Nota informativa nº 01 /2020 - DVAST/ DVDVZ /SVS/SES: recomendações aos agentes de combates à endemias-ace para enfrentamento da pandemia de Coronavírus ­ covid-19 (infecção pelo SARS-CoV-2) / Informative note nº 01 / 2020 - DVAST / DVDVZ / SVS / SES: recommendations to agents to combat ace-endemic diseases for coping with the Coronavirus pandemic - covid-19 (SARS-CoV-2 infection)

Traz reflexões e recomendações aos gestores e trabalhadores na discussão coletiva de medidas que minimizem os riscos à saúde dos Agentes de Combates à Endemias-ACE, como também, reduzam a disseminação do COVID-19 para seus familiares e a população em geral. Complementa os informes e protocolos emitidos pela SES-TO e seu Comitê Operacional de Emergências em Saúde e pelo Ministério da Saúde.

It brings reflections and recommendations to managers and workers in the collective discussion of measures that minimize the health risks of Agents to Combat Endemics-ACE, as well as reduce the spread of COVID-19 to their families and the population in general. It complements the reports and protocols issued by SES-TO and its Operational Committee for Health Emergencies and the Ministry of Health.

Aporta reflexiones y recomendaciones a directivos y trabajadores en la discusión colectiva de medidas que minimicen los riesgos para la salud de los Agentes de Lucha contra las Endemias-ACE, así como reduzcan la propagación del COVID-19 a sus familias y a la población en general. Complementa los informes y protocolos emitidos por la SES-TO y su Comité Operativo de Emergencias Sanitarias y el Ministerio de Salud.

Desempeño del rol de cuidador primario y eficiencia del programa Atención Hospitalaria a Domicilio / Caregiver role performance and efficiency of the Home Health Care program

Resumen:

Introducción: el programa de Atención Hospitalaria a Domicilio (ATHODO), del Instituto Mexicano del Seguro Social (IMSS), se implemento con el fin de llevar atención médica hasta el domicilio de los pacientes con enfermedades crónicas o terminales. Como requisito indispensable para formar parte del programa, el paciente debe contar con un cuidador primario, persona en la que recae la responsabilidad del cuidado del paciente.

Objetivo: evaluar el desempeño del cuidador principal y su relación con la eficiencia del programa ATHODO.

Metodología: estudio descriptivo y transversal correlacional en 72 cuidadores principales inscritos en el programa ATHODO. El desempeño del cuidador principal se evaluó con el instrumento elaborado por Landeros y Huitzache "Valoración para el Agente de Cuidado Dependiente", validado con alfa de Cronbach de 0.862; y la eficiencia del programa, con una lista de cotejo realizada conforme a lo establecido en los siete indicadores de calidad que marca el IMSS. Se consideró eficiente si se cumplieron positivamente los siete indicadores.

Resultados: el desempeño del rol de cuidador principal fue bueno en 58 % y regular en 42 %. El programa ATHODO fue evaluado como insuficiente por los cuidadores debido a que no se cumplió favorablemente con los siete indicadores. Se identificó asociación entre desempeño y eficiencia del programa.

Conclusiones: la asociación entre desempeño y eficiencia del programa ATHODO permite proponer acciones que lo perfeccionen y que mejoren el desempeño del cuidador principal.

Abstract:

Introduction: Instituto Mexicano del Seguro Social's (IMSS) Home Health Care program (ATHODO, according to its initials in Spanish) was implemented to bring medical care to the home of patients with chronic or terminal diseases. As a prerequisite for joining the program, the patient must have a primary caregiver: a person with the responsibility of giving care to him.

Objective: To evaluate the performance of the primary caregiver role and its relationship with the efficiency of ATHODO program.

Methodology: A descriptive, correlational cross-sectional study in 72 primary caregivers enrolled in ATHODO. Primary caregiver performance was assessed with the instrument developed by Lan-deros and Huitzache "Valoración para el Agente de CuidadoDependiente" ("Calculation for Dependent Care Agent"), validated with Cronbach's alpha of 0.862. The efficiency of the program was validated with a checklist made as provided in the seven indicators of quality that marks the IMSS. The program was considered efficient if it met with the seven points positively. Results: the performance of the role of primary caregiver was good in 58 %, fair in 42 %. The ATHODO program was evaluated as inefficient by all caregivers, because it didn't met favorably with the seven indicators. An association between performance and efficiency of the program was identified. Conclusions: the association between performance and efficiency of the program allows to propose actions to improve the program and consequently the performance of the primary caregiver.

Clinical Outcomes and Quality of Life of Home Health Care Patients

PURPOSE: This study aimed to evaluate the quality of life (QOL) in home health care patients according to change in health status outcomes between the start of care and discharge or 60 days, whichever came first. METHODS: This is a prospective descriptive study. The convenience sample consisted of 100 home health care patients, who started receiving home health care services from a home health care agency in the United States. The World Health Organization Quality of Life Scale-Brief (WHOQOL-BREF) was used for measuring QOL; activities of daily living (ADLs) and instrumental ADLs were collected from the Outcome and Assessment Information Set data via Centers for Medicare and Medicaid Services-required home health agencies. Descriptive statistics, paired t tests, and multiple linear regressions were used for data analysis. RESULTS: ADLs and instrumental ADLs of participants significantly improved between start of care and discharge or 60 days. Overall QOL, general health, and three of four QOL domains (physical, psychological, and environmental, but not social domain) were significantly improved at discharge or 60 days. CONCLUSION: Home health care nurses should maintain and improve the functional ability of patients, as this could improve the QOL of these patients.

The Social Construction of Identity in HIV/AIDS Home-based Care Volunteers in Rural KwaZulu-Natal; South Africa

Home-based care volunteer (HBCV) identity and how it is shaped was the main focus of the study. Fifteen HBCVs were interviewed about their work and personal life stories and then interviewed reflectively using a narrative interviewing style. Specific attention was paid to contextual meta-narratives and social field narratives in understanding the women's stories. Findings indicate that social field narratives of the women's stories were dominated by negative aspects of gender; poverty and socio-political factors. These were seen to coincide with the 'feminisation of responsibility' in this context effectively coercing the women into agency which manifested as their home-based care work. Meta-narratives influencing the women's lives were dominated by stories of communal motherhood; aspirations to service-oriented work and religious beliefs and commitment. The question of how it is possible for women who are seemingly constrained by oppressive narratives to voluntarily engage in community participation was answered in the women's personal life stories about being compassionate; hopeful; helpful and ambitious and having initiative. These characteristics collectively pointed to personal agency. Exploring connections between the different aspects of identity and context revealed that the women made sense of their community participation through their personal identities as strong and loving mothers. Connections between volunteer personal identity; agency and volunteer group identity were explored to make sense of the link between HBCV identity and volunteerism. The mother identity; encompassing personal agency (strength or power) and love (the meta-narrative of communal motherly love); was salient in influencing community participation of the group

Development of the Quality Indicators in Long Term Care Service / 간호행정학회지

PURPOSE: This study was designed to develop quality outcome indicators for nursing homes and community-based home care that would contribute to an appropriate evaluation and improvement of quality of long term care in Korea. METHODS: The preliminary quality indicators of long term care were developed from a literature review and clinical expert panel. A content validity testing was done using a panel of experts who were selected from academic and clinical field of long-term care. The final quality indicators were confirmed after application in four nursing homes and four home care agencies to test clinical validity. RESULTS: The preliminary quality indicators consisted of 3 domains and 19 indicators. The final quality indicators were composed of 4 domains and 17 indicators. CONCLUSION: This study demonstrated the feasibility of outcome quality indicators in long term care. These quality indicators can be effectively used to evaluate the quality of nursing home and home care and to improve the quality of care in the Korean long-term care system.

Práticas de saúde da mulher no espaço domiciliar: análise a partir de Agentes Comunitários de Saúde / Women's health practices in the home space: analysis from Community Health Agents

política atual de reorganização do Sistema de Saúde no Brasil utiliza a estratégia de atendimento domiciliar, tendo a atenção primária como base de sua ação, revalorizando o uso das práticas de saúde no domicílio. Este espaço, histórica e culturalmente atribuído às mulheres, influencia e é influenciado por diferentes práticas sociais. Este estudo tem como objetivo analisar como as práticas de saúde voltadas para a Mulher e realizadas no domicílio, estão sendo desenvolvidas por ACS do Distrito Sanitário Barra/ Rio Vermelho reproduzindo as desigualdade de gênero. Utilizou-se a metodologia qualitativa, usando o Materialismo Histórico Dialético como referencial teórico- filosófico. Para a coleta de dados, utilizou-se da observação participante e entrevista semi-estruturada e gravada dos ACS, usando-se a análise de conteúdo. A visita domiciliar apresenta-se como instrumento de trabalho revalorizado. A articulação dos ACS com os serviços apresenta-se com deficiências, considerando-se o atendimento à demanda espontânea. O trabalho dos agentes reproduz características do Modelo Médico Assistencial. Da mesma forma, as práticas de saúde mesmo voltadas para promoção/prevenção de problemas de saúde não são suficientes para enfrentar os conflitos e as necessidades existentes no âmbito domiciliar. O despreparo dos agentes para lidar com problemas complexos reproduzem desigualdades de gênero, na medida em que reforçam o papel da mulher como única cuidadora reafirmando estereótipos sexistas. (AU)

Assistência domiciliar na cidade de Salvador-BA: possibilidade de atuação fonoaudiológica em Motricidade Orofacial / Home care in Salvador-BA: a work possibility for speech therapists in orofacial myofunction

OBJETIVO: caracterizar o atendimento fonoaudiológico nas empresas de Assistência Domiciliar de Salvador. MÉTODOS: pesquisa retrospectiva por meio da aplicação de questionário às empresas, fonoaudiólogos e pacientes atendidos com fonoaudiólogo, de Janeiro a Março de 2006. RESULTADOS: o tempo médio de funcionamento das empresas é 9,17 anos. A média de pacientes atendidos por fonoaudiólogo é 14,33 com média de 3,17 fonoaudiólogos atendendo por empresa; profissionais presentes em 100 por cento das empresas são médicos e fisioterapeutas; os fonoaudiólogos trabalham por prestação de serviço, com valor médio de 33 reais por atendimento. A maioria dos pacientes são mulheres, idosos (média de 69 anos), com diagnóstico de doença neurológica: AVE (39,1 por cento), Demências (19,1 por cento); os fonoaudiólogos são em maioria mulheres, jovens e graduadas no próprio estado. CONCLUSÕES: a assistência domiciliar é atividade recente na Bahia, porém a presença do Fonoaudiólogo já é estabelecida, com profissionais graduados no próprio estado e trabalhando por prestação de serviço.

PURPOSE: to characterize the speech therapy service of home care service companies in Salvador. METHODS: a partially retrospective survey through questionnaires done by companies, speech therapists and patients attended by speech therapist from January to March 2006. RESULTS: companies have been open an average of 9.17 years. The average number of speech therapists per company is 3.17 and the average number of patients attended by speech therapist is 14.33; 100 percent of the company professionals are licensed doctors and physical therapists; speech therapists work as service rendering self-employed professionals, with average cost of R$ 33,00 per attendance. Most patients are women, elderly (average of 69 years), with diagnosis of neurological illness: Cerebrovascular disease (39.1 percent), Dementia (19.1 percent); most of the speech therapists are young women, who graduated from a local school. CONCLUSIONS: home care service is a recent activity in Bahia. However, speech therapist presence is already settled, with professionals graduated in their own states and working as service rendering self-employed professionals.

An Analysis of the Elderly Care and Management in Hospital-Based Home Care Agencies

PURPOSE: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. METHOD: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. RESULT: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. CONCLUSION: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.

Current Status of Costs and Utilizations of Hospital Based Home Health Nursing Care in Korea / 간호학회지

PURPOSE: The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. METHOD: A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. RESULT: The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won (approximately equal to 48 Dollars, 1 Dollar=960 Won). The costs ranged from 74,523 Won (approximately equal to 78 Dollars, loss of chronic kidney function, N18) to 32,270 Won (approximately equal to 34 Dollars, other cerebrovascular diseases, I67). CONCLUSION: Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

Working Conditions in Home Health Care Nursing: A Survey of Home Care Nurses in Hospitals in Korea / 간호학회지

PURPOSE: The purpose of this research was to address the working conditions of home health nurses through a nationwide home health agency survey conducted at hospitals. METHOD: The mail surveys were sent to 303 home health nurses nation wide and returned with a response rate of 71.8%. RESULT: (a) Seventy-five percent of home health agencies were established within the past5 years and half of home health nurses are over 40 years old. (b) Working conditions were considered as follows: Seventy-one percent of respondents were full-time employees, sixty-sixpercent of home health nurses had unscheduled visits on a regular day of duty and forty-eight percent were on vacation. Fifty-one percent of home health nurses have experienced traffic accidents and paid penalties (65.9%). Self-reported monthly income level per year was an average of 28,364,000 won. (c) Rates were significantly higher for shoulder pain (61.5%), lower back pain (54.1%), knee pain (39.4%), and gastrointestinal problems (33.0%). CONCLUSION: These baseline results show the importance of improving home health nursing working conditions, a comprehensive prevention system and safeguards from physical discomfort.

O home care e o cooperativismo médico / Home care and medical cooperation

No presente artigo, os autores buscaräo fazer uma síntese de toda a experiência e os conhecimentos acumulados por uma cooperativa médica que mantém, há quase quatro anos, um serviço de Home Care inédito em sua regiäo e que hoje certamente se constitui em uma iniciativa de sucesso. Partindo-se de uma visäo histórica que se inicia pelo surgimento das primeiras modalidades de assistência domiciliar na Inglaterra e nos EUA e chega a uma perspectiva da situaçäo do Home Care no Brasil dos dias atuais, passar-se á a uma delimitaçäo dos papéis desempenhados pelo médico e demais profissionais que compöem uma Equipe Multidisciplinar na assistência em domicílio. A seguir seräo abordadas as razöes pelas quais o Sistema Unimed, maior cooperativa de trabalho médico do mundo, vem investindo na criaçäo destes programas em muitas de suas Singulares, e porque tais serviços assumen uma configuraçäo própria quando florescem no ambiente fértil do cooperativismo. Em termos de experiência concreta, a parte mais ilustrativa deste trabalho será aquela que apresenta detalhadamente o funcionamento do Unimed Domiciliar de Juiz de Fora/MG...

Home care in America

This article discuss the American history and the evolution of home health care that has taken place over the last few years

Assistência domiciliar: uma modalidade de assistência para o Brasil? / Home care: a dishospitalization strategy to Brazil?

O presente estudo tem como objetivo discutir a modalidade assistência domiciliar como uma proposta a ser considerada na estratégia de desospitalização no Brasil. Para realizar esse trabalho, dois recursos metodológicos foram utilizados: pesquisa bibliográfica referente ao tema e entrevistas semi-estruturadas com profissionais e representantes de organizações que trabalham com assistência domiciliar no Brasil. A assitência domiciliar à saúde é entendida como uma prestação de serviços de saúde às pessoas de qualquer idade em seus domicílios. Entretando, tem sido utilizada, freqüentemente nos países mais desenvolvidos, no cuidado à saúde dos idosos. Diante da tendência de rápido crescimento do número de idosos no nosso país, justifica-se discutir essa modalidade sob a perspectiva estratégica de desospitalização. Manter o status quo com a assistência centrada na hospitalização gerará uma situação de superlotação das unidades hospitalares, ocupadas por doentes idosos, com doenças crônico-degenerativas, aumentando os custos da assistência à saúde, aumentando a premência no hospital, expondo esse paciente a riscos de toda série de agravos, em particular a depressão, causadora de aceleração de diversas doenças e do comprometimento da qualidade de vida. No momento em que a modalidade existe basicamente no setor privado e ainda assim de forma ainda incipiente - 1 por cento do número de empresas comparado aos Estados Unidos - o Ministério da Saúde deveria considerar esse tipo de atenção, entre outros, como uma opção importante no cuidado de idosos, não só definindo diretrizes para a implantação do modelo na assistência pública, como discutindo a regulamentação das atividades no setor privado, no sentido de assegurar um padrão de qualidade.