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Demonstration project on epilepsy in Brazil: outcome assessment
Li, Li M; Fernandes, Paula T; Noronha, Ana L. A; Marques, Lucia H. N; Borges, Moacir A; Borges, Karina; Cendes, Fernando; Guerreiro, Carlos A. M; Zanetta, Dirce M. T; De Boer, Hanneke M; Espíndola, Javier; Miranda, Claudio T; Prilipko, Leonid; Sander, Josemir W.
  • Li, Li M; UNICAMP. Faculty of Medicine. Department of Neurology. Campinas. BR
  • Fernandes, Paula T; UNICAMP. Faculty of Medicine. Department of Neurology. Campinas. BR
  • Noronha, Ana L. A; UNICAMP. Faculty of Medicine. Department of Neurology. Campinas. BR
  • Marques, Lucia H. N; Faculty of Medicine of São José do Rio Preto. Department of Neurology. São José do Rio Preto. BR
  • Borges, Moacir A; Faculty of Medicine of São José do Rio Preto. Department of Neurology. São José do Rio Preto. BR
  • Borges, Karina; Faculty of Medicine of São José do Rio Preto. Department of Neurology. São José do Rio Preto. BR
  • Cendes, Fernando; UNICAMP. Faculty of Medicine. Department of Neurology. Campinas. BR
  • Guerreiro, Carlos A. M; UNICAMP. Faculty of Medicine. Department of Neurology. Campinas. BR
  • Zanetta, Dirce M. T; Faculty of Medicine of São José do Rio Preto. Department of Epidemiology. São José do Rio Preto. BR
  • De Boer, Hanneke M; Global Campaign Against Epilepsy Secretariat. Geneva. CH
  • Espíndola, Javier; Pan-american Health Organization. Washington. US
  • Miranda, Claudio T; Pan-american Health Organization. Washington. US
  • Prilipko, Leonid; Global Campaign Against Epilepsy Secretariat. Geneva. CH
  • Sander, Josemir W; SEIN. Epilepsy Institute of the Netherlands. Heemstede. NL
Arq. neuropsiquiatr ; 65(supl.1): 58-62, jun. 2007. graf
Article in English | LILACS | ID: lil-452674
ABSTRACT

PURPOSE:

To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy.

METHOD:

We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence.

RESULTS:

A total of 181 patients (93 women - 51 percent) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59 percent) the health status had improved a lot, some (19 percent) had improved a little, 20 percent experienced no change and in 2 percent the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only.

DISCUSSION:

The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward...
RESUMO

OBJETIVO:

Avaliar o resultado do tratamento de pacientes com epilepsia na atenção básica sob o modelo proposto pelo Projeto Demonstrativo no Brasil, como parte da Campanha Global Contra a Epilepsia da WHO/ILAE/IBE.

MÉTODO:

Avaliamos o resultado do tratamento nos pacientes acompanhados em quatro unidades básicas de saúde. As equipes de saúde fizeram um treinamento padrão. O resultado do tratamento foi baseado em cinco aspectos 1) redução da freqüência das crises, 2) percepção subjetiva dos pacientes e dos médicos, 3) redução de absenteísmo, 4) integração social (escola, trabalho), e 5) senso de independência.

RESULTADOS:

Um total de 181 pacientes (93 mulheres - 51 por cento), com uma média de 38 anos (variando de 2 a 86 anos) entraram nesta análise. O tempo médio de seguimento foi de 26 meses (variou de 1 a 38 meses, 11 pacientes tinham seguimento menos de 12 meses). A freqüência das crises foi categorizada variando de 0 (sem nenhuma crise nos últimos 24 meses) a 7 (>10 crises/dia). O escore mediano da freqüência de crises no começo era de 3 (uma a três crises por mês). O escore mediano da freqüência de crises no final era de 1 (uma a três crises por ano). A opinião dos pacientes e familiares é que a maioria (106 casos) houve uma melhora importante na saúde, 34 tiveram pouca melhora, 37 não tiveram mudanças e em quatro houve piora. Em relação ao absenteísmo, integração social e senso de independência houve pouca melhora. DISCUSSÃO O modelo desenvolvido de tratamento de epilepsia na atenção primária com base na estrutura de saúde existente, com estratégias centradas nos profissionais de saúde e na comunidade, provou ser efetivo com redução importante na freqüência das crises bem como na melhora em geral da saúde. Esse modelo pode ser aplicado em âmbito nacional, pois os elementos chaves já existem, desde que essas estratégias sejam pactuadas com os organismos locais de saúde.
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Primary Health Care / Outcome Assessment, Health Care / Epilepsy Type of study: Evaluation studies / Observational study / Prognostic study / Qualitative research Limits: Adolescent / Adult / Aged / Aged80 / Child / Child, preschool / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Arq. neuropsiquiatr Journal subject: Neurology / Psychiatry Year: 2007 Type: Article Affiliation country: Brazil / Netherlands / Switzerland / United States Institution/Affiliation country: Faculty of Medicine of São José do Rio Preto/BR / Global Campaign Against Epilepsy Secretariat/CH / Pan-american Health Organization/US / SEIN/NL / UNICAMP/BR

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Full text: Available Index: LILACS (Americas) Main subject: Primary Health Care / Outcome Assessment, Health Care / Epilepsy Type of study: Evaluation studies / Observational study / Prognostic study / Qualitative research Limits: Adolescent / Adult / Aged / Aged80 / Child / Child, preschool / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Arq. neuropsiquiatr Journal subject: Neurology / Psychiatry Year: 2007 Type: Article Affiliation country: Brazil / Netherlands / Switzerland / United States Institution/Affiliation country: Faculty of Medicine of São José do Rio Preto/BR / Global Campaign Against Epilepsy Secretariat/CH / Pan-american Health Organization/US / SEIN/NL / UNICAMP/BR