Development of rheumatology training in Brazil: the option for a medical residency program

Albuquerque, Cleandro Pires de; Santos-Neto, Leopoldo Luiz dos

doi:10.1016/j.rbre.2016.04.001

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…An important challenge faced by rheumatologists in Brazil is patient access and follow-up, which may be associated with compromised care. 43 Furthermore, the median time to medication access through the SUS for PsA treatment following a medical prescription has been reported to be longer than 2 months. 5 Therefore, additional strategies that can help achieve good disease control should be considered, which may include: This study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study

et al. 2022

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BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple joints. It is associated with psoriasis and treated with synthetic and biologic drugs. OBJECTIVE: The objective of this study was to assess the outcomes of patients who received biologic therapy with tumor necrosis factor (TNF) inhibitors in terms of effectiveness, safety, functionality, and quality of life. DESIGN AND SETTING: A prospective observational study was performed at a single center in Belo Horizonte, Brazil. METHODS: Patients with PsA who received their first TNF inhibitor treatment were followed up for 12 months. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BAS-DAI) and Clinical Disease Activity Index (CDAI). Functionality was measured using the Health Questionnaire Assessment (HAQ), and quality of life was evaluated using the European Quality of Life Five Dimensions (EQ-5D). Multiple linear regression was used to identify predictors of the clinical response at 12 months. RESULTS: A total of 143 patients treated with adalimumab or etanercept were evaluated. Most of the clinical measures were significantly improved at 12 months. However, 31%-51% of the patients did not achieve good clinical control. No differences were observed between adalimumab and etanercept, except for poor functionality at 12 months among patients treated with etanercept. The main predictors of a worse clinical response were female sex, etanercept use, poor functionality, or lower quality of life at baseline. The main adverse reactions were alopecia, headache, injection site reaction, sinusitis, flu, dyslipidemia, and infections. CONCLUSION: TNF inhibitor therapy was effective and safe. However, despite improvements in clinical measures, most patients did not achieve satisfactory control of the disease.

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Section: Discussionmentioning

confidence: 99%

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study

et al. 2022

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“…This may be found in different countries, as shown in this study, but also within each country, as in Argentina 11,12 and Brazil. 13 Although in Latin America it is necessary to homologate professional titles to practice medicine in another country of the region, it is important to consider implementing minimum requirements in the training of rheumatology residents, as previously suggested in Europe 14 and the United States. 15 This initiative could be led by PANLAR.…”

Section: Discussionmentioning

confidence: 99%

Rheumatology Training in Latin America

et al. 2021

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Background/Objective: Demand for rheumatology care has steadily increased in recent years. The number of specialists in this field, however, seems insufficient. No recent studies have diagnosed the attributes of rheumatology training in Latin America.Methods: This is a descriptive cross-sectional study. We obtained data on each country through local rheumatologists of the Pan-American League Against Rheumatism, who acted as principal investigators for participating countries. Our sample was analyzed and described through means and standard deviations or through frequencies and percentages, depending on the variable. Results: Countries with the most rheumatology-training programs wereBrazil (n = 50), Argentina (n = 18), and Mexico (n = 15). Ecuador, Honduras, and Nicaragua do not have rheumatology-training programs. The countries with the most available slots for rheumatology residents were Brazil (n = 126) and Argentina (n = 36). To be admitted into rheumatology training, candidates were required to have completed graduate studies in internal medicine in 42.1% of the programs. In 8 countries (42.1%), residents are not required to pay tuition; the median cost of tuition in the remaining countries is US $528 (interquartile range, US $2153). Conclusions: Conditions associated with rheumatology training in LatinAmerica vary. Significant differences exist in income and tuition fees for residents, for example, and 4 countries in Latin America do not currently offer programs. Information collected in this study will be useful when comparing the status of rheumatology services offered in Latin America with those in other countries. Most countries require a wider offering of rheumatology-training programs, as well as more available slots.

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“…Clinical recommendations and guidelines mark the diagnosis delay as a great challenge that needs to be approached, as it negatively impacts the treatment result; so, strategies to promote the early forwarding and decrease the delay in diagnoses and inflammatory arthritis treatment have been proposed [14]. This is a problem that has been confronted in Brazil and one of the challenges found is represented by the concentration of rheumatologist physicians in the larger cities and the low availability of rheumatologists at SUS [15].…”

Section: Discussionmentioning

confidence: 99%

“…In 2013, Brazil had an approximate ratio of 118,000 inhabitants per rheumatologist, being that, at SUS, such ratio overcomes 400,000 users per rheumatologist. Therefore, SUS has proven to be inefficient to retain a sufficient number of these specialists, who, once finished the medical residence, migrate to private care [15].…”

Section: Discussionmentioning

confidence: 99%

Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

et al. 2019

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Background: Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. Methods: A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. Results: A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44-90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. Conclusion: The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

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Development of rheumatology training in Brazil: the option for a medical residency program

Cited by 6 publications

References 8 publications

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study

Rheumatology Training in Latin America

Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

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