Daniele Araújo Campos Szuster

Pesquisa e produção científica em economia da saúde no Brasil

This article presents a diagnosis of the health economics (HE) in Brazil, based on a survey of HE research groups currently registered in the National Council for Scientific and Technological Development (CNPq), as well as an inventory of the Brazilian scientific production in HE, published between January 1999 and June 2004, available in the Bireme Virtual Health Library (Paho/WHO). It describes the data considering geographic regions, types of institution and topics of research. Of the research groups with works related to HE subject matters, 48 have very diversified activities, concentrated in the Southeastern region of the country. Only 14% (376) of the 2.617 publications that had been evaluated were related to HE. Most of the studies were published in 2002 and their main topics were management, financing, allocative efficiency and equity in the distribution of health resources. The diagnosis allows the identification of important aspects that help understand the development of the HE field in Brazil between 1999 and 2004.

Fatores associados à qualidade de vida de pacientes em terapia renal substitutiva no Brasil

End-stage renal disease (ESRD) is a serious public health problem. The study of the impact of renal replacement therapy (RRT) in quality of life (QoL) has become increasingly important. The aim of this study was to evaluate the QoL of patients on RRT and associated factors. 3036 patients on RRT in Brazil were interviewed in relation to socioeconomic, demographic, clinical and QoL aspects. Patients were randomly selected after a cluster sampling process on two levels: health services and patients. QoL was measured by Eq5D. The instrument allows the indirect measurement of QoL and utility calculation, in addition to the direct measurement of QoL by a visual analog scale (VAS). It was observed that transplant patients have better QoL and that the most prejudicial aspects are pain/discomfort and anxiety/depression. The main factors associated with QOL are age, female gender, variables associated with the clinical condition of the patient such as the need for hospitalization and the presence of comorbidities, social class and variables associated with the health service use. The correlation between VAS and utility calculated was moderate and the 5 Eq5D questions explain 43% of the variability of VAS. The calculated utility can be used in cost-utility analysis.

Sobrevida de pacientes em diálise no SUS no Brasil

The aim of this study was to analyze the survival of patients who initiated renal replacement therapy (RRT) with hemodialysis or peritoneal dialysis in the Brazilian Unified National Health System from 2002 to 2004. This was an observational, prospective, non-concurrent study. The study used the National Database for Renal Replacement Therapies resulting from probabilistic matching of Authorization of High-Complexity Procedures/Outpatient Information System and the Mortality Information System. The study included patients admitted in 2002 and 2003, with 3 months of treatment, and 18 years or older. Of the 31,298 patients, the majority: began RRT with hemodialysis, were male, with mean age 54 years, and living in the Southeast region and in municipalities with a mean HDI of 0.78. Increased risk of death was associated with: female gender, age greater than 55 years, diagnosis of diabetes mellitus, peritoneal dialysis, and not residing in the Southeast region. Residing in cities with higher HDI was associated with lower risk. Adjusted risk was HR = 1.17 in favor of hemodialysis. The results suggest shorter survival for peritoneal dialysis and older patients. It is thus necessary to support policies to better evaluate the RRT modality with studies that further elucidate the findings.

Avaliação de efetividade da atenção domiciliar de uma cooperativa médica de Belo Horizonte, Minas Gerais, Brasil

A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter. Higher rates of home visits by physicians and nurses showed a protective dose-response effect on hospitalization-free survival time. The data suggest that regular home visits by physicians and nurses lengthen hospitalization-free survival time among elderly patients enrolled in the program.Foi realizado estudo de coorte retrospectiva com o objetivo de avaliar o impacto do plano de cuidados do Programa de Atencao Domiciliar da Unimed-BH, modalidade Gerenciamento de Casos (PrGC/AD), sobre o tempo livre de hospitalizacao entre os pacientes com 60 anos ou mais assistidos pelo programa. Utilizou-se o modelo de Cox para avaliar o efeito do intervalo entre as visitas domiciliares dos profissionais do programa sobre o tempo livre de hospitalizacao de 2.943 idosos, ajustado por idade, medicamentos em uso, via de alimentacao, ulcera de pressao, deficit cognitivo, dependencia fisica, oxigenioterapia, consultas ambulatoriais e hospitalizacoes no trimestre anterior. Foram fatores de risco para menor tempo livre de hospitalizacao: o grau de dependencia fisica, alimentacao enteral, oxigenioterapia suplementar, ulceras de pressao e hospitalizacoes no trimestre anterior. Observouse efeito protetor dose-resposta da frequencia de visitas medicas e de enfermagem. Os resultados sugerem que visitas domiciliares regulares de medico e enfermeiro aumentam significativamente o tempo livre de hospitalizacao nos pacientes assistidos pelo PrGC/AD.

Home care effectiveness assessment in a health maintenance organization in Belo Horizonte, Minas Gerais State, Brazil

A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter. Higher rates of home visits by physicians and nurses showed a protective dose-response effect on hospitalization-free survival time. The data suggest that regular home visits by physicians and nurses lengthen hospitalization-free survival time among elderly patients enrolled in the program.Foi realizado estudo de coorte retrospectiva com o objetivo de avaliar o impacto do plano de cuidados do Programa de Atencao Domiciliar da Unimed-BH, modalidade Gerenciamento de Casos (PrGC/AD), sobre o tempo livre de hospitalizacao entre os pacientes com 60 anos ou mais assistidos pelo programa. Utilizou-se o modelo de Cox para avaliar o efeito do intervalo entre as visitas domiciliares dos profissionais do programa sobre o tempo livre de hospitalizacao de 2.943 idosos, ajustado por idade, medicamentos em uso, via de alimentacao, ulcera de pressao, deficit cognitivo, dependencia fisica, oxigenioterapia, consultas ambulatoriais e hospitalizacoes no trimestre anterior. Foram fatores de risco para menor tempo livre de hospitalizacao: o grau de dependencia fisica, alimentacao enteral, oxigenioterapia suplementar, ulceras de pressao e hospitalizacoes no trimestre anterior. Observouse efeito protetor dose-resposta da frequencia de visitas medicas e de enfermagem. Os resultados sugerem que visitas domiciliares regulares de medico e enfermeiro aumentam significativamente o tempo livre de hospitalizacao nos pacientes assistidos pelo PrGC/AD.

Evaluación de la eficacia de un programa de atención domiciliaria en una cooperativa médica de Belo Horizonte, Minas Gerais, Brasil

A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter. Higher rates of home visits by physicians and nurses showed a protective dose-response effect on hospitalization-free survival time. The data suggest that regular home visits by physicians and nurses lengthen hospitalization-free survival time among elderly patients enrolled in the program.Foi realizado estudo de coorte retrospectiva com o objetivo de avaliar o impacto do plano de cuidados do Programa de Atencao Domiciliar da Unimed-BH, modalidade Gerenciamento de Casos (PrGC/AD), sobre o tempo livre de hospitalizacao entre os pacientes com 60 anos ou mais assistidos pelo programa. Utilizou-se o modelo de Cox para avaliar o efeito do intervalo entre as visitas domiciliares dos profissionais do programa sobre o tempo livre de hospitalizacao de 2.943 idosos, ajustado por idade, medicamentos em uso, via de alimentacao, ulcera de pressao, deficit cognitivo, dependencia fisica, oxigenioterapia, consultas ambulatoriais e hospitalizacoes no trimestre anterior. Foram fatores de risco para menor tempo livre de hospitalizacao: o grau de dependencia fisica, alimentacao enteral, oxigenioterapia suplementar, ulceras de pressao e hospitalizacoes no trimestre anterior. Observouse efeito protetor dose-resposta da frequencia de visitas medicas e de enfermagem. Os resultados sugerem que visitas domiciliares regulares de medico e enfermeiro aumentam significativamente o tempo livre de hospitalizacao nos pacientes assistidos pelo PrGC/AD.

Utilização de eritropoetina por pacientes incidentes em hemodiálise no Sistema Único de Saúde, Brasil, 2002-2003

This study aimed to describe the demographic and epidemiological profile of Brazilian patients entering hemodialysis from 2002 to 2003 and identify predictors of erythropoietin use. The study analyzed demographic and clinical characteristics and dialysis facility-related variables from 32,136 patients identified by deterministic-probabilistic matching in the database of authorizations for high-cost procedures and the Mortality Information System. Poisson regression was used to identify predictors of erythropoietin use. Male gender, age < 65 years, diabetic renal failure, arteriovenous fistula at the beginning of hemodialysis, and living in States of Brazil other than Mato Grosso were predictors of erythropoietin use. The policy of care for chronic kidney disease, resource allocation for States and municipalities, and anemia management according to the patients drug therapy profile need to be revised in order to reduce observed inequities in erythropoietin use.