scholarly journals Screening in rheumatology: the impact on the everyday experience of patients in the Brazilian public health system

2021 ◽  
Author(s):  
Varlei Antonoio Serratto ◽  
Dora Pedroso Kowacs ◽  
Sérgio Candido Kowalski
Keyword(s):  
Public Health ◽  
Health System ◽  
Waiting Time ◽  
Public Health System ◽  
Waiting List ◽  
Waiting Period ◽  
Rheumatologic Diseases ◽  
Number Of Patients ◽  
Specialized Care ◽  
The Impact

Abstract Background In recent years, due to the increased incidence of rheumatologic diseases, the demand for consultations in rheumatology has risen. In the Brazilian public health system, patients with rheumatologic complaints are referred from primary care to specialized consultation, and must wait in a waiting list for the specialized care. In 2015, the waiting time for the first consultation in rheumatology, in Curitiba- Brazil, was 600 days. In attempt to reduce this time, in-person and remote screening was implemented that same year in a healthcare service in Curitiba. From 2015 to 2019 the variation in the number of patients in waiting lists for their first rheumatology consultation and the length of the waiting period for their first referral was evaluated. Methods Observational study in a time series. The patients in the study were referred to a primary healthcare center for an assessment of rheumatology in Curitiba, Brazil. The data was analyzed based on the first consultation with the rheumatologist. The variables were the number of patients in the waiting list and the waiting period for the appointment with the doctor. The research was carried out through a computerized system called “e-saude”[electronic health] runed by the Health Secretary of the Municipality of Curitiba. A comparison was made between the period of 2013–2015, in a model for treatment without screening, and 2015–2019, when the in-person and remote screening first began. Results Between 2015 and 2019 there was a reduction in the waiting list of 6,429 patients to 25 patients, while there was an average of 56.5 patients in the last two years;. With regard to the waiting period for the first appointment with the rheumatologist in 2019, there was a reduction of 600 days to a minimum of 4 days and a maximum of 52 days. Conclusion Both in-person and remote screening for asynchronous electronic consultations for rheumatologist in Curitiba led to a reduction in the waiting time and number of patients for the first appointment with the rheumatologist, proving to be a useful method for reducing the time and number of patients in the waiting list for a specialized consultation.

scholarly journals Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

2017 ◽  
Vol 54 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Elinton Adami CHAIM ◽  
José Carlos PAREJA ◽  
Martinho Antonio GESTIC ◽  
Murillo Pimentel UTRINI ◽  
Everton CAZZO
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Public Health System ◽  
Wound Dehiscence ◽  
Pulmonary Complications ◽  
Multidisciplinary Program ◽  
The Impact ◽  
Access To Surgery

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

scholarly journals The high cost patients on waiting list for the Liver Transplantation. main burdens and consequences for the Public Health System

2015 ◽  
Vol 18 (3) ◽  
pp. A224
Author(s):  
J.A. Turri ◽  
L.B. Haddad ◽  
W. Andrauss ◽  
L.A. D’Albuquerque ◽  
M.A. Diniz
Keyword(s):  
Public Health ◽  
Liver Transplantation ◽  
Health System ◽  
Public Health System ◽  
Waiting List ◽  
The Public

scholarly journals Preference for artificial intelligence medicine after COVID-19 pandemic: Discrete choice experiment (Preprint)

2021 ◽  
Author(s):  
Wai-Kit Ming ◽  
Taoran Liu ◽  
Winghei Tsang ◽  
Yifei Xie ◽  
Kang Tian ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Health System ◽  
Waiting Time ◽  
Latent Class ◽  
Public Health System ◽  
Individual Preference ◽  
Female Respondent ◽  
Reference Level ◽  
The Public

BACKGROUND The COVID-19 pandemic poses a great threat to the public health system globally and has squeezed medical and doctor resources. Artificial intelligence (AI) has potential uses in virus detection and relieving the public health pressure caused by the pandemic. In the case of a shortage of medical resources caused by the pandemic, whether people’s preference for AI doctors and traditional clinicians has changed is worth exploring. OBJECTIVE We aim to quantify and compare people’s preference for AI medicine and traditional clinicians before and after the COVID-19 pandemic to check whether people’s preference is affected by the pressure of pandemic METHODS The propensity score matching (PSM) method was applied to match two different groups of respondents recruited in 2017 and 2020 with similar demographic characteristics. A total of 2048 respondents (1520 from 2017 and 528 from 2020) completed the questionnaire and were included in the analysis. The Multinomial Logit Model (MNL) and Latent Class Model (LCM) were used to explore people’s preferences for different diagnosis methods. RESULTS Among these respondents, 84.7% in 2017 and 91.3% in 2020 were confident that AI diagnosis would outperform human clinician diagnoses in the future. Both groups of respondents matched from 2017 and 2020 attached most importance to the attribute ‘accuracy’, followed by ‘diagnosis expense’, and they prefer the combined diagnosis of AI and human clinicians (2017: odds ratio [OR] 1.645; 95% CI 1.535,1.763, p < 0.001; 2020: OR 1.513, 95% CI 1.413, 1.621, p < 0.001, Reference level: Clinician). LCM identified three classes with different attribute priorities. In Class 1, the preference for combination diagnosis and accuracy remains constant in 2017 and 2020, and higher accuracy (e.g., 2017 OR for 100% 1.357; 95% CI 1.164, 1.581) is preferred. People in 2017 and 2020 prefer 0 min outpatient waiting time and 0 RMB diagnosis expense. In Class 2, the 2017 matched data is also very similar to class 2 in 2020, AI combined with human clinicians (2017: OR 1.204, 95% CI 1.039, 1.394, p = 0.011; 2020: OR 2.009, 95% CI 1.826, 2.211, p < 0.001, Reference level: Clinician) and 20 minutes (2017: OR 1.349, 95% CI 1.065, 1.708, p < 0.001; 2020: OR 1.488, 95% CI 1.287, 1.721, p < 0.001, Reference level, 0 min) of outpatient waiting time were consistently preferred. In Class 3, the respondents in 2017 and 2020 had different preferences for diagnosis method; respondents in Class 3 of 2017 prefer clinicians, whereas respondents in Class 3 of 2020 prefer AI diagnosis. The odds ratios of accuracy continued increasing with the increasing of accuracy, like other classes of 2017 and 2020. As for the latent class segmented according to different sexes, all of the male and female respondent classes from 2017 and 2020 rank accuracy as the most important attribute. CONCLUSIONS Individual preference for clinical diagnosis between AI and human clinicians were very similar and mostly unaffected by the burden of the public health system caused by the pandemic. Diagnosis accuracy and expense for diagnosis were of the most important attributes of choice of the type of diagnosis. These findings can provide guidance for policymaking relevant to the development of AI-based healthcare.

scholarly journals Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System

2017 ◽  
Vol 3 (3) ◽  
pp. 201-207 ◽  
Author(s):  
Márcio Debiasi ◽  
Tomás Reinert ◽  
Rafael Kaliks ◽  
Gilberto Amorim ◽  
Maira Caleffi ◽  
...  
Keyword(s):  
Public Health ◽  
Breast Cancer ◽  
Health System ◽  
Advanced Breast Cancer ◽  
Public Health System ◽  
Her2 Positive ◽  
The Public ◽  
Premature Deaths ◽  
Number Of Patients ◽  
Positive Breast Cancer

Purpose Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients. Methods On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions. Results It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab. Conclusion Trastuzumab is included in the WHO’s list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil.

PP155 The Impact Of Lawsuits In The Brazilian Public Health System

2017 ◽  
Vol 33 (S1) ◽  
pp. 141-141
Author(s):  
Carla Biella ◽  
Viviane Pereira ◽  
Fabiana Raynal ◽  
Jorge Barreto ◽  
Vania Canuto ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Public Health System ◽  
Scientific Evidence ◽  
Health Technology ◽  
Health Technologies ◽  
Access To Health ◽  
The Right ◽  
The Impact

INTRODUCTION:The increase of litigation in Brazil on the right to health, and the Brazilian Public Health System (SUS) targets of litigation, are phenomena that generate discussions both in the judiciary, and among researchers and managers of health. The lawsuits are based on the integrality that includes the right to any health technology. Our aim was to gather information on the use of scientific evidence by judges and other law professionals to support their decisions in lawsuits involving health care in Brazil.METHODS:A narrative review by literature search using key terms of legalization in specific databases was conducted.RESULTS:Twenty-five studies showed litigation matters relating to health care which were focused on legal claims about drugs. In general, law operators used the scientific evidences in a limited way when making decisions, by considering the medical report and medication label indications and disregarding therapeutic alternatives contemplated in the SUS list. The access to health technologies, by litigation, reveals that the gap between scientific knowledge and legal practice are similar to those found between science and decision-making in the formulation and implementation of health policies. The Health Technology Assessment studies have high potential for use by the judiciary as a reference source to support technical and scientific decisions in lawsuits on health care.CONCLUSIONS:For the judiciary to ensure not only access to health technologies, but also the efficacy and safety of technologies to system users, their decisions must be substantiated by scientific evidence. The National Committee for Health Technology Incorporation (CONITEC) in SUS has established actions in conjunction with law operators and society, such as a communication using e-mail, aiding the decision for the injunction and elaboration of technical reports and a policy brief, with the intention that the decisions are taken with the greatest possible knowledge about technologies provided by SUS, and based on scientific evidence.

scholarly journals Breast Feeding in Pandemic Situation. How Does Sri Lanka Face the Challenge?

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 214-214
Author(s):  
Neerodha Dharmasoma
Keyword(s):  
Public Health ◽  
Sri Lanka ◽  
Health System ◽  
Breast Feeding ◽  
Public Health System ◽  
Feeding Practices ◽  
Health Staff ◽  
Emergency Situations ◽  
Public Health Staff ◽  
The Impact

Abstract Objectives Sri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020 (1) with the support of public health system. But, deviating attention of health services towards emergency pandemic situation has resulted in strained health systems and interruptions in humanitarian response leading to eroding access to essential and often life-saving nutrition services. Therefore, optimal breast feeding practices are at risk due to infected mothers’ isolation practices, exhausted public health system and misbeliefs among the community (2). This finds out how Sri Lanka plans to maintain high standards of breast feeding in pandemic situation. Methods We searched for the publications on breast feeding, Sri Lanka in pandemic situation from January 2020 to date. Results As a low and middle income country with an unbeatable public health system, Sri Lanka has already issued an interim guideline for public health staff in continuation maternal and child care services (3). It ensures domiciliary visits by public health midwives (PHMs), although the clinic based teaching sessions on breast feeding have been cancelled. Community awareness has been created that no evidence of transmission of SARS COV-2 via breast milk is available and how the benefits of breast feeding outweigh the risk of infection (4). It is recommended that breast feeding shouldn't be interrupted at all and hand hygienic practices before touching the baby are ideal. Infected mothers can wear a protective mask and rooming in, and kangaroo mother care should be practiced. Sri Lanka already had guidelines on ensuring adequate and appropriate infant feeding guidelines in emergency situations (5). Conclusions Despite the challenges faced by community and public health staff, Sri Lanka make efforts to maintain the achieved breast feeding standards. Further studies are needed to assess the impact of the pandemic on breast feeding practices in near future. Funding Sources None

scholarly journals OPEN VS LAPAROSCOPIC HERNIA REPAIR IN THE BRAZILIAN PUBLIC HEALTH SYSTEM. AN 11-YEAR NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 57 (4) ◽  
pp. 484-490
Author(s):  
Eduardo Morais EVERLING ◽  
Daniela Santos BANDEIRA ◽  
Felipe Melloto GALLOTTI ◽  
Priscila BOSSARDI ◽  
Antoninho José TONATTO-FILHO ◽  
...  
Keyword(s):  
Public Health ◽  
Minimally Invasive ◽  
Hernia Repair ◽  
Health System ◽  
Public Health System ◽  
Laparoscopic Hernia Repair ◽  
Dominant Group ◽  
The Public ◽  
Early Return ◽  
The Impact

ABSTRACT BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

Equestrian-related injuries, predictors of fatalities, and the impact on the public health system in Sweden

Public Health ◽  
2019 ◽  
Vol 168 ◽  
pp. 67-75 ◽  
Author(s):  
L. Meredith ◽  
R. Thomson ◽  
R. Ekman ◽  
J. Kovaceva ◽  
H. Ekbrand ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
The Public ◽  
The Impact

Analysis of the Challenges and Problems in the Development of Public Health System in Beijing, China

2020 ◽  
Author(s):  
Ayan Mao ◽  
Cordia Chu ◽  
Yujie Yang ◽  
Yueli Meng ◽  
Wuqi Qiu
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Municipal Government ◽  
Legal Framework ◽  
System Capacity ◽  
Health Staff ◽  
The Public ◽  
Information Strategies ◽  
The Impact

Abstract Background: To discern the main problems of Beijing’s public health service system, in order to provide suggestions to modernize the public health system and to enforce the implementation of the “Health Beijing 2030” plan. Methods: We carried out a quantitative study mostly based on interviews. There are over 40 directors and scholars who came from public health institutions and government sectors or organization that related to the public health work in Beijing were interviewed. The interview records were summary analyzed on key issues in accordance with the interview outline. Results: The challenges for the system include the change of structure of the population, the impact of the changing spectrum of diseases and changing environmental factors, and macro-institutional changes. The main problems include structure of the public health system, capacity of public health staff, systems for information management and legal framework for public health. On this basis, several relevant policy recommendations are put forward. Conclusion: To improve the public health system, the Beijing municipal government should design and construction of a system planning and perfecting their investment mechanism on public health. Stability of personnel and encouragement of innovation in scientific research and reliable health information strategies are also urgent needed.

scholarly journals The Abolition of User Fees in the Jamaican Public Health System: Impact on Access, Care Provided and the Work of the Professional Nurse

2021 ◽  
Author(s):  
◽  
Adella Campbell
Keyword(s):  
Public Health ◽  
Health Care ◽  
Developing Countries ◽  
Health Services ◽  
Health System ◽  
Public Health System ◽  
User Fees ◽  
Professional Nurse ◽  
The Public ◽  
The Impact

<p>The negative impact of user fees on the utilisation of the health services by the poor in developing countries such as Uganda and Jamaica is well documented. Therefore, various governments have been engaged in reforming public health systems to increase access by underserved populations. One such reform is the introduction of free health services. In Jamaica, user fees were abolished in the public health sector in 2007 for children under 18 years and in 2008 free health care was introduced for all users of the public health system. This study evaluated the impact of the 2008 reform on the Jamaican public health system at 1) the national level, 2) the provider level, and 3) the user level. Perspectives were sought on access to care, the care provided, and the work of the professional nurse. Participants were selected from the Ministry of Health (MOH), the four Regional Health Authorities (RHAs), and urban and rural health facilities. Data collection was done during March – August 2010, using a multi-layered mixed methods evaluation approach, incorporating both qualitative and quantitative methods. Methods included individual interviews with key policymakers (eight) at the MOH and the four RHAs, as well as a senior medical officer of health (one) and pharmacists (three); focus groups with representatives of the main practitioners in the health system including nurses (six groups), pharmacists (one group) and doctors (two groups); document reviews of the MOH and RHAs‘ annual reports, and a survey of patients (200). Views on the impact of the abolition of user charges differed across the three levels and among the health authorities, facilities, and perspectives (policymakers, practitioners and users). Patient utilisation of the public health system increased exponentially immediately following the abolition of user fees, then declined, but remained above the pre-policy level. The work of health care providers, especially the professional nurse, was affected in that they had to provide the expected and required services to the patients despite an increase in workload and constraints such as inadequate resources. The research found that, while policymakers were optimistic about the policy, providers had concerns but patients were satisfied with the increased access and the quality care they were now receiving. Users also encountered challenges that constituted barriers to access. In addition to providing further evidence about the abolition of user fees in the public health system, this research provides important new insights into the impact of the nationwide abolition of user fees, as well as the impact of the policy change on the work of the professional nurse. Equally, the findings highlighted the potential benefits, gaps, and failures of the abolition of user fees‘ policy, and will serve as a catalyst to improve the policy process regarding access to health services and the work of the professional nurse. The findings of this research will be valuable in the planning of health-related programmes for the consumers of health care in developing countries. Despite the need for further research in this area, this research has contributed to the body of knowledge regarding user fees and access to health care in developing countries.</p>

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