Browsing by Author "Coelho, Anabela"
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- Abordagem e Registo da Anafilaxia em PortugalPublication . Mota, Inês; Pereira, Ana Margarida; Pereira, Celso; Tomaz, Elza; Ferreira, Manuel Branco; Sabino, Filipa; Coelho, Anabela; Santos, Anabela; Martins, Henrique; Morais-Almeida, MárioA anafilaxia apresenta uma incidência crescente, particularmente em idade pediátrica. Constituindo uma emergência médica, o sucesso terapêutico depende de uma intervenção precoce e adequada. A adrenalina por via intramuscular constitui o fármaco de eleição para o seu tratamento, devendo a dose ser ajustada ao peso e à idade. Resolvida a reação aguda, o doente deve ser mantido sob vigilância médica por um período de 6 a 24 horas, pelo risco de ocorrência de reações bifásicas. Deverá ser considerada a prescrição de um dispositivo de autoadministração de adrenalina em todos os doentes com diagnóstico ou suspeita de anafilaxia; adicionalmente estes doentes têm indicação formal para estudo em consulta de imunoalergologia, de modo a permitir uma adequada intervenção diagnóstica e terapêutica que reduzirá o risco futuro. Todos os episódios de anafilaxia devem ser registados no Catálogo Português de Alergias e outras Reações Adversas (CPARA), constituindo este um instrumento fundamental de partilha de informação clínica dentro do Sistema de Saúde. Este manuscrito pretende divulgar as orientações para o diagnóstico e tratamento da anafilaxia, tornando a sua abordagem clínica mais eficiente e consertada a nível nacional, e promover a adesão ao Catálogo Português de Alergias e outras Reações Adversas como um instrumento essencial de registo e partilha de informação dos episódios de anafilaxia ocorridos em Portugal.
- Comparação dos utentes do antigo Hospital do Desterro com os utentes do Hospital de S. José no acesso à consulta de Medicina Interna - Parte I : objectivos, população, métodos e resultados sobre potencial de acessoPublication . Pereira, Maria Isabel; Sousa, Bruno de; Coelho, Anabela; Ferrinho, PauloCenário: Na sequência do encerramento do Hospital do Desterro (HD), é focada a atenção na integração do seu serviço de Consulta Externa de Medicina Interna (MI) no serviço de Consulta Externa de MI do Hospital de São José. Objectivos: O objectivo geral deste estudo publicado em duas partes é, nesta primeira parte, comparar o potencial de acesso à consulta externa de MI do HSJ dos utilizadores da consulta externa de MI do HD (nos três meses que antecederam a transferência do serviço) com o dos sujeitos que já eram utilizadores da consulta externa de MI do HSJ, antes da integração de serviços. População e métodos: Trata-se de um estudo epidemiológico, transversal e analítico, optando-se pelo método de amostragem aleatória proporcionalmente estratificada dos dois grupos em estudo, de acordo com o género e idade da população previamente analisados e de dimensão igual a 256 elementos para cada um dos grupos. A colheita de dados foi realizada através da aplicação de um questionário por via telefónica, precedida por o envio de uma carta registada com aviso de recepção. Realizada a análise dos dados comparando os dois grupos através dos testes de homogeneidade e independência do qui-quadrado e ANOVA one-way. Principais resultados: Existem diferenças estatisticamente significativas no potencial de acesso entre o grupo I (HD) e o grupo II (HSJ) nomeadamente no que diz respeito: à idade, sendo o grupo I (HD) mais envelhecido que o grupo II (HSJ); ao estado civil, sendo o grupo I (HD) marcado por conter maior proporção de viúvos que o grupo II (HSJ); à situação profissional, com maior proporção de pessoas activas no grupo II (HSJ); ao número de crianças residentes na mesma casa do respondente, superior no grupo I (HD); à escolaridade, detendo o grupo II (HSJ) níveis académicos superiores aos do grupo I (HD); às expectativas antes da última consulta, mais baixas no grupo I (HD); à percepção sobre acessibilidade física ao HSJ, percebida como mais difícil para o grupo I (HD) do que para grupo II (HSJ) e à distância e tempo de viagem do domicílio ao HSJ, menores para o grupo I (HD). Conclusão: As diferenças de potencial de acesso poderão vir a repercutir-se em diferenças de acesso realizado à consulta externa de MI do HSJ como se estudará na segunda parte deste artigo.
- Comparação dos utentes do antigo Hospital do Desterro com os utentes do Hospital de São José no acesso à consulta de Medicina Interna - Parte II: diferenças em acesso realizadoPublication . Pereira, Maria Isabel; Sousa, Bruno de; Coelho, Anabela; Ferrinho, PauloContext: Following the Hospital do Desterro (HD) closure, the main attention of this study is focused on Outpatient Department of Internal Medicine (MI) and its integration in the Hospital de São José (HSJ). Purpose: The general purpose of this paper is, in this second part, to compare the realized access at HSJ Outpatient Department of Internal Medicine from users of HD Outpatient Department of Internal Medicine (in the three months prior to the transfer of the department) with those who were already users of HSJ Outpatient Department before the integration of both departments. Population and methods: This is an epidemiological, cross-sectional and analytical study, where selection was made through random sampling proportionally stratified from the two study groups, according to gender and age of the population, previously analyzed, with a final size equal to 256 elements for each group. Data collection was performed for the two groups by administering a questionnaire by telephone, preceded by the sending of a registered letter explaining the outlines of the study. Data analysis was performed by comparing the two groups using de chi-square test for homogeneity and independence, ANOVA one-way and ordinal regression. Main findings: Significant differences in realized access were found between group I (HD) and group II (HSJ) particularly with regard to the number of appointments in 2008 at HSJ to which the user has not shown, the perception about the quality of care by the administrative, the waiting time before consultation, the level of perceived quality about the information received from the physician about one’s own health, the involvement in the therapeutic decision, the fulfillment of the expectations, the overall perceived quality, the overall satisfaction, the loyalty and the likelihood to recommend the HSJ service to family members, friends or colleagues. Conclusion: The closure of HD and the subsequent transfer of Outpatient Department of Internal Medicine to HSJ had a negative effect on important components of performed access such as the use of services, the perceived quality of the service, the satisfaction, the loyalty and the recommendation to family members, friends or colleagues.
- Construção e Validação da Tabela Nacional de Funcionalidade para as Doenças CrónicasPublication . Pereira, Carla; Branco, Jaime; Lopes, Manuel; Escoval, Ana; Nogueira, Paulo; Diniz, Alexandre; Guerra, Fernando; Coelho, AnabelaIntrodução: A avaliação sistemática e registo da funcionalidade de pessoas adultas com doença crónica permite horizontalizar políticas de saúde, sociais e emprego de acordo com a funcionalidade; dotar os profissionais de saúde e sociais de um instrumento de recolha de informação, que complemente os registos de doença; medindo os ganhos de funcionalidade. O objetivo de estudo foi desenvolver uma Tabela Nacional de Funcionalidade para adultos em idade ativa com doença crónica, de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde da Organização Mundial de Saúde. Material e Métodos: Recorremos a métodos quantitativos e qualitativos; revisão da literatura (17 artigos), grupo focal (nove peritos), painel de Delphi (16 peritos) e estudo exploratório (309 pessoas com doença crónica). Resultados: Na revisão da literatura, foram identificadas 67 atividades limitadas na população em estudo das quais foram selecionadas 40 atividades pelo grupo focal e 38 validadas pelo painel de Delphi. Discussão: Para testar as propriedades psicométricas comparamos o valor médio de todos os coeficientes possíveis do tipo consistência interna (split-half). Na análise da discriminação dos níveis de funcionalidade em amostras diferentes, verificou-se a igualdade de variâncias pelo teste de Levene e a igualdade de média por recurso ao teste t. De acordo com a observação e análise do coeficiente α de Cronbach, verificou-se que a Tabela Nacional de Funcionalidade proposta apresenta bons níveis de fiabilidade. Na análise de componentes principais, identificaram-se cinco dimensões. Conclusão: A referida tabela tem características psicométricas apropriadas no que diz respeito à consistência, fiabilidade e validade interna.
- A Cross-Sectional Study of the Perception of Individualized Nursing Care Among Nurses in Acute Medical and Perioperative SettingsPublication . Ramos, Ana; Pires, Sara; Sá, Eunice; Gomes, Idalina; Alves, Elisabete; Fonseca, César; Coelho, Anabela; Coelho, AnabelaIndividualized nursing care allows for systematic assessment and intervention; considers a patient’s preferences, values, and context; and contributes to a positive care trajectory. However, its operationalization has proven to be challenging. This research aimed to evaluate nurses’ perceptions of individualized care and analyze their relationship with sociodemographic variables. Methods: A cross-sectional study was conducted on 122 eligible and registered nurses at a Hospital Center, in the Ophthalmology (operating room and inpatient ward) service, the Cardiology service, the Internal Medicine service, and the Medical Emergency Unit, for adults/older adults in Portugal. The nursing version of the Individualized Care Scale (ICS-Nurse) was used for the assessment, including three sub-dimensions: clinical situation, personal life situation, and decisional control over care-related decisions. Cronbach’s alpha and principal component analysis were used for the data analysis. The STROBE checklist was used to report this study. Results: No statistically significant differences were found based on the age, gender, level of education, or years of professional experience of the nurses within the sub-dimensions of individualization. The nurses overall had a good perception of the importance of individualized care (4.06 ± 0.46 ICS-A-NURSE) but faced difficulties in its implementation during the last shift they worked (3.97 ± 0.49 ICS-B-NURSE). Conclusions: The items considered to be of greatest importance were the response to the physical and emotional needs arising from illness and assistance in decision-making through educational instructions. Aspects related to the personal lives of patients, such as family inclusion in an individual’s care plan, everyday habits, and previous experiences of hospitalization, received the lowest scores. Recognizing priority areas for improvement in the individualization of nursing care can contribute to developing training programs and policies that promote a holistic approach. Future studies should consider patient outcomes related to their needs for individualization.
- Determinants of violence against health workers in PortugalPublication . Craveiro, Isabel; Fronteira, Inês; Coelho, Anabela
- Gestão integrada da doença renal crónica: análise de uma política inovadora em PortugalPublication . Coelho, Anabela; Diniz, Alexandre; Hartz, Zulmira; Dussault, GillesThe implementation in Portugal of a model for integrated management of disease applied to the end-stage renal disease, from 2008 onwards, has completely restructured the way of providing care, as well as the payment and follow-up of patients under dialysis. This article describes the steps taken by the Ministry of Health, in terms of the planning, implementation and follow-up of the policy, with a particular focus on the importance of involving the various groups of interest, the leadership, as well as the capacity of negotiation and influence of the Government.
- Gestão integrada da doença: uma abordagem experimental de gestão em saúdePublication . Escoval, Ana; Coelho, Anabela; Diniz, José Alexandre; Rodrigues, Miguel; Moreira, Filipa; Espiga, PauloThe health systems are faced with new paradigms, on one hand in the healthcare services delivered to the populations, and on the other hand, in the need to control costs in the health sector, forcing organizations to adapt and provide the most appropriate response to the individuals growing needs. The magnitude of this problem, in terms of public health, requires the adoption of a directed, targeted, planned and integrated action, based on clear and well defined strategies in order to obtain health gains, improving the quality of care and streamlining the costs. In Portugal, the application of those principles forming the basis of the disease management models, led to the Integrated Disease Management model which, apart from the clinical management of the disease, also incorporates the healthcare delivery structure reorganization, a specific financing model based on an information system that allows the process monitoring and evaluation. The development of Integrated Disease Management models is a central strategy and a tool for improving healthcare delivery, more effectively and efficiently, and can even be an important and permanent vehicle of information for health decision support. Therefore, it is important to promote a concerted action towards achieving a precise intervention, mobilizing the resources, improving the health status, quality of life and the overall patients’ wellbeing. This action means increasing collaboration and coordination of the different levels of care, offering integrated healthcare services with high quality levels regarding prevention, diagnosis, treatment, rehabilitation and monitoring.
- Integrated Disease Management: A Critical Review of Foreign and Portuguese ExperiencePublication . Coelho, Anabela; Leone, Cláudia; Ribeiro, Vanessa; Moreira, Pedro Sá; Dussault, GillesIntroduction: The present article reviews findings from empirical evaluations of integrated disease management programmes. The objective is to provide insights on integration levels, priority interventions and their effect on patient outcomes. Material and Methods: The literature review identified 1 251 articles, published from 2006 to 2011. Upon a detailed screening 61 articles were selected for bibliometric analysis and critical discussion. Results: Among several findings, it can be noted that United States of America is the country with the highest amount of published evidence on the subject under study. The most frequently referred disease is diabetes mellitus and the main reported issue of integrated disease management is self-management support. The majority of the studies were developed and exclusively managed by managed care organizations, organized family doctors or hospitals. From a total of 360 interventions reported in studies, patient interventions are the most frequently used across all disease groups, followed by professional interventions. To monitor the effectiveness of the disease programmes, the most frequently used outcomes are patient physiological measures, service use and patient health status. Discussion: Every country has its own way to implement the integrated disease management strategy. The focus of practice lies on patient empowerment, particularly through self-management. Physiological measures and service use are the outcomes with the highest rate of assessment, which are also the indicators that show higher impact among all integrated disease management programmes. Conclusion: The Portuguese health care system still faces challenges in the coordination and integration of care for patients with chronic disease thus improvements at integrated disease management programmes should be incorporate.
- A national e-Delphi towards the measurement of safe medication practices in Portuguese hospitalsPublication . Guerreiro, Mara Pereira; Plácido, Madalena; Barros, Carla Teixeira; Coelho, Anabela; Graça, Anabela; Gaspar, Maria João; Martins, Sofia de OliveiraObjectives: To determine the face and content validity of items for measuring safe medication practices in Portuguese hospitals. Methods: 128 items were drafted from content analysis of existing questionnaires and the literature, employing preferred terms of the WHO International Classification for Patient Safety (Portuguese version). A two-round e-Delphi was convened, using a purposive multidisciplinary panel. Hospital-based experts were asked to rate the relevance of items on a 7-point Likert scale and to comment on their clarity and completeness. Results: The response rate was similar in both rounds (70.3% and 73.4%, respectively). In the first round 91/128 (71.1%) items reached the predefined level of positive consensus. In the second round 23 additional items reached positive consensus, as well as seven items newly derived by the panel. Conclusions: Most items have face and content validity, indicating relevance and clarity, and can be included in a future questionnaire for measuring safe medication practices in Portuguese hospitals.