RESUMO
This document aims to provide evidence-based recommendations to estimate the personal protective equipments (PPE), medical devices, and drugs commonly used in the Intensive Care Unit during the COVID-19 pandemic. A systematic literature review and gray literature assessment was performed, and the evidence was categorized using the GRADE methodology. Then a predictive model was built to support the estimation of resources needed during 30 days of the pandemic. In the development of these recommendations, 33 publications were included, with variable quality of evidence (low to very low quality). They refer to the use of PPE according to the risk of exposure; management and reuse of PPE, and the stock of drugs and medical devices needed for the care of patients with COVID-19. It is important to remark the difficult in estimating and managing the number of essential supplies and equipment required during a pandemic. The model allowed us to predict the resources required to provide critical care during 30 days of pandemic activity. Given the constant evolution of COVID-19, these recommendations might change as evidence evolves.
El presente documento tiene como fin proporcionar recomendaciones basadas en la evidencia para estimar los equipos de proteccion personal (EPP), los dispositivos médicos y los medicamentos comúnmente utilizados en la Unidad de Cuidados Intensivos durante la pandemia de COVID-19. Se llevó a cabo una revisión sistemática de la literatura y evaluación de la literatura gris. La evidencia se clasificó utilizando la metodología GRADE. Luego, se construyó un modelo predictivo para apoyar la estimación de recursos durante 30 días de la pandemia. En el desarrollo de estas recomendaciones se incluyeron 33 publicaciones con calidad de evidencia variable (calidad baja a muy baja), acerca del uso de EPP según el riesgo de exposición; manejo y re-uso de EPP, y las necesidades de fármacos y dispositivos médicos para la atención de pacientes con COVID-19. Es destacable lo difícil que resulta estimar y administrar la cantidad de suministros y equipos esenciales necesarios durante una pandemia. El modelo nos permitió predecir los recursos necesarios para proporcionar cuidados críticos durante 30 días de actividad pandémica. Dada la evolución constante de COVID-19, estas recomendaciones pueden cambiar a medida que evolucione la evidencia.
Assuntos
Coronavirus , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva/economia , Equipamento de Proteção Individual/provisão & distribuição , Alocação de Recursos/organização & administração , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2RESUMO
New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.
Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Neoplasias Pulmonares/terapia , Pandemias/prevenção & controle , Assistência ao Paciente/normas , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Idoso , Betacoronavirus , Brasil , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Neoplasias Pulmonares/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Alocação de Recursos/economia , Alocação de Recursos/organização & administração , SARS-CoV-2 , Sociedades MédicasRESUMO
El presente documento tiene como fin proporcionar recomendaciones basadas en la evidencia para estimar los equipos de proteccion personal (EPP), los dispositivos médicos y los medicamentos comúnmente utilizados en la Unidad de Cuidados Intensivos durante la pandemia de COVID-19. Se llevó a cabo una revisión sistemática de la literatura y evaluación de la literatura gris. La evidencia se clasificó utilizando la metodología GRADE. Luego, se construyó un modelo predictivo para apoyar la estimación de recursos durante 30 días de la pandemia. En el desarrollo de estas recomendaciones se incluyeron 33 publicaciones con calidad de evidencia variable (calidad baja a muy baja), acerca del uso de EPP según el riesgo de exposición; manejo y re-uso de EPP, y las necesidades de fármacos y dispositivos médicos para la atención de pacientes con COVID-19. Es destacable lo difícil que resulta estimar y administrar la cantidad de suministros y equipos esenciales necesarios durante una pandemia. El modelo nos permitió predecir los recursos necesarios para proporcionar cuidados críticos durante 30 días de actividad pandémica. Dada la evolución constante de COVID-19, estas recomendaciones pueden cambiar a medida que evolucione la evidencia.
This document aims to provide evidence-based recommendations to estimate the personal protective equipments (PPE), medical devices, and drugs commonly used in the Intensive Care Unit during the COVID-19 pandemic. A systematic literature review and gray literature assessment was performed, and the evidence was categorized using the GRADE methodology. Then a predictive model was built to support the estimation of resources needed during 30 days of the pandemic. In the development of these recommendations, 33 publications were included, with variable quality of evidence (low to very low quality). They refer to the use of PPE according to the risk of exposure; management and reuse of PPE, and the stock of drugs and medical devices needed for the care of patients with COVID-19. It is important to remark the difficult in estimating and managing the number of essential supplies and equipment required during a pandemic. The model allowed us to predict the resources required to provide critical care during 30 days of pandemic activity. Given the constant evolution of COVID-19, these recommendations might change as evidence evolves.
Assuntos
Humanos , Alocação de Recursos para a Atenção à Saúde/métodos , Coronavirus , Alocação de Recursos/organização & administração , Equipamento de Proteção Individual/provisão & distribuição , Unidades de Terapia Intensiva/economia , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , SARS-CoV-2 , COVID-19 , Unidades de Terapia Intensiva/organização & administraçãoRESUMO
OBJECTIVE: to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order. METHOD: qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowball sampling. Data collected by interview and analyzed using the Discursive Textual Analysis technique. RESULTS: three categories were analyzed, entitled deficiency of physical structure and human resources; Lack of clear policies and criteria for patient admission and inadequate discharge from the intensive care unit. In situations of hospitalization by court order, there is a change in the criteria for the allocation of intensive care beds, due to the credibility of professionals, threats of medico-legal processes by family members and judicial imposition on institutions and health professionals. CONCLUSION: nurses defend the needs of the patients, too, with actions that can positively impact the availability of intensive care beds and adequate care infrastructure.
Assuntos
Ocupação de Leitos/legislação & jurisprudência , Hospitalização/legislação & jurisprudência , Unidades de Terapia Intensiva/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Pesquisa Qualitativa , Alocação de Recursos/organização & administração , Inquéritos e Questionários , Carga de Trabalho/psicologiaRESUMO
Effective admission planning can improve inpatient throughput and waiting times, resulting in better quality of service. The uncertainty in the patient arrival and the availability of resources makes the patient's allocation difficult to manage. Thus, in the admission process hospitals aim to accomplish targets of resource utilization and to lower the cost of service. Both objectives are related and in conflict. In this paper, we present a bi-objective stochastic optimization model to study the trade-off between the resource utilization and the cost of service, taking into account demand and capacity uncertainties. Real data from the surgery and medical areas of a Chilean public hospital are used to illustrate the approach. The results show that the solutions of our approach outperform the actual practice in the Chilean hospital.
Assuntos
Modelos Estatísticos , Admissão do Paciente/estatística & dados numéricos , Alocação de Recursos/organização & administração , Ocupação de Leitos/estatística & dados numéricos , Chile , Hospitais Públicos , Humanos , Alocação de Recursos/estatística & dados numéricos , Processos Estocásticos , Centro Cirúrgico Hospitalar/estatística & dados numéricosRESUMO
New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.
Assuntos
Humanos , Idoso , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Coronavirus , Pandemias/prevenção & controle , Assistência ao Paciente/normas , Neoplasias Pulmonares/terapia , Pneumonia Viral/transmissão , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sociedades Médicas , Brasil , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Alocação de Recursos/economia , Alocação de Recursos/organização & administração , Betacoronavirus , SARS-CoV-2 , COVID-19 , Neoplasias Pulmonares/complicaçõesRESUMO
Resumo Desde 2014, o Brasil vive crise econômica-fiscal-política-institucional. Este estudo avalia se a implementação das respostas à crise contribuiu para fragilizar a governança regional e federativa do SUS. Trata-se de estudo de implementação, ampliando-o com duas categorias da saúde coletiva, o poder em Testa e o sujeito em Campos, compreendendo que a implementação desloca poder e constrói sujeitos. Analisamos dados públicos, de 2014 a 2018, organizados em quatro eixos de análise: a) instrumentos de implementação da resposta à crise; b) interferência do Legislativo e do Judiciário nos investimentos; c) marcos legais da regionalização; d) atores federativos e possíveis coalizões de defesa. Os resultados revelam redução de recursos federais, especificamente para redes regionais de atenção; aumento da interferência legislativa e judicial nos recursos da saúde, pela evolução das emendas parlamentares e das ações judiciais e mudanças nas diretrizes de regionalização do SUS. Observa-se deslocamento de poder dos arranjos regionais federativos para o governo central, parlamento, judiciário e serviços locais isolados. Conclui-se que a resposta à crise fragilizou a governança regional federativa do SUS, agravando os impactos da crise na saúde.
Abstract Since 2014, Brazil has been experiencing an economic-fiscal-political-institutional crisis. This study evaluates whether the implementation of crisis responses contributed to weaken SUS regional and federative governance. This is an implementation study, and two theoretical categories of public health, the power in Testa and the subject in Campos have been incorporated. It presumes that the implementation shifts power and develops subjects. We analyzed public data from 2014 to 2018, organized into four axes of analysis: a) instruments for implementing crisis response; b) parliament and judicial interference in investments; c) legal frameworks of regionalization; d) federative actors and possible defense coalitions. Results show reduced federal resources, specifically for regional care networks; increased parliament and judicial interference with health resources, due to the evolution of congressional amendments and lawsuits, and changes in SUS regionalization guidelines. There is a shift of power from federative regional arrangements to the central government, parliament, the judiciary, and isolated local services. It is concluded that the response to the crisis weakened the regional federative governance of SUS, aggravating the impacts of the crisis on health.
Assuntos
Humanos , Atenção Primária à Saúde/economia , Planos Governamentais de Saúde/economia , Alocação de Recursos/economia , Recessão Econômica , Atenção Primária à Saúde/organização & administração , Responsabilidade Social , Planos Governamentais de Saúde/organização & administração , Brasil , Saúde da Família/economia , Cidades , Redução de Pessoal/economia , Alocação de Recursos/organização & administração , Desenvolvimento Sustentável , Acessibilidade aos Serviços de Saúde/economiaRESUMO
Resumo Este artigo aborda a crise na atenção primária à saúde do sistema público de saúde da cidade do Rio de Janeiro, a partir de 2018. Tal município teve forte expansão da atenção primária desde 2009, adotando Organizações Sociais para a contratação de profissionais e gerenciamento dos serviços, qualificando a infraestrutura das unidades e priorizando a medicina de família e comunidade, além de adotar práticas gerenciais como normatizações de ofertas, avaliação e remuneração por desempenho, "marketing", dentre outras. Diante da recente crise econômica, a decisão do gestor municipal foi de reduzir equipes de saúde da família, considerando a atual Política Nacional de Atenção Básica e argumentando ser possível otimizar recursos (fazendo mais com menos). Neste processo, enfrentou resistências, que não foram suficientes para freá-lo. Pela ressonância desta cidade (segunda maior do Brasil e com destaque na imprensa nacional) e tomando como base documentos públicos e formulações sobre a gestão, a crise expressa na atenção básica deste município foi problematizada em torno das implicações da adoção de Organizações Sociais na sustentabilidade dos serviços, da condução dos processos de gestão e suas racionalidades bem como da atuação política de agentes sociais em defesa do SUS e da atenção primária em particular.
Abstract This paper addresses the primary health care crisis of Rio de Janeiro public health system as of 2018. This municipality has experienced a robust primary care expansion since 2009, adopting Social Organizations for recruiting professionals and managing services, qualifying the infrastructure of units and prioritizing family and community medicine, as well as adopting management practices such as standardized offers, evaluation and pay-for-performance compensation, marketing, among others. Given the recent economic crisis, the municipal manager decided to reduce family health teams, considering the current National Policy of Primary Care and arguing that it is possible to optimize resources (doing more with less). In this process, he faced resistance that was not enough to stop him. Due to the resonance of this city (second largest in Brazil and prominent in the national press) and based on public documents and formulations on management, the crisis expressed in the primary health care of this city was debated around the implications of the adoption of Social Organizations in the sustainability of health services, conducting management processes and their rationalities, as well as the political action of social agents advocating for the SUS and primary care in particular.
Assuntos
Humanos , Atenção Primária à Saúde/economia , Planos Governamentais de Saúde/economia , Alocação de Recursos/economia , Recessão Econômica , Atenção Primária à Saúde/organização & administração , Responsabilidade Social , Planos Governamentais de Saúde/organização & administração , Brasil , Saúde da Família/economia , Cidades , Redução de Pessoal/economia , Alocação de Recursos/organização & administração , Desenvolvimento Sustentável , Acessibilidade aos Serviços de Saúde/economiaRESUMO
This paper addresses the primary health care crisis of Rio de Janeiro public health system as of 2018. This municipality has experienced a robust primary care expansion since 2009, adopting Social Organizations for recruiting professionals and managing services, qualifying the infrastructure of units and prioritizing family and community medicine, as well as adopting management practices such as standardized offers, evaluation and pay-for-performance compensation, marketing, among others. Given the recent economic crisis, the municipal manager decided to reduce family health teams, considering the current National Policy of Primary Care and arguing that it is possible to optimize resources (doing more with less). In this process, he faced resistance that was not enough to stop him. Due to the resonance of this city (second largest in Brazil and prominent in the national press) and based on public documents and formulations on management, the crisis expressed in the primary health care of this city was debated around the implications of the adoption of Social Organizations in the sustainability of health services, conducting management processes and their rationalities, as well as the political action of social agents advocating for the SUS and primary care in particular.
Este artigo aborda a crise na atenção primária à saúde do sistema público de saúde da cidade do Rio de Janeiro, a partir de 2018. Tal município teve forte expansão da atenção primária desde 2009, adotando Organizações Sociais para a contratação de profissionais e gerenciamento dos serviços, qualificando a infraestrutura das unidades e priorizando a medicina de família e comunidade, além de adotar práticas gerenciais como normatizações de ofertas, avaliação e remuneração por desempenho, "marketing", dentre outras. Diante da recente crise econômica, a decisão do gestor municipal foi de reduzir equipes de saúde da família, considerando a atual Política Nacional de Atenção Básica e argumentando ser possível otimizar recursos (fazendo mais com menos). Neste processo, enfrentou resistências, que não foram suficientes para freá-lo. Pela ressonância desta cidade (segunda maior do Brasil e com destaque na imprensa nacional) e tomando como base documentos públicos e formulações sobre a gestão, a crise expressa na atenção básica deste município foi problematizada em torno das implicações da adoção de Organizações Sociais na sustentabilidade dos serviços, da condução dos processos de gestão e suas racionalidades bem como da atuação política de agentes sociais em defesa do SUS e da atenção primária em particular.
Assuntos
Recessão Econômica , Atenção Primária à Saúde/economia , Alocação de Recursos/economia , Planos Governamentais de Saúde/economia , Brasil , Cidades , Saúde da Família/economia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Redução de Pessoal/economia , Atenção Primária à Saúde/organização & administração , Alocação de Recursos/organização & administração , Responsabilidade Social , Planos Governamentais de Saúde/organização & administração , Desenvolvimento SustentávelRESUMO
BACKGROUND: To date, few studies have assessed how Brazil's universal healthcare system's (SUS, Sistema Único de Saúde) systemic, infrastructural, and geographical challenges affect individuals' abilities to access organ transplantation services and receive quality treatment. DISCUSSION: In this article we evaluated the existing literature to examine the impact that SUS has had on an increasingly important healthcare sector: organ transplantation services. We assess how equity challenges within the transplantation system can be explained by wider problems within SUS. Findings suggest stark disparities in access to transplantation services both within and across Brazil's regions. We found that these regional differences are partially due to logistical challenges, especially in loosely populated areas but are also a consequence of disparities in resource allocations within SUS and under-capacitated health care facilities affecting transplantation services. We suggest that Brazil needs to improve its health outcome measurement system for organ transplantations and epidemiological surveillance, to gain more comprehensive and comparable data. Finally, we recommend policy strategies to reduce barriers to access to transplantation services by increasing transplantation service coverage in some areas and investing in emerging technologies.
Assuntos
Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Programas Nacionais de Saúde , Alocação de Recursos/organização & administração , Obtenção de Tecidos e Órgãos/organização & administração , Brasil , Atenção à Saúde/economia , Setor de Assistência à Saúde , Acessibilidade aos Serviços de Saúde/economia , Pesquisa sobre Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Transplante de Órgãos , Obtenção de Tecidos e Órgãos/economiaRESUMO
The implementation of a specific policy for rare diseases in the Brazilian Unified Health System presents challenges in terms of its rationale. Recognizing the importance of rarity in the context of public health means understanding genetics as one of the dimensions of disease and accepting that Brazil is undergoing a period of transition in health indicators. Although most rare diseases lack pharmacological treatment and genetic counseling constitutes the best strategy for their prevention, the cost of "orphan drugs" and their consequent lack of cost-effectiveness are still claimed as hurdles to the implementation of public policies in this field. Epidemiological aspects should not be used as isolated criteria for prioritization in public policies
Assuntos
Humanos , Assistência Farmacêutica/história , Doenças Raras/economia , Doenças Raras/tratamento farmacológico , Política de Saúde , Doenças Genéticas Inatas/tratamento farmacológico , Produção de Droga sem Interesse Comercial/legislação & jurisprudência , Apoio à Pesquisa como Assunto , Bioética , Brasil , Análise Custo-Benefício , Pesquisa Biomédica , Alocação de Recursos/organização & administração , Genética Médica/história , Acessibilidade aos Serviços de Saúde/organização & administração , Doenças Genéticas Inatas/epidemiologiaAssuntos
Humanos , Alocação de Recursos/organização & administração , Recursos Humanos , Organização e Administração , Política Pública , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde , Sistemas de Saúde , Aposentadoria , Modelos Organizacionais , Pensões , Previdência Social , Recursos Financeiros em Saúde , Reforma dos Serviços de SaúdeRESUMO
O artigo apresenta as formas tradicionais de alocação de recursos a prestadores de serviços de saúde e se concentra na apresentação e discussão de experiências alternativas encontradas no contexto internacional. Aponta, ainda, as tendências atuais formuladas nos países da OECD, que consistem na adoção de sistemas mistos ou complementados pelo ajuste por desempenho, sendo este predominantemente referido a resultados sobre a saúde da população, ou seja, à efetividade dos serviços de saúde. Ainda, destaca-se uma tendência a adotar sistemas de alocação de recursos diferenciados, segundo o nível de atenção do prestador: aos centros de atenção primária responsáveis pela saúde da população de um dado território, corresponde a alocação de recursos per capita ajustada por risco (ou, em alguns casos, por linhas de cuidado), enquanto os hospitais são em alguns casos remunerados por orçamento global ajustado por desempenho e, em outros, por pagamento prospectivo por procedimento.
This article presents the traditional ways of allocating resources to health service providers and focuses on the presentation and discussion of alternative experiences found in the international context. It also shows the current trends in the OECD countries, involving the adoption of mixed systems or performance-related bonuses, the latter being predominantly referred to the effects on the health of the population, i.e. the effectiveness of the health services. It further stresses the tendency to adopt resource allocation systems that are differentiated according to the level of care provider: to primary care centers, responsible for the health of the population of a given territory, a per capita adjusted for risk factor is granted (or, in some cases, resource allocation defined for lines of care), while in other cases hospitals are either paid according to a performance-adjusted global budget or through prospective payment per procedure.
Assuntos
Humanos , Atenção à Saúde , Alocação de Recursos/organização & administração , Internacionalidade , Estudos ProspectivosRESUMO
This article presents the traditional ways of allocating resources to health service providers and focuses on the presentation and discussion of alternative experiences found in the international context. It also shows the current trends in the OECD countries, involving the adoption of mixed systems or performance-related bonuses, the latter being predominantly referred to the effects on the health of the population, i.e. the effectiveness of the health services. It further stresses the tendency to adopt resource allocation systems that are differentiated according to the level of care provider: to primary care centers, responsible for the health of the population of a given territory, a per capita adjusted for risk factor is granted (or, in some cases, resource allocation defined for lines of care), while in other cases hospitals are either paid according to a performance-adjusted global budget or through prospective payment per procedure.
Assuntos
Atenção à Saúde , Alocação de Recursos/organização & administração , Humanos , Internacionalidade , Estudos ProspectivosAssuntos
Humanos , Alocação de Recursos/organização & administração , Serviços de Saúde , Sistemas de Saúde , Emprego , Organização e Administração , Política Pública , Prestação Integrada de Cuidados de Saúde/organização & administração , Recursos Financeiros em Saúde , Reforma dos Serviços de Saúde , Modelos Organizacionais , Pensões , Aposentadoria , Previdência SocialRESUMO
The National Kidney Transplant Program with cadaveric donors is based on centralized and unique waitlist, serum bank, and allocation criteria, approved by Instituto Nacional de Donación y Trasplante (INDT) in agreement with clinical teams. The median donor rates over last 3 years is 20 per million population and the median number of waitlist candidates is 450. The increased number of waiting list patients and the rapid aging of our populations demanded strategies for donor acceptance, candidate assignment, and analysis of more efficient and equitable allocation models. The objectives of the new national allocation system were to improve posttransplant patient and graft survivals, allow equal access to transplantation, and reduce waitlist times. The objective of this study was to analyze variables in our current allocation system and to create a mathematical/simulation model to evaluate a new allocation system. We compared candidates and transplanted patients for gender, age, ABO blood group, human leukocyte agents (HLA), percentage of reactive antibodies (PRA), and waiting list and dialysis times. Only 2 factors showed differences: highly sensitized and patients >65 years old (Bernoulli test). An agreement between INDT and Engineering Faculty yielded a major field of study. During 2008 the data analysis and model building began. The waiting list data of the last decade of donors and transplants were processed to develop a virtual model. We used inputs of candidates and donors, with outputs and structure of the simulation system to evaluate the proposed changes. Currently, the INDT and the Mathematics and Statistics Institute are working to develop a simulation model, that is able to analyze our new national allocation system.
Assuntos
Transplante de Rim/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/organização & administração , Adolescente , Adulto , Distribuição por Idade , Idoso , Algoritmos , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Rim , Masculino , Pessoa de Meia-Idade , Alocação de Recursos/organização & administração , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Uruguai , Listas de EsperaAssuntos
Surtos de Doenças/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/organização & administração , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/epidemiologia , Oftalmologia , Alocação de Recursos/organização & administração , Argentina , Hospitais Públicos , Humanos , Triagem , Recursos HumanosRESUMO
INTRODUCTION: Although investment in HIV/AIDS prevention has increased worldwide, it remains uncertain how the additional resources can be most efficiently allocated to maximize the number of infections averted, especially at the country, regional and local levels. METHODS: Data from developing countries in Africa, Asia and Latin America were reviewed on the allocation of HIV/AIDS prevention funds in relation to the prevalence of infection, as well as budgetary allocations for specific population groups at high risk of infection, such as sex workers, intravenous drug users and men who have sex with men. The variation in unit costs of voluntary counselling and testing in five countries was also examined. RESULTS: Evidence was found of three distinct sources of inefficiency in the allocation of HIV/AIDS prevention resources: inefficiency in the mix of interventions selected; inefficient targeting of key populations; and technical inefficiency in the production of HIV prevention services. CONCLUSION: A general conceptual framework for evaluating the efficiency of HIV/AIDS prevention programmes at the country, regional and local levels is proposed. This framework stresses three equally important components of programme efficiency: cost-effectiveness (the choice of the mix of interventions); targeting (the choice of the mix of target populations); and technical efficiency (the delivery of prevention services at least cost).
Assuntos
Países em Desenvolvimento , Infecções por HIV/prevenção & controle , Modelos Econômicos , Serviços Preventivos de Saúde/economia , Alocação de Recursos/organização & administração , África , Ásia , Orçamentos , Análise Custo-Benefício , Feminino , Alocação de Recursos para a Atenção à Saúde , Humanos , América Latina , Masculino , Avaliação de Programas e Projetos de SaúdeRESUMO
Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.
Assuntos
Governo Local , Modelos Econômicos , Atenção Primária à Saúde/economia , Alocação de Recursos/organização & administração , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Chile , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendênciasRESUMO
Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.