RESUMO
BACKGROUND: In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil. PURPOSE: To describe the successful experience of the TNMG in 10 years of activities. METHODS: The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff. RESULTS: Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction. CONCLUSIONS: The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the quality of the PHC.
Assuntos
Atenção Primária à Saúde/organização & administração , Consulta Remota/organização & administração , Atitude do Pessoal de Saúde , Brasil , Comportamento do Consumidor , Análise Custo-Benefício , Apoio Financeiro , Humanos , Monitorização Ambulatorial/economia , Monitorização Ambulatorial/métodos , Atenção Primária à Saúde/economia , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde/organização & administração , Consulta Remota/economia , Telemedicina/organização & administraçãoRESUMO
Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.
Assuntos
Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Apneia Obstrutiva do Sono/diagnóstico , Pressão Positiva Contínua nas Vias Aéreas , Análise Custo-Benefício , Humanos , Monitorização Ambulatorial/economia , Polissonografia , Apneia Obstrutiva do Sono/terapiaRESUMO
Stress is a hypothesized pathway in socioeconomic status (SES)-physical health associations, but the available empirical data are inconsistent. In part, this may reflect discrepancies in the approach to measuring stress across studies, and differences in the nature of SES-stress associations across demographic groups. We examined associations of SES (education, income) with general and domain-specific chronic stressors, stressful life events, perceived stress, and stressful daily experiences in 318 Mexican-American women (40-65 years old). Women with higher SES reported lower perceived stress and fewer low-control experiences in everyday life (ps < .05), but greater chronic stress (education only, p < .05). Domain-specific analyses showed negative associations of income with chronic housing and financial stress (ps < .05), but positive associations of SES with chronic work and caregiving stress (all ps < .05 except for income and caregiving stress, p < .10). Sensitivity analyses showed that most SES-stress associations were consistent across acculturation levels. Future research should adopt a multi-dimensional assessment approach to better understand links among SES, stress, and physical health, and should consider the sociodemographic context in conceptualizing the role of stress in SES-related health inequalities.
Assuntos
Americanos Mexicanos/etnologia , Classe Social , Estresse Psicológico/etnologia , Aculturação , Adulto , Idoso , Doença Crônica/economia , Feminino , Humanos , Acontecimentos que Mudam a Vida , Americanos Mexicanos/psicologia , Pessoa de Meia-Idade , Monitorização Ambulatorial/economia , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Estresse Psicológico/economia , Estresse Psicológico/psicologiaRESUMO
Chronic diseases are currently recognized as one of the leading causes of mortality and morbidity worldwide. On top of this, these diseases represent a major burden for the healthcare systems in terms of costs and resources, which is driving them to define and adopt novel programs for prevention and chronic disease management. Still, many aspects of the processes of care and follow up of these patients remain unsolved and there is yet uncertainty on how technology can provide an added value to the current processes of care. This paper addresses the importance of the adoption of strategies for the anticipation to acute events within the disease management programs and suggests a holistic approach to embrace the healthcare organizations in the design development and implementation of the new personal health systems.