REGIONALIZAÇÃO DA SAÚDE NO BRASIL: Desigualdades socioeconômicas e na performance em saúde

Paschoalotto, Marco Antônio Catussi; Passador, João Luiz; Passador, Cláudia Souza; Endo, Gustavo Yuho

doi:10.13037/gr.vol38n113.7017

Cited by 4 publications

(3 citation statements)

References 15 publications

(33 reference statements)

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“…These regions are home to centers of excellence for treatment of neuromuscular diseases in the public health care system (i.e., the Sarah Kubitschek Hospitals) or major academic centers, where muscle biopsies and genetic tests are available. This is consistent with findings of Paschoalotto et al [ 33 ] and Horovitz [ 34 ] that demonstrated most care centers and services in the area of clinical genetics are concentrated in the most developed regions of the country. We were unable to determine if the database over- or under-represents rural vs. urban regions.…”

Section: Discussionsupporting

confidence: 93%

A healthcare claims analysis to identify and characterize patients with suspected X-Linked Myotubular Myopathy (XLMTM) in the Brazilian Healthcare System

Souza,

Haselkorn,

Baima

et al. 2024

Orphanet J Rare Dis

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Background X-linked myotubular myopathy (XLMTM) is a rare, life-threatening congenital disease, which is not well-defined. To our knowledge, no studies characterizing the XLMTM disease burden have been conducted in Brazil. We identified and described patients with suspected XLMTM using administrative claims data from the Brazilian public healthcare system. Methods Data from 2015 to 2019 were extracted from the DATASUS database. As no XLMTM-specific ICD-10 code was available, a stepwise algorithm was applied to identify patients with suspected XLMTM by selecting male patients with a congenital myopathies code (G71.2), aged < 18 years at index date (first claim of G71.2), with an associated diagnostic procedure (muscle biopsy/genetic test) and without spinal muscular atrophy or Duchenne muscular dystrophy. We attempted to identify patients with suspected severe XLMTM based on use of both respiratory and feeding support, which are nearly universal in the care of XLMTM patients. Analyses were performed for the overall cohort and stratified by age at index date < 5 years old and ≥ 5 years old. Results Of 173 patients with suspected XLMTM identified, 39% were < 5 years old at index date. Nearly all (N = 166) patients (96%) were diagnosed by muscle biopsy (91% of patients < 5 years old and 99% of patients ≥ 5 years old), six (3.5%) were diagnosed by clinical evaluation (8% of patients < 5 years old and 1% of patients ≥ 5 years old), and one was diagnosed by a genetic test. Most patients lived in Brasilia (n = 55), São Paulo (n = 33) and Minas Gerais (n = 27). More than 85% of patients < 5 years old and approximately 75% of patients ≥ 5 years old had physiotherapy at the index date. In both age groups, nearly 50% of patients required hospitalization at some point and 25% required mobility support. Respiratory and feeding support were required for 3% and 12% of patients, respectively, suggesting that between 5 and 21 patients may have had severe XLMTM. Conclusion In this real-world study, genetic testing for XLMTM appears to be underutilized in Brazil and may contribute to underdiagnosis of the disease. Access to diagnosis and care is limited outside of specific regions with specialized clinics and hospitals. Substantial use of healthcare resources included hospitalization, physiotherapy, mobility support, and, to a lesser extent, feeding support and respiratory support.

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Section: Discussionsupporting

confidence: 93%

A healthcare claims analysis to identify and characterize patients with suspected X-Linked Myotubular Myopathy (XLMTM) in the Brazilian Healthcare System

Souza,

Haselkorn,

Baima

et al. 2024

Orphanet J Rare Dis

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“…Results from the REAL study (2020) of 1115 patients with RA treated at 11 public (SUS) centers across Brazil reported a median age of 56.6 years, 89.5% female, and 58.6% white 29 . Although potential genetic factors may contribute to RA predisposition among whites/Caucasians (proposed in REAL study) 29 , and more than half (52.9%) of patients in our study were from the south and southeast regions in Brazil where there is a high proportion of white/Western European ethnic population, this region benefits from better access to healthcare from a higher concentration of physicians 30 , 31 . The geographic heterogeneity found in our study is in line with previous Brazilian perspectives findings of patients with RA 32 .…”

Section: Discussionmentioning

confidence: 72%

Real-world treatment patterns of rheumatoid arthritis in Brazil: analysis of DATASUS national administrative claims data for pharmacoepidemiology studies (2010–2020)

Birck,

Ferreira,

Curi

et al. 2023

Sci Rep

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Our study assessed DATASUS as a potential source for pharmacoepidemiologic studies in rheumatoid arthritis (RA) in the Brazilian population focusing on treatment patterns and determinants of initiating or switching to a novel therapy. This was a descriptive database study of RA patients with at least one claim of RA and ≥ 2 claims of disease-modifying anti-rheumatic drug (DMARD); conventional synthetic (cs), biologic (b) or targeted synthetic (ts) DMARD with more than 6 months of follow-up from 01-Jan-2010 to 31-Dec-2020. Analyses were stratified for SUS-exclusive and SUS+ private user cohorts. We identified 250,251 patients with RA in DATASUS: mean age of 58.4 years, majority female (83%) and white (58%). 62% were SUS-exclusive and 38% SUS+ private. Most common bDMARDs were adalimumab and etanercept. Age (adjusted odds ratio 1.78 [50+]; 95% CI 1.57–2.01), SUS exclusive status (0.53; 0.47–0.59), distance to clinic [160+ km] (0.57; 0.45–0.72), and pre-index csDMARD claims (1.23; 1.08–1.41) were independent predictors of initiating a novel oral tsDMARD. Switching from bDMARD to tsDMARD, associations were similar, except for the direction of associations for SUS exclusive status (adjusted hazard ratio 1.10; 1.03–1.18), distance to clinic (1.18; 1.03–1.35), and number of previous bDMARD (0.15; 0.14–0.16). DATASUS is a source suitable for treatment-related analyses in RA reflecting the public health system in Brazil.

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“…Tem atividades que precisamos executar, mas que infelizmente acabamos não fazendo porque o tempo é insuficiente. (6°GL) Embora a integralidade das ações ofertadas na UBSF tenha sido reconhecida como incipiente, as condições de atendimento na UBSF não diferem significativamente da capacidade instalada nas unidades básicas da região Norte 19,20 , reconhecidas na literatura como carentes de boas instalações e marcadas pela fragilidade das ações intersetoriais e de promoção da saúde 14,17,21 .…”

Section: Temporalidades Diversificadasunclassified

Institutional support for the management and delivery of health services by a mobile river clinic unit in the Amazon

Ferreira

Herkrath

Horta

et al. 2023

Interface (Botucatu)

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O estudo analisou o processo de trabalho do apoiador institucional ao atendimento ofertado em Unidade Básica de Saúde Fluvial. Neste estudo qualitativo, foi entrevistada 100% da equipe de gestão das unidades móveis fluviais que atendem à população rural residente entre Manaus e Novo Airão. Resultados evidenciaram baixa institucionalidade do trabalho de apoiador, em paralelo à importância da imersão nas atividades itinerantes desenvolvidas no meio rural e à centralidade do trabalho vivo cotidianamente realizado. A carência de suporte administrativo às atividades da unidade fluvial obriga o apoiador a desenvolver amplo leque de ações logísticas, requeridas pelo regime de trabalho itinerante rural. Práticas verticalizadas de tomada de decisão e restrições de investimento em infraestrutura e logística fragilizam a interveniência do apoiador e das equipes multiprofissionais, em que pese a contribuição delas à extensão de cobertura provida pelas unidades móveis fluviais rurais.

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REGIONALIZAÇÃO DA SAÚDE NO BRASIL: Desigualdades socioeconômicas e na performance em saúde

Cited by 4 publications

References 15 publications

A healthcare claims analysis to identify and characterize patients with suspected X-Linked Myotubular Myopathy (XLMTM) in the Brazilian Healthcare System

A healthcare claims analysis to identify and characterize patients with suspected X-Linked Myotubular Myopathy (XLMTM) in the Brazilian Healthcare System

Real-world treatment patterns of rheumatoid arthritis in Brazil: analysis of DATASUS national administrative claims data for pharmacoepidemiology studies (2010–2020)

Institutional support for the management and delivery of health services by a mobile river clinic unit in the Amazon

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