RESUMO
BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.
Assuntos
Neoplasias Colorretais , Melhoria de Qualidade , Adulto , Humanos , Pessoa de Meia-Idade , Idoso , Detecção Precoce de Câncer/métodos , Neoplasias Colorretais/diagnóstico , Saúde Pública , Atenção Primária à SaúdeRESUMO
BACKGROUND: The patients' guide by the Batz Patient Safety Foundation promotes patients' active participation in healthcare and a safe hospital experience. OBJECTIVE: The aim was to adapt the Spanish version of the guide to the local context and evaluate its acceptability from healthcare professionals' and patients' perspectives in two hospitals in Buenos Aires, Argentina. METHODS: This implementation study had a formative research phase to adapt the guide with input from individual interviews and focus group discussions. The intervention comprised training sessions for professionals on patient-centered care and use of the guide, the appointment of coordinators, and distribution of the guide. The adapted guide (section During Admission) was distributed in two hospitals. Before and after intervention, we administered surveys to explore acceptability, utility, and patient satisfaction. RESULTS: Findings from formative research showed that the Batz guide needed to be shortened and adapted to the local healthcare context Although professionals had agreed on the importance of clinical guidelines; after using the Batz guide, they found it complex and difficult to implement. Patients' satisfaction with healthcare before and after implementing the guide did not differ significantly. Best scores were found in items related to availability of nurses, staff competence and staff kindness. A 78% of patients found the Batz guide useful. CONCLUSION: It is of critical importance to adapt the guide to the local culture, pilot it, and provide training to promote its implementation, improving acceptability and utility.
Assuntos
Pessoal de Saúde , Hospitais , Humanos , Pesquisa Qualitativa , Grupos Focais , Assistência Centrada no PacienteRESUMO
Although obesity and non-communicable disease (NCD) prevention efforts to-date have focused mainly on individual level factors, the social and physical environments in which people live are now widely recognized as important social determinants of health. Obesogenic environments promote higher dietary energy intakes and sedentary behaviors, thus contributing to the obesity/NCD burden. To develop quality indicators (QIs) for measuring food and physical activity (PA)-built environments in municipalities. A literature review was conducted. Based on the best practices identified from this review, a draft set of candidate QI was retrieved. The initial 67 QIs were then evaluated by a modified Delphi panel of multidisciplinary health professionals (n = 40) to determine their relevance, validity, and feasibility in 3 rounds of voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. Response rate for the panel was 89.4%. All final 42 QIs were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses for the PA domain: (i) promotion of PA; and (ii) improvements in the environment to strengthen the practice of PA; and for Food environment domain: (i) promotion of healthy eating; (ii) access to healthy foods; and (iii) promotion of responsible advertising. We generated a set of indicators to evaluate the PA and food built environment, which can be adapted for use in Latin American and other low- and middle-income countries.
The built environment has a considerable effect on health indicators such as physical activity, eating behavior, and community. There is considerable research evidence demonstrating a direct relationship between our built environments and our health. In Argentina, the Healthy Municipalities and Communities Program focuses in health promotion interventions. It was developed to seek collaboration among community members, local government authorities and other stakeholders in order to improve quality of life. However, up to date, there has not been a homogenous measure to evaluate how well a particular locality or a whole municipality supports the health and wellbeing its residents. The proposed study aims to develop a set of local valid and common measures in order to evaluate what is happening within a particular municipality. A designated group of local experts will select a set of final measures trough out an iterative multistage process in order to combine opinion into group consensus. We will ask the panel to rate, discuss and re-rate the proposed measures (based on the existing evidence). This will study provide an evaluative tool to inform policy making and program implementation, and to guide programs and initiatives aimed at combating obesogenic environments in municipalities and communities.
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Exercício Físico , Indicadores de Qualidade em Assistência à Saúde , Acesso a Alimentos Saudáveis , Argentina , Ambiente Construído , Doença Crônica , HumanosRESUMO
OBJECTIVE: To assess whether the implementation of a package of activities through the joint action of three international healthcare professional associations (HCPAs) increased the use of essential interventions (EIs) for delivery and neonatal care. METHODS: A noncontrolled pre-intervention versus post-intervention study was conducted from June 13 to December 13, 2016, among women older than 18 years of age, who had delivered at one of two urban tertiary hospitals in Nepal. RESULTS: The study included 9252 women. Minimal change was found after the implementation of EIs that were used frequently at baseline (e.g. social support during delivery in the emergency room, and promotion and support for early initiation of breastfeeding). By contrast, an increase was recorded for some EIs that had not been used regularly at baseline. For example, the rate of timely administration of prophylactic antibiotics before cesarean delivery increased from 0.0% (0/496) to 94.0% (409/435) at one hospital. Nonetheless, some EIs with low use at baseline did not show improvement after implementation (e.g. kangaroo mother care). CONCLUSION: The present study strengthened previous findings regarding the uptake of EIs following joint promotion by HCPAs in low-income settings.
Assuntos
Antibioticoprofilaxia/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Parto Obstétrico/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Melhoria de Qualidade , Sociedades Médicas , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Cesárea , Atenção à Saúde/métodos , Atenção à Saúde/normas , Feminino , Promoção da Saúde/normas , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Método Canguru/estatística & dados numéricos , Nepal , Gravidez , Avaliação de Programas e Projetos de Saúde , Apoio Social , Adulto JovemRESUMO
BACKGROUND: Re-use of medical devices labeled and marketed for single use only is a current practice around the world. OBJECTIVES: To estimate the average difference per surgery in device-related costs (DRCs) when performed with single-use devices under a single-use policy (SUP) instead of a re-use policy (RP) from the perspective of the private health sector of Argentina. METHODS: An analytical model was developed in Microsoft Excel and populated with data from a literature review, a Delphi-like panel, and local cost estimations. Four single-use devices were selected for analysis: plastic trocars, endocutters, linear cutters, and harmonic scalpels. DRCs were expressed in 2012 US dollars and divided into four cost categories: devices, adverse events, device failure, and surgical time extension. Outputs were expressed as DRCs per surgery under a SUP, under a RP, the difference between them expressed in US dollars (Diff_$), and the difference between them expressed as a percentage of surgery costs (Diff_%S). Deterministic and probabilistic sensitivity analyses were performed to analyze the impact of uncertainty on results. RESULTS: Expected DRCs per surgery were as follows: for trocars: SUP, US $424.6; RP, US $244.2; Diff_$, US $-180.4; and Diff_%S, -3.8%; for endocutters: SUP, US $1667.4; RP, US $1102.3; Diff_$, US $-565.1; and Diff_%S, -11.1%; for linear cutters: SUP, US $1228.1; RP, US $1045.9; Diff_$, US $-182.2; and Diff_%S, -3.4%; and for harmonic scalpels: SUP, US $1040.9; RP, US $292.4; Diff_$, US $-748.5; and Diff_%S, -14.8%. Sensitivity analyses showed results to be robust. CONCLUSIONS: RP was shown to be less costly in all devices and scenarios considered. Nevertheless, the real frequency of adverse events and their cost implications are still uncertain. More research is needed to assess the effectiveness and safety of these off-label policies.
Assuntos
Análise Custo-Benefício , Instrumentos Cirúrgicos , Humanos , Controle de Infecções/normas , Instrumentos Cirúrgicos/economia , Instrumentos Cirúrgicos/estatística & dados numéricosRESUMO
OBJECTIVE: To assess whether the implementation of a package of activities through the joint action of the three international healthcare professionals associations (HCPAs) increased the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda. METHODS: A non-controlled before-and-after study was undertaken to evaluate the effect of a package of activities designed to change practice relating to nine EIs among providers. Coverage of the EIs was measured in a 3-month pre-implementation period and a 3-month post-implementation period in 2014. Data were obtained for women older than 18 years who delivered vaginally or by cesarean. RESULTS: Overall, 4816 women were included. Level of use remained high for EIs used widely at baseline. Some EIs that had low use at baseline did not show improvement after the implementation. Promotion of breastfeeding showed a significant improvement in the Kampala hospital, from 8.5% (8/94) to 25.6% (30/117; P=0.001), whereas promotion of hygiene in cord care improved at the Mbarara hospital, from 0.1% (2/1592) to 46.0% (622/1351; P<0.001). CONCLUSION: These exploratory results show that a package delivered through the joint work of the three HCPAs was feasible to implement along with rigorous data collection. Although the data show disparities, trends suggest that improvement could be achieved.
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Relações Interprofissionais , Serviços de Saúde Materno-Infantil/normas , Equipe de Assistência ao Paciente , Assistência Perinatal/normas , Adolescente , Adulto , Aleitamento Materno , Feminino , Hospitais , Humanos , Inovação Organizacional , Gravidez , Melhoria de Qualidade , Uganda , Adulto JovemRESUMO
INTRODUCCIÓN La hipertensión arterial constituye uno de los principales factores de riesgo de las enfermedades cardiovasculares. Dado su impacto, no sólo a nivel individual sino de la salud pública, es recomendable proporcionar la mejor calidad de atención a los pacientes hipertensos. OBJETIVOS Estimar la brecha entre el cuidado recomendado y el cuidado recibido en los tres subsistemas del sistema de salud, a partir de una muestra de adultos con hipertensión atendidos en el ámbito ambulatorio de la ciudad y la provincia de Buenos Aires. MÉTODOS Se realizó un estudio de corte transversal en tres centros de atención médica. Utilizando un formulario de extracción previamente validado, se revisaron las historias clínicas de pacientes hipertensos mayores de 50 años que habían asistido a la consulta ambulatoria al menos una vez en el último año. Se consideró que alcanzaban el nivel óptimo aquellos pacientes que recibían todos los cuidados recomendados. Asimismo, se estudiaron variables sociodemográficas, comorbilidades de los pacientes y aspectos estructurales de cada subsistema. RESULTADOS Se analizó un total de 295 historias clínicas de hipertensos mayores de 50 años de tres centros de atención. En conjunto, el puntaje global de cada subsector mostró diferencias significativas: la seguridad social presentó el mayor nivel de adherencia a los cuidados recomendados con el 22,70%, frente al 2,30 y 2,50% del sector público y privado, respectivamente. Del total de los pacientes con calidad de atención óptima, el 16,22% poseía valores de tensión arterial menores a 150/90 mmHg en los últimos nueve meses. DISCUSIÓN La calidad de atención de los pacientes hipertensos en los tres subsectores del sistema de salud argentino dista de ser la ideal. La herramienta para la extracción de datos ofrece una alternativa útil y fiable para evaluar el desempeño de los sistemas de salud