Management In Health, MIH (National School of Public Health, Management, Romania)
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Managementul pacientului în chirurgia de zi
No full textThis article presents us preoperative care, care during surgery, postoperative care including monitoring and assessment, discharge, and follow up via telephone post-discharge as strategies frequently implemented in day surgery units to minimise postdischarge complications and the support needed by patients. Although there were no comparative trials of pre-admission clinics one survey of patients using a pre-admission clinic demonstrated a high level of satisfaction. Possible complications make it especially important that all aspects of day surgery are carried out as meticulously as possible. These aspects are discussed in this article and include preoperative care, care during surgery, postoperative care including monitoring and assessment, discharge, and follow up.Keywords: day surgery, pre-admission care, post-admission care, staffing mixContent available only in Romanian.This article presents us preoperative care, care during surgery, postoperative care including monitoring and assessment, discharge, and follow up via telephone post-discharge as strategies frequently implemented in day surgery units to minimise postdischarge complications and the support needed by patients. Although there were no comparative trials of pre-admission clinics one survey of patients using a pre-admission clinic demonstrated a high level of satisfaction. Possible complications make it especially important that all aspects of day surgery are carried out as meticulously as possible. These aspects are discussed in this article and include preoperative care, care during surgery, postoperative care including monitoring and assessment, discharge, and follow up.Keywords: day surgery, pre-admission care, post-admission care, staffing mixContent available only in Romanian
Statutul socio-economic al populaţiei şi accesibilitatea serviciilor de sănătate în cadrul asigurărilor obligatorii de asistenţă medicală din Republica Moldova
No full textResults of the household survey have shown that in the Republic of Moldova only approximately 75,4% of population are covered by mandatory health insurance. Out of those non insured 68,1% reported as being self employed or individual entrepreneurs. Uninsured persons are manly employed in construction, trade and agriculture fields. It has been proved that accessibility of population to health care services has been improved as a result of implementation of mandatory health insurance. Although households’ expenditures for health care services and drugs have decreased by 21% after the introduction of mandatory health insurance.Keywords: household survey, mandatory health insurance, uninsured persons, Republic of MoldovaContent available only in Romanian
Alocarea resurselor către spitale pe baza costurilor standard pe grupe de diagnostic
No full textHealthcare systems are confronted with multiple challenges in the past years due to changes in the political and socio-economic international arena as well as to decreasing quality of healthcare services, decreasing population health status, lack of efficiency of the delivery system, the rigid norms and functioning of the system, lack of competition and of an active role of consumers. These have led to a growing number of healthcare facilities, with overused and outdated medical equipments, with no incentives to provide preventive care, and wide disparities between regions and socio-economic categories regarding access to and quality of hospital services.The scope of the research was to analyze actual methods of resource allocation to hospitals and to develop an improved allocation model, based on optimal costs of delivering services according to standards of actual medical practice in Romanian hospitals. The model suggests a standardization of care per types of patients (ex. Diagnostic Related Groups - DRGs) by means of developing care pathways. Once developed and implemented, care pathways may be the base for calculating the costs of „standard” care, so that they can provide a realistic image of the financial value of resources consumed in the care processes in Romanian hospitals.The model of costing care pathways offers a basis for multiple actions in the areas of financing, cost control, quality of services, adapting to international standards of care, organizational culture, patient safety and patient satisfaction. For the impact it may have on the hospital care system, the implementation of this model may be considered a bottom-up reforming of the system.Keywords: hospital financing, healthcare services costs, management accounting, care pathways, standard costs Sistemele de sănătate se confruntă cu multiple provocări în ultimii ani ca urmare a schimbărilor de pe scena politică şi socio-economică internaţională, precum şi diminuării calităţii serviciilor de sănătate, degradării stării de sănătate a populaţiei, lipsei de eficienţă a sistemului de trimiteri, rigidităţii normele şi func-ţionării sistemului, lipsei de concurenţă şi de implicare activă a consumatorilor. Acestea au condus la o creştere a numărului de unităţi sanitare, dotate cu echi-pamente medicale suprautilizate şi depăşite moral, fără existenţa unor stimulente pentru acordarea de servicii preventive, inechităţi mari între regiuni şi categorii defavorizate socio-economic în ceea ce priveşte accesul la servicii spitaliceşti şi calitatea acestora. Scopul cercetării a fost de a analiza metodele de alocare a resurselor pentru spitale şi de a dezvolta un model de alocare îmbunătăţit, în concordanţă cu standardele practicii medicale actuale din spitalele româneşti. Modelul sugerează o standardizare a îngrijirii pe tipuri de pacienţi (de ex. DRG-uri), prin mijloace de a dezvolta trasee de îngrijire. O dată dezvoltate şi implementate, aceste trasee de îngrijire pot fi bază de calcul a costurilor pentru îngrijiri "standard", astfel încât acestea să poată oferi o imagine realistă a valorii resurselor financiare consumate în procesul de îngrijiri acordate în spitalele din România. Modelul oferă o bază pentru acţiuni multiple în domeniul financiar, controlul costurilor, calitatea serviciilor, adaptarea la standardele internaţionale, cultura organizaţională, siguranţa şi satisfacţia pacientului. Pentru impactul pe care acest model l-ar putea avea asupra sistemului spitalicesc, implementarea modelului poate fi considerată o reformare de jos în sus a sistemului.Cuvinte cheie: finanţare spitale, costuri servicii medicale, contabilitate de gestiun
Evaluarea cost-eficacităţii terapiei cu Tocilizumab
No full textThe aim of the study is to evaluate cost-effectiveness of tocilizumab for the treatment of Rheumatoid Arthritis in patients with traditional DMARD inadequate response (DMARD-IR).Methodology compares two alternatives: sequence of treatment including either infliximab, etanercept or adalimumab, followed by rituximab, and sequence of treatment including tocilizumab as first agent in the treatment sequence, followed by rituximab.Data used is from clinical trials, and also local cost data for direct and indirect costs of treatment sequences. Time horizon is life-time period of each individual.The type of evaluation is cost-utility, and the perspective is that of the payer (National Health Insurance House) as well as of the society. The Incremental Cost-Effectiveness Ratio is 58,866 Rol per QALY gained, which compares favorably with other treatments reimbursed by the National Health Insurance House. Results were tested using a one-way sensitivity analysis.Keywords: cost-effectiveness analysis, rheumatoid arthritis, treatment using tociluzumab.Content temporarely available only in Romanian.Studiul are ca scop evaluarea cost-eficacităţii tratamentului cu tocilizumab la pacienţii cu poliartrită reumatoidă cu răspuns inadecvat la DMARDs convenţionali (DMARD-IR). Metodologia de evaluare a presupus compararea a două secvenţe de tratament: utilizarea unui anti-TNF urmat de rituximab şi, respectiv, tocilizumab ca prim agent în secvenţa de tratament cu biologice, urmat de rituximab. Datele utilizate sunt cele din studiile clinice precum şi date de costuri locale, pentru estimarea costurilor directe şi a costurilor indirecte ale secvenţelor de tratament. Orizontul de timp considerat este întreaga durată de viaţă a pacienţilor.Analiza este de tip cost-utilitate, iar perspectiva studiului este cea a plătitorului, respectiv Casa Naţională de Asigurări de Sănătate, precum şi cea a societăţii. Raportul incremental cost-eficacitate este de de 58.866 lei/ QALY câştigat şi este comparabil în mod favorabil cu alte tratamente finanţate de către Casa Naţională de Asigurări. Rezultatele au fost testate printr-o analiză de senzitivitate univariată.Cuvinte cheie: analiza cost-eficacitate, poliartrita reumatoidă, tratement cu tociluzumab
Muzica - un tip de intervenţie în spitale
Get PDFA systematic review was conducted to summarise current best evidence on the use of music in hospitals. During the search of the literature it became evident that there were two distinct populations that had participated in studies evaluating music: Hospital Patients and Procedure Patients. Music in the context of this review, was considered to be recorded music played, via a tape recorder or compact disc player, for a patient during a single episode of care.A number of outcomes have been used to evaluate the effectiveness of music, and these include: anxiety, pain, severity of pain, analgesic usage, sedation usage, satisfaction, tolerance, mood.Based on the findings of the systematic review, the use of music in Hospital Patients will: reduce their anxiety, produce a small reduction in the respiratory rate, improve their mood. Music does not have any impact on patients’ heart rate or systolic blood pressure.Based on the findings of the systematic review, the use of music during unpleasant or invasive procedures does not have any impact on: patient anxiety, heart rate or systolic blood pressure, the rating of the severity of pain. Based on limited and at times contradictory evidence, there are suggestions that during unpleasant procedures, music may: reduce the need for sedation and analgesia.Keywords: uses of music, systematic review, effect of music, implication for practice, implementing music in hospitals, implication for research, recommendationsContent available only in Romanian.A systematic review was conducted to summarise current best evidence on the use of music in hospitals. During the search of the literature it became evident that there were two distinct populations that had participated in studies evaluating music: Hospital Patients and Procedure Patients. Music in the context of this review, was considered to be recorded music played, via a tape recorder or compact disc player, for a patient during a single episode of care.A number of outcomes have been used to evaluate the effectiveness of music, and these include: anxiety, pain, severity of pain, analgesic usage, sedation usage, satisfaction, tolerance, mood.Based on the findings of the systematic review, the use of music in Hospital Patients will: reduce their anxiety, produce a small reduction in the respiratory rate, improve their mood. Music does not have any impact on patients’ heart rate or systolic blood pressure.Based on the findings of the systematic review, the use of music during unpleasant or invasive procedures does not have any impact on: patient anxiety, heart rate or systolic blood pressure, the rating of the severity of pain. Based on limited and at times contradictory evidence, there are suggestions that during unpleasant procedures, music may: reduce the need for sedation and analgesia.Keywords: uses of music, systematic review, effect of music, implication for practice, implementing music in hospitals, implication for research, recommendationsContent available only in Romanian
Posibilităţi de investigare a datelor privind sănătatea, utilizând sisteme de clasificare socio-economică şi de informaţii geografice
Get PDFIn actual context of the Romanian health system, creating and managing a health data base using socio-economic classification system and geographic information’s system will allow visualization of the population health status in close correlation with the existing socio-economic context.The article presents an exercise which matches data from the Mosaic system with data from DRG system for answering to 2 questions:1. Why Satu Mare district has, for some years, the lowest life expectation of birth? 2. Which could be the benefit of using Mosaic system in the efficient managing of the interventions for improving population health status?Keywords: consumer segmentation system, health status, diseases prevalence, Satu Mare, RomaniaContent available only in Romanian
The Retrospective Study on the Ethio-Pathogenic Factors of the Congenital Malformations in the Bihor district
Get PDFMalformaţiile congenitale reprezintă o cauză majoră de mortalitate şi morbiditate în copilărie, pentru prevenirea acestora impunându-se cunoaşterea nivelului de morbiditate şi a etiologiei lor. Cunoaşterea nivelului prevalenţei bolii şi a factorilor etio-patogenetici este necesară pentru construirea unei imagini reale a fenomenului malformaţiilor congenitale, imagine care va avea rolul de a sta la baza strategiilor şi măsurilor ce se impun în acest domeniu.Studiul de faţă a fost proiectat în vederea furnizării de repere ştiinţifice (evidenţe) pentru formularea ipotezelor de lucru privind abordarea strategică a problemei determinate de malformaţiile congenitale în rândul populaţiei infantile din judeţul Bihor şi pentru aprecierea impactului (social, economic etc) pe care malformaţiile congenitale îl au asupra stării de sănătate a populaţiei. Cuvinte cheie: anomalii congenitale, factori etio-patogenici, promovarea sănătăţii.The congenital malformations represent a major cause of mortality and morbidity in childhood; to prevent this, it is important to know the level of morbidity and its etiology.Knowing the level of the diseases prevalence as well as the ethiopathogenetic factors is necessary to obtain a real image of the congenital malformation phenomenon, image which will have the role of creating the strategies and measures to be used in this field.This study was designed to provide scientific evidence in order to formulate hypothesis regarding the strategical approach of the problem caused by the congenital malformations among of the underage population from the Bihor district as well as to apreciate the impact which the congenital malformations have upon the people’s health.Key words: congenital anomalies, ethiopathogenetic factors, health promotion
Comunicarea medic de familie - medic specialist
No full textThe communication between the family doctor and the specialist is initiated when there are cases of affections seldom seen in the current practice of family medicine or when they are away of the regular pattern of diagnosis and treatement. The family doctor makes a referral paper where he requests the clarification of the elements mentioned above, the answer being the medical letter. This document has to comprise the diagnosis (its formulation and its supporting elements), the treatement (therapeutic objective, inital treatement) and the dispensarisation (its rythm, follow-up elements, indicators of satisfactory evolution and alarm signals).The functions of the medical letter are both the funding of the long term treatement, within the family medicine office, and the centralisation of the medical information regarding the respective pacient.Keywords: family doctor, medical communication, medical letter, therapeutic objective, dispensarisationContent available only in Romanian
Avantaje şi dezavantaje ale informatizării în medicina de familie
Get PDFOur objective is to evaluate the advantages and disadvantages of the informatisation of family medicine offices within the context of the current Romanian medical system. Following our study, we can consider that the key drive of the informatisation for family medicine is “contextual necessity” as the main beneficiaries of this process are the external structures (the third paying party and the public healthcare data collectors). These structures wish very detailed data, in electronic form, regarding the office activity and the characteristics of the patient population and they “impose” the informatisation of the family medicine offices by imposing the data form. There may be offices that go for the informatisation for improving their functionality as well as there may be offices that may use informatisation for developing a competitive advantage. But these last two categories are probably less represented at present time. The theoretical frame described in our paper was the foundation of a questionnaire applied at the 2006 Conference of the Family Doctors Association – Bucharest for evaluating the family doctors attitude towards informatisation. This questionnaire was used for gathering and analyzing real-life data regarding the theoretical aspects presented above. The results of this questionnaire will be presented in a future paper.Keywords: informatisation, family medicine, competitive strategy, disadvantages, data gatheringContent available only in Romanian