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[PMID]:28464945
[Au] Autor:Phok S; Phanalasy S; Thein ST; Likhitsup A; ACTwatch Group
[Ad] Endereço:Population Services Khmer, 29 334 St, Boeung Keng Kang, P. O. Box 258, Phnom Penh, Cambodia.
[Ti] Título:Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.
[So] Source:Malar J;16(1):180, 2017 05 02.
[Is] ISSN:1475-2875
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People's Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was >75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. CONCLUSIONS: Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies.
[Mh] Termos MeSH primário: Administração de Caso/estatística & dados numéricos
Regulamentação Governamental
Fidelidade a Diretrizes/estatística & dados numéricos
Malária/prevenção & controle
Setor Privado/estatística & dados numéricos
Garantia da Qualidade dos Cuidados de Saúde/normas
[Mh] Termos MeSH secundário: Ásia Sudeste
Administração de Caso/normas
Seres Humanos
Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12936-017-1800-5


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[PMID]:28464890
[Au] Autor:Buregyeya E; Rutebemberwa E; LaRussa P; Lal S; Clarke SE; Hansen KS; Magnussen P; Mbonye AK
[Ad] Endereço:Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda. eburegyeya@musph.ac.ug.
[Ti] Título:Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda.
[So] Source:Malar J;16(1):183, 2017 05 02.
[Is] ISSN:1475-2875
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Public health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care. METHODS: A survey was conducted within 57 geographical areas (parishes), from August to October 2014 in Mukono district, central Uganda. The survey comprised both facility and health worker assessment. Data were collected on drug stocks, availability of treatment guidelines, diagnostic equipment, and knowledge in management of malaria, pneumonia and diarrhoea, using a structured questionnaire. RESULTS: A total of 53 public and 241 private health facilities participated in the study. While similar proportions of private and public health facilities stocked Coartem, the first-line anti-malarial drug, (98 vs 95%, p = 0.22), significantly more private than public health facilities stocked quinine (85 vs 53%, p < 0.01). Stocks of obsolete anti-malarial drugs, such as chloroquine, were reported in few public and private facilities (3.7 vs 12.5%, p = 0.06). Stocks of antibiotics-amoxycillin and gentamycin were similar in both sectors (≥90% for amoxicillin; ≥50 for gentamycin). Training in malaria was reported by 65% of public health facilities vs 56% in the private sector, p = 0.25), while, only 21% in the public facility and 12% in the private facilities, p = 0.11, reported receiving training in pneumonia. Only 55% of public facilities had microscopes. Malaria treatment guidelines were significantly lacking in the private sector, p = 0.01. Knowledge about first-line management of uncomplicated malaria, pneumonia and diarrhoea was significantly better in the public facilities compared to the private ones, though still sub-optimal. CONCLUSION: Deficiencies of equipment, supplies and training exist even in public health facilities. In order to significantly improve the capacity to handle acute febrile illness among children under five, training in proper case management, availability of supplies and diagnostics need to be addressed in both sectors.
[Mh] Termos MeSH primário: Administração de Caso/estatística & dados numéricos
Febre/terapia
Instalações de Saúde/estatística & dados numéricos
Malária/terapia
Setor Privado/estatística & dados numéricos
Setor Público/estatística & dados numéricos
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Pessoal de Saúde/estatística & dados numéricos
Seres Humanos
Lactente
Recém-Nascido
Masculino
Uganda
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12936-017-1842-8


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[PMID]:27776588
[Au] Autor:Mibei DJ; Kiarie JW; Wairia A; Kamene M; Okumu ME
[Ad] Endereço:National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya.
[Ti] Título:Treatment outcomes of drug-resistant tuberculosis patients in Kenya.
[So] Source:Int J Tuberc Lung Dis;20(11):1477-1482, 2016 Nov.
[Is] ISSN:1815-7920
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:SETTING: Successful treatment of drug-resistant tuberculosis (DR-TB) is crucial in preventing disease transmission and reducing related morbidity and mortality. A standardised DR-TB treatment regimen is used in Kenya. Although patients on treatment are monitored, no evaluation of factors affecting treatment outcomes has yet been performed. OBJECTIVE: To analyse treatment outcomes of DR-TB patients in Kenya and factors associated with successful outcome. DESIGN: Retrospective analysis of secondary data from Kenya's National Tuberculosis, Leprosy and Lung disease programme. DR-TB data from the national database for January to December 2012 were reviewed. RESULTS: Of 205 DR-TB patients included in the analysis, 169 (82.4%) had a successful treatment outcome, 18 (9%) died and 18 (9%) were lost to follow-up. Only sex (P = 0.006) and human immunodeficiency virus (HIV) status (P = 0.008) were predictors of successful treatment. Females were more likely to attain treatment success (OR 3.86, 95%CI 1.47-10.12), and HIV-negative status increased the likelihood of successful treatment (OR 3.53, 95%CI 1.4-8.9). CONCLUSION: Treatment success rates were higher than World Health Organization targets. Targeted policies for HIV-positive patients and males will improve treatment outcomes in these groups.
[Mh] Termos MeSH primário: Antituberculosos/uso terapêutico
Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Índice de Massa Corporal
Criança
Pré-Escolar
Dieta
Feminino
Infecções por HIV/tratamento farmacológico
Seres Humanos
Lactente
Recém-Nascido
Quênia/epidemiologia
Perda de Seguimento
Masculino
Meia-Idade
Estado Nutricional
Setor Privado
Setor Público
Estudos Retrospectivos
Resultado do Tratamento
Organização Mundial da Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antitubercular Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:27776581
[Au] Autor:Uplekar M
[Ad] Endereço:Global TB Programme, World Health Organization, Geneva, Switzerland.
[Ti] Título:Public-private mix for tuberculosis care and prevention. What progress? What prospects?
[So] Source:Int J Tuberc Lung Dis;20(11):1424-1429, 2016 Nov.
[Is] ISSN:1815-7920
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Public-private mix (PPM) for tuberculosis (TB) care implies working with all relevant public and private health care providers to ensure that high-quality TB care is offered to all who need it. Despite significant global progress in PPM expansion and in TB control in general, a large proportion of care providers in high-incidence countries remain unengaged, and one third of the estimated TB cases go unnotified or undetected. OBJECTIVE: To present a global perspective on the progress and prospects of expanding PPM for TB care and prevention. DISCUSSION: People with TB in high-incidence countries approach diverse care providers. Productive working collaborations between national TB programmes and other care providers have been scaled up in many countries. However, a large proportion of private providers still do not participate in collaboration or follow recommended TB management practices. Persisting challenges include weak commitment and capacity to work together within both public and private sectors, poor enforcement of essential regulations and inadequate investments. CONCLUSION: Scaling up PPM programmes is critical to ending the TB epidemic. Investing in implementing bold policies that harness public and private sector capacity, combine collaborative and regulatory approaches and promote modern digital tools to simplify care delivery is the logical way forward.
[Mh] Termos MeSH primário: Assistência à Saúde/tendências
Setor Privado/tendências
Setor Público/tendências
Tuberculose/tratamento farmacológico
Tuberculose/prevenção & controle
[Mh] Termos MeSH secundário: Saúde Global
Seres Humanos
Incidência
Parcerias Público-Privadas
Qualidade da Assistência à Saúde/tendências
Organização Mundial da Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:27771545
[Au] Autor:Wang Q; Zhang D; Hou Z
[Ad] Endereço:School of Business, Dalian University of Technology, 2 Dagong Road, Panjin 124221, Liaoning, China. Electronic address: qingwang@dlut.edu.cn.
[Ti] Título:Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China.
[So] Source:Soc Sci Med;170:124-132, 2016 12.
[Is] ISSN:1873-5347
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The private health care sector has become an increasingly important complement to China's health care system. During the health care reform in 2009, China's central government established multiple initiatives to relax constraints on the growth of the private health care sector. However, private health services have not been growing as rapidly as private health care facilities. Using data from the China Health and Retirement Longitudinal Study collected between 2011 and 2013, this study investigated patient choice between private and public providers for outpatient care and estimated its relationship with health insurance and socioeconomic status (SES). The Heckman sample selection model was applied to address the problem of selection bias caused by a lack of awareness of provider ownership. We found that 82.1% of the outpatient care users were aware of their provider's ownership, and 23.8% chose private health care providers. Although patients with health insurance and higher SES were more likely to be aware of their provider's ownership, they preferred public providers over private providers. For example, having Urban Employee Basic Medical Insurance was associated with a 16.5% lower probability of choosing private providers than no health insurance. Respondents with the highest level of household expenditure had a 7.5% lower probability of choosing private providers than those with the lowest level of expenditure. The probability of choosing private providers were significantly lower by 4.0% among respondents with an education level of junior high school and above than those with no formal education. For private providers to play an effective role in the health care system, policies that have constrained the growth of the private sector should be changed, and more effort should be directed toward equalizing health insurance coverage for both types of providers.
[Mh] Termos MeSH primário: Comportamento de Escolha
Cobertura do Seguro/normas
Setor Privado/utilização
Setor Público/utilização
Fatores Socioeconômicos
[Mh] Termos MeSH secundário: Idoso
China
Feminino
Reforma dos Serviços de Saúde/métodos
Reforma dos Serviços de Saúde/tendências
Pessoal de Saúde/utilização
Seres Humanos
Cobertura do Seguro/economia
Cobertura do Seguro/estatística & dados numéricos
Masculino
Meia-Idade
Setor Privado/economia
Setor Público/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29304049
[Au] Autor:Subramanian S; Gakunga R; Kibachio J; Gathecha G; Edwards P; Ogola E; Yonga G; Busakhala N; Munyoro E; Chakaya J; Ngugi N; Mwangi N; Von Rege D; Wangari LM; Wata D; Makori R; Mwangi J; Mwanda W; East African Economics and Implementation Group (EAEIG)
[Ad] Endereço:Public Health Research Division, RTI International, Waltham, MA, United States of America.
[Ti] Título:Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors.
[So] Source:PLoS One;13(1):e0190113, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services. METHODS AND FINDINGS: We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to $36, while diagnostic procedures, particularly for breast and cervical cancer, were substantially more expensive. Annual hypertension medication costs ranged from $26 to $234 and $418 to $987 in public and private facilities, respectively. Stroke admissions ($1,874 versus $16,711) and dialysis for chronic kidney disease ($5,338 versus $11,024) were among the most expensive treatments. Cervical and breast cancer treatment cost for stage III (curative approach) was about $1,500 in public facilities and more than $7,500 in the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health insurance, which makes NCD services unaffordable for most people given the overall high cost of services relative to income (average household expenditure per adult is $413 per annum). CONCLUSIONS: There is substantial variation in patient costs between the public and private sectors. Most NCD diagnosis and treatment costs, even in the public sector, represent a substantial economic burden that can result in catastrophic expenditures.
[Mh] Termos MeSH primário: Financiamento Pessoal/economia
Custos de Cuidados de Saúde
Doenças não Transmissíveis
Setor Privado
Setor Público
[Mh] Termos MeSH secundário: Gerenciamento Clínico
Seres Humanos
Quênia
Doenças não Transmissíveis/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190113


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[PMID]:29346342
[Au] Autor:Anderson KN; Ailes EC; Danielson M; Lind JN; Farr SL; Broussard CS; Tinker SC
[Ti] Título:Attention-Deficit/Hyperactivity Disorder Medication Prescription Claims Among Privately Insured Women Aged 15-44 Years - United States, 2003-2015.
[So] Source:MMWR Morb Mortal Wkly Rep;67(2):66-70, 2018 Jan 19.
[Is] ISSN:1545-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects individuals across the lifespan. ADHD medication use among pregnant women is increasing (1), but consensus about the safety of ADHD medication use during pregnancy is lacking. Given that nearly half of U.S. pregnancies are unintended (2), and early pregnancy is a critical period for fetal development, examining trends in ADHD medication prescriptions among reproductive-aged women is important to quantify the population at risk for potential exposure. CDC used the Truven Health MarketScan Commercial Database* for the period 2003-2015 to estimate the percentage of women aged 15-44 years with private employer-sponsored insurance who filled prescriptions for ADHD medications each year. The percentage of reproductive-aged women who filled at least one ADHD medication prescription increased 344% from 2003 (0.9% of women) to 2015 (4.0% of women). In 2015, the most frequently filled medications were mixed amphetamine salts, lisdexamfetamine, and methylphenidate. Prescribing ADHD medications to reproductive-aged women is increasingly common; additional research on ADHD medication safety during pregnancy is warranted to inform women and their health care providers about any potential risks associated with ADHD medication exposure before and during pregnancy.
[Mh] Termos MeSH primário: Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico
Prescrições de Medicamentos/estatística & dados numéricos
Seguro Saúde/estatística & dados numéricos
Setor Privado/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estimulantes do Sistema Nervoso Central/efeitos adversos
Estimulantes do Sistema Nervoso Central/uso terapêutico
Feminino
Planos de Assistência de Saúde para Empregados/estatística & dados numéricos
Seres Humanos
Formulário de Reclamação de Seguro
Gravidez
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Central Nervous System Stimulants)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180119
[St] Status:MEDLINE
[do] DOI:10.15585/mmwr.mm6702a3


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[PMID]:28468641
[Au] Autor:Dale KD; Tay EL; Trauer JM; Trevan PG; Denholm JT
[Ad] Endereço:Victorian Tuberculosis Program, The Peter Doherty Institute for Infection and Immunity, Victoria, Australia. katie.dale@mh.org.au.
[Ti] Título:Comparing tuberculosis management under public and private healthcare providers: Victoria, Australia, 2002-2015.
[So] Source:BMC Infect Dis;17(1):324, 2017 05 03.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Private healthcare providers are important to tuberculosis (TB) management globally, although internationally there are reports of suboptimal management and disparities in treatment commencement in the private sector. We compared the management of TB patients receiving private versus public healthcare in Victoria, an industrialised setting with low tuberculosis (TB) incidence. METHODS: Retrospective cohort study: 2002-2015. Private healthcare provision was included as an independent variable in several multivariate logistic and Cox proportional hazard regression models that assessed a range of outcome variables, encompassing treatment commencement delays, management and treatment outcomes. RESULTS: Of 5106 patients, 275 (5.4%) exclusively saw private providers, and 4714 (92.32%) public. Private care was associated with a shorter delay to presentation (HR 1.36, p = 0.065, 95% CI 1.02-2.00). Private patients were less likely to have genotypic testing (OR 0.66, p = 0.009, 95% CI 0.48-0.90), those with pulmonary involvement were less likely to have a sputum smear (OR 0.52, p = 0.011, 95% CI 0.31-0.86) and provided samples were less likely to be positive (OR 0.54, p = 0.070, 95% CI 0.27-1.05). Private patients with extrapulmonary TB were less likely to have a smear sample (OR 0.7, 95% CI 0.48-0.90, p = 0.009) and radiological abnormalities (OR 0.71, p = 0.070, 95% CI 0.27-1.05). Treatment commencement delays from presentation were comparable for cases with pulmonary involvement and extrapulmonary TB, although public extrapulmonary TB patients received radiological examinations slightly earlier than private patients (HR 0.79, p = 0.043, 95% CI 0.63-0.99) and public patients with pulmonary involvement from high burden settings commenced treatment following an abnormal CXR more promptly than their private counterparts (HR 0.41, p = 0.011, 95% CI 0.21-0.81). Private patients were more likely to receive <4 first-line medications (OR 2.17, p = 0.001, 95% CI 1.36-3.46), but treatment outcomes were comparable between sectors. CONCLUSIONS: The differences we identified are likely to reflect differing case-mix as well as clinician practice. Sputum smear status was an important covariable in our analysis; with its addition we found no significant disparity in the health-system delay to treatment commencement between sectors. Our study highlights the importance of TB programs engaging with private providers, enabling comprehensive data collection that is necessary for thorough and true comparison of TB management and optimisation of care.
[Mh] Termos MeSH primário: Setor Privado/estatística & dados numéricos
Setor Público/estatística & dados numéricos
Tuberculose/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Pessoal de Saúde
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Quartos de Pacientes
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Escarro/microbiologia
Tuberculose/epidemiologia
Tuberculose/mortalidade
Tuberculose Pulmonar/tratamento farmacológico
Tuberculose Pulmonar/mortalidade
Vitória
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180120
[Lr] Data última revisão:
180120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2421-x


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[PMID]:29324733
[Au] Autor:Ailes EC; Summers AD; Tran EL; Gilboa SM; Arnold KE; Meaney-Delman D; Reefhuis J
[Ti] Título:Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections - United States, 2014.
[So] Source:MMWR Morb Mortal Wkly Rep;67(1):18-22, 2018 Jan 12.
[Is] ISSN:1545-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4). To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs. Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy. Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole. Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women's health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Prescrições de Medicamentos/estatística & dados numéricos
Seguro Saúde/estatística & dados numéricos
Setor Privado
Infecções Urinárias/tratamento farmacológico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Guias de Prática Clínica como Assunto
Gravidez
Primeiro Trimestre da Gravidez
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180119
[Lr] Data última revisão:
180119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.15585/mmwr.mm6701a4


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Fotocópia
[PMID]:29235785
[Au] Autor:Patel YM; Guterman S
[Ti] Título:The Evolution of Private Plans in Medicare.
[So] Source:Issue Brief (Commonw Fund);2017:1-10, 2017 Dec 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans--now known as Medicare Advantage plans--have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. Goal: To examine major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost-sharing, total costs to Medicare, and quality of care. Methods: Review of key policy documents, reports, position statements, and academic studies. Findings and Conclusions: Private plans have changed considerably since their introduction into Medicare. Enrollment has risen to 33 percent of all Medicare beneficiaries; 99 percent of beneficiaries have access to private plans in 2017. Recent policies have improved risk-adjustment methods, rewarded plans' performance on quality of care, and reduced average payments to private plans to 100 percent of traditional Medicare spending. As enrollment in private plans continues to grow and as health care costs rise, policymakers should enhance incentives for private plans to meet intended goals for higher-quality care at lower cost.
[Mh] Termos MeSH primário: Medicare Part C/estatística & dados numéricos
Medicare/estatística & dados numéricos
Setor Privado/estatística & dados numéricos
[Mh] Termos MeSH secundário: Custo Compartilhado de Seguro
Planos de Pagamento por Serviço Prestado/economia
Planos de Pagamento por Serviço Prestado/tendências
Previsões
Sistemas Pré-Pagos de Saúde
Seres Humanos
Medicare/tendências
Medicare Part C/tendências
Qualidade da Assistência à Saúde
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE



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