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      Introducing care management to Brazil’s alcohol and substance use disorder population

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          Abstract

          Brazil has a sizable alcohol and substance use disorder (ASUD) population, yet there are considerable gaps in treatment access and retention. ASUD, a chronic medical condition, is highly comorbid with medical and behavioral health disorders. This indicates a need for more targeted interventions in order to achieve health care integration (a major goal of Brazil’s health care system). Care management – that is, the organization of patient care by an institution – is a viable strategy to engage individuals with ASUD who might benefit from treatment but are not aware of or do not use the available resources, as well as to help maintain patients in treatment. Care management is considered an essential supplement to the treatment of chronic disease. The objective of this article is to discuss the applicability of care management for the treatment of ASUD within the public health care system in Brazil. We describe models of care management that have been adopted internationally and identify the feasibility and advantages for its adoption in Brazil.

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          Most cited references 32

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          Improving chronic illness care: translating evidence into action.

          The growing number of persons suffering from major chronic illnesses face many obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical management, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely designed for acute illness. Evidence of effective system changes that improve chronic care is mounting. We have tried to summarize this evidence in the Chronic Care Model (CCM) to guide quality improvement. In this paper we describe the CCM, its use in intensive quality improvement activities with more than 100 health care organizations, and insights gained in the process.
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            A Cobertura da Estratégia de Saúde da Família (ESF) no Brasil, segundo a Pesquisa Nacional de Saúde, 2013

            Resumo O objetivo deste artigo é apresentar a cobertura da Estratégia Saúde da Família (ESF) estimada pela Pesquisa Nacional de Saúde (PNS), comparando com dados administrativos e coberturas anteriores da Pesquisa Nacional de Amostras de Domicílios (PNAD), além de descrever frequências de visitas domiciliares das equipes. Foram comparados dados de inquéritos populacionais em 2008 (PNAD), em 2013 (PNS) e dados administrativos do Departamento de Atenção Básica, sobre a proporção de pessoas moradoras em domicílios cadastrados em unidade de saúde da família, para Brasil, Grandes Regiões e Unidades da Federação, além de indicadores com visitas domiciliares por escolaridade. Observou-se aumento na cobertura da população pelo Saúde da Família no Brasil, passando de 50,9%, segundo a PNAD 2008, para 53,4% em 2013, segundo a PNS. O crescimento ocorreu no Brasil, Grandes Regiões, urbano e rural. Os dados da PNS em 2013 foram semelhantes aos administrativos do DAB em 2013, cerca de 56% de domicílios cadastrados. Populações com menor escolaridade receberam mais visitas domicíliares mensalmente. A ESF é um importante promotor de equidade em saúde e o aumento de sua cobertura e abrangência é exitoso no país.
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              Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis

              Background An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care ‘at-risk’ of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. Methods and Findings We carried out a systematic review and meta-analysis of the effectiveness of case management for ‘at-risk’ patients in primary care. Six bibliographic databases were searched using terms for ‘case management’, ‘primary care’, and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health – self-assessed health status, mortality; Cost – total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction – patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial ‘strength’ of primary care. Conclusions This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the effects of key moderators. Current results do not support case management as an effective model, especially concerning reduction of secondary care use or total costs. We consider reasons for lack of effect and highlight key research questions for the future. Review Protocol The review protocol is available as part of the PROSPERO database (registration number: CRD42014010824).
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                Author and article information

                Journal
                Braz J Psychiatry
                Braz J Psychiatry
                bjp
                Brazilian Journal of Psychiatry
                Associação Brasileira de Psiquiatria
                1516-4446
                1809-452X
                18 December 2017
                2018
                : 40
                : 3
                : 320-324
                Affiliations
                [1 ]The National Center on Addiction and Substance Abuse, New York, USA
                [2 ]Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
                Author notes
                Correspondence: Ilana Pinsky, 633 Third Avenue, New York, NY, 10017-6706, USA. E-mail: pinskyilana@ 123456gmail.com
                Article
                10.1590/1516-4446-2017-2235
                6899403
                29267603

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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