scholarly journals Management of COPD within the Brazilian Unified Health Care System in the state of Bahia: an analysis of real-life medication use patterns

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Charleston Ribeiro Pinto ◽  
Antônio Carlos Moreira Lemos ◽  
Lindemberg Assunção-Costa ◽  
Aramis Tupiná de Alcântara ◽  
Laira Lorena Lima Yamamura ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Pharmacological Treatment ◽  
Real Life ◽  
The State ◽  
Public Health Care ◽  
Cross Sectional ◽  
Long Acting ◽  
Severe Copd ◽  
Care System

ABSTRACT Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient’s pharmacological treatment was evaluated by comparing the patient’s current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.

The 1st All-Ukrainian Conference of Urologists

1934 ◽  
Vol 30 (11-12) ◽  
pp. 1200-1201
Author(s):  
B. V. Ognev
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care System ◽  
The State ◽  
Public Health Care ◽  
Insufficient Attention ◽  
History Of Development ◽  
History Of ◽  
Care System

On the first program topic concerning urology in the Soviet health care system were reports by Prof. I. V. Kudintsev on the state and history of development of urological care in the Ukrainian SSR. Prof. Voytashevsky made a report on the state and development of minor urology. Prof. P. M. Fronshtein, like the previous speakers, pointed out the insufficient attention to the teaching of urology in the system of public health care.

scholarly journals Distribution of mammograms and mammography offering in relation to the parametric care of the Public Health Care System in Pernambuco

2018 ◽  
Vol 18 (3) ◽  
pp. 609-618
Author(s):  
Maria Tatiane Alves da Silva ◽  
Valdecir Barbosa da Silva Júnior ◽  
Jorgiana de Oliveira Mangueira ◽  
Garibaldi Dantas Gurgel Junior ◽  
Eliane Maria Medeiros Leal
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care System ◽  
Cross Sectional Study ◽  
Public Health Care ◽  
Public Health Care System ◽  
Cross Sectional ◽  
The Public ◽  
Installed Capacity ◽  
Care System

Abstract Objective: to describe the distribution of available mammograms in the Sistema Único de Saúde (SUS) (Public Health Care System) and the mammography offering were carried out by this system, throughout the health regions in Pernambuco State, and compared them with the parametric care recommended by the Ministry of Health. Methods: this is a descriptive cross-sectional study that used secondary mammograms data in December 2016 by the Cadastro Nacional de Estabelecimentos de Saúde (National Registy on Health Establishments); and about mammography performed at SUS in 2016 by the Sistema de Informação Ambulatorial (Ambulatory Information System). The parametric care document No. 1.631/2015 was used as a comparability standard in relation to the distribution of the equipment and the mammography offering. Results: Pernambuco State presented approximately the double amount of mammograms and mammography was performed about 46% below the recommended parameter used in this study. All the health regions presented sufficient quantity of mammograms. However, the use of the installed capacity was less than 50% in all the health regions in the state. Conclusions: this study shows the need for a better use of the installed capacity for mammograms in Pernambuco State taken by the insufficient mammography offering and the poor distribution of the equipment in its territory.

scholarly journals Relação entre o número de consultas do pré-natal e desfechos adversos perinatais em pacientes de baixo risco

2021 ◽  
Vol 2 (5) ◽  
pp. 1441-1454
Author(s):  
João Pedro Ribeiro Baptista ◽  
Guilherme Schroder Stepic ◽  
Júlia Opolski Nunes Da Silva ◽  
Rodrigo Ribeiro e Silva ◽  
Iramar Baptistella Do Nascimento ◽  
...  
Keyword(s):  
Health Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Health Care System ◽  
Adverse Outcomes ◽  
Public Health Care ◽  
Cross Sectional ◽  
The Public ◽  
Neonatal Icu ◽  
Care System

RESUMO Objetivo: Avaliar os impactos do número de consultas realizadas no acompanhamento de pré-natal na rede básica sobre os desfechos adversos. Metodologia: Estudo de corte transversal, foram selecionadas aleatoriamente puérperas de risco habitual com mais de 18 anos que fizeram pré-natal na rede pública de Joinville-SC, com gestação única. Os desfechos avaliados foram prematuridade, número de cesarianas, internação de UTI neonatal e baixo peso ao nascer. O cálculo da razão de chance teve intervalo de confiança de 95%. Resultados: Comparamos as características e desfechos materno-fetais de pacientes que fizeram 5 consultas ou menos (n=109), puérperas com 6 ou 7 consultas (n=146) e pacientes que realizaram 8 (n=430). Dos resultados do perfil materno, foram significativos, os resultados socioeconômicos como idade, gestações anteriores, escolaridade, raça, estado civil, profissão, número de pessoas na casa e remuneração. Do recém-nascido encontramos diferenças no capurro e peso, ambos maiores em pacientes com mais de 8 consultas. No cálculo da razão de chance ajustado encontramos redução na prematuridade nas pacientes que fizeram 6 ou 7 consultas (0,26 IC95% 0,073-0,928) e nas que realizaram 8 ou mais (0,06 IC95% 0,016-0,229). Não encontramos diferença no número de cesarianas, baixo peso ao nascer e na internação de UTI neonatal em nenhuma das populações. Conclusão: A realização de 6 ou 7 consultas de pré-natal reduz 74% as chances de prematuridade, enquanto a realização de 8 ou mais consultas diminuiu em 94%.   ABSTRACT Objetive: Evaluate the impacts of the number of prenatal consultations during medical follow-up in the basic health care system over adverse outcomes. Methodology: Cross-sectional cohort study, selected randomly puerperal women with habitual risk with at least 18 year old who did prenatal care in the public health care system in Joinville-SC, with single pregnancy. The adverse outcomes evaluated were prematurity, number of caesarean sections, neonatal ICU admission and low birth weight. The odds ratio calculation had a confidence interval of 95%. Results: We compared characteristics and maternal-fetal outcomes of patients with 5 consultations or less (n=109), puerperal women with 6 or 7 consultations (n=146) and patients with 8 (n=430). Of the maternal profile results found, were significant, the socioeconomic results like age, number of pregnancy, schooling, race, marital status, profession, number of people living in the house and salary. Of the newborns, we found differences in the capurro and weight; both were higher in patients with more than 8 consultations. In the adjusted odds ration calculation we found reduction in prematurity who did 6 or 7 consultations (0,26 CI95% 0,073-0,928) and in the 8 or more consultations group (0,06 CI95% 0,016-0,229). We did not found difference in the number of caesarean sections, low birth weight and neonatal ICU admissions in any of the populations. Conclusion: The realization of 6 or 7 prenatal consultations reduces in 74% the chances of prematurity, while the realization of 8 or more consultations reduces it in 94%.

Assisting People With Their Living, Not Their Dying: Health Professionals’ Perspectives of Palliative Care and Opioids in ILD

2021 ◽  
pp. 104990912110186
Author(s):  
Lauren Russo ◽  
Karen Willis ◽  
Natasha Smallwood
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Health Care System ◽  
Therapeutic Relationships ◽  
Specialist Palliative Care ◽  
Cross Sectional ◽  
Symptom Palliation ◽  
Care System

Objectives: Interstitial lung disease (ILD) is a debilitating and life-limiting condition, requiring multi-disciplinary care. While guidelines recommend early specialist palliative care referral to improve symptoms and quality of life, few patients access such care towards the end-of-life. This study aimed to explore clinicians’ perspectives regarding specialist palliative care and opioids to understand barriers to optimal care and guide clinical practice improvement initiatives. Methods: A cross-sectional, exploratory, qualitative study was undertaken with Australian respiratory clinicians caring for people with ILD (n = 17). In-depth, semi-structured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data. Results: Four themes were identified: 1) understanding how to improve patient care and support, 2) the need to dispel stigmatized beliefs and misconceptions, 3) the importance of trusted relationships and good communication and 4) the challenges of navigating the health-care system. Participants discussed the need to implement early specialist palliative care and symptom palliation to alleviate symptoms, provide emotional support and augment quality of life. Participants described challenges accessing palliative care and opioids due to stigmatized beliefs amongst patients and clinicians and difficulties navigating the health-care system. Trusted therapeutic relationships with patients and strong inter-disciplinary partnerships with collaborative education and communication were perceived to improve patients’ access to symptom palliation. Conclusion: Specialist palliative care and opioids were believed to improve patients’ quality of life, however, many barriers can make accessing such care challenging. To address these issues, multi-disciplinary collaboration, high-quality communication and trusted therapeutic relationships are crucial throughout the ILD illness journey.

scholarly journals An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues

2021 ◽  
pp. 194173812110215
Author(s):  
Gillian R. Currie ◽  
Raymond Lee ◽  
Amanda M. Black ◽  
Luz Palacios-Derflingher ◽  
Brent E. Hagel ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care System ◽  
Policy Change ◽  
National Policy ◽  
Ice Hockey ◽  
Public Health Care ◽  
Public Health Care System ◽  
Body Checking ◽  
Care System

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

scholarly journals Modelling the dynamics of a public health care system: evidence from time-series data

2011 ◽  
Vol 44 (23) ◽  
pp. 2955-2968 ◽  
Author(s):  
Fabrizio Iacone ◽  
Steve Martin ◽  
Luigi Siciliani ◽  
Peter C. Smith
Keyword(s):  
Public Health ◽  
Health Care ◽  
Time Series ◽  
Health Care System ◽  
Time Series Data ◽  
Public Health Care ◽  
Series Data ◽  
Public Health Care System ◽  
Care System
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