Costo-efectividad de un tratamiento antituberculoso alternativo: seguimiento a convivientes residenciales de los pacientes / Cost-effectiveness of an alternative tuberculosis treatment: home-based guardian monitoring of patients

Objetivo. Estimar la relación de costo-efectividad del tratamiento de corta duración bajoobservación directa (DOTS), comparándolo con una variación de dicho tratamiento, que incluyeun mayor seguimiento a los convivientes residenciales de los pacientes (DOTS-R) parael tratamiento de tuberculosis (TB).Métodos. Tomando una perspectiva social que incluye los costos para las institucionesde salud, para los pacientes y sus familiares, y para otras entidades que contribuyen a hacerefectiva la operación del programa, se evaluaron los costos incurridos con cada una de las dosestrategias y se estimaron razones costo-efectividad adoptando las medidas de efecto usadas porlos programas de control. La estimación de los costos de cada una de las dos estrategias incluyelos correspondientes a las instituciones de salud que administran el tratamiento, los pacientesy sus familiares, y los de la secretaría de salud que gestiona los programas de salud pública anivel municipal. Con base en estos costos y el número de casos curados y tratamientos terminadoscomo medidas de resultado de cada una de las estrategias evaluadas, se calcularon lasrazones costo-efectividad y costo incremental.Resultados. El DOTS-R se halló más costo-efectivo para lograr tratamientos exitosos queel DOTS. El DOTS-R registró costos de entre US$ 1 122,4 y US$ 1 152,7 por caso curado,comparados con valores de entre US$ 1 137,0 y US$ 1 494,3 correspondientes al DOTS. Laproporción de casos tratados con éxito fue mayor con DOTS-R que con DOTS.Conclusiones. El DOTS-R es una alternativa costo-efectiva promisoria para mejorar elcontrol de la TB en sitios endémicos. Se recomienda a las autoridades del sector salud incorporaren su gestión institucional del programa contra la TB, acciones de seguimiento de losconvivientes de pacientes, con la participación del personal de salud y los recursos físicos yfinancieros que apoyan actualmente dicho programa.

Objective. Estimate the cost-effectiveness ratio of the directly observed treatmentshort course (DOTS) for treatment of tuberculosis (TB), comparing it to a variation ofthis treatment that includes increased home-based guardian monitoring of patients(DOTS-R).Methods. Taking a social perspective that includes the costs for the healthinstitutions, the patients, and their family members, and for other entities thatcontribute to making operation of the program effective, the costs incurred with eachof the two strategies were evaluated and the cost-effectiveness ratios were estimatedadopting the measures of effect used by the control programs. The estimate of the costof each of the two strategies includes the cost to the health institutions that administertreatment, the patients and their family members, and the cost to the Ministry ofHealth that manages public health programs on the municipal level. Based on thesecosts and the number of cases cured and treatments completed as outcome measuresof each of the strategies evaluated, the cost-effectiveness ratio and incremental costwere calculated.Results. The DOTS-R was found to be more cost-effective for achievement ofsuccessful treatments than the DOTS. The DOTS-R recorded costs of US$ 1 122.40 toUS$ 1 152.70 for each case cured compared to values of US$ 1 137.00 to US$ 1 494.30for the DOTS. The percentage of cases treated successfully was higher with DOTS-Rthan with DOTS.Conclusions. The DOTS-R is a promising cost-effective alternative for improvedcontrol of TB in endemic areas. It is recommended that the health authorities includehome-based guardian monitoring of patients in their institutional management of theTB program, with the participation of health workers and the physical and financialresources that currently support this program.

A construção do cuidado pela equipe de saúde e o cuidador em um programa de atenção domiciliar ao acamado em Porto Alegre (RS, Brasil) / The construction of care by the health team and the caretaker within a home-care program for bedridden patients in Porto Alegre (RS, Brazil)

Este artigo é um estudo de caso cujo objetivo principal foi compreender a construção do cuidado no Programa de Atendimento Domiciliar ao Acamado (PADA) de uma unidade básica de saúde (UBS) em Porto Alegre, RS. Os dados foram obtidos em 13 grupos de cuidadores na UBS e em observação participante registrada em diário de campo nos domicílios. Foi realizada análise das práticas discursivas, inspirada nos conceitos de discurso de Foucault e nos estudos sobre ética e cuidado de si. No transcurso dos grupos, os cuidadores ocuparam um espaço que chamamos metaforicamente de Oráculo de Delfos, lócus de acolhimento, escuta e de suporte. Escutar os diálogos travados entre equipe e cuidadores defrontou-nos com a contradição presente no discurso institucional que ao mesmo tempo que estimula o cuidado de si impõe normas, deveres e fazeres. O cuidado como direito de cidadania em contraposição ao cuidado como submissão e assujeitamento tensionou o grupo em vários momentos. A noção foucaultiana de cuidado compreende uma síntese entre o exercício de uma pessoa sobre ela mesma, tornando-a melhor como ser humano e, ao mesmo tempo, capacitando-a a se tornar melhor como cidadão.

The main objective of this case study was to understand the construction of care in the Homecare Program for Bedridden Patients (PADA) of a basic health unit (UBS) in Porto Alegre, RS. Data were obtained from 13 caretaker groups in the UBS, and participating observation recorded in field diary in the patient's homes. An analysis of the discourse practices was performed inspired in Foucault's discourse concepts speeches and in studies on ethics and self-care. In the groups, the caretaker occupied a space that we metaphorically called the Delphic Oracle, a place for acceptance, listening and support. Hearing the dialogues that took place between the team and the caretakers made us face the contradiction present in the institutional discourse, which both stimulates self-care, and imposes rules, duties, tasks. Care as a citizenship right opposite to care as submission and subjugation created tension inside the group several times. Foucault's notion of care comprises a synthesis of the exercise of a person over his- or herself, making him or her better as a human being and, at the same time, capacitating him or her to become a better citizen.

Home caregivers' satisfaction with the services provided by Riyadh Military Hospital's home support program

The satisfaction of the family is essential to the success of home care support services. This study aimed to assess home caregivers' satisfaction with support services and to identify potential factors affecting their satisfaction. The study was conducted in the Family and Community Medicine Department at Riyadh Military Hospital using cross-sectional design over a period of six months. Two hundred forty participants were recruited by systematic random sampling from the division registry. Data were collected through telephone calls using a designed structured interview form. All research ethics principles were followed. The response rate was 76.25%. Most caregivers were patients' sons or daughters. The duration of patients' disabling illnesses varied from less than 1 year to up to 40 years. The majority of caregivers agreed that a home care services team provided the proper healthcare-related support to the patients and improved caregivers' self-confidence in caring for their patients. Overall, on a scale of 100%, the median level of satisfaction was 90%, and 73.2% of caregivers had a satisfaction score of 75% or higher. Increased age, female gender, and more frequent home visits were positive independent factors associated with caregivers' satisfaction scores. Although most caregivers are satisfied with the services provided by a home care support program, there are still areas of deficiency, particularly in physiotherapy, vocational therapy, and social services. The implications are that caregivers need to be educated and trained in caring for their patients and need to gain self-confidence in their skills. The program's administration should improve physiotherapy, vocational therapy, social services, and procedures for hospital referral

Normas de internación domiciliaria / Rules for home care

El presente artículo relata la elaboración de las Normas de Organización y Funcionamiento de Servicios de Internación Domiciliaria para la República Argentina, destacando el aporte de la representante de enfermería. A continuación se detalla el contenido de la Resolución 704/200 sobre las mencionadas Normas