Conectar
Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this change in policy, and the implications of these variations for people affected by MDR/RR-TB.
A mixed methods study was done of patient movements between healthcare facilities, reconstructed from laboratory records. Facility visits and staff interviews were used to determine reasons for movements.
People identified with MDR/RR-TB from 13 high-burden districts within South Africa.
Geospatial movement patterns were used to identify organisational models. Reasons for patient movement and implications of different organisational models for people affected by MDR/RR-TB and the health system were determined.
Among 191 participants, six dominant geospatial movement patterns were identified, which varied in average hospital stay (0–281 days), average patient distance travelled (12–198 km) and number of health facilities involved in care (1–5 facilities). More centralised models were associated with longer delays to treatment initiation and lengthy hospitalisation. Decentralised models facilitated family-centred care and were associated with reduced time to treatment and hospitalisation duration. Responsiveness to the needs of people affected by MDR/RR-TB and health system constraints was achieved through implementation of flexible models, or the implementation of multiple models in a district.
Understanding how models for organising care have evolved may assist policy implementers to tailor implementation to promote particular patterns of care organisation or encourage flexibility, based on patient needs and local health system resources. Our approach can contribute towards the development of a health systems typology for understanding how policy-driven models of service delivery are implemented in the context of variable resources.
Objetivo: Describir los factores relacionados entre la adherencia terapéutica y el tratamiento farmacológico antihipertensivo. Material y métodos: Estudio observacional de prevalencia sobre una muestra de 100 pacientes hipertensos a tratamiento que acudieron a la Unidad de Hipertensión Arterial del Complejo Hospitalario Universitario de Ferrol. Resultados: La media de edad es de 59,71±13.97 años. El 84% son conocedores de su enfermedad. El 86% de los pacientes son cumplidores, test morinsky-Green. El 36% de los pacientes están confusos con el actual cambio a prescripción electrónica de medicamentos genéricos. La no adherencia se asocia con una mala percepción de los genéricos (p=0,027; OR=0,98) y con vivir en zonas rurales (p=0,028; OR: 2,13). Conclusión: La percepción de la prescripción de genéricos por el usuario es mala aunque la adherencia al tratamiento es buena (86%). La no adherencia fue mayor en las zonas rurales y los pacientes con una mala percepción de la e-receta y medicamentos genéricos.
Una mujer de 41 años de edad presentó una historia de cefaleas de 24 meses de evolución. Diagnosticada de aneurisma gigante del sifón carotideo izquierdo. La lesión tenía 28 mm de longitud en su diámetro más grande y con un cuello indefinido (implicación extensiva de las paredes del vaso aferente). Se realizó embolizacion con Coils de platino y colocacion de dispositivo flow diverter para derivacion del flujo sanguineo.
FreshRSS 