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  1. Article ; Online: Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021.

    Silva, Rildo Pinto da / Pazin-Filho, Antonio

    Ciencia & saude coletiva

    2023  Volume 29, Issue 1, Page(s) e00512023

    Abstract: Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the ...

    Title translation Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021.
    Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.
    MeSH term(s) Pregnancy ; Female ; Humans ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Cesarean Section ; Brazil ; Delivery, Obstetric ; Health Facilities ; Health Planning
    Language English
    Publishing date 2023-04-08
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 2078799-6
    ISSN 1678-4561 ; 1678-4561
    ISSN (online) 1678-4561
    ISSN 1678-4561
    DOI 10.1590/1413-81232024291.00512023
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  2. Article ; Online: Improving the Quality of Residency Programs in Family and Community Medicine.

    Ribeiro, Lucas Gaspar / Cyrino, Eliana Golbfarb / Pazin-Filho, Antônio

    Revista de saude publica

    2023  Volume 57, Page(s) 65

    Abstract: Objective: To develop and present an instrument to evaluate and monitor the quality of medical residency programs in residencies in family and community medicine (FCM) based on preceptors and residents, considering the insertion of the health network ... ...

    Abstract Objective: To develop and present an instrument to evaluate and monitor the quality of medical residency programs in residencies in family and community medicine (FCM) based on preceptors and residents, considering the insertion of the health network program.
    Method: The instrument was developed in three stages: 1) interview with the preceptors of FCM; 2) literature review; and 3) production, adequacy, and approval of the evaluation instrument by renowned professionals of the Brazilian FCM. The third stage included 9 people and used the Delphi technique with 80% agreement. For the qualitative results, Bardin's Content Analysis was used.
    Results: In all, there were five evaluation cycles to adapt the proposed recommendations, with the elimination of one item and weighting, with a results analysis methodology of 10 resulting items, reaching an expected matrix for organizing residency programs in the health network, divided into 3 domains: Organization of the Unit, Human Resources, and Preceptor-resident relationship.
    Conclusion: An instrument for evaluating and monitoring residency programs in family and community medicine can be a tool to facilitate program managers and allow evaluation and monitoring, continuously qualifying them.
    MeSH term(s) Humans ; Internship and Residency ; Community Medicine ; Brazil ; Workforce
    Language Portuguese
    Publishing date 2023-10-20
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 732179-x
    ISSN 1518-8787 ; 0034-8910
    ISSN (online) 1518-8787
    ISSN 0034-8910
    DOI 10.11606/s1518-8787.2023057004822
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  3. Article ; Online: Decreasing boarders in the emergency department by reducing clerical work in the discharge process of in-hospital patients in Brazil - an interrupted time-series analysis.

    Moroço, Diego Marques / Pazin-Filho, Antonio

    BMC emergency medicine

    2022  Volume 22, Issue 1, Page(s) 99

    Abstract: Background: Emergency Department (ED) boarding is related to in-hospital patients' discharge since no beds will be available for receiving ED patients if there is a delay for patients in the yard leaving the hospital. New techniques implemented in ... ...

    Abstract Background: Emergency Department (ED) boarding is related to in-hospital patients' discharge since no beds will be available for receiving ED patients if there is a delay for patients in the yard leaving the hospital. New techniques implemented in hospital institutions, such as digital signatures to facilitate clerical work improve these processes. We evaluated the impact of expediting patients' discharge after medical orders with the number of patients with an unplanned hospital admission from the Hospital Out Clinic directed to ED for waiting for an available bed in a public tertiary hospital in Brazil.
    Methods: We conducted a quasi-experimental study before and after an intervention. It consisted of an encrypted digital signature to reduce clerical work and expedite the patient's release from the institution after medical discharge. We used an interrupted time-series analysis based on administrative data (number of hospital discharges, bed turnover, the time between medical discharge, and the time the patient effectively left the hospital) from 2011 to 2020.
    Results: We enrolled 210,496 patients admitted to the hospital from January 2011 to December 2020. Of those, 69,897(33%) composed the group after the intervention. There was no difference between the groups' gender, age distribution, the proportion of surgical patients, or in-hospital stay (≤ 7 or > 7 days). The interrupted time series analysis for the time from medical order to effectively hospital discharge showed an immediate change in level (Coefficient β2 -3.6 h-95% confidence interval -3.9;-3.4), but no a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient-95% confidence interval -0.0040;0.0050). For the number of patients directed to ED, we observed no immediate change in level (Coefficient β2 -0.84 patients-95% confidence interval -0.33;0.16), but a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient-95% confidence interval -0.0040;0.0050).
    Conclusion: Reducing clerical work and expediting patient discharge was associated with decreased potential boarders to ED.
    MeSH term(s) Brazil ; Crowding ; Emergency Service, Hospital ; Humans ; Interrupted Time Series Analysis ; Length of Stay ; Patient Admission ; Patient Discharge ; Retrospective Studies ; Tertiary Care Centers
    Language English
    Publishing date 2022-06-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050431-7
    ISSN 1471-227X ; 1471-227X
    ISSN (online) 1471-227X
    ISSN 1471-227X
    DOI 10.1186/s12873-022-00656-y
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  4. Article ; Online: Rational Use of Evidence-Based Medicine: Why We Resist So Much?

    Schmidt, André / Pazin-Filho, Antonio

    Arquivos brasileiros de cardiologia

    2019  Volume 112, Issue 6, Page(s) 727–728

    MeSH term(s) Acute Coronary Syndrome ; Cardiologists ; Decision Making ; Evidence-Based Medicine ; Humans ; Prognosis
    Language Portuguese
    Publishing date 2019-07-15
    Publishing country Brazil
    Document type Editorial ; Comment
    ZDB-ID 730261-7
    ISSN 1678-4170 ; 0066-782X
    ISSN (online) 1678-4170
    ISSN 0066-782X
    DOI 10.5935/abc.20190100
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  5. Article ; Online: Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations.

    Romo-Castillo, Hugo Fernando / Pazin-Filho, Antonio

    Journal of global antimicrobial resistance

    2021  Volume 29, Page(s) 462–467

    Abstract: Objectives: Ecuador is a lower-to-middle-income country not yet adherent to World Health Organization (WHO) antibiotic stewardship strategies, and data regarding basic metrics are still lacking.: Methods: We conducted a retrospective study of an ... ...

    Abstract Objectives: Ecuador is a lower-to-middle-income country not yet adherent to World Health Organization (WHO) antibiotic stewardship strategies, and data regarding basic metrics are still lacking.
    Methods: We conducted a retrospective study of an antibiotic stewardship programme (ASP) consisting of restrictive measures on carbapenem dispensing pending required pre-authorisation and expert audit. We evaluated antibiotic consumption and its relationship to carbapenem resistance at a 610-bed, tertiary-level hospital in Quito, Ecuador. We used prescription data from 2010-2017 and converted them into defined daily doses (DDD). We then correlated these findings with the nature of service provided and antibiotic resistance data from the microbiology laboratory. We used descriptive statistics and interrupted time series (ITS) analysis.
    Results: Throughout the study period, we analysed 16 984 355 prescriptions of 8 191 418.57 g of antibiotics (5 760 479.37 DDD). The in-hospital mean antibiotic prescription rate was 148.8 ± 14.8 DDD/100 occupied bed-days and 293.5 ± 65.3 DDD/100 occupied bed-days in the ICU. First-, second- and third-line antibiotic consumption was 38%, 52% and 10%, respectively. Our hospital data showed a high rate of antibiotic prescription in all hospital areas, mainly broad-spectrum antibiotics. Regarding the ASP introduced in 2016, ITS analysis showed a change in the outcome level immediately following the introduction for imipenem [-3.97; 95% confidence interval (CI) -5.31 to -2.61] but not for meropenem (0.66; 95% CI -0.37 to 1.71).
    Conclusion: Although our institution's ASP was successful in reducing imipenem consumption, a more embracing plan is required for further interventions to avoid unexpected effects.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship ; Carbapenems/therapeutic use ; Ecuador ; Imipenem ; Retrospective Studies ; Tertiary Care Centers ; World Health Organization
    Chemical Substances Anti-Bacterial Agents ; Carbapenems ; Imipenem (71OTZ9ZE0A)
    Language English
    Publishing date 2021-11-14
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2710046-7
    ISSN 2213-7173 ; 2213-7173
    ISSN (online) 2213-7173
    ISSN 2213-7173
    DOI 10.1016/j.jgar.2021.11.001
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  6. Article ; Online: Lung Ultrasound in a Patient With ARDS Secondary to Pancreatitis.

    Ferreira, Aron H / Pazin-Filho, Antonio

    Chest

    2021  Volume 158, Issue 2, Page(s) e85–e87

    MeSH term(s) Adult ; Humans ; Male ; Pancreatitis/complications ; Pancreatitis/diagnostic imaging ; Respiration, Artificial ; Respiratory Distress Syndrome/diagnostic imaging ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Ultrasonography
    Language English
    Publishing date 2021-06-01
    Publishing country United States
    Document type Case Reports ; Journal Article ; Video-Audio Media
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2019.09.045
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  7. Article ; Online: Comparison Between Short Text Messages and Phone Calls to Reduce No-Show Rates in Outpatient Medical Appointments: A Randomized Trial.

    Lance, Rogério Cortecioni / Pazin-Filho, Antônio / Neves, Fábio Fernandes

    The Journal of ambulatory care management

    2021  Volume 44, Issue 4, Page(s) 314–320

    Abstract: The objective of this study was to evaluate the impact of telephone calls and short text messages (SMS) on no-show rates regarding scheduled appointments with a general practitioner. In a prospective, intervention-controlled, and randomized study, we ... ...

    Abstract The objective of this study was to evaluate the impact of telephone calls and short text messages (SMS) on no-show rates regarding scheduled appointments with a general practitioner. In a prospective, intervention-controlled, and randomized study, we divided 306 patients into 3 groups: telephone call, SMS, and no intervention. We compared no-show rates, as well as variables that influenced it. The lowest percentage of no-show (9.5%) occurred in the telephone call group, while the SMS group presented at 21% and the no-intervention group at 22.8% (P = .025). Telephone calls proved to be a superior strategy to text messaging.
    MeSH term(s) Appointments and Schedules ; Cell Phone ; Humans ; Outpatients ; Prospective Studies ; Reminder Systems ; Telephone ; Text Messaging
    Language English
    Publishing date 2021-05-29
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 198845-1
    ISSN 1550-3267 ; 0148-9917
    ISSN (online) 1550-3267
    ISSN 0148-9917
    DOI 10.1097/JAC.0000000000000388
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  8. Article: Palliative care team in a Brazilian tertiary emergency department.

    Lourençato, Frederica Montanari / Miranda, Carlos Henrique / de Carvalho Borges, Marcos / Pazin-Filho, Antonio

    International journal of emergency medicine

    2022  Volume 15, Issue 1, Page(s) 53

    Abstract: Objectives: To describe the process of implementing a palliative care team (PCT) in a Brazilian public tertiary university hospital and compare this intervention as an active in-hospital search (strategy I) with the Emergency Department (strategy II).!## ...

    Abstract Objectives: To describe the process of implementing a palliative care team (PCT) in a Brazilian public tertiary university hospital and compare this intervention as an active in-hospital search (strategy I) with the Emergency Department (strategy II).
    Methods: We described the development of a complex Palliative Care Team (PCT). We evaluated the following primary outcomes: hospital discharge, death (in-hospital and follow-up mortality) or transfer, and performance outcomes-Perception Index (difference in days between hospitalization and the evaluation by the PTC), follow-up index (difference in days between the PTC evaluation and the primary outcome), and the in-hospital stay.
    Results: We included 1203 patients-strategy I (587; 48.8%) and strategy II (616; 51.2%). In both strategies, male and elderly patients were prevalent. Most came from internal medicine I (39.3%) and II (57.9%), p <  0.01. General clinical conditions (40%) and Oncology I (27.7%) and II (32.4%) represented the majority of the population. Over 70% of all patients had PPS 10 and ECOG 4 above 85%. There was a reduction of patients identified in ICU from I (20.9%) to II (9.2%), p <  0.01, reduction in the ward from I (60.8%) to II (42.5%), p <  0.01 and a significant increase from I (18.2%) to II (48.2%) in the emergency department, p <  0.01. Regarding in-hospital mortality, 50% of patients remained alive within 35 days of hospitalization (strategy I), while for strategy II, 50% were alive within 20 days of hospitalization (p <  0.01). As for post-discharge mortality, in strategy II, 50% of patients died 10 days after hospital discharge, while in strategy I, this number was 40 days (p <  0.01). In the Cox multivariate regression model, adjusting for possible confounding factors, strategy II increased 30% the chance of death. The perception index decreased from 10.9 days to 9.1 days, there was no change in follow-up (12 days), and the duration of in-hospital stay dropped from 24.3 to 20.7 days, p <  0.01. The primary demand was the definition of prognosis (56.7%).
    Conclusion: The present work showed that early intervention by an elaborate and complex PCT in the ED was associated with a faster perception of the need for palliative care and influenced a reduction in the length of hospital stay in a very dependent and compromised old population.
    Language English
    Publishing date 2022-09-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 2411462-5
    ISSN 1865-1380 ; 1865-1372
    ISSN (online) 1865-1380
    ISSN 1865-1372
    DOI 10.1186/s12245-022-00456-y
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  9. Article ; Online: Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy.

    Moreira, Henrique Turin / Volpe, Gustavo Jardim / Mesquita, Gustavo Marques / Braggion-Santos, Maria Fernanda / Pazin-Filho, Antonio / Marin-Neto, José Antonio / Schmidt, André

    Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

    2022  Volume 24, Issue 1, Page(s) 52

    Abstract: Background: Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular ...

    Abstract Background: Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy.
    Methods: This retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack-TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up.
    Results: A total of 113 patients were included. Median age was 56 years (IQR: 45-67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41-62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93-0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38-7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year.
    Conclusions: LV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.
    MeSH term(s) Humans ; Female ; Middle Aged ; Male ; Chagas Cardiomyopathy/complications ; Chagas Cardiomyopathy/diagnostic imaging ; Chagas Cardiomyopathy/epidemiology ; Retrospective Studies ; Atrial Flutter ; Predictive Value of Tests ; Ventricular Function, Left ; Cardiomyopathies ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/epidemiology ; Ventricular Dysfunction, Left/etiology ; Stroke Volume ; Atrial Fibrillation ; Thromboembolism/diagnostic imaging ; Thromboembolism/epidemiology ; Thromboembolism/etiology ; Stroke ; Heart Diseases
    Language English
    Publishing date 2022-11-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1458034-2
    ISSN 1532-429X ; 1097-6647
    ISSN (online) 1532-429X
    ISSN 1097-6647
    DOI 10.1186/s12968-022-00885-x
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  10. Article ; Online: Impact of children with complex chronic conditions on costs in a tertiary referral hospital.

    Mattiello, Regina Maria Antunes / Pazin-Filho, Antonio / Aragon, Davi Casale / Cupo, Palmira / Carlotti, Ana Paula de Carvalho Panzeri

    Revista de saude publica

    2022  Volume 56, Page(s) 89

    Abstract: Objectives: To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil.: Methods: This is a longitudinal study ... ...

    Abstract Objectives: To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil.
    Methods: This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year.
    Results: Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients' complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95).
    Conclusions: Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.
    MeSH term(s) Child ; Humans ; Tertiary Care Centers ; Retrospective Studies ; Longitudinal Studies ; Brazil ; Hospital Costs ; Chronic Disease
    Language English
    Publishing date 2022-10-17
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 732179-x
    ISSN 1518-8787 ; 0034-8910
    ISSN (online) 1518-8787
    ISSN 0034-8910
    DOI 10.11606/s1518-8787.2022056004656
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