Management In Health, MIH (National School of Public Health, Management, Romania)
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MANAGEMENTUL PACIENTULUI CU POLIARTRITA REUMATOIDA IN ROMANIA
No full textIntroduction. Rheumatoid Arthritis is a chronic disease with long evolution which produces important consequences at the level of patient and society, a disease with several available therapeutic options, but not all of them having the same effects. The therapeutic measures are applied on a long term basis and they are, in most of the time, the result of medical practice guidelines developed at local or international level. Methods. The authors made a revision of the local and international speciality literature regarding rheumatoid arthritis and studied the legal framework in Romania regarding the medical practice guidelines, therapeutic protocols and treatment reimbursement conditions. Results. In Romania the management of patient with rheumatoid arthritis is based on several clinical and administrative decisions, reflected into the medical practice guidelines and therapeutic protocols with normative value. Because of high costs, the availability of biologic therapies for the rheumatoid arthritis patients is restricted only to these patients with approved treatment by the public payer, according to specific therapeutic protocols developed by the Ministry of Health and National Health Insurance House. The limited available financial resources in the social health insurance system create the conditions for waiting lists of the patients with medical recommendation for expensive therapies. Conclusions. The management of patient with rheumatoid arthritis is a complex process related with patient factors, but also with the health system functionality. In Romania, the usage of newly and expensive treatments requires the utilization of some medical practice guidelines and therapeutic protocols which should rely more and more on the effectiveness rather than the efficacy of treatments, considering the fact that clinical data regarding effectiveness of drugs treatments started to be available. Key words: patient management, rheumatoid arthritis, efficacy, effectiveness therapeutic protocols, quality of lifeIntroducere. Poliartrita reumatoida este o boala cronica cu evolutie indelungata, ce are consecinte importante la nivel individual si social si la care optiunile terapeutice disponibile sunt multiple, dar nu toate produc aceleasi efecte. Masurile terapeutice recomandate se utilizeaza timp indelungat si sunt de cele mai multe ori rezultatul unor ghiduri de practica medicala, dezvoltate la nivel national sau international. Metodologie. Autorii au realizat o revizie a literaturii de specialitate privind poliartrita reumatoida la nivel mondial si in Romania si au studiat cadrul normativ in Romania privind ghidurile de practica medicala, protocoalele de tratament si conditiile de finantare ale tratamentului bolii. Rezultate. Managementul pacientului cu poliartrita reumatoida in Romania presupune o serie de decizii clinice si administrative reflectate in ghiduri de practica si protocoale de tratament cu valoare normativa. In Romania, datorita costurilor ridicate, disponibilitatea terapiilor biologice la pacienti este conditionata de aprobarea tratamentului de catre tertul-platitor, pe baza unor protocoale terapeutice elaborate de Ministerul Sanatatii si Casa Nationala de Asigurari de Sanatate. Insuficienta resurselor financiare la nivelul sistemului asigurarilor sociale de sanatate face ca accesul la terapiile mai scumpe sa fie limitat si conditionat de existenta unor liste de asteptare. Concluzii. Managementul pacientului cu poliartrita reumatoida este un proces complex, conditionat de mai multi factori ce tin de pacient, dar si de functionalitatea sistemului de sanatate. Utilizarea in Romania a unor tratamente novatoare si costisitoare presupune urmarirea unor ghiduri de practica sau a unor protocoale, care sa se bazeze pe eficacitatea practica mai degraba decat pe eficacitatea clinica a tratamentelor, in conditiile in care incep sa fie disponibile date clinice privind efectele terapeutice ale acestor medicamente. Cuvinte cheie: managementul pacientului, poliartrita reumatoida, eficacitate, ghiduri de practica, protocoale terapeutice, calitatea vieti
INITIEREA UNUI PROGRAM DE FORMARE IN DOMENIUL EPIDEMIOLOGIEI APLICATE,IN TURCIA
No full textAbstractField Epidemiology and Training Programmes are intended to strengthen the public health capacity within Ministries of Health by developing the human resource infrastructure within countries. The success of these programmes depends in a large part upon Ministry of Health involvement in the development process. Participation of the Ministry of Health in the development of the training programme is essential because of their knowledge of the health system and the pre-existing skills of their staff who are generally the training participants. Incorporating local stakeholders such as universities into the training programmes is also desirable in the early stages of programme development. The involvement universities helps to institutionalize the programme by creating ties with existing learning institutions, allows development of local language training materials, makes local mentoring of trainees possible, and enhances the sustainability of the programmes. This paper outlines the initial steps in the development process in Turkey of a Field Epidemiology and Training Programmes under the Strengthening of the Epidemiological Surveillance and Control of Communicable Diseases System phase I and II. Keywords: field epidemiology, training, human resurces managementRezumat Programele de formare in domeniul epidemiologiei aplicate sunt destinate sa consolideze capacitatea de sanatate publica in cadrul ministerelor sanatatii, prin dezvoltarea infrastructurii de resurse umane, la nivel national. Succesul acestor programe depinde, in mare parte, de implicarea Ministerul Sanatatii in procesul de dezvoltare. Participarea Ministerului Sanatatii in dezvoltarea programului de formare este esentiala datorita bunei cunoasteri a sistemului de sanatate si competentelor preexistente a personalului din minister, care sunt, in general, participanti ai procesului de instruire. De asemenea, este de dorit participarea, inca din stadiile incipiente de dezvoltare a programului, a partilor interesate de la nivel local, cum ar fi universitatile. Implicarea universitatilor ajuta la institutionalizarea programului prin crearea de legaturi cu institutiile existente de invatamant, permite dezvoltarea de materiale de curs in limba oficiala, face posibila indrumarea cursantilor, si sporeste durabilitatea programelor. Aceasta lucrare prezinta pasii initiali ai procesului de dezvoltare a unui program de formare in domeniul epidemiologiei aplicate, desfasurat in cadrul Proiectului de Consolidare a Sistemului de Supraveghere Epidemiologica si Control al bolilor Transmisibile din Turcia (faza I si faza II). Cuvinte cheie: epidemiologie aplicata, formare, management, resurse uman
UTILIZAREA UNOR SPITALE INCHISE CA FACILITATI PROVIZORII DE INGRIJIRE A PACIENTILOR IN SITUATIILE CU AFLUX DE VICTIME IN MASA
No full textAbstractThe health care system in America is close or very near to the limit of its operating capacity, both in urban and rural environments, with very little opportunity to expand if needed to respond to unusual events with an influx of mass casualties or a sudden event This activity is managed by public health administrations which are organized so that to update the evidence on shuttered hospital capacities and status of each health facility. The same need arises in Romania following the recent measures to restrict the number of hospital beds. The difference between the two health care systems is the necessary capabilities, facilitated by principles of medical resource planning, for incidents with mass casualties. This is hampered by the effort to fit the Romanian Hospital Service into some economic indicators that have no relevance in terms of ensuring health care capacities, in exceptional circumstances.This article provides suggestions to allow decommissioning of closed facilities in Romania. Keywords: health care capacities, hospital beds, number of hospitals, influx of casualties, shuttered hospitals.Sistemul de ingrijiri de sanatate din SUA, fiind pastrat la limita capacitatii sale de functionare in mod obisnuit, are nevoie, pentru a fi profitabil, de o expandare rapida si ordonata in cazul producerii unor incidente cu aflux masiv de victime. Aceasta activitate este asigurata de administratiile de sanatate publica organizate astfel incat sa tina evidenta capacitatilor spitalicesti inchise precum si sa revizuiasca periodic starea in care se afla. Acelasi lucru devine imperios necesar si la noi in urma recentelor masuri de restrangere a numarului de paturi si spitale.Diferenta dintre cele doua sisteme de ingrijiri de sanatate o face grija fata de asigurarea capacitatilor necesare, pe de o parte, si stradania de a ne incadra in niste indicatori economici care nu au nici o relevanta din punct de vedere al asigurarii capacitatii de ingrijire a sanatatii, in situatii exceptionale, si respectarea principiilor de planificare a resurselor medicale in cazul incidentelor cu aflux masiv de victime, pe de alta parte.Acest articol ofera sugestii pentru a permite dezafectarea unitatilor sanitare inchise, din Romania. Cuvinte cheie: Capacitati de ingrijire a sanatatii, numar de paturi de spital, numar de spitale necesare, situatii cu aflux masiv de victime, spitale inchise
MEDICINA PERSONALIZATA - o noua abordare in domeniul ingrijiriilor de sanatate, la nivel european
No full textAbstract The revolution in medicine related to the concept of "personalized medicine" consists in finding individualized treatment for each patient but also in testing and monitoring its effectiveness. The concept is perceived as a challenge for Healthcare policy in the European context and the concerns are related to aspects such as: Patient's Hopes & Concerns, Patient Rights, Opportunities & Challenges, Cost of Medicine.Research must support and stay at the basis of a good understanding of disease mechanism and then, based on these scientific evidence, specific scientific advice must be produced and provided in this field, at European and international level. Key words: personalized medicine, opportunities, challenges, social, economic, ethic, political, values.Rezumat Revolutia in medicina, legata de conceptul “medicina personalizata” consta in gasirea tratamentului individualizat fiecarui pacient dar si in testarea si monitorizarea eficientei acestuia. Conceptul este perceput ca o provocare pentru politica din domeniul sanatatii, in context european, iar preocuparile sunt legate de aspecte precum: asteptarile si preocuparile pacientilor, drepturile pacientilor, oportunitatile, provocarile si costurile medicinei personalizate. Cercetarea trebuie sa sprijine si sa stea la baza unei bune intelegeri a mecanismului bolii, iar apoi, pe baza acestor dovezi stiintifice, consilierea stiintifica (science advice) specifica acestui domeniu trebuie produsa si furnizata la nivel european si international. Cuvinte cheie: medicina personalizata, oportunitati, provocari, valori, sociale, economice, etice, politic
GOVERNMENT RESPONSIVENESS: THE EXTENT OF EQUITY IN HEALTH SERVICES IN TURKEY
Get PDFWhy is the objective of equity in the health sector significant? What is the relevance of equity, particularly in a medium-income country like Turkey, which has been ‘structurally adjusting’ for over three decades which planned to cut government expenditures by encouraging ‘cost-effectiveness’ and ‘efficiency’ in public services including the health sector? Has the health reform in Turkey since the early 1990s succeeded in ensuring its enhancement, despite an extensive discussion on equity?In this study, equity in the health sector in Turkey were analysed considering its basic dimensions including finance and provision. The Health Services Utilization Survey (HUS) conducted in 1992 was used us to show the extent of the problem of inequity in the health system in Turkey and the areas of intervention toward a more equitable health sector. This has been instrumental in understanding how and why equity can be relevant in enhancing the responsiveness of the government to the health care needs of the population. The analysis revealed that the inequity problem in Turkey was mainly from the inequalities in health insurance coverage and the geographical distribution of the health care resources. To overcome structural problems as well as inefficiencies in the health system, government started a series of reforms under the Health Transformation Project in 2003. The unification of the existing health insurance schemes and introduction of the universal health insurance to the whole population in 2008 was a prominent change in the health system. Our framework of analysis in this study can provide a basis for evaluating the effect of recent changes to the equity in health system in Turkey. A similar analysis will enable whether there has been any improvement in the health system in reaching its equity objective
CALITATEA SI COSTUL SERVICIILOR DE SANATATE: O PERSPECTIVA DIN INDIA O EVALUARE A COSTURILOR DIRECTE ALE CALITATII IN SPITALELE DIN INDIA
No full textWith recent advances in healthcare, quality has become a pertinent issue. As the demand for healthcare is rapidly rising with increasing population base and increasing levels of affordability, so is the demand for quality healthcare services. Superior quality of medical care is often associated with higher costs of hospitalization. This paper attempts to explore the relationship between quality of medical care services and the cost of hospitalization across hospitals in India. The findings have indicated a strong positive association between the cost of hospitalization and infrastructure, while a negative association was observed between staff to patient ratios. Though both these parameters affect and contribute to superior quality of care their impact of cost of hospitalization differs significantly.O data cu descoperirile recente din sanatate, calitatea a devenit un aspect pertinent. O data cu cresterea cererii pentru servicii de sanatate, avand ca substrat cresterea populationala si a nivelului de disponibilitate financiara, a crescut si cererea pentru ingrijiri medicale de calitate. Calitatea superioara a ingrijirilor medicale este deseori asociata cu costuri de spitalizare ridicate. Acest articol urmareste sa exploreze relatia dintre calitatea ingrijirilor medicale si costurile de spitalizare in spitalele din India. Rezultatele au indicat o stransa asociere pozitiva intre costurile de spitalizare si infrastructura, in timp ce pentru raportul personal medical/pacient s-a identificat o asociere negativa. Desi ambii parametrii influenteaza si contribuie la o calitate superioara a ingrijirilor, impactul asupra costurilor spitalizarii difera in mod substantial
THE THERAPEUTIC MANAGEMENT OF THE GIANT GASTRIC NEUROENDOCRINE TUMOR (NET) – CASE REPORT
Get PDF In Romania, circa 1.3 milioane de romani sufera de o boala rara in cursul vietii lor. Desi au o prevalenta scazuta in randul populatiei, bolile rare pot fi considerate o prioritate de sanatate publica, in masura in care consecintele bolii sunt numeroase si se manifesta pe toate planurile (boli cu potential letal, invalidante, costuri economice si sociale ridicate etc.). Tumorile neuroendocrine gastrice (TNE), in principal, prin potentialul lor metastazant, reprezinta una dintre categoriile de tumori cu evolutie nefavorabila. Ca urmare a potentialului de crestere in volum a unora dintre formele clinice ale TNE, conduita terapeutica a acestor forme necesita o abordare complexa, etapizata, precum si multidisciplinara. Cazul prezentat in articolul de fata sustine necesitatea abordarii multisectoriale a managementului de caz pentru bolile extrem de rare, asa cum este situatia tumorilor neuroendocrine digestive. Prezentarea tardiva, dimensiunea semnificativa a tumorii, precum si lipsa altor simptome evocatoare ale unei tumori secretante, derivate din sistemul endocrin difuz, impun o abordare inter-disciplinara pentru rezolvarea cazului, cu chemoembolizare preoperatorie, extrem de utila pentru reducerea volumului tumoral. Depistarea, diagnosticarea, tratarea, monitorizarea si supravegherea ulterioara a cazului sunt fazele implicite ale managementului eficient al cazului, iar desfasurarea acestor faze trebuie sa se realizeze prin colaborarea si participarea activa a unei echipe multidisciplinare. Cuvinte cheie: tumora neuroendocrina giganta, conduita terapeutica, abordare multidisciplinara, studiu de cazIn Romania, about 1.3 million people suffer from a rare disease in their lifetime. Although a low prevalence in the population, rare diseases can be considered a public health priority, as their consequences are numerous and occur on many dimensions (diseases generating death, invalidity, high economic and social costs, etc.). Gastric neuroendocrine tumors (NET), mainly through their metastatic potential, is a type of tumors with unfavorable evolution. Because of their potential to increase their size and volum, the therapeutic approach of these forms is complex, phased and multi-disciplinary. The case we presented strengthens the necessity for using a multisectoral approach in case management of rare diseases, as neuroendocrin tumor is. The late presentation of the patient, with a tumor having significant dimensions, as well as the absence of other evocative symptoms of an secreting tumors derived from the diffuse endocrine system, requires an inter-disciplinary approach to solving the case with preoperative chemical embolization extremely useful for reducing tumor volume. Detection, diagnosis, treatment, monitoring and subsequent supervision of the case must be achieved through collaboration and active participation of a multidisciplinary medical team. Keywords: Giant neuroendocrin tumor, therapeutic management, mutidisciplinary approach, case study
MANAGEMENTUL NOU-NASCUTULUI PREMATUR, IN ROMANIA
No full textAlthough significant improvements in Romania health indicators were made since 1990’s neonatal, post neonatal and infant mortality rates remain high in regional comparison and continue to give rise to concern.The chief aim of our project proposal “National Registry for premature neonates born before 32 gestational ages” is to maintain and improve the quality and safety of medical care. The goal is to build the research base in the areas of epidemiology/ health services research and Quality Improvement Science. We want to develop an Internet-based, real-time data entry, data management, and report-on-demand information system for: identify trends and variation in neonatal mortality and morbidity, to benchmark local trends, to monitor the effect of guidelines implementation.We want to collect a standardized, anonymous set of data from every child born at participating hospitals or transferred to a participating hospital from another hospital without intermediate discharge home. Data will be submitting to the Network electronically and will be used to provide comprehensive confidential reports to participating hospitals. De identified data will be transmitted and stored anonymously. The issue of confidentiality arises in the context of the intervention, and in the context of our research activities. The principles of confidentiality apply for individuals and for hospitals.In ciuda investitiilor care s-au facut in ultimii ani, ratele mortalitatii si morbiditatii neonatale din Departamentele de Terapie Intensiva Neonatala din Romania au ramas inacceptabil de mari in comparatie cu ale altor tari europene.Propunem dezvoltarea unei Baze de Date adresata Centrelor de Terapie Intensiva Neonatala de nivel tertiar din Romania, cu scopul mentinerii si imbunatatirii calitatii serviciilor medicale. Dezvoltarea acestei structuri simple si functionale bazata pe internet va permite interpretarea datelor in timp real, va oferi informatii la cerere cu ajutorul carora sa identificam: diferente de mortalitate si morbiditate neonatala intre centre, monitorizarea implementarii Ghidurilor de Buna Practica Medicala, dar si diferente de practica medicala si rezultatelor lor. Dorim sa propunem un model de retea de colectare a datelor neonatale intr-un mod standardizat astfel ca toti copiii care se nasc inainte de 32 de saptamani de gestatie in unul dintre centrele participante sau care este transferat catre aceste centre vor fi cuprinsi in aceasta baza de date. Datele vor fi colectate si stocate anonim. Datele vor fi folosite ulterior pentru redactarea unor rapoarte periodice adresate centrelor participante
TUBERCULOZA IN MEDIUL INCARCERAT - O AMENINTARE PENTRU SANATATEA PUBLICA -
No full text: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. A third of people in the world are considered to be infected each year; about 8 to 10 million people develop active disease that leads to an increased number of deaths due to TB. Our study has identified 260 patients with TB admitted to Colibasi Prison Hospital between 2006 and 2009. A considerable proportion (19.61%) of cases with TB were identified before their entry into prison and this percent confirmed that regardless of incarceration, the socio-economic status of the subjects placed them to a higher risk in developing active TB in comparison with general population; this may be one of the main reasons for the high incidence of tuberculosis observed in prison. However, the risk for TB was higher in incarcerated persons group (50.76%). According to our data, the risk of infection was 2.5 times higher for those living in the prison environment, what strongly suggests that the transmission of TB within the prison also contributes to this observed higher prevalence rate. We considered the outcome of treatment of patients with tuberculosis which were treated in the Prison Hospital Colibaşi as satisfactory. The treatment success rate with al TB cases was 65.38%. Prison conditions influence the effectiveness of the treatment in the new cases: the therapeutic success was achieved in 69.18% of cases. Keywords: tuberculosis, detention, risk for disease, treatment assessmentTuberculoza (TBC) este o boala infectioasa cauzata de Mycobacterium tuberculosis. O treime din populatia lumii este considerata a fi infectata si, in fiecare an, 8 pana la 10 milioane persoane dezvolta boala activa ce duce la un numar crescut de decese cauzate de TBC. Studiul nostru a identificat, in perioada 2006-2009, 260 pacienti. Un numar considerabil (19,6%) de cazuri de TBC au fost identificate inaintea intrarii pacientilor in inchisoare, confirmand faptul ca, independent de incarcerare, statutul socio-economic al subiectilor le conferea un risc mai mare de a dezvolta TBC activa decat populatia generala; aceasta poate constitui unul dintre principalele argumente ale incidentei crescute a tuberculozei in inchisori. Totusi, riscul de boala a fost mai mare pentru persoanele incarcerate (50,7%). Conform datelor noastre, riscul de infectare a fost de 2,5 ori mai mare in randul celor care traiau in mediul penitenciar, ceea ce sugereaza ca transmiterea in interiorul inchisorii, de asemenea, contribuie la prevalenta inalta. Am considerat ca rezultatul tratamentului pacientilor cu tuberculoza, incarcerati si tratati in cadrul Spitalului Penitenciar Colibasi, este satisfacator. Rata de succes a tratamentului tuturor cazurilor de tuberculoza a fost de 65,3%. Prin controlul strict din inchisori, penitenta influentat eficienta tratamentului la cazurile noi: s-a obtinut succes terapeutic in 69,1% dintre cazuri. Cuvinte cheie: tuberculoza, detentie, risc de imbolnavire, evaluare tratamen