu com o uso adequado da terapêutica, garantindo a sustentabilidade do sistema de saúde. Apresentando-se como uma opção custo-efetiva para a maioria dos esquemas de QT em comparação com a sua não utilização no tratamento, para a saúde suplementar brasileira

Objective: To evaluate the cost-effectiveness of the use of a genetic panel of 21 genes in adult patients diagnosed with early stage breast cancer in a healthcare provider with more than 500,000 lives. Methods: A prospective cohort study was conducted, followed by cost-effectiveness, among patients who used Oncotype DX® , in 2020. The total costs of each chemotherapy scheme (QT) were calculated, adding the costs of the products and infusion fees. Results: Of the 35 patients who used 21 gene tests in the evaluation period, 60% (n = 21) did not require QT. When simulations were applied, there was an avoided cost of R$ -1.945.448,88 (Potentials incremental costs from -R$ 6.488.207,56 to +R$ 443.485,26, depending on the chosen QT scheme). Conclusion: The insertion of 21-Gene recurrence score in the breast cancer treatment journey in supplementary health showed significant relevance, as it contributes to the appropriate use of therapy, guaranteeing the sustainability of the health system. Presenting itself as a cost-effective option for most QT schemes compared to not being used in treatment, for Brazilian supplementary health System

Health care seeking behaviour of pulmonary tuberculosis patients in Jabalpur district, Madhya Pradesh

Background: Successful tuberculosis control requires specific behaviors from patients and health providers. Therefore, understanding behaviors is fundamental to design interventions to strengthen tuberculosis control programs, including communication interventions. The aim of this study was to assess the healthcare-seeking behavior of pulmonary tuberculosis (PTB) patients in Jabalpur district.Methods: Cross-sectional study was conducted among category I new sputum positive PTB patients identified from nine designated microscopy centres from November 2013 to October 2014. Calculated sample size of 135 with a multistage random sampling method was used. Student’s t-test and Chi-square test were used along with descriptive statistics.Results: Mean age of patients was 33.87 (14.3) years, males constituted 66.7%, 72.5% patients belonged to below class IV socioeconomic status. Cough was experienced by 91.1% subjects, followed by fever (69.6%). First action was consulting a health care provider (HCP) in 41.5% followed by self-medication (21.5%). It took two attempts for 76% of patients to reach a formal health care provider. Private health care providers were consulted as first choice among HCPs by 86.7% patients, initial diagnosis was made by them in 25.9% cases. Sixty-three percent of patients were not satisfied with care at government hospitals, 41.5% had not heard of tuberculosis before their diagnosis, 59.5% of patients got information about tuberculosis from their relatives suffering from it.Conclusions: Cough is the most common and earliest symptom responsible for seeking care in pulmonary tuberculosis. Government health facilities contribute maximum to diagnosis but private health facility is the first choice for initial consultation. Patients’ perception of suggestive symptoms needs to be changed.

Use of the patient fall prevention reminder checklist to increase health care provider awareness at the Philippine Children's Medical Center

@#<p><strong>BACKGROUND:</strong> Falls in the hospital are preventable. Prevention of fall requires cooperation from the health care provider, caregivers, as well as the hospital administration. This study was done to utilize standard reminders for fall to increase the awareness of health care providers of a tertiary hospital for children. <br /> <br /><strong>OBJECTIVES:</strong> To determine the effectiveness of the Patient Fall Prevention Reminder Checklist in increasing the awareness of health care providers of patients admitted at the Philippine Children's Medical Center. <br /> <br /><strong>METHODOLOGY:</strong> After obtaining permission to use an established Patient Fall Prevention Reminder checklist from the Intermountain Health Care (USA), participants were recruited after giving their informed consent. A pre-test was conducted to gauge the awareness and practices of the participants in preventing falls in the hospital. After the pre-test, the tool was introduced and discussed by the author to the participants. After 7 days, the participantswere followed up to take the post-test. Data collected were encoded then analyzed throughdescriptive statistics. <br /> <br /><strong>RESULTS:</strong> There were one hundred twenty-one (121) respondents with 42 males and 79 females. There is an increase in awareness in fall prevention amongthe residents and nurses, based on their pre and post-test examination results. The midwives had previous awareness in preventing falls even prior to the study. <br /> <br /><strong>CONCLUSIONS AND RECOMMENDATIONS:</strong> The checklist served as an effective tool in increasing the awareness of most study participants. We recommend the establishment of an institutionalized Fall Prevention Reminder Checklist at the Philippine Children's Medical Center for use by health care personnel.</p>

Judicialization of health arising from prepaid insurance plans and health law: an integrative review / Judicialización de la salud resultante de los planes de prepago y el derecho sanitario: revisión integrativa / Judicialização da saúde decorrente dos planos de pré-pagamento e o direito sanitário: revisão integrativa

ABSTRACT Objective: To analyze publications regarding judicial demands related to the violation of the rights of the client who uses private health insurance in Brazil. Method: Integrative review, from September to October 2017, of national character, with complete texts online, in Portuguese and English, published between 2012 and 2017 in the Virtual Health Library portal, excluding studies that were duplicated or with indiscriminate methodology. Results: The judicial demands were for: medication (32%); ward hospitalization (11%); surgical procedures (9%); orthosis, prothesis and special materials (9%); others (9%); and diagnostic procedures, outpatient service, hospitalization in Intensive Care Units, food formulas and disposable diapers (30%). Conclusion: The prevalence of legal disputes arising from the failure in providing health service by private health insurances was observed, which makes it easier for the administrators to identify the sought health products and services in order to reorganize the administrative sphere and provide quality care.

RESUMEN Objetivo: Analizar las publicaciones acerca de las demandas judiciales relacionadas con la infracción a los derechos del usuario que utiliza un plan privado de salud en Brasil. Método: Revisión integrativa realizada entre septiembre y octubre de 2017, en ámbito nacional en los idiomas portugués e inglés, con textos completos y publicados en línea de 2012 a 2017 en el Portal de la Biblioteca Virtual en Salud, con la exclusión de los duplicados y de metodología indiscriminada. Resultados: Las demandas judiciales fueron: un 32% por medicamentos; un 11% por internación en enfermería; un 9% por procedimientos quirúrgicos; un 9% por ortesis, prótesis y materiales especiales; un 9% por otros; y un 30% por procedimientos diagnósticos, de atención ambulatoria, de internación en un Centro de Terapia Intensiva, de fórmulas alimentarias y pañales desechables. Conclusión: Se demostró una prevalencia de los litigios judiciales resultantes de una falla en la prestación del servicio de salud por los planes privados, lo que les facilita a los gestores identificar los productos y servicios de salud necesarios para reorganizar la esfera administrativa y la prestación de una asistencia con calidad.

RESUMO Objetivo: Analisar as publicações a respeito de demandas judiciais relacionadas à infração aos direitos do usuário que utiliza plano privado de saúde no Brasil. Método: Revisão integrativa de setembro a outubro de 2017, com caráter nacional em português e inglês, textos online completos e publicados entre 2012 e 2017 no Portal da Biblioteca Virtual em Saúde, excluindo os duplicados e com metodologia indiscriminada. Resultados: As demandas judiciais foram: 32% medicamentos; 11% internação em enfermaria; 9% procedimentos cirúrgicos; 9% órtese, prótese e materiais especiais; 9% outros; e 30% de procedimentos diagnósticos, atendimento ambulatorial, internação em Centro de Terapia Intensiva, fórmulas alimentares e fraldas descartáveis. Conclusão: Demonstra-se a prevalência dos litígios judiciais decorrentes da falha na prestação do serviço de saúde pelos planos privados, o que facilita aos gestores identificar produtos e serviços de saúde pleiteados para reorganização da esfera administrativa e prestação de assistência com qualidade.

Evaluation of Educational intervention on Standard Precautions among Healthcare Provider Based on Health Belief Model

Background and objective: Occupational exposure makes healthcare provider at risk of a variety of infections such as AIDS, Hepatitis B, and Hepatitis C. This study investigated the effect of educational intervention on standardized precautionary behaviors in healthcare provider based on health belief model, in Jam city, Iran during 2016. Methods: This experimental study was carried out on Tohid hospital staff and health care provider of Jam`s health center. Random stratified sampling based on different occupation designated into two groups, intervention (n=50) and control (n=50). After confirming the validity and reliability of the data collection tool, the educational intervention was examined before and after the intervention. Data were analyzed using descriptive statistical methods, independent t-test and one-way ANOVA (SPSS 20). Results: The results revealed that the healthcare provider did not have any previous educational background on standardized precautionary (34.3%). Furthermore, the history of needle stick injuries (42.5%) and contact with patients' body fluids (17.5%) were reported. Educational intervention regarding to standardized precautions in the intervention group was significantly increased the mean score of knowledge constructs, perceived sensitivity, perceived severity, perceived benefits, perceived barriers and behaviors. However, no significant changes were observed in increasing the self-efficacy the score. Conclusion: The results indicate the effectiveness of educational intervention on standard precautionsamong healthcare provider based on health belief model. Educational program based on promotion behavioral pattern in relation to standard precautionsis recommended to the healthcare provider

Prácticas de atención del parto en una institución prestadora de servicios de salud en la ciudad de Bogotá / Delivery practices at a health care provider in the city of Bogota / Práticas de atendimento do parto numa instituição prestadora de serviços da saúde na cidade de Bogotá

Resumen Objetivos: Analizar las prácticas del personal de salud durante la atención del parto en una institución prestadora de servicios de salud en la ciudad de Bogotá, desde dos perspectivas, género y humanización del parto, teniendo en cuenta que en Colombia se adelanta, desde 2016, la implementación de la Ruta Integral de Atención en Salud Materno Perinatal como parte del nuevo modelo de atención en salud propuesto por el Ministerio de Salud y Protección Social. Métodos: Estudio cualitativo, descriptivo e interpretativo realizado entre junio y agosto de 2017, que incluyó observación no participante en salas de parto y entrevistas semiestructuradas a las mujeres a quienes se les observó el parto y al personal de salud que las atendió. Se codificaron los diarios de campo y las entrevistas, se realizó análisis de contenido y se trianguló la información. Resultados: La atención de parto se fundamenta en una atención medicalizada, que subordina a las mujeres y que coincide con un trabajo realizado rutinariamente, sumado a fallas en la comunicación entre estas y el personal de salud. Se evidenciaron aspectos que vulneran los derechos de las mujeres en trabajo de parto y en parto, y que son legitimados por el personal de salud y justificados por ellas. Conclusiones: Este trabajo es un aporte a la salud pública, dado que visibiliza un fenómeno normalizado en la práctica médica que amerita una intervención desde la perspectiva de la humanización de los servicios de salud.

Abstract Objectives: To analyze the practices of healthcare personnel during deliveries at a healthcare provider institution in the city of Bogota from two perspectives: gender and humanization of the delivery. Taking into account that in Colombia there has been an integral implementation, since 2016, of a comprehensive route to provide maternal perinatal Health Care as a part of a new healthcare model proposed by the Ministry of Health and Social Protection. Methodology: Qualitative, descriptive and interpretive study conducted between June and August 2017; it included non-participative observation in delivery rooms and semi-structured interviews of women whose delivery had been observed, and the healthcare Personnel that attended them. Field journals and interviews were coded. Content analysis was conducted and the information was triangulated Results: Delivery care is based on medicalized care, which subordinates women and coincides with a routine job, including a lack of communication between women and the healthcare personnel. The research showed aspects that violate women's rights during labor and delivery, which are legitimized by healthcare personnel and justified by women themselves. Conclusions: This study is a contribution to Public Health, for it evidences a phenomenon normalized in medical practice, which deserves an intervention from the perspective of humanizing Health Care Services.

Resumo Objetivos: Analisar as práxis do pessoal da saúde durante a atenção do parto numa instituição prestadora dos serviços da saúde na cidade de Bogotá, desde duas perspectivas, género e humanização do parto, levando em conta que na Colômbia se adianta, desde 2016, a implementação da Rota Integral de Atendimento em Saúde Materno Perinatal como parte dum novo modelo de atenção em saúde proposto pelo Ministério de Saúde e Proteção Social. Metodologia: Estudo qualitativo, descritivo e interpretativo realizado entre junho e agosto do 2017, que incluiu observação não participante nas salas de parto nem entrevistas semiestruturadas nas mulheres nas quais se observou o parto e ao pessoal da saúde que as atendeu. Se codificaram os diários de campo e as entrevistas, se realizou análise de conteúdo e se triangulou a informação. Resultados: A atenção do parto se fundamenta numa atenção medicadora, que subordina as mulheres e que coincide com um trabalho realizado rotineiramente, somado as falhas na comunicação entre estas e o pessoal da saúde. Se evidenciaram aspectos que vulneram os direitos das mulheres em trabalho de parto e no parto, e que são legitimados pelo pessoal da saúde e justificados por elas. Conclusões: Este trabalho é uma verba pra saúde pública, dado que visibiliza um fenómeno normalizado na práxis médica que decorre numa intervenção desde a perspectiva da la humanização dos serviços da saúde.

An Analysis of Self-reported Income Status and Related Determinants among Primary Care Providers in a County in Dali / 昆明医科大学学报

Objective To assess the income status of primary care providers and to explore the determinants of income in a county of Dali. Methods In August 2016, the questionnaire was employed to collect the data of income status of 191 rural health workers and 217 village doctors in the county. Results Through the study, we found that the income of rural health workers in the county was 34, 000 (26, 000, 46,000) yuan with a satisfaction rate of 62.3% (95% CI 55.4%～69.2%) and no change (74.7%) was seen in the income among majorities after implementing the Zero Mark-up Policy for essential medicines. For the village doctors, the income was 20,000 (15,000, 24,000) yuan with a satisfaction rate of 40.6% (95% CI 34.0%～47.1%) and a fall of the income was found in more than half of the doctors after the implement of the policy. Conclusion Health care workers in towns are quite satisfied with their income whereas those in health stations of villages are not content, compared with the average income at the national level. We should increase government's investments on grass-root healthcare team, improve the incentive pay plans and promote the integrated management of health facilities in towns and villages.

Health Care Providers' Perceptions of Family-centered Care in Pediatrics

PURPOSE: The purpose of this study was to identify and describe health care providers' perceptions of family-centered care in pediatrics. METHODS: A qualitative descriptive study was designed. Data were collected from individual interviews using open-ended questions. Fifty-six pediatric health care providers participated in the study from January to April 2015. Data were analyzed using qualitative content analysis to identify the major perceptions of pediatric health care providers. RESULTS: The providers perceived that the concept of family-centered care has been incompletely implemented. Five themes (respecting a child's family, taking care of a child with the child's family, sharing information about children, supporting a child's family, a child's family participating in child care) with 11 sub-themes were identified in the providers' experiences with families. To achieve the goal of family-centered care in pediatrics, medical and nursing conditions must be improved, education about family-centered care must be provided, and improvements should be made in the mindset of health care providers regarding patients and in families' willingness to participate in care. CONCLUSION: The findings from this study provide insight into pediatric health care providers' perceptions of family-centered care. It will contribute to the establishment of a foundation for implementing family-centered care in pediatric nursing.

Barriers and opportunities in recalls management at the health care provider level / Barreras y oportunidades en la gestión de retiro de productos farmacéuticos en las instituciones proveedoras de salud / Barreiras e oportunidades na gestão de lembranças no nível do provedor de cuidado da saúde

Abstract One of the operational risks to which a Health Care Provider (HCP) is exposed is the receiving and use of products such as pharmaceuticals and medical devices that could become subject to a health alert. This patient safety issue has to be managed in order to prevent and mitigate adverse events at the last echelon of the supply chain. This article aims to expose a characterization of the alerts response process at the HCP level based on a review of the literature. Additionally, local regulations, strengths and weaknesses were identified. Finally, the study allowed for the identification of the principal opportunities and barriers that should be addressed in order to integrate the recall management process within and outside the HCP. Among these opportunities is traceability along the supply chain, and among the barriers is the high investment in the technology required to facilitate supply chain integration.

Resumen Uno de los riesgos operacionales a los que está expuesto un Proveedor de Atención Médica (HCP por sus siglas en inglés) es la recepción y uso de productos farmacéuticos y dispositivos médicos que podrían estar sujetos a una alerta de salud. Este problema de seguridad del paciente tiene que ser manejado con el fin de prevenir y mitigar los eventos adversos en el último escalón de la cadena de suministro. Este artículo pretende exponer una caracterización del proceso de respuesta de alertas desde el HCP basado en una revisión de la literatura. Además, se identificaron la normativa local, fortalezas y debilidades. Finalmente, el estudio permitió identificar las principales oportunidades y barreras que se deben abordar para integrar el proceso de gestión de retiro de productos dentro y fuera del HCP. Entre estas oportunidades está la trazabilidad a lo largo de la cadena de suministro, y entre las barreras está la alta inversión en la tecnología requerida para facilitar la integración de la cadena de suministro.

Resumo Um dos riscos operacionais aos que está exposto um Provedor de Atenção Médica (HCP) é a recepção e o uso de produtos como produtos farmacêuticos e dispositivos médicos que poderiam estar sujeitos a uma alerta de saúde. Este problema de segurança do paciente tem que ser manejado com o fim de prevenir e mitigar os eventos adversos no último degrau da cadeia de fornecimento. Este artigo pretende expor uma caracterização do processo de resposta de alertas a nível do HCP baseado numa revisão da literatura. Ademais, identificaram-se as regulações locais, fortalezas e debilidades. Finalmente, o estudo permitiu identificar as principais oportunidades e barreiras que devem-se abordar para integrar o processo de gestão de produtos dentro e fora do HCP. Entre estas oportunidades está a traçabilidade ao longo da cadeia de fornecimento, e entre as barreiras está o alto investimento na tecnologia requerida para facilitar a integração da cadeia de fornecimento.

Atenção primária à saúde como ordenadora de um modelo de integração assistencial na rede de urgência e emergência / Primary health care as coordinator of a caring integration model for the emergency care network

Esta pesquisa teve como objetivo geral: Elaborar uma proposta de modelo assistencial de intervenção com vistas à melhoria da integração entre a Unidade de Saúde e a Unidade de Pronto Atendimento, tendo a Atenção Primária à Saúde como ordenadora da Rede de Urgência e Emergência. Como objetivos específicos buscou-se: analisar os fluxos entre a US e a UPA; e, identificar como os profissionais das US, da UPA e os gestores definem as funções de cada equipamento que compõe a rede de atenção à urgência/emergência do município. Trata-se de uma pesquisa de abordagem qualitativa, do tipo descritivo e exploratório. A pesquisa compôs-se das seguintes etapas: etapa de aproximação com o campo de pesquisa; coleta de dados principal; elaboração do modelo assistencial de integração entre as US e a UPA. A coleta de dados da etapa de aproximação com o campo de pesquisa foi realizada com 17 usuários que aguardavam atendimento em uma UPA, durante duas rodas de conversa no mês de outubro de 2014; e, com 16 enfermeiros, 12 médicos e 21 gestores da Secretaria Municipal de Saúde do município de Curitiba -PR na etapa de coleta de dados principal por meio de entrevistas com roteiro semiestruturado, posteriormente gravadas e transcritas. O processamento e análise dos dados da etapa prévia foram feitos a partir dos registros das rodas de conversas transcritos pelas observadoras e sistematizados pela pesquisadora, que conduziu a análise a partir dos temas identificados, classificando-os em duas categorias: dificuldade de acesso à US e compreensões sobre as atribuições da US e UPA. Para processamento dos dados das entrevistas foi utilizado o software IRAMUTEQ, que faz cálculos estatísticos sobre dados qualitativos. Em função da frequência dos vocábulos e do valor do qui-quadrado igual ou superior a 3.84, os dados foram classificados em quatro classes: comunicação formal e informal na organização do sistema de saúde, acesso da população aos serviços de saúde, a integração entre a US e UPA e funções da US e da UPA na rede de atenção à saúde. A elaboração do Modelo Assistencial de Integração entre a US e a UPA apresenta duas propostas: a primeira proposta está relacionada à mudança no processo de trabalho da US e UPA, e a segunda proposta envolve maior mudanças estruturais, ambos assumem a APS como ordenadora do cuidado. Conclui-se que a integração entre US e a UPA encontra-se frágil, fragmentada e desarticulada; o processo de trabalho da APS organiza-se de forma rígida, seletiva e com barreiras de acesso aos usuários, que procuram pela UPA quando necessitam de atendimento. Os resultados permitem visualizar que a dificuldade de comunicação e integração entre a APS e UPA está relacionada a uma sobreposição de funções e que é necessário reorganizar o modelo da rede de atenção à saúde, considerando os atributos da APS e as necessidades dos usuários.

This research study had as general objective: to elaborate a proposal of a caring intervention model in order to improve the integration between the Health Care Unit and the Emergency Care Unit (ECU) with the Primary Health Care as coordinator for the Emergency Care Network. As specific objectives, it aimed: to analyze flows between the Health Care Unit and the ECU; and to apprehend how Health Care Unit as well as ECU professionals and managers define the functions of each unit that comprises emergency health care network in the municipality. It is a descriptive-exploratory, qualitative research study. The study encompasses the following steps: approaching step with the research field; main data collection; elaboration of a health care integration model between the health care units and the ECU. Data collection in the approaching step with the research field was held with 17 users waiting for care delivery at an ECU, during two rounds of conversation in October, 2014; and with 16 nurses, 12 doctors and 21 managers of the Municipal Secretary of Health from the municipality of Curitiba -Paraná State, Brazil, during the main data collection by means of semi-structured interviews, recorded and further transcribed. Data process and analysis of the first step were carried out from records of the conversation rounds transcribed by the observers and systematized by the researcher, who carried out the analysis from the identified themes, classifying them in two categories: access difficulty to a Health Care Unit and understandings on the attributions of Health Care Units and ECUs. IRAMUTEQ software, which performs statistical calculations of qualitative data, was used for processing the data from the interviews. Due to the word frequency and chi-square ? 3.84, data were classified in four classes: formal and informal communication in the health system organization, population access to health care services, integration between Health Care Unit and ECU, and Health Care Unit and ECU functions in the health care network. The elaboration of the Health Care Integration Model between the Health Care Unit and the ECU features two proposals: the first proposal is related to the change in Health Care Unit and ECU work process, and the second proposal entails major structural changes, both assuming Primary Health Care as the care manager. It can be concluded that the integration between the Health Care Unit and the ECU is fragile, fragmented and disarticulated; Primary Health Care work process is organized in a rigid, selective way, with access hurdles to the users who reach for the ECU for care delivery. Results enable to apprehend that the difficulty of communication and integration between the Primary Health Care and ECU is related to a function overlap, being necessaryto reorganize the heath care network model by considering Primary Health Care attributes as well as users' needs.

Determinants of Out-of-Pocket and Catastrophic Health Expenditure: A Cross-sectional Study.

Background: In India, Out of Pocket Health Expenditures (OOPHE) is as high as 70-80% of total health expenditures, borne by the families of ailing persons. In most cases such high OOPHE is catastrophic in nature, in the backdrop of high poverty level in the country. High OOPHE and Catastrophic Health Expenditures (CHE) have a potential to impoverish people. It is therefore important to identify the predictors of OOPHE and CHE, to formulate an equitable and efficient financial protection measure from health expenditure. Methods: The study tried to understand the factors of out-of-pocket health expenditure and catastrophic health expenditure using the cross-sectional data from 986 sampled households in Koderma district of the state of Jharkhand in India. A multi-staged sampling method was followed to select households with incidences of in-patient care in the last one and child birth in the last two years and of out-patient care in the last one month. Alongside health expenditure data of the sampled households, their socio-demographic and socio-economic information were also collected using survey questionnaire. Findings: Male headed households, families with more than five members, household head who were unemployed or were engaged in agriculture or labour works as compared to those in service; household head aged above 60 years, households from higher expenditure quintiles, households with any member suffering from chronic illness, households reporting any episode of hospitalisation, in-patient or delivery services availed from private providers in the reference periods, families living closer to service providers especially private providers were significant predictors of high OOPHE. Residence in rural area (aOR: 1.65, 95% CI 1.10 - 2.49), families living in ‘kutcha’ (mud house) houses (aOR: 1.46, 95% CI 1.06 - 2.0), families with lower social status like Schedule Tribe (aOR: 1.76, 95% CI 1.0 – 3.13), Scheduled Caste (aOR: 1.73, 95% CI 1.02 - 2.92) and Other Backward Classes (aOR: 1.42, 95% CI 1.02 - 2.01) compared to General castes, families where any member suffering from chronic illness (aOR: 2.33, 99% CI 1.48 – 3.67), families where any member had received in-patient care in the last one year irrespective of type of providers (aOR: 2.18, 99% CI 1.60 - 2.97), longer distance from health service providers, had higher likelihood of CHE. Conclusion: The study tried to identify different predictors of Out of Pocket Health Expenditure (OOPHE) and Catastrophic Health Expenditure (CHE), incurred by families seeking medical care for various ailments. OOPHE was found higher among families from higher expenditure quintile; however, people from disadvantaged socio economic profile had higher likelihood of CHE. Apparently, even smaller OOPHE is proving to be catastrophic for families from lower socio-economic segments. Families with any member suffering from chronic illness were at a higher risk of CHE. OOPHE was considerably higher when services have been sought from private providers compared to public health providers, however, for in-patient care, expenditure incurred in both situations were found to be catastrophic. Urgent action is needed for designing healthcare finance policies that is more equitable and efficient and has a potential to reduce OOPHE and incidences of CHE.

A single hospital survey of anaphylaxis awareness among health care providers and medical students

PURPOSE: Anaphylaxis is a rapidly progressive allergic reaction that requires precise recognition and immediate management. However, health care providers, awareness of anaphylaxis has not been acknowledged. The aim of this study is to investigate the extent of knowledge and principal management skills on anaphylaxis among medical personnel and students. METHODS: We performed a questionnaire survey on knowledge, education, and managing skills for anaphylaxis to physicians, nurses, health personnel, and medical students in Ajou University Medical Center, from 26 June to 31 October, 2014. The survey contained 2 main sections: questions about demographic data and 2 types of questionnaire (type I for all participants and type II for only medical staffs) for self-assessment on anaphylaxis. RESULTS: A total of 1,615 participants (128 doctors, 828 nurses, 436 students, and 223 health personnel) completed the survey. For questionnaire I, the percentages of correct answers in doctors, nurses, medical students, and health personnel were 77.5%, 56.4%, 47.8%, and 28.0% respectively, showing significant differences between groups (P<0.001). For questionnaire II, 93% of doctors and 75.6% of nurses indicated epinephrine as the drug of choice, and 79.7% of doctors and 71.3% of nurses selected the correct intramuscular route. More than 3 quarters of the doctors (80.5%) selected epinephrine within the first 5 steps of treatment, but only 48% included epinephrine within the first 3 steps. CONCLUSION: Our study showed considerable lack of knowledge on anaphylaxis among health care providers, especially on the specific management steps of anaphylaxis. As significant gaps on overall knowledge of anaphylaxis were observed between different groups of medical personnel, regular education should be implemented for each department in the health care setting.

La empatía en l relacion médico-paciente como anifestacion del respeto por la dignidad de la persona: una aportación de edith stinn / Empathy i the phhysician-atient relationship as a demonstration of respeect for the dignity of the individual: a contribution by edith stein / A empatia narelaação médico-paciente como manifestação do repeito pela dignnidade da pessoa: uma contribuição de edith stein

Una medicina altamente tecnificada, con una certeza diagnóstica sin precedentes y con resultados bastante eficientes pero, a su vez, con una elevada tasa de desconfianza por parte de los usuarios, lo que da como resultado una medicina defensiva, es una realidad que se repite habitualmente en el ámbito sanitario. Al parecer, el poderío de la técnica sobre la vida ha dejado de lado lo eminentemente humano en el acto de curar, ocasionando una inevitable fractura en la esencia misma de la profesión. Frente a ello se plantea rehumanizar la relación clínica a través del uso de la empatía, para contribuir de este modo a la superación del excesivo positivismo en el que ha caído la medicina.

A high-tech medicine, with unprecedented diagnostic certainty and quite efficient outcomes but, at the same time, with a high level of distrust from the users, which results in a defensive medicine, is a reality that is often repeated in healthcare. Apparently, the power of technique over life has left aside the eminent humaneness in the act of healing, causing an inevitable split in the very essence of the profession. In the presence of this, the issue arises of re-humanizing the clinical relationship through the use of empathy, thus contributing to overcoming the excessive positivism in which medicine has fallen.

Uma medicina altamente tecnificada, com uma certeza diagnóstica sem precedentes e com resultados eficientes, mas, ao mesmo tempo, com uma elevada taxa de desconfiança por parte dos usuários, o que resulta numa medicina defensiva, é uma realidade que se repete habitualmente no âmbito sanitário. Ao que tudo indica, o poder da técnica sobre a vida tem deixado de lado o eminentemente humano no ato de curar, o que tem ocasionado uma inevitável fratura na essência em si da profissão. Diante disso, propõe-se reumanizar a relação clínica por meio do uso da empatia, para contribuir, desse modo, para a superação do excessivo positivismo no qual a medicina tem caído.

Users’ Satisfaction with Services Provided Under National Health Insurance Scheme in South Western Nigeria.

Aims: National Health Insurance Scheme became operational in Nigeria over eight years ago; yet, population coverage is below 20% and healthcare services are provided ineffectively and inefficiently. Satisfaction surveys might be part of useful interventions required to increase universal healthcare coverage and improve optimal access and success of the scheme. Study Design: A cross-sectional, exploratory study. Place and Duration of Study: Federal Secretariat, Ibadan, Nigeria. 4 weeks of the month of July, 2011. Methodology: 380 eligible federal staff completed a self-administered modified SERVQUAL questionnaire, which assessed satisfaction domains of healthcare provider services (competence), staff attitude and waiting time. Clients’ experiences were related to a health facility visit in the last three months preceding the survey and assessed on a 5-point Likert scale of “very poor = 1”, “poor = 2”, “good = 3”, “very good = 4” and “excellent = 5”. Associations between dependent and independent variables were subjected to Chi-square test and logistic regression at P-value of 0.05. Results: 201 (52.8%) male and 179 (47.2%) female participated in the study. Their mean age was 42.5±8.0 years. Most frequently health conditions for which services were sought were malaria (52.9%), medical check-up (5.8%) and dental problem (2.9%). 55.6% of participants were satisfied with drug services, 56.2% with healthcare provider services, 77.8% with waiting time and 51.7% with staff attitude. Education and type of health facility were predictors of satisfaction with healthcare provider services. Length of years of enrolment was a predictor of satisfaction with waiting time while length of years and grade level attained in service were predictors of satisfaction with staff attitude. Conclusion: Periodic documentation of experiences of enrollees in relation to satisfaction domains of social insurance is useful as it could help identify and prioritise appropriate interventions required to improve its effectiveness and efficiency.

Experiencia de cuidadores familiares sobre el cuidado de transición en mujeres mastectomizadas / Experience of family caregivers on transition care in mastectomized women / Experiência de cuidadores familiares no cuidado de transição em mulheres mastectomizadas

En la actualidad presenciamos cambios en la presentación de servicios de salud e implementación de políticas públicas cada vez más eficientes, sin embargo gran parte de los cuidados a mujeres con cáncer sometidas a tratamiento quirúrgico como la mastectomía se administran en el hogar. Esta situación establece un compromiso para la paciente y su familia. Con frecuencia, algún familiar se encarga del cuidado de la paciente que en muchos casos podría considerarse altamente especializado. En nuestra sociedad se desconoce el nivel de la experiencia o la calidad de la misma que tienen los cuidadores familiares posteriormente al alta hospitalaria y previa a la siguiente consulta. Este espacio de tiempo podría definirse como de transición. Los cuidados de transición se refieren al periodo durante el cual los pacientes pasan de una fase a otra de la enfermedad o del tratamiento, o bien, cuando cambian de un entorno de atención a otro. Los cuidados de transición tienen repercusiones importantes en la salud de la paciente. Estos periodos de cambio se ubican generalmente en el hogar. El presente estudio expone y analiza el factor de la experiencia durante el cuidado de transición por los cuidadores familiares de mujeres mastectomizadas. Se realizó una investigación cualitativa, con entrevistas semiestructuradas realizadas a tres familiares responsables del cuidado así como un análisis de contenido. Después de validad los resultados, situamos como la principal preocupación la curación de herida quirúrgica sin lastimar a la paciente. Se identifican momentos clave perfectamente determinados durante la transición. La falta de conocimientos por el cuidador se sustituye por buena voluntad y utilizando su propio criterio. Está presente la fe en el cuidador como su principal sostén, así como una necesidad de información orientada hacia la técnica de curación. Los cuidados de transición encauzados hacia la curación de herida quirúrgica cuentan con elementos que están más en función de una lógica primaria que de una capacitación sobre el tema. Esto contrasta con la literatura que se hace re4ferencia en el cuidador, donde frecuentemente se ocupa de aspectos puntuales como: la dieta, medicación, el estado general y anímico de la paciente. Finalmente se elaboran propuestas para conformar un puente de cuidados de transición hospital-hogar-hospital, considerando una consultoría de enfermería durante el proceso para favorecer el bienestar de la mujer mastectomizada, al disminuir complicaciones, disminuyendo costos previsibles para la institución y evitando una atención biomédica fragmentada.

Nowadays, we witness changes in health services presentation and public policies implementation more4 and more efficient. Nevertheless, most care for women with cáncer, subjected to surgical treatment, such as mastectomy, is provided at home. The aforementioned situation establishes an engagement for the patient and her family. Frequently some family members take charge of the care of the patients. In many cases, this care could be regarded as specialized. In our society, the level of experience and the care quality of the care givers, afte4r the hospital discharge and before the following medical consultation, are unknown. This mentioned period could be named as the transitional period. Transitional cares are referred to the period during qhich patients go from one phase to another in the disease or in the treatment; or when the patients move from one attention background to another fifferent ambience. Transitional cares present an important impacto n patients´ health. Those change periods are usually located at home. The present study exposes and analyzes the experience factor during transitional cares for the mastectomized women by part of family care providers. The study performed a qualitative reserch, with semi-structured interviews carried out on family members responsible for the care, as well as an analysis of contets. After validating the results, our first concern was the surgical wound healing, without causing the patient any harm. Several completely well-determined key moments were identified during the transitional period. The lack of care knowledge by part of the care providers may be substituted by good willin and the use of their own criterion. The reliance on the caregiver is always present, as well the need for information oriented to the healing technique. The transitional cares guided to healing the surgical wound count on some elements that are more in terms of a prmary logic tan guided by training on the matter. This is opposed to the concept found in the literatura that makes reference to the caregiver, where the main points refer to certain punctual aspects, such as diet, medication, and the patient´s physical and psychic condition. Finally, the study gives some propositions in order to establish some kind of hospital-home-hospital brindging transitional care, considering a nursing consulting during the process so as to improve mastectomized women´s welfare, diminishing complications for the patients, decreasing predictable costs, and avoiding a fragmented biomedical attention.

Atualmente testemunhando mudanças na apresentação dos serviços de saúde e implementar políticas públicas cada vez mais eficientes, por mais cuidados para mulheres com submetidos a cirurgia de câncer, como a mastectomia são administradas em casa. Essa situação estabelece um compromisso para o paciente e sua família. Freqüentemente, um membro da família cuida do paciente, que em muitos casos pode ser considerado altamente especializado. Em nossa sociedade o nível de experiência ou a qualidade do que tem posteriormente parentes para alta hospitalar e antes de as seguintes cuidadores de consulta é desconhecida. Esse espaço de tempo poderia ser definido como transitório. tratamento de transição são relativos ao período durante o qual os pacientes se mover a partir de uma fase para outra doença ou tratamento, ou quando alterar o ambiente cuidado para outro. O cuidado de transição tem importantes repercussões na saúde do paciente. Esses períodos de mudança geralmente estão localizados em casa. Este estudo descreve e analisa o fator experiência para cuidar de transição para cuidadores familiares de mulheres mastectomizadas. A pesquisa qualitativa foi realizada por meio de entrevistas semi-estruturadas com três cuidadores familiares, bem como uma análise de conteúdo. Após validar os resultados, colocamos como principal preocupação a cicatrização da ferida cirúrgica sem prejudicar o paciente. Momentos chave perfeitamente identificados durante a transição são identificados. A falta de conhecimento do cuidador é substituída por boa vontade e usando seus próprios critérios. A fé está presente no cuidador como seu esteio, assim como a necessidade de uma técnica de cura orientado a informações. cuidados de Transição introduzido a cicatrização da ferida cirúrgica tem elementos que são mais em termos de uma lógica primária de formação sobre o assunto. Isto contrasta com a re4ferencia literatura no cuidador, que muitas vezes lida com aspectos específicos, tais como dieta, medicação e o humor geral do paciente. Finalmente, as propostas são feitas para formar um cuidado transicional ponte do hospital-home-hospitalar, considerando-se uma enfermeira de consultoria durante o processo para promover o bem-estar das mulheres com mastectomias, diminuindo complicações, diminuindo custos previsíveis para a instituição e evitando cuidados biomédica fragmentado

Job Analysis of Medical Care Client Managers based on DACUM / 산업간호학회지

PURPOSE: The purpose of this study is to establish the standards for duty of Medical Care Client Managers and analyze the extent of accomplishment, importance, and difficulty according to the standards. METHODS: The draft for duty of Medical Care Client Managers was formed by the method of developing a curriculum (DACUM) and data were collected from 185 Medical Aid Client Managers in 234 areas to evaluate the actual frequency of accomplishment, importance and difficulty in comparison with the standards for duties. RESULTS: The standard duty draft for Medical Care Client Manager is composed of five separate groups of duties and thirty five tasks. The five duties are Case Management, Extension Approval, External Cause of Injury, Duplicate Claims and Other Administrations. Seven Tasks are allocated to each duty such as Case Management, Extension Approval and External Cause of Injury. Five tasks are allocated to 'Duplicate Claims' duty and nine tasks are allocated to 'Other Administrations' duty. CONCLUSION: From the results of analysis for duties, it was apprehensive about overburdened responsibilities and carelessness in professional duties. It was necessary to establish specific guidelines for duties because of redundent application or regional variation in frequency of accomplishing other administrative duties. It was necessary to relieve a regional disparity of business charge and also was necessary to propose an alternative plan to relieve the overburdened responsibilities.

Factores asociados al no control de la presión arterial en pacientes inscritos al programa de hipertensión de una Entidad Promotora de Salud en Cali-Colombia, 2004 / Factors associated with lack of blood pressure control in patients enrolled in a hypertension control program of a private primary Health Care Organization in Cali, Colombia, in 2004

Objetivos: determinar los factores asociados al no control de la presión arterial en pacientes inscritos al programa de control de la hipertensión de una Entidad Promotora de Salud en Cali-Colombia, en el año 2004. Métodos: estudio descriptivo de corte transversal, en el que se seleccionaron de manera aleatoria 356 pacientes mayores de 18 años de los inscritos en el programa de control de la hipertensión arterial. Se clasificó como paciente no controlado en hipertensión arterial a quien presentó presión arterial sistólica superior a 139 mm Hg o presión arterial diastólica superior a 89 mm Hg. Se consideraron como variables independientes: factores de riesgo no modificables, comportamentales, biológicos y administrativos. Mediante un análisis bivariado y multivariado se identificaron factores asociados al no control de la presión arterial. Resultados: la prevalencia del no control fue 30,1% (IC 95% 25,3-34,8), siendo mayor en el género masculino (c2= 9,368; p=0,002). La adherencia al tratamiento farmacológico fue 56,2% (IC 95%: 51,0% - 61,3%). El riesgo relativo indirecto (OR) de no control de la tensión arterial ajustada por género y según el uso de inhibidores de la enzima convertidora de angiotensina solos o en combinación con medicamentos hipolipemiantes, fue de 1,71 (IC 95%: 1,0-2,94); según el tipo de Institución Prestadora de Salud donde se lleva a cabo el programa de hipertensión arterial adscrita a la Entidad Promotora de Salud en comparación con los que asisten a Instituciones Prestadoras de Salud propias, el OR fue 2,13 (IC 95%: 1,3- 3,5). Conclusiones: la prevalencia de hipertensión arterial no controlada en un programa de una Entidad Promotora de Salud fue de 30,1%. Los factores asociados fueron: tipo de Institución Prestadora de Salud, género masculino y uso de inhibidores de la enzima convertidora de angiotensina y la interacción del medicamento con antecedentes de dislipidemia.

Objectives: to determine the factors associated to the lack of control of arterial blood pressure in patients enrolled in a hypertension control program of a private primary health care organization in Cali, Colombia in 2004. Methods: descriptive cross-sectional study. 356 patients >18 years were randomly chosen from the hypertension control program. Those patients with systolic blood pressure >139 mm Hg or diastolic blood pressure >89 mm Hg were classified as patients with lack of blood pressure control. Risk factors that could not be modified, behavioral, biological and administrative factors, were considered independent variables. Through a bivariate and multivariate analysis, factors associated to lack of blood pressure control were identified. Results: the prevalence of lack of blood pressure control in this health care organization was 30,1% (95% CI, 25,3-34,8), being higher in males (c2= 9,368; p=0,002). Adherence to pharmacological treatment was 56,2% (95% CI: 51,0% - 61,3%). Odds ratio (OR) for lack of blood pressure control adjusted by gender and according to hypolipemic drugs combination was 1,71 (95% CI: 1,0-2,94); OR according to the contracted health care organization in comparison with the institutional health care was 2.13 (95% CI: 1.3 - 3.5). Conclusions: the prevalence of lack of blood pressure control in a hypertension control program of a private health care organization was 30,1%. Associated factors were: type of health care organization, male gender, use of inhibitors on angiotensing-converting enzyme and drug interaction with concomitant use of hypolipemis.