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BACKGROUND: The objective of this study is to present cardiovascular results of a national study about the implementation of clinical guidelines and other instruments and practices for clinical care management among health plan operators in Brasil. METHODS: This was a cross-sectional study based on a representative sample of the 1,573 Brazilian health plan operators, stratified by macro region and market segment. Each stratum was subdivided in take-all and take-some strata by Hedlin's method, with equiprobability selection in each take-some stratum. The resulting sample size was of 90 health plan operators who were interviewed using a structured questionnaire. The study had a descriptive nature and, to obtain estimates for percents and total number of health plan operators relative to a population size of N=1572., sample weights were taken into account. RESULTS: Of the health plan operators, 61.2% considered that the implementation of clinical guidelines should be conducted by administrative and regulatory government organizations, involving a partnership with health plan operators, health service providers and medical societies. It was shown that only 32.3% of the health plan operators in the country enforce clinical guidelines. With regard to cardiovascular disease, the reported utilization of guidelines was one of the highest among all diseases analyzed. The percentages for acute myocardial infarction (87%), congestive heart failure (85%) and the use of invasive procedures (81.1%) were higher than for arterial hypertension (74.1%) and cerebrovascular disease (72.2%). CONCLUSION: This study indicated the incipient utilization of clinical guidelines among health plan operators in the Brazilian health system. In general, the cardiovascular area showed one of the highest rates of utilization reported in the study.

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OBJETIVO: Apresentar resultados da área cardiovascular de um estudo nacional sobre a utilização de diretrizes clínicas na saúde suplementar. MÉTODOS: Estudo transversal, baseado em amostra representativa das 1573 operadoras de planos de saúde do Brasil, estratificada por macrorregião e segmento do mercado, subdividida em estratos certos e amostrados pelo método de Hedlin, com seleção eqüiprovável feita pelo algoritmo de Hájek em cada estrato amostrado, resultando em 90 operadoras entrevistadas com questionário estruturado; estimação pontual de porcentagens, totais e médias através de fatores de expansão, relativas a uma população N=1572. RESULTADOS: Para 61,2 por cento das operadoras a utilização de diretrizes clínicas deve ser conduzida por órgãos reguladores governamentais, com participação de operadoras, prestadores de saúde e associações médicas. Apenas 32,3 por cento das operadoras conduzem a utilização de diretrizes clínicas, variando de 6,5 por cento (filantrópicas) a 38,2 por cento (autogestão). Entre as operadoras que conduzem o uso de diretrizes, a área cardiovascular apresenta uma das maiores utilizações: infarto agudo do miocárdio (87 por cento); insuficiência cardíaca (85 por cento); procedimentos invasivos em cardiologia (81,1 por cento); hipertensão arterial (74,1 por cento); acidente vascular encefálico (72,2 por cento); diabetes (65,4 por cento). As sociedades médicas são a fonte mais comum dessas diretrizes. 64,1 por cento das operadoras monitoram indicadores de processo/resultado dos prestadores, mas apenas 10,5 por cento monitoram o uso de reperfusão coronariana no IAM de forma sistemática. 73,2 por cento promovem campanhas de promoção/prevenção de agravos: hipertensão arterial (97 por cento), diabetes (93,3 por cento), obesidade (70,7 por cento) e tabagismo (60,8 por cento). CONCLUSÃO: Implementação baixa e incipiente de diretrizes, com variação regional e por segmentos do mercado. De uma forma geral, a área cardiovascular...

BACKGROUND: The objective of this study is to present cardiovascular results of a national study about the implementation of clinical guidelines and other instruments and practices for clinical care management among health plan operators in Brasil. METHODS: This was a cross-sectional study based on a representative sample of the 1,573 Brazilian health plan operators, stratified by macro region and market segment. Each stratum was subdivided in take-all and take-some strata by Hedlin's method, with equiprobability selection in each take-some stratum. The resulting sample size was of 90 health plan operators who were interviewed using a structured questionnaire. The study had a descriptive nature and, to obtain estimates for percents and total number of health plan operators relative to a population size of N=1572., sample weights were taken into account. RESULTS: Of the health plan operators, 61.2 percent considered that the implementation of clinical guidelines should be conducted by administrative and regulatory government organizations, involving a partnership with health plan operators, health service providers and medical societies. It was shown that only 32.3 percent of the health plan operators in the country enforce clinical guidelines. With regard to cardiovascular disease, the reported utilization of guidelines was one of the highest among all diseases analyzed. The percentages for acute myocardial infarction (87 percent), congestive heart failure (85 percent) and the use of invasive procedures (81.1 percent) were higher than for arterial hypertension (74.1 percent) and cerebrovascular disease (72.2 percent). CONCLUSION: This study indicated the incipient utilization of clinical guidelines among health plan operators in the Brazilian health system. In general, the cardiovascular area showed one of the highest rates of utilization reported in the study.

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