Number Of Outpatient Consultations Research Articles

Reasons for implementation success despite health system constraints: qualitative insights on ‘what worked’ for cotrimoxazole preventive therapy

BackgroundAlthough Cotrimoxazole preventive therapy (CPT) has shown to be highly efficacious in reducing morbidity and mortality among people living with Human immunodeficiency virus (HIV) under ‘ideal world’ study conditions, operational challenges are limiting its effectiveness when implementing in countries most affected by the HIV epidemic. The fact that Mozambican authorities reported high coverage of CPT among patients with HIV, has led to this qualitative case study aimed at exploring possible factors responsible for the successful implementation of CPT in the Province of Maputo.MethodsBetween February and April 2019, we individually interviewed nine governmental stakeholders, including the person responsible for the HIV Program, the person responsible for the TB Program and the person responsible for Pharmaceutical management at three administrative levels (central, provincial and district level). Interviews were recorded, transcribed, and analysed thematically using MAXQDA Analytics Pro. Findings were translated from Portuguese into English.ResultsFive themes iteratively emerged: (a) Role of governance & leadership, (b) Pharmaceutical strategies, (c) Service delivery modifications, (d) Health care provider factors, and (e) Patients’ perspectives.Interviews revealed that continuous supply of cotrimoxazole (CTZ) had been facilitated through multiple-source procurement and a push-pull strategy. One part of CTZ arrived in kits that were imported from overseas and distributed to public health facilities based on their number of outpatient consultations (push strategy). Another part of CTZ was locally produced and distributed as per health facility demand (pull strategy). Strong district level accountability also contributed to the public availability of CTZ. Interviewees praised models of differentiated care, the integrated HIV service delivery and drug delivery strategies for reducing long queues at the health facility, better accommodating patients’ needs and reducing their financial and organisational burden.ConclusionsThis study presents aspects that governmental experts believed to be key for the implementation of CPT in the Province of Maputo, Mozambique. Enhancing the implementation outcomes – drug availability and feasibility of the health facility-based service delivery – seemed crucial for the implementation progress. Reasons for the remarkable patient acceptability of CPT in our study setting should be further investigated.

The first results of changes in the financing of federal centers in the system of compulsory health insurance on the example of the Bakulev National Medical Research Center for Cardiovascular Surgery

Until 2021, there were problems with the ability of citizens to receive medical care in organizations subordinate to federal authorities, especially those located in Moscow. Since 2021, the federal centers have been funded by the Federal Compulsory Health Insurance Fund (CHI).Goal. To study the impact of the new system of payment for specialized medical care under the CHI program on its volume in the A. N. Bakulev NMICSSH.Results. Number of outpatient consultations in the first half of 2021 has almost reached the level of 2019, despite the pandemic of a new coronavirus infection. The number of patients hospitalized for receiving high-tech medical care under the CHI program exceeded the indicator of 2019, for residents of the subjects of the Russian Federation, except Moscow, – for all types of specialized care.Discussion. In the regions, measures were taken to limit the referral of patients to medical institutions that are not subordinate to the region. The possibilities of federal clinics were not fully used, citizens were limited in the possibility of receiving timely highly qualified medical care, waiting for it in regional institutions. In the worst situation were federal medical organizations located in Moscow, where payment was carried out at the tariffs of Moscow, which are significantly higher than in the absolute majority of other subjects of the Russian Federation. In this connection, the regions faced the question of paying for medical care for 10 patients in “their” medical organizations or 6–7 patients in federal clinics in Moscow.Conclusion. The transition to the new system of payment for medical care in federal clinics directly from the Federal CHI Fund has significantly improved the implementation of citizens ‘ rights to choose a medical organization, reduced the waiting time for specialized, including high-tech, medical care, increased the efficiency of using the capabilities of federal centers both in terms of the use of modern technologies and personnel potential.

Cardio-Oncology: a medical specialty in constant growth and evolution. the 10-year experience of the first cardio-oncology service in the United Kingdom

Abstract Introduction Survivorship has increased significantly in cancer patients with the advent of novel therapies. However, this improvement has been at the cost of higher rates of cardiotoxicity. Cardiovascular disease has become the main cause of death or cancer therapy interruption in many of these patients. The need for specialist services to deal with these emerging problems has led to global development of many Cardio-Oncology services. Objectives To describe how a Cardio-Oncology service has grown and evolved over a 10 year period in response to the constantly changing oncological landscape. Methods and results Prospective, single center, study of cancer patients referred to our service from February 2011 to December 2021. 1499 patients were referred to the service. Mean age was 60 years (SD: 15) and 60% were female. CV risk factors including hypertension (32%), dyslipidaemia (12%) and diabetes (6%) were common. The most frequent primary tumour location was breast (427 patients, 28%), followed by haematological (151, 10%) and gastrointestinal tract (114, 8%). The average number of referrals per month increased 6 fold from 2011, from 3.3 patients per month to 21 patients in 2021. In the last 5 years there was a 10 fold increase in the number of outpatient consultations from 189 consultations in 2016 to 1988 consultations in 2021. The most frequent reason for referral was pre-treatment assessment (39%), followed by cancer therapy related cardiac dysfunction (CTRCD) (33%) and other acute cancer therapy related CV diseases (CTR-CVDs) (22%). From 2011 to 2017 CTRCD was the main CTR-CVD due to anthracycline and trastuzumab. This ratio changed in 2018 when other CTR-CVDs became the most frequent referral reason following pre-treatment assessment. Patients referred to our service were or had been, mostly under medical therapy alone or in combination with surgery or radiotherapy (1058 patients, 70%), anthracyclines being the predominant treatment (435 patients, 40%). Targeted therapies and immune check point inhibitors became more popular in the last two years (2020–2021). A multivariable logistic regression model was built to assess the relation between the medical treatment and the prevalence of CTRCD vs other CTR-CVDs. Anthracyclines and HER2 therapy are independently associated with a higher prevalence of CTRCD while tyrosine kinase inhibitors and immune checkpoint inhibitors increase the risk of other CTR-CVDs e.g. hypertension, arrhythmias and myocarditis. Conclusions Cardio-Oncology has rapidly evolved from its origin as a subspecialty of heart failure medicine, to a diverse medical specialty that encompasses many different domains of cardiology. Future cardio-oncology services should reflect this and be dynamic, collaborating with cardiac sub-specialities as necessary. Provision of cardio-oncology services requires a considerable knowledge and understanding of the ever growing and changing oncology therapies. Funding Acknowledgement Type of funding sources: None.

Factors associated with potentially inappropriate opioid use in community-living older adults consulting in primary care.

To study the factors associated with opioid use and potentially inappropriate opioid use (PIOU) in primary care older adults with non-cancer pain referring to theconceptual framework developed by the American Agency for Healthcare Research and Quality. This is a secondary analysis of health survey and medico-administrative data from Québec, Canada. Individuals aged ≥65 were recruited between 2011 and 2013 in primary care clinics to participate in face-to-face interviews. The sample included 945 older adults without a malignant tumor over the study period or any tumor in the 2 years surrounding opioid use. Opioid use within a 3 year follow-up period was identified from the public drug plan database. Potentially inappropriate opioid use (PIOU) was defined using the American Geriatrics Society Beers 2019 list. Multinomial regression analyses were performed to study the factors (patient, pain, substance use, provider, healthcare system) associated with opioid use and PIOU. In this sample of older adults, 26.2% used an opioid and 18.4% were categorized as PIOU. Factors associated with PIOU compared to opioid use included female sex, higher psychological distress, number of emergency department visits, and recruitment type of healthcare practice. Factors associated with PIOU compared to no use included female sex, country of origin, presence of a trauma, physical/psychiatric multimorbidity, number of outpatient consultations, pain severity/type, and number of prescribers. Mental health and health system factors were associated with PIOU. Results highlights the importance of a multidisciplinary approach for pain management, and the urgent need for implementing organizational efforts to optimize opioid use in primary care.

Changes in the Care of Neurological Diseases During the First Wave of the COVID-19 Pandemic: A Single Private Center Study in Argentina.

Introduction: Healthcare systems are struggling to cope with the rapid evolution of the COVID-19 pandemic. In Argentina, the pandemic is advancing despite prolonged lockdown measures. We aim to analyze the impact of the easing of lockdown measures in the number of visits to the emergency department (ED), and outpatient consultations (OC) to a tertiary neurological center.Methods: We compared the number of ED visits with the social mobility overtime. We also compared the number of OC, and the geographic distribution of patients' addresses between 2019 and 2020.Results: ED visits decreased 48.33% (n = 14,697 in 2019 vs. n = 7,595 in 2020). At the beginning of the lockdown, the social mobility decreased in pharmacies/groceries, and workplaces, along with a reduction in the number of ED visits. With the easing of lockdown restrictions, the social mobility decreased in residential places, slightly increased in workplaces and almost return to normal in pharmacies/groceries. Variations in ED visits correlate better with social mobility in workplaces (coef. =0.75, p < 0.001) than in groceries/pharmacies (coef. =0.68, p < 0.001). OC decreased 43%. Fourteen percent of OC were tele consults. This was associated with an increase of the geographical area of influence of our center (standard distance of 109 km in 2019 and 127 km in 2020).Conclusions: Despite an increase in social mobility, the number of ED visits and OC to an Argentinian tertiary neurological center remain worrisomely low. The pandemic catalyzed the introduction of telemedicine in our country. This has also allowed patients from distant zones to gain access to specialized neurological care.

Impact of Social, Economic, and Healthcare Factors on the Regional Structure of Antibiotic Consumption in Primary Care in Poland (2013-2017).

Antibiotic resistance is one of the most important public health threats worldwide. Antimicrobial misuse and overuse are well-recognized risk factors for the resistance emergence and spread. Monitoring of antibiotic consumption (AC) is an important element in strategies to combat antibiotic resistance. As a result of AC surveillance in Poland, regional differences in AC levels were observed. This study aimed to characterize the regional AC in the period 2013–2017 in primary care in Poland and to assess the possible determinants that influence the AC at the regional level. The study analyzed relationships between AC and its factors (grouped in three different categories: demographic, economic, and related to the organization of healthcare). Data covered AC in primary care in 5 years period (2013–2017) from all 16 Polish voivodeships. The AC primary care data were sales data, expressed in defined daily doses (DDD) according to the WHO methodology. The yearly data on demographic, economic, and related healthcare factors were downloaded from the Central Statistical Office of Poland. Standard statistical parameters were used to characterize the AC. Non-standardized regression coefficients were used to estimate the quantitative dependence of variables. The strongest correlation was demonstrated with factors related to employment, female reproductive activity, mobility of the population, the number of outpatient consultations, and the number of dentists. A correlation was also found between population mobility and density. Recognized risk factors for increased AC should be a priority for interventions implementing and disseminating rational antibiotic policy.

Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013

IntroductionCambodia’s health equity fund (HEF) is the country’s most significant social security scheme, covering the poorest one-fifth of the national population. During the last two decades, the HEF system was...

Étude coût-efficacité du pamoate d’olanzapine : analyse en miroir sur un an

IntroductionOlanzapine pamoate has a higher cost of treatment than the oral form and requires administration in a hospital setting (unlike other long-acting antipsychotics), and the cost-effectiveness of this treatment may be questioned. Many scientific societies and national health systems are increasingly interested in the pharmacoeconomic impact of health products. The search for efficacy of a treatment can be done in two ways: medico-economic modeling studies or observational studies i.e. randomized controlled trials or mirror studies. The models are based on theoretical models from published clinical data simulating the course and evolution of patient health conditions, which benefit from a particular therapeutic strategy. Even if the design of observational mirror studies makes it possible to get closer to the clinical reality by observing the patient before and after the initiation of the treatment, the majority of the pharmacoeconomic studies published on olanzapine pamoate are modeling works that do not reflect actual conditions of care. The Guillaume Régnier Hospital Center in Rennes has a large cohort of patients treated with olanzapine pamoate: 121 instauration treatments are recorded from April 1, 2010 to Mars 1, 2015. The objective of this study is to evaluate the cost-effectiveness of olanzapine pamoate in actual clinical practice. MethodsThis is a one-year cost-effectiveness retrospective observational mirror-image study of a cohort of 52 patients with schizophrenia who were treated for at least three months with olanzapine pamoate. The primary efficacy endpoint is the differential in the number of full-time hospitalizations before and after the introduction of olanzapine pamoate versus the hospital cost differential. The secondary criteria are the difference of the number of the days spent in hospital and the number of outpatient consultations between the year preceding the injection and the year following it. The results were calculated on the general cohort and within 2 subgroups: patients treated for more than one year and those receiving less than one year of treatment with olanzapine pamoate. ResultsFifty-two patients were included (median age=35 years, sex ratio H/F=2.7) and only 38.5% discontinued treatment. For patients who maintained long-acting treatment, they received a dosage of 25mg oral olanzapine (min=7.5mg, max=60mg), 5mg more medially than the group having stopped the olanzapine pamoate (20mg; min=10mg, max=40mg). The majority of these patients were receiving off-label authorized marketing doses of oral olanzapine, whereas 22% of them had off-label dosages of olanzapine pamoate. The main causes of discontinuation were symptom persistence, loss of vision and the occurrence of adverse effects (including weight gain and sedation). Olanzapine pamoate significantly reduced the number of hospitalizations compared to the previous management strategy (1 less hospitalization, P<0.001 in patients treated more than one year and in the general cohort). As a logical consequence the number of hospitalization days in day care increased after the establishment of this long-acting antipsychotic with hospital reserve status (18 in median; min=0, max=159). We observed a non-statistically significant tendency of decrease in the number of days of full-time hospitalization and an increase in the number of ambulatory procedures, particularly in patients who have maintained the treatment for one year. This efficiency had a non-significant additional cost of €3361 per year. There was an average multiplication by 8,5 of the drug cost a year later in the general cohort (5.5 in the group of patients treated less than one year and 10.4 in the group of patients who maintained it a year). There was a 23,2% average increase in the cost of hospitalization in the general cohort (3.75 % in patients who maintained treatment compared to 48.9% in patients who discontinued treatment). ConclusionBy its mirror design, the study was placed in real conditions of care of the patient with schizophrenia. A total of 61.5% of patients maintained treatment with olanzapine pamoate for a minimum of one year. This APAP is more effective without significantly increasing the cost compared to the previous therapeutic strategy (including oral olanzapine). The additional cost is partly due to the administration restriction in a hospital setting in relation to risk of Post-Injection Delirium/Sedation Syndrom (PDSS). There is currently no acceptable efficiency limit. The results of this cost-effectiveness analysis cannot be extrapolated to the other long-acting antipsychotics since it is the only one with hospital reserve status. The current limitations of medico-economics in psychiatry derive from the heterogeneity of clinical forms and the management of mental pathologies.

MP02-09 EVALUATION OF SURGICAL OUTCOMES WITH PHOTOSELECTIVE GREENLIGHT XPS LASER VAPORIZATION OF THE PROSTATE IN HIGH MEDICAL RISK MEN WITH BENIGN PROSTATIC ENLARGEMENT: A MULTICENTER STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2017MP02-09 EVALUATION OF SURGICAL OUTCOMES WITH PHOTOSELECTIVE GREENLIGHT XPS LASER VAPORIZATION OF THE PROSTATE IN HIGH MEDICAL RISK MEN WITH BENIGN PROSTATIC ENLARGEMENT: A MULTICENTER STUDY Emad Rajih, Abdullah Alenizi, Malek Meskawi, Come Tholomier, Pierre-Alain Hueber, Mounsif Azizi, Ricardo R. Gonzalez, Gregg Eure, Lewis Kriteman, Mahmood Hai, and Kevin Zorn Emad RajihEmad Rajih More articles by this author , Abdullah AleniziAbdullah Alenizi More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , Come TholomierCome Tholomier More articles by this author , Pierre-Alain HueberPierre-Alain Hueber More articles by this author , Mounsif AziziMounsif Azizi More articles by this author , Ricardo R. GonzalezRicardo R. Gonzalez More articles by this author , Gregg EureGregg Eure More articles by this author , Lewis KritemanLewis Kriteman More articles by this author , Mahmood HaiMahmood Hai More articles by this author , and Kevin ZornKevin Zorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.105AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the safety and short-term outcomes of photoselective vaporization of the prostate using GreenLight XPS in treatment of high medical risk men. METHODS A multicenter retrospective analysis of 941 men who underwent photoselective vaporization of the prostate between August 2010 and August 2014 was performed. Patients were considered high medical risk if they had an American Society of Anesthesiologists physical status score >= 3. Postoperative adverse events, unexpected postoperative medical provider visits after intervention, and functional urinary outcomes were examined. RESULTS High medical risk men (n=273) were older (mean age 72.3 +/- 8.1 vs. 67.1 +/- 9 years, p < 0.01), had larger prostate volume (82.8 +/- 48.2 vs. 73.7 +/- 49.4 g, p < 0.01), and were more likely to be on anticoagulant and antiplatelet medications (all p < 0.01). Moreover, overall operative time (65 +/- 35.1 vs. 53.9 +/- 24.9 min), energy delivered (313.4 +/- 207 vs. 258 +/- 164 KJ), and energy density used (4.2 +/- 3.8 vs. 3.8 +/- 3 KJ/g) were greater in the high medical risk group (all p < 0.05). Although high medical risk men were more often treated in a hospital setting (p < 0.01), there were no differences in intraoperative adverse events. Both groups had sustained improvements from baseline for all urinary functional outcomes at six months. Regarding safety, the two groups had comparable 90-day Clavien-Dindo complication rates, number of urgent care visits, and number of outpatient consultations. High medical risk men, however, had more hospital readmissions within 90-day post-surgery (3.7% vs. 1.3% [p = 0.04]). CONCLUSIONS Despite older age, comorbidities, and higher use of anticoagulants, HMR men (ASA-PS 3/4) who undergo GL-XPS experience postoperative complications similar to healthier men (ASA-PS 1/2) in short term follow-up in addition to symptom improvement. GL-XPS produces safe and effective short-term outcomes in patients with multiple comorbidities. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e13-e14 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Emad Rajih More articles by this author Abdullah Alenizi More articles by this author Malek Meskawi More articles by this author Come Tholomier More articles by this author Pierre-Alain Hueber More articles by this author Mounsif Azizi More articles by this author Ricardo R. Gonzalez More articles by this author Gregg Eure More articles by this author Lewis Kriteman More articles by this author Mahmood Hai More articles by this author Kevin Zorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PTU-209 Intra-operative swab cultures do not predict the development of anal fistula in patients undergoing emergency incision and drainage of perianal abscess: Abstract PTU-209 Table 1

Introduction Routine swab cultures at the time of perianal abscess drainage remains common practice in modern day emergency colorectal surgery. We aimed to analyse the effectiveness of culture swabs to predict short term and long term outcomes of perianal abscess drainage. Method 350 consecutive patients from January 2008 to December 2010 undergoing incision and drainage (I&D) of perianal abscesses with packing of wound in community were analysed for readmission, follow up outpatient visit, repeat procedure for ongoing symptoms and presence of anal fistula at follow up examination under anaesthesia (EUA). Patients with inflammatory bowel disease and known anal fistula disease were excluded. Inter-group comparative analyses were made for patients with and without intra-operative culture swabs and for the microbial growth. Results Overall fistula formation rate after I and D was 12% at 36 month follow up. No statistical significant differences were found between the different groups for rate of readmission, presence of fistula and number of outpatient consultations (P > 0.05). There was no significant difference in fistula rates for patients with positive microbial growth and negative microbial growth (10% vs. 8%, p = 0.12). No significant variation was observed for different types of organisms and rate of fistula formation. (See Table 1). Conclusion Routine swab cultures do not influence short and long term outcome associated with I&D of perianal abscess. Disclosure of interest None Declared.

Factors associated with suicide in the month following contact with different types of health services in Quebec.

The aim of the study was to identify factors associated with suicide death occurring in the month following an outpatient visit, emergency room contact, or hospitalization. The results of this study are based on data for 8,851 individuals ages 11 years and older who died between January 1, 2000, and December 15, 2007, and whose death was confirmed as suicide by the coroner's office in Quebec, Canada. Health service use in the year prior to death was assessed by review of data from the province's public health insurance agency. Multivariate logistic regression models were used to assess the association of clinical and sociodemographic factors and the occurrence of suicide death in the month following versus more than one month after the last use of health services. A total of 81.6% of suicide decedents had consulted on an outpatient basis, 48.7% had visited an emergency department, and 28.5% were hospitalized in the year prior to death. Among individuals who had been discharged from an emergency department or a hospital closest to their death, 29.5% and 75.3%, respectively, died in the month following discharge. The most consistent modifiable factor associated with death in the month following last contact was number of outpatient consultations following discharge. Ensuring follow-up care after an emergency department visit or hospitalization may be associated with a longer period between discharge and suicide, allowing for more time to intervene and, possibly, prevent suicide.

Seasonal Patterns of Abdominal Pain Consultations Among Adults and Children

Consultations for chronic abdominal pain are frequent in adults and children. A seasonal pattern of abdominal pain consultations with winter predominance was shown in previous pediatric studies; however, no studies have investigated whether such a pattern exists in adult patients. Understanding the differences in seasonal patterns of abdominal pain consultations among adults and children may indicate that either different mechanisms exist for common chronic pain conditions or triggering factors may vary by age. The aim of the study was to investigate whether a seasonal variation in abdominal pain consultation patterns exists among adults and children. The number of outpatient consultations among children (5-17 years) and adults (18 years or older) with a diagnosis of abdominal pain of nonspecified origin (International Classification of Diseases-9 code 789.0) from May 2000 to December 2008 was identified in an administrative claims database. The primary outcome measure was the rate of abdominal pain consultations (total number of abdominal pain consultations/total number of distinct patients by month×1000) by season in children and adults. Seasons were defined as follows: winter (December-February), spring (March-May), summer (June-August), and fall (September-November). A trend test was conducted to determine the degree of linearity in the patterns between the 2 groups. Among children, subanalyses by age 5 to 11 years and 12 to 17 years and sex were conducted. A total of 172.4 million distinct patients (13.4% children, 87.6% adults) were identified in the database between May 2000 and December 2008. During the same time period, 15.6 million patient consultations for abdominal pain were identified (10.1% children, 89.9% adults). Children demonstrated a seasonal pattern in abdominal pain consultations, which best fit a quadratic regression curve, with consultations less common during the summer months. Abdominal pain consultations in adults were linear with no seasonal predominance. The trend in seasonal variation of abdominal pain consultations among children stratified by age and sex remained consistent with the overall child population. Abdominal pain consultations in children are less common during summer months, whereas no evidence of seasonal pattern of consultation was found in adults. Factors involved in the pathogenesis of abdominal pain in adults and children may differ.

The influence of personality disorders on the use of mental health services in adolescents with psychiatric disorders

ObjectiveThe aims of this study were to explore the influence of personality disorders (PDs) in Spanish adolescents with Axis I psychiatric disorders on their use of mental health services and to analyze the risk of having a comorbid PD in relation to psychiatric service use. MethodsThe Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases, Tenth Revision (ICD-10) modules of the semistructured interview International Personality Disorders Examination were administered to a sample of 112 adolescent psychiatric patients (mean age = 15.8 years; SD, 0.8; range, 15-17; 79% women) at the point of initiating treatment. On the basis of the interview, subjects were divided into two groups: a PD group (PDG) and a non-PD group (NPDG). After 3 years of treatment, clinical records were retrospectively analyzed. ResultsThe PDG showed a significantly higher number of psychiatric admissions (P < .001), days per psychiatric admission (P < .001), and psychiatric emergencies (P < .010) than the NPDG, although the number of outpatient consultations was not significantly higher. Logistic regression analysis showed that the probability of belonging to the PDG rather than the NPDG increased with each psychiatric admission (odds ratio [OR] = 1.67 for DSM-IV criteria and OR = 1.59 for ICD-10 criteria), after controlling by sex, age, and comorbidity (Axis I disorders). ConclusionsPatients with comorbid PD used more inpatient and emergency psychiatric services than did patients without a PD. Large number of psychiatric hospitalizations suggests the likelihood of a PD being present.

Avaliação de impacto da ONG Refazer no tratamento médico de crianças em risco social

Assess the impact of activities by the nongovernmental organization Refazer in support of medical care for children at social risk. A longitudinal study was conducted of 77 patients from Rio de Janeiro in treatment at the Fernandes Figueira Institute and supported by Refazer. The assessment period was two years, one before and the other during the intervention period while being supported by the NGO. The percentage of hospitalizations, average length of stay, severity of the illness, use of technology, number of outpatient consultations, and clinical conditions involved were compared. The indicators linked with the hospitalizations revealed changes during the intervention period. There was a reduction in the average time and percentage of hospitalization. The most common pathologies were congenital malformations, chromosomal anomalies, and diseases of the nervous system. These diseases and HIV/AIDS were more prevalent in children that remained hospitalized even after receiving support from the NGO. Analysis of the indicators showed that the outcomes are adequate to the NGO's mission and that the population helped benefits from participation in the social support network. Although it cannot be stated that the benefits found are due exclusively to the activities of the NGO, a simple and easy-to-use evaluation of adequacy was developed that NGOs themselves can use, representing progress toward the institutional use of evaluations by NGOs working in health.

Changes in mental health services and suicide mortality in Norway: an ecological study

BackgroundMental disorders are strongly associated with excess suicide risk, and successful treatment might prevent suicide. Since 1990, and particularly after 1998, there has been a substantial increase in mental health service resources in Norway. This study aimed to investigate whether these changes have had an impact on suicide mortality.MethodsWe used Poisson regression analyses to assess the effect of changes in five mental health services variables on suicide mortality in five Norwegian health regions during the period 1990-2006. These variables included: number of man-labour years by all personnel, number of discharges, number of outpatient consultations, number of inpatient days, and number of hospital beds. Adjustments were made for sales of alcohol, sales of antidepressants, education, and unemployment.ResultsIn the period 1990-2006, we observed a total of 9480 suicides and the total suicide rate declined by 26%. None of the mental health services variables were significantly associated with female or male suicide mortality in the adjusted analyses (p > 0.05). Sales of antidepressants (adjusted Incidence Rate Ratio = 0.98; 95% CI = 0.97-1.00) and sales of alcohol (adjusted IRR = 1.41; 95% CI = 1.18-1.72) were significantly associated with female suicide mortality; education (adjusted IRR = 0.86; 95% CI = 0.79-0.94) and unemployment (adjusted IRR = 0.91; 95% CI = 0.85-0.97) were significantly associated with male suicide mortality.ConclusionsThe adjusted analyses in the present study indicate that increased resources in Norwegian mental health services in the period 1990-2006 were statistically unrelated to suicide mortality.

Estudio de la dinámica de servicios hospitalarios mediante la utilización de técnicas estadísticas multivariables: el caso del Hospital Clínico de la Universidad de Chile

Objective To obtain useful hospital management indicators, based on the technique of principal components analysis. Material and method We analyzed information on the activity of medical-surgical services in the Hospital Clinico de la Universidad de Chile from January 2003 to December 2004. The following variables were analyzed: number of discharges, lethality rate, readmissions rate, number of outpatient consultations, number of hospital stays, and the surgical complexity index. The principal components analysis (PCA) technique was applied and the R correlation matrix was used. Results The first two principal components for each year were selected, accounting cumulatively for 75.92% of the variability in the data: 47.02% for the first and 28.90% the second. The first component may be interpreted as a new index related to clinical complexity and the second related to healthcare demand. Conclusions The use of these new indicators would aid classification of hospital services and performance monitoring, allowing appropriate corrective measures to be introduced.

Nueva propuesta de indicadores de gestión de los servicios médico-quirúrgicos mediante técnicas estadísticas multivariantes

Objective To obtain indicators useful for hospital management based on descriptive multivariate techniques. Material and method Data on hospital admissions in 2003 were analyzed in April 2006 in the Hospital Clínico de la Universidad de Chile. The variables monitored by the Operations Management Department in the university hospital were studied: number of discharges, mortality rate, re-admissions rate, number of outpatient consultations, number of hospital stays, length of stay in the intensive care unit, patient age, and surgical complexity index. The variables were considered for a total of 24,345 discharges. The principal components analysis (PCA) technique was applied and the R correlation matrix was used. Results The first two principal components were selected, accounting accumulatively for 71.3% of the variability: the first component for 49.4% and the second component for 21.9%. Conclusions The first component may be related to a new index representing the complexity of the patients attended, which we have termed Case Complexity. The second principal component would explain the number of persons attended, which we have termed Case Load. These two indices allow us to classify hospital services.

Lack of patients? – a hypothesis for understanding discrepancies between hospital resources and productivity

BackgroundDespite a substantial increase in hospital resources, increased hospital admissions and out-patient visits, long waiting lists have been a significant problem in Norwegian health care. A detailed analysis of the development in resource allocation and productivity at St. Olavs University Hospital in central Norway was therefore undertaken.MethodsResource allocation and patient volume was analysed during the period 1995 to 2001. Data were analysed both for emergency and elective admissions as well as outpatient visits specified into new referrals and follow-up consultations.ResultsFull time employee equivalents for doctors and nurses increased by 36.6% and 25.9%, respectively, and all employees by 28.1%. However, admitted patients, outpatient consultations and surgical procedures only increased by 10%, 15% and 8.3%, respectively. Thus, the productivity for each hospital employee, defined as operations pr. surgeon, outpatient consultations pr. doctor etc. was significantly reduced. A striking finding was that although the number of outpatient consultations increased, the number of new referrals actually went down and the whole increase in activity at the outpatient clinics could be explained by a substantial increase in follow-up consultations. This trend was more evident in the surgical departments, where some departments actually showed a reduction in total outpatient consultations.ConclusionIn view of the slow increase in hospital activity in spite of a significant increase in resources, it can be speculated that patient volume might be a limiting factor for hospital activity. The health market (patient population) might not be big enough in relation to the investments in increased production capacity (equipment and manpower).

Data validation in an economic evaluation of surgery for colon cancer

This study aimed to validate the accuracy of data retrieved in a prospective multicenter trial, the purpose of which was an economic evaluation of two techniques of surgery for colon cancer. Within the Swedish contribution of the COLOR trial (Colon Cancer Open or Laparoscopic Resection), an economic evaluation of open versus laparoscopic surgical techniques was conducted. Data were collected by case record forms (CRF), patient diaries, and telephone surveys every 2 weeks. The study period was 12 weeks, and the perspective was societal. Data from the first consecutive forty patients to complete the health economic study protocol were validated. Retrieved data were compared with data from medical records and data from local social security offices for agreement. Statistically significant differences were found for duration of anesthesia, length of surgery, number of outpatient consultations by doctors and district nurses, complication rate, and the use of central venous lines. No significant differences were observed concerning length of hospital stay, disposable instruments cost, and time off work, all of which heavily influence total costs. The present method of data collection regarding resources used in this setting seems to produce accurate data for economic evaluation; however, relative to complication rates, the method did not retrieve accurate data.

Propuesta de índices de gestión de servicios médico-quirúrgicos hospitalarios mediante técnicas estadísticas multivariantes

Diagnosis related groups (DRGs) are the most reliable patient classification system in hospital management. When this information is unavailable, other reliable classification system must be used. To obtain useful indices for hospital management, based on descriptive multivariate techniques. Data on admissions to a University Hospital during 2003 were analyzed. Number of discharges, lethality rate, re-admission rate, number of outpatient consultations, length of hospital stay and surgical complexity index were analyzed, using information obtained by the Operations Management Department. The Principal Components Analysis (PCA) technique was applied and the R correlation matrix was used. A total of 24,345 discharges were analyzed. The first two principal components were selected, accounting cumulatively for 76% of data variability (47% for the first and 29% for the second). The first component may be assimilated to a new index representing the difficulty of the attended cases, which we have termed Case Complexity. The second principal component would explain the number of attended persons, which we have termed Case Load. These two indices allow us to classify hospital services.