PP061 Direct Cost Of Physiotherapeutic Devices Judicialization In Brazil

2017 ◽  
Vol 33 (S1) ◽  
pp. 99-100
Author(s):  
Dominique Moraes ◽  
Luciana Tarbes ◽  
Bruna de Veras ◽  
Marisa Santos
Keyword(s):  
Direct Cost ◽  
Rio De Janeiro ◽  
Sleep Apnea Syndrome ◽  
Chronic Obstructive ◽  
Cost Information ◽  
Public And Private ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases ◽  
Unified Health System ◽  
Obstructive Sleep

INTRODUCTION:The “Judicialization of health” is a judicial option, provided by the Brazilian constitution, which aims to guarantee the access of the population to healthcare products or services to which they were denied or that were otherwise unavailable on the Unified Health System (SUS) (1). This highlights deficiencies in public policies (2). Considering the progressive impact of the judicialization on the budget and the lack of real-world evidence on the subject, the objective was to describe the judicialization profile of physiotherapeutic devices in the city of Rio de Janeiro and to estimate the spending on them within the system.METHODS:The profile was traced based on the analysis of the processes (n = 243) submitted to the Technical Advice Unit of the Rio de Janeiro Justice Court between May 2013 and September 2015, which litigated the provision of physiotherapeutic devices. Direct cost information was obtained from both public and private sources. The analysis was carried out using the SUS perspective.RESULTS:About 63 percent of the patients were over 60 years old. The majority of the requests were due to chronic respiratory diseases, the most common being obstructive sleep apnea-syndrome (31 percent), chronic obstructive pulmonary disease (14 percent) and pulmonary fibrosis (11 percent). The most judicialized devices were continuous positive airway pressure (21 percent), oxygen concentrator (17 percent) and portable oxygen cylinder (13 percent). None of these devices are currently covered by SUS. The expenses related to the purchase of the devices pleaded was approximately USD812,500 over 29 months.CONCLUSIONS:The total spend on these devices were considered very high when compared to Rio de Janeiro's health budgetary capacity. This scenario could be worse if this type of demand were not planned, and needed to be accomplished quickly with urgent purchases. The results obtained shows that judicialization phenomenon has a meaningful impact on the economic viability of the Brazilian healthcare system.

scholarly journals Revolving door respiratory patients: A rehabilitative perspective

2017 ◽  
Vol 87 (3) ◽  
Author(s):  
Massimiliano Polastri ◽  
Lara Pisani ◽  
Andrea Dell'Amore ◽  
Stefano Nava
Keyword(s):  
Sleep Apnea Syndrome ◽  
Neuromuscular Diseases ◽  
Bed Rest ◽  
Revolving Door ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Mobility Limitations ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep ◽  
Chronic Pulmonary Diseases

Rehabilitation is an integral component of care for patients affected by either acute or chronic pulmonary diseases. The key elements of rehabilitation treatment for critical respiratory patients are as follows: weaning from mechanical ventilation, respiratory therapy, physical reconditioning, and occupational therapy. It should be noted that patients affected by pulmonary diseases are prone to hospital re-admission due to frequent exacerbations, especially in cases with more severe stages of chronic obstructive pulmonary disease. A periodical worsening of clinical conditions is common in asthma, acute respiratory distress syndrome survivors, obstructive sleep apnea syndrome, and pulmonary fibrosis, as well as in patients with severe neuromuscular diseases. These patients are often identified as “revolving door patients”. Pulmonary patients are typically forced to maintain bed rest, or at least spend most of their waking hours dealing with mobility limitations, due to various pathological conditions including dyspnea, fatigue, and poor tolerance of movements. Alterations in mood are common in pulmonary patients who experience a decreased quality of life and limited social interactions. These negative emotional and cognitive aspects can be a major limitation to the provision of care, because to enhance and facilitate a degree of autonomy, the patient must be cooperative and pro-active.

scholarly journals Burden of Comorbidities in Patients with OSAS and COPD-OSAS Overlap Syndrome

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1201
Author(s):  
Athanasios Voulgaris ◽  
Kostas Archontogeorgis ◽  
Athanasia Pataka ◽  
Alexandros N. Flaris ◽  
Paschalis Ntolios ◽  
...  
Keyword(s):  
Sleep Apnea Syndrome ◽  
Sleep Time ◽  
Overlap Syndrome ◽  
Smoking History ◽  
Apnea Hypopnea Index ◽  
Chronic Obstructive ◽  
Laboratory Examination ◽  
Obstructive Pulmonary Disease ◽  
Oxygen Desaturation Index ◽  
Obstructive Sleep

Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are usually associated with multi-morbidity. The aim of this study was to retrospectively investigate the prevalence of comorbidities in a cohort of patients with OSAS and COPD-OSAS overlap syndrome (OS) patients and to explore differences between these two groups. Materials and Methods: Included were consecutive OS patients and OSAS patients who had been referred to our sleep laboratory, and were matched in terms of sex, age, BMI, and smoking history. Presence of comorbidities was recorded based on their medical history and after clinical and laboratory examination. Results: The two groups, OS patients (n = 163, AHI > 5/h and FEV1/FVC < 0.7) and OSAS patients (n = 163, AHI > 5/h, and FEV1/FVC > 0.7), did not differ in terms of apnea hypopnea index (p = 0.346), and oxygen desaturation index (p = 0.668). Compared to OSAS patients, OS patients had lower average SpO2 (p = 0.008) and higher sleep time with oxygen saturation <90% (p = 0.002) during sleep, and lower PaO2 (p < 0.001) and higher PaCO2 (p = 0.04) in wakefulness. Arterial hypertension was the most prevalent comorbidity for both OS and OSAS, followed by dyslipidemia, cardiovascular disease (CVD) and diabetes. OS was characterized by a higher prevalence of total comorbidities (median (IQR):2 (1–3) vs. 2 (1–2), p = 0.033), which was due to the higher prevalence of CVD (p = 0.016) than OSAS. No differences were observed in other comorbidities. Conclusions: In OS patients, nocturnal hypoxia and impaired gas exchange in wakefulness are more overt, while a higher burden of CVD is observed among them in comparison to sex-, age- and BMI-matched OSAS patients.

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