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      Difficulties in the diagnosis and treatment of rare diseases according to the perceptions of patients, relatives and health care professionals

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          Abstract

          OBJECTIVES:

          The aim of this study is to present a survey of vulnerabilities and to suggest approaches for the treatment of rare diseases according to the perceptions of a group of affected individuals, patient association representatives and health care professionals.

          METHODS:

          The focus group technique was used in interviews with patients and primary caregivers, patient support groups/non-governmental organizations, primary health care professionals and physician specialists.

          RESULTS:

          The transcript analysis focused on thematic units, which were tailored to each group and allowed comparisons in search of concordant views. Unanimity was observed in relation to the physical, emotional and social damage to the life standards of the affected individuals and their families as a result of illness. The Brazilian health system was unanimously classified as inadequate to respond to the needs of patients with rare diseases, and this inadequacy led to unpleasant experiences, such as the seemingly endless referrals among health services to reach a final diagnosis and develop a treatment plan.

          CONCLUSIONS:

          The complex set of health system requirements necessary to support the care of patients with rare diseases represents an obstacle to successfully meeting the needs of patients and their families. Therefore, it is important to develop specific public policies to create referral services, guarantee access to appropriate therapeutic modalities and incorporate technologies that promote research for developing new, affordable therapies.

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          Most cited references35

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          Análise de conteúdo temático-categorial: uma proposta de sistematização

          O presente texto foi elaborado a partir de uma experiência de sistematização da técnica de análise de conteúdo, desenvolvida nas disciplinas de metodologia de pesquisa, ministradas para os cursos de graduação e pós-graduação em enfermagem, da Faculdade de Enfermagem da Universidade do Estado do Rio de Janeiro. A sua versão original foi elaborada em 2004, e aperfeiçoada ao longo dos últimos quatro anos, a partir das experiências de aplicação do modelo de análise pelos alunos dos cursos de graduação e de pós-graduação. O objetivo do trabalho é apresentar uma proposta de sistematização da técnica de análise de conteúdo temático-categorial, de forma a contribuir para o ensino da referida técnica e para uma prática de pesquisa qualitativa metodologicamente orientada. São apresentados os conceitos que embasam a técnica, seguidos dos procedimentos para a análise de conteúdo e dos instrumentos necessários para o suporte do seu desenvolvimento.
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            Stress and well-being among parents of children with rare diseases: a prospective intervention study.

            This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention. Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders. We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological strain were used. Stratified analyses were carried out for mothers and fathers, and related to parental demands: single mothers, full-time employment, participation in a parent association, child's age and type of disability. We found high parental stress, physical and emotional strain among mothers, especially among single mothers. Fathers showed high stress related to incompetence, which decreased after the intervention. Decreased strain was found among full-time working mothers and fathers after the intervention. Parents' perceived knowledge and active coping and mothers' perceived social support were increased at follow-up. Factors related to parents' overall life satisfaction (57-70% explained variance) changed after the intervention, from being more related to internal demands (perceived strain, incompetence and social isolation) to other conditions, such as problems related to spouse, paid work and social network. Parents, especially fathers and full-time working parents, may benefit from an intensive family competence programme.
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              Distorções causadas pelas ações judiciais à política de medicamentos no Brasil

              OBJETIVO: Descrever os efeitos das ações judiciais que requerem o fornecimento de medicamentos, em relação a aspectos da política nacional de medicamentos. MÉTODOS: Pesquisa documental, com abordagem metodológica quali-quantitativa. Foram analisados todos os processos movidos por cidadãos contra a Secretaria Municipal de Saúde de São Paulo, referentes ao fornecimento de medicamentos, durante o ano de 2005. Utilizou-se formulário padronizado para a coleta de dados, realizando-se uma análise exploratória. RESULTADOS: Foram impetradas 170 ações contra a Secretaria requerendo o fornecimento de medicamentos. Os serviços do Sistema Único de Saúde originaram 59% das prescrições (26% municipais e 33% os demais). Câncer e diabetes foram as doenças mais referidas (59%). Faziam parte de listas de serviços 62% dos medicamentos solicitados itens solicitados. O gasto total foi de R$876 mil, efetuado somente para itens não selecionados (que não fazem parte da Relação Municipal de Medicamentos Essenciais), 73% dos quais poderiam ser substituídos. Do gasto total, 75% foram destinados à aquisição de antineoplásicos, cuja comprovação de eficácia necessita de mais ensaios clínicos. Dois desses medicamentos não estavam registrados no Brasil. CONCLUSÕES: A maioria das demandas por medicamentos geradas por ações judiciais poderia ser evitada se fossem consideradas as diretrizes do Sistema Único de Saúde, a organização do atendimento em oncologia e a observância das relações de medicamentos essenciais. A falta dessa observância compromete a Política Nacional de Medicamentos, a eqüidade no acesso e o uso racional de medicamentos no Sistema Único de Saúde.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                24 March 2018
                2018
                : 73
                : e68
                Affiliations
                [I ]Pediatria, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
                [II ]Saude Materno Infantil, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
                Author notes
                *Corresponding author. E-mail: m.thomazin@ 123456yahoo.com.br
                Article
                cln_73p1
                10.6061/clinics/2018/e68
                5866403
                29641803
                72ba0f74-e949-4f95-8298-d7f09d512b42
                Copyright © 2018 CLINICS

                This is an Open Access article distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

                History
                : 17 September 2017
                : 7 November 2017
                Categories
                Original Article

                Medicine
                diagnosis,therapy,rare diseases,research,qualitative study,vulnerability
                Medicine
                diagnosis, therapy, rare diseases, research, qualitative study, vulnerability

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