Interesses públicos e privados na rede SUS de Petrópolis / Public and private interests in the SUS network at Petrópolis

Essa dissertação tem como objetivo analisar a rede SUS de Petrópolis e a proposta de sua reorganização, sugerida pelo Diagnóstico executado pela equipe CEPESC/IMS/UERJ no ano de 2019. considerando os interesses em jogo que interferem nas chances de efetivação da proposta no Plano Municipal de Saúde para o período 2022-2025. O estudo consistiu principalmente em uma abordagem qualitativa por meio de entrevistas com atores-chave envolvidos no processo de tomada de decisão, além, de procedimentos quantitativos utilizando cálculos estatísticos simples. Os resultados demonstraram que as principais propostas sugeridas e aprovadas na 1ª Conferência Extraordinária de Saúde no ano de 2019 e no Fórum de Saúde em 2021, foram colocadas de forma secundária e tangencial no Plano Municipal de Saúde. Foi ponderada ainda, a dinâmica da relação público/privado e os meios de incentivo que facilitam a proliferação do setor privado a partir da falta de planejamento e organização da rede pública de saúde, de modo a discutir a quem interessa? Ou cui bono ?

The aim of this dissertation aims is the analysis of the SUS network at Petrópolis and the proposal for reorganization, suggested in the Diagnosis executed by the CEPESC/IMS/UERJ team in the year 2019, considering the interests at stake that interferes in the chances of implementation of the proposal in the Municipal Health Plan for the period 2022-2025. The study consisted mainly of qualitative approach through interviews with key actors involved in the decision-making process, in addition to quantitative procedures using simple statistical calculations. The results showed that the main proposals suggested and approved at the 1st Extraordinary Health Conference in 2019 and at the Health Forum in 2021 were placed in a secondary and tangential way in the Municipal Health Plan. It also considered the dynamics of the public/private relation and the means of incentive that facilitate the proliferation of the private sector from the lack of planning and organization of the public health network, in order to discuss who is interested? Or cui bono?.

HIVAIDS services quality in health centers of East Shoa zone, Oromia, Ethiopia

Background: HIV/AIDS is a major public health, social and economic problem in Ethiopia. However, little has been done on assessment of the quality of the services given to patients in this country. Objective: To assess the quality of HIV/AIDS services in health centers of East Shoa Zone, Oromia region, Ethiopia. Method: Cross sectional survey was undertaken in selected health centers of East Shoa Zone between February and May 2017. Data was collected using researcher administered structured questionnaire, logistics indicators assessment tool and observation check list. SPSS for windows version 20 was utilized in the analysis of the collected data. Results: The study facilities were providing various services to HIV/AIDS patients. All (100%) and 6(75%) facilities respectively had shortage of trained human power required to give ART and TB services. Regarding ARV medicines availability, majority of the study facilities, 5 (62.50%) reported that they had the stockout of AZT300/3TC150/NVP200 in six months prior to study while 4 (66.7%) of the facilities had the stockout of NVP 240ml (50mg/5ml) syrup on day of visit. Among anti-TB medicines, E100 was out of stock in three facilities (37.5%) on day of visit and INH100 had been out of stock in 4 (50%) of the facilities in six months prior to the study. From OIs medicines, Cotrimoxazole 960mg tablet stocked out in 4 (66.70%) on day of visit and in 5 (83.30%) health centers in six months prior to the study. Considerable number of study facilities, 4 (66.70%) had the stockout of tramadol 50mg tablet on day of visit and ibuprofen 400mg tablet in six months prior to the study, 5 (71.40%). Conclusion: The studied facilities were challenged by different factors including, scarcity of human power, stockout of various HIV/AIDS related medicines and inability to make patients adhere to the services given by the facilities. The consequences of these factors can be dangerous to the patients as well as to the wider public and hence making available the appropriate human resource and HIV/AIDS related commodities including medicines should be the priority for the health facilities and the region to improve the quality of HIV/AIDS services in the study area

Prescripción y adquisición de medicamentos y procedimientos: análisis de las limitaciones actuales en el ejercicio médico / Prescription and acquisition of medications and procedures: Analysis of current limitations in medical practice

Analizar el cumplimiento de la prescripción y de los procedimientos en los pacientes atendidos por un internista en la situación sanitaria venezolana actual y conocer el estado de insatisfacción de estos médicos ante las prescripciones realizadas. Método: Parte A: Dirigida a los pacientes y será un estudio de casos, descriptivo, prospectivo y transversal basado en una evaluación médica y una entrevista. Parte B: dirigido a los médicos: estudio descriptivo, prospectivo y transversal a través de una encuesta. Tratamiento estadístico: Descripción estadística con medidas de tendencia central y de proporción. Resultados: En la fase A se analizaron 422 pacientes. Los principales diagnósticos fueron Hipertensión Arterial (45.13% mujeres y 32.14%-), Diabetes Mellitus tipo 2 (32.74% mujeres y 18.37 % hombres) y Cardiopatía (19.03% mujeres y 16.33% Hom-bres). El 67.77% refería cumplimiento irregular o nulo y la principal causa fue la no disponibilidad del tratamiento en 62.13%. En la fase B: se analizaron 100 encuestas, donde se afirmó no contar con todos los implementos necesarios para el ejercicio profesional en el 80% de los que ejercían en instituciones públicas, y el 31 % en privadas, y el nivel de insatisfacción fue alto. Discusión: el acto médico del internista en el país está limitado por la imposibilidad de adquirir medicamentos y el ejercicio médico es generador de frustración y estrés(AU)

To analyze the fulfilment of prescriptions and medical procedures in patients treated by internists in the current Venezuelan health situation and learn about the level of dissatisfaction of these physicians with this situation. Methods: This study was done in two kinds of population: group A: a descriptive, prospective and cross-sectional case study based on a comprehensive medical evaluation and an interview. Group B: also, a descriptive, prospective and cross-sectional study, but through a survey on the physicians. Statistical treatment: Statistical description with measures of central tendency and proportion. Results: In phase A, 422 patients were analyzed. The main diagnoses were Arterial Hypertension (45.13% female and male 32.14%), Diabetes Mellitus type 2 (32.74% female and18.37% male) and Cardiopathy 19.03% female - and 16.33% male). The 67.77% reported irregular or null fulfillment and the reason was the lack of availability for purchase in 62.13%. In phase B: 100 surveys were analyzed,; 80% of those who work in public institutions eclared that not all the implements needed for their professional practice were available. This was true, also in 31% in private practice with a high the level of dissatisfaction. Discussion: the internist's medical act in the country is limited by the impossibility of acquiring medications and perform the right medical procedures. This situation generates in them feelings of frustration and stress(AU)

Costo-efectividad de las estatinas para el tratamiento de dislipidemia en Colombia / Cost-effectiveness of statins for the treatment of dyslipidemia in Colombia

Objetivo: determinar la relación de costo-efectividad relativa de las estatinas entre sí en pacientes adultos con dislipidemia con predominio de hipercolesterolemia para la prevención de eventos cardiocerebrovasculares, en Colombia, desde la perspectiva del sistema de salud colombiano. Métodos: se construyó un modelo de Markov con años de vida ajustados por calidad (AVAC) ganados como desenlace principal, tasa de descuento de 3% tanto para costos como desenlaces, y cinco años de horizonte temporal. Probabilidades y costos se extrajeron de la literatura y de fuentes oficiales del país, respectivamente. El umbral de costo-efectividad fue tres veces el PIB per cápita de 2012. Se realizaron análisis de sensibilidad univariados, probabilísticos, umbral y curva de aceptabilidad. Resultados: el costo promedio del tratamiento con estatinas para un paciente con dislipidemia en cinco años es de $3 472 733. La ganancia en AVAC en rosuvastatina fue mayor con respecto a las otras estatinas; sin embargo, es la estrategia más costosa. La atorvastatina, que resultó segunda, es la más costo-efectiva. Conclusión: la intervención más costo-efectiva para pacientes con dislipidemia con predominio de hipercolesterolemia e indicación de manejo farmacológico con terapia moderada y alta con estatinas en Colombia es la atorvastatina. (Acta Med Colomb 2015; 40: 118-124).

Objective: to determine the relative cost-effectiveness among statins in adult patients with dyslipidemia with predominant hypercholesterolemia to prevent cardiocerebrovascular events in Colombia, from the perspective of Colombian health system. Methods: a Markov model with quality-adjusted life years (QALY) gained as the main outcome, discount rate of 3% for both costs and outcomes, and five-year time horizon was built. Probabilities and costs were extracted from the literature and from official sources in the country, respectively. The threshold for cost-effectiveness was three times the 2012 per capita GDP. Univariate probabilistic, sensitivity analysis, threshold and acceptability curve were performed. Results: the average cost of statin therapy for a patient with dyslipidemia in five years is $3 472 733. The QALY gain was higher in rosuvastatin compared to other statins, however, it is the most costly strategy. Atorvastatin, which was second, is the most cost-effective. Conclusion: the most cost-effective intervention for patients with dyslipidemia with predominant hypercholesterolemia and indication of pharmacological management with moderate and high statin therapy in Colombia is atorvastatin. (Acta Med Colomb 2015; 40: 118-124).