Mônica Viegas Andrade

Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project

BACKGROUND Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. OBJECTIVE To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. METHODS The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. RESULTS The average cost of an ECG in the MTC project was R

Desigualdade socioeconômica no acesso aos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras em 1998 e 2008

28.92, decomposed into R

Antenatal care use in Brazil and India: scale outreach and socioeconomic inequality.

8.08 for the cost of implementation and R

Implementation of a telecardiology system in the state of Minas Gerais: the Minas Telecardio Project

20.84 for maintenance. The cost simulation of the ECG with referral ranged from R

Determinants of expenditures on dialysis in the Unified National Health System, Brazil, 2000 to 2004

30.91 to R

Income transfer policies and the impacts on the immunization of children: the Bolsa Família Program

54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsors and societys points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. CONCLUSION The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.

Brazilian Valuation of EQ-5D-3L Health States: Results from a Saturation Study.

Este artigo mensura a desigualdade socioeconomica no acesso aos servicos de saude no Brasil e regioes, em 1998 e 2008. A analise controla por fatores predisponentes, capacitantes e de necessidade. Os resultados mostram um aumento das taxas de utilizacao e reducao das desigualdades no cuidado primario, especialmente entre individuos sem plano sugerindo melhora nos servicos publicos. A excecao e a utilizacao de servicos odontologicos, que ainda apresenta desigualdade elevada e maior utilizacao entre individuos com plano. Para o indicador de problema de acesso, observa-se ainda desigualdade favoravel aos ricos. Ao controlar para plano de saude, essa desigualdade se reduz consideravelmente.

Inpatient care of the elderly in Brazil and India: Assessing social inequalities

This paper investigates the extent of socioeconomic inequalities in antenatal care use and related medical procedures in Brazil and India, which represent transition economies with contrasting geographical and sociocultural composition and health care provision. Concentration indices and regression analyses applied on recent Demographic Health Survey data reveal high and proportionate distribution of antenatal coverage in Brazil, whereas the Indian case present problems of both scale and equity. Inequalities in access to four or more antenatal visits are significantly pronounced in India, and in Brazil the differences are significant only for those who had six or more visits. Brazils universal healthcare model which proved effective in promoting equitable distribution of antenatal care could be implemented in India. Future interventions should emphasis quality of care in monitoring essential antenatal services especially targeting the poor and deprived communities.

Implantação de um sistema de telecardiologia em Minas Gerais: projeto Minas Telecardio

FUNDAMENTO: Embora as doencas cardiovasculares sejam a maior causa de morbimortalidade em todo Brasil, o acesso das populacoes de cidades pequenas a eletrocardiografia e a avaliacao cardiologica e limitado. O uso da telecardiologia para facilitar o acesso da populacao de municipios remotos a eletrocardiografia e a segunda opiniao em cardiologia e promissora, entretanto nao foi formalmente testada. OBJETIVO: Avaliar a viabilidade de se implantar o sistema publico de telecardiologia de baixo custo em pequenas cidades brasileiras. METODOS: Foram selecionadas 82 cidades do Estado de Minas Gerais, com populacao 70% de cobertura pelo Programa Saude da Familia (PSF), com interesse do gestor e acesso pela internet. Em cada municipio foi instalado um aparelho de eletrocardiografo (ECG) digital, com subsequente treinamento da equipe. A implantacao foi coordenada pelo HC/UFMG, em conjunto com outros quatro hospitais universitarios mineiros (UFU, UFTM, UFJF e UNIMONTES). Os ECGs foram realizados nos municipios e enviados pela internet para analise imediata em plantao de telecardiologia. Realizaram-se discussoes de casos medicos on-line e off-line e cursos de atualizacao via web. RESULTADOS: No periodo de implantacao, foram treinados 253 profissionais de saude. De julho de 2006 a novembro de 2008, o projeto atendeu 42.664 pacientes, realizando 62.865 ECGs. Foram efetuados 2.148 atendimentos de urgencia e 420 teleconsultorias. A avaliacao intermediaria apontou boa aceitacao da tecnologia implantada e uma diminuicao de 70% de encaminhamentos de pacientes para outros centros de referencia. CONCLUSAO: E factivel a utilizacao de recursos habituais de informatica para facilitar o acesso de populacoes de cidades pequenas a eletrocardiografia e avaliacao cardiologica especializada.BACKGROUND Although cardiovascular diseases are the main cause of morbimortality in Brazil, the access of small-town populations to electrocardiography and cardiology assessment is limited. The use of telecardiology to assist the access of distant towns to electrocardiography and a second opinion in cardiology is promising; however, it has not been formally assessed. OBJECTIVE To assess the feasibility of implementing a low-cost public telecardiology system in small Brazilian towns. METHODS A total of 82 towns in the state of Minas Gerais, with a population < 10,500 inhabitants, presenting > 70% coverage by the Family Health Program (Programa Saude da Familia-PSF), local government compliance and internet access, were selected. Each town was supplied with digital electrocardiography (ECG) device and a team was trained. The implementation was coordinated by HC/UFMG, together with four university hospitals in the state of Minas Gerais (UFU, UFTM, UFJF and UNIMONTES). The ECG assessments were carried out in the towns and sent through the Internet for prompt analysis by an on-duty telecardiology team. Online and offline discussions on the medical cases were carried out through the Internet, as well as refreshment courses. RESULTS During the implementation period, a total of 253 health professionals were trained. From July 2006 to November 2008, the project assisted 42,664 patients, with a total of 62,865 ECG assessments being performed. A total of 2,148 emergency cases were treated, as well as 420 teleconsultations. The intermediate evaluation showed good acceptance of the implemented technology and a 70% decrease in patient referrals to other reference centers. CONCLUSION The use of the customary resources in informatics to assist the access of small-town populations to electrocardiography and specialized cardiology assessment is feasible.

Health and economic growth among the states of Brazil from 1991 to 2000

The aim of this study was to compare total outpatient expenditures on hemodialysis and peritoneal dialysis from 2000 to 2004 in patients that began dialysis in 2000 under the Unified National Health System (SUS). A historical cohort was developed, consisting of patients that began dialysis in 2000, identified by probabilistic matching in the database of Authorizations for High-Complexity/High-Cost Procedures (APAC). A multiple linear regression model was used, including individual and clinical attributes and health services supply variables. The cohort included 10,899 patients, 88.5% of whom began hemodialysis and 11.5% peritoneal dialysis. The dialysis modality explains 12% of the variance in expenditures, and patients in peritoneal dialysis showed 20% higher mean annual expenditure. The differences in expenditures are explained according to the State of Brazil and health services supply level. Individual risk variables did not alter the models explanatory power, while age and diabetes mellitus were significant. The study showed the importance of the National Health Systems payment mechanism for explaining differences in expenditures on dialysis treatment in Brazil.