A Combinação Público-Privado em Saúde:impacto no desempenho do sistema e nos resultados em saúde no contexto português

Tese de Doutoramento em Ciências Sociais na Especialidade de Administração da Saúd

As grandes pandemias da história da Europa e os seus impactos na nossa civilização: desafios da moderna saúde pública

A história das pandemias está intrinsecamente associada à evolução da humanidade. Ao longo do tempo, ocorreram sucessivos eventos de natureza pandémica, que condicionaram, em grande medida, o desenvolvimento dos povos. A história milenar das pandemias revela o caráter recorrente deste tipo de fenómeno. Nas últimas décadas, tem sido crescente a preocupação com o risco associado a doenças emergentes. As alterações decorrentes do modelo de desenvolvimento social e económico têm contribuído para um agravamento das desigualdades relativamente às condições de vida das populações. A concentração humana, com tendência à concentração urbana, a mobilidade, as questões relativas ao meio ambiente e ao comportamento humano persistem como fatores determinantes na defesa contra os diferentes tipos de ameaças. A pandemia causada pelo vírus Sars-Cov-2 pôs à prova, em termos globais, os níveis de preparação e a capacidade de reação dos diferentes países, revelando a fragilidade das respostas e a grande dificuldade na proteção dos grupos sociais mais expostos à doença. O mundo contemporâneo dispõe de instrumentos tecnológicos e de capacitação ao nível da investigação científica e da partilha de informação e geração de conhecimento, que o tornam mais forte e mais bem preparado para reagir a fenómenos biológicos inesperados. A moderna saúde pública terá de prevenir e antecipar riscos potenciais e emergentes, preparando os cidadãos e os sistemas de saúde para uma resposta robusta e adequada a este tipo de eventos

A perspective on the OECD report "health at a Glance 2019"

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Does Austerity Drives Healthcare Accessibility?

The financial crisis may impact on healthcare systems, and challenge healthcare accessibility by increasing the percentage of patients with unmet medical needs due to the cost, the distance, and waiting lists. In order to analyze if austerity drives healthcare accessibility, we take annual data at country level, for Germany, United Kingdom, Spain, France, Italy, Ireland, Greece, and Portugal, from 2005 to 2011 (n=56). The countries were clustered according to the external intervention during financial crisis. We consider a period ex-ante and another one ex-post crisis, and assess the difference in averages, by using the t Student test. This is followed by a correlation analysis by calculating Spearman’s coefficient, to assess if there is an association between the unemployment rate and the percentage of patients with unmet medical needs, considering the educational levels and income quintiles, regarding each one of the clusters. We found that during austerity there is an increase in the percentage of patients with unmet medical needs due to excessive cost, except for Germany and United Kingdom, but a decrease in the percentage of patients with unmet medical needs due to the distance and waiting lists. These figures were higher for low income and educational levels. For the cluster of France, Italy and Spain, the healthcare accessibility improves with increasing unemployment rates; but for Greece, Ireland and Portugal there is no association between accessibility and unemployment rate

What solutions for the financing of innovation?

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effects in the health care sector

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate – composed of the European Commission, the International Monetary Fund, and the European Central Bank – signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens’ life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts–related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.publishersversionpublishe

Clinical, economical and safety impact of ferric carboxymaltose use in Patient Blood Management programme in Portuguese National Health Service hospitals

Funding Information: We would like to thank everyone who contributed to the study, namely the teams of participating hospitals who helped us to collect data: Centro Hospitalar Tâmega e Sousa (CHTS) – Maria da Anunciação Ruivo, MD; Centro Hospitalar Entre o Douro e Vouga (CHEDV) – Cristina Portal, MD; Centro Hospitalar de Vila Nova de Gaia e Espinho (CHVNG/E) – Fátima Lima, MD; Unidade Local de Saúde do Nordeste (ULSNE) –Anabela Correia, MD; Centro Hospitalar Universitário Cova da Beira (CHUCB) – Jorge Martinez, MD; Centro Hospitalar e Universitário de Lisboa Central (CHULC - Hospital Curry Cabral) – Nuno Diogo, MD; Hospital Professor Doutor Fernando Fonseca (HFF) – Diana Sousa Mendes, MD. Funding Information: This paper reflects the main results of the O impacto do uso da carboximaltose férrica no consumo de sangue através da otimização pré-operatória da hemoglobina em hospitais portugueses (Patient Blood Management) funded by Vifor Pharma Management Ltd. Publisher Copyright: © 2022, The Author(s).Ferric carboxymaltose (FCM) can be used in Patient Blood Management (PBM) to promote the optimization of preoperative haemoglobin (Hb), which aims to minimise the use of allogeneic blood components and improve clinical outcomes, with better cost-effectiveness. This was an observational study conducted in a retrospective and multicentre cohort with adults from elective orthopaedic, cardiac and colorectal surgeries, treated according to local standards of PBM with allogeneic blood product transfusions (ABTs) on demand and with FCM to correct iron deficiency with or without anaemia. In this work, only the first pillar of the PBM model issue by Directorate-General for Health (DGS) was evaluated, which involves optimising Hb in the preoperative period with iron treatment if it’s necessary/indicated. Before the implementation of PBM in Portugal, most patients did not undergo preoperative laboratory evaluation with blood count and iron kinetics. Therefore, the existence of Iron Deficiency Anaemia (IDA) or Iron Deficiency (ID) without anaemia was not early detected, and there was no possibility of treating these patients with iron in order to optimise their Hb and/or iron stores. Those patients ended up being treated with ABTs on demand. A total of 405 patients from seven hospitals were included; 108 (26.7%) underwent FCM preoperatively and 197 (48.6%) were transfused with ABTs on demand. In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM, respectively, a decrease from 31.7 to 9.6% in moderate anaemia and no cases of severe anaemia after FCM administration, while 7.7% of patients were severely anaemic before FCM treatment. There were significant differences (p < 0.001) before and after correction of preoperative anaemia and/or iron deficiency with FCM in Hb, serum ferritin and transferrin saturation rate (TS). In the ABT group, there were significant differences between pre- and postoperative Hb levels (p < 0.001). Hb values tended to decrease, with 44.1% of patients moving from mild anaemia before transfusion to moderate anaemia in the postoperative period. Concerning the length of hospital stay, the group administered with ABTs had a longer hospital stay (p < 0.001). Regarding the clinical outcomes of nosocomial infection and mortality, there was no evidence that the rate of infection or mortality differed in each group (p = 0.075 and p = 0.243, respectively). However, there were fewer nosocomial infections in the FCM group (11.9% versus 21.2%) and mortality was higher in the transfusion group (21.2% versus 4.2%). Economic analysis showed that FCM could reduce allogenic blood products consumption and the associated costs. The economic impact of using FCM was around 19%. The preoperative Hb value improved when FMC was used. Patients who received ABTs appeared to have a longer hospital stay. The FCM group reported fewer infections during hospitalisation. The economic results showed savings of around €1000 for each patient with FCM administration. The use of FCM as part of the PBM program had a positive impact on patients’ outcomes and on economic results. However, it will be essential to perform studies with a larger sample to obtain more robust and specific results.publishersversionpublishe

Application of the OPtimising HEalth LIteracy and Access (Ophelia) process

APP1155125. The present publication was funded by Funda??o Ci?ncia e Tecnologia, lP national support through CHRC (UIDP/04923/2020), and NOVA National School of Public Health ? NOVA University of Lisbon. Publisher Copyright: © Copyright © 2021 Dias, Gama, Maia, Marques, Campos Fernandes, Goes, Loureiro and Osborne.The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.publishersversionpublishe

COMPRIME - COnhecer Mais PaRa Intervir MElhor: Preliminary Mapping of Municipal Level Determinants of COVID-19 Transmission in Portugal at Different Moments of the 1st Epidemic Wave

The role of demographic and socio-economic determinants of COVID-19 transmission is still unclear and is expected to vary in different contexts and epidemic periods. Exploring such determinants may generate a hypothesis about transmission and aid the definition of prevention strategies. Objectives: To identify municipality-level demographic and socio-economic determinants of COVID-19 in Portugal. Methods: We assessed determinants of COVID-19 daily cases at 4 moments of the first COVID-19 epidemic wave in Portugal, related with lockdown and post-lockdown measures. We selected 60 potential determinants from 5 dimensions: population and settlement, disease, economy, social context, and mobility. We conducted a multiple linear regression (MLR) stepwise analysis (p < 0.05) and an artificial neural network (ANN) analysis with the variables to identify predictors of the number of daily cases. Results: For MLR, some of the identified variables were: resident population and population density, exports, overnight stays in touristic facilities, the location quotient of employment in accommodation, catering and similar activities, education, restaurants and lodging, some industries and building construction, the share of the population working outside the municipality, the net migration rate, income, and renting. In ANN, some of the identified variables were: population density and resident population, urbanization, students in higher education, income, exports, social housing buildings, production services employment, and the share of the population working outside the municipality of residence. Conclusions: Several factors were identified as possible determinants of COVID- 19 transmission at the municipality level. Despite limitations to the study, we believe that this information should be considered to promote communication and prevention approaches. Further research should be conducted.info:eu-repo/semantics/publishedVersio

Mobilidade e propagação do sars-cov-2 em Portugal continental: modelo explicativo territorializado em contexto anterior à vacinação

A difusão do novo coronavírus tem importantes associações com a mobilidade da população. Recorrendo a modelos de regressão linear múltipla, com informação epidemiológica da Direção-Geral da Saúde (DGS) e dados de mobilidade disponibilizados pela Google, captura-se a relação causal existente entre alterações na mobilidade e a tendência de incidência de COVID-19 para várias escalas em Portugal, demonstrando-se que maior mobilidade está associada a maior número de novos casos. Com base nesta premissa e recorrendo aos padrões de mobilidade da população é possível desenvolver um modelo de previsão do número de infeções futuras, com pelo menos 14 dias de antecedência.The diffusion of the new coronavirus has important associations with population mobility. Using multiple linear regression models, with epidemiological information and mobility data from Google, a causal relationship between changes in mobility and the trend of COVID 19 incidence for several scales in Portugal has been identified, showing that greater mobility is associated with a higher number of new cases. Based on this premise and using information on mobility patterns of the population, it is possible to develop a model to predict the number of future infections, at least 14 days in advance.info:eu-repo/semantics/publishedVersio