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Abstract(s)
A sustentabilidade financeira dos Sistemas de Saúde representa um problema da atualidade. Em Portugal, agudizado pela crise financeira, e para o controlo das despesas, a classe política e os profissionais de saúde, procuram soluções e novas práticas de gestão que possam promover uma distribuição de recursos mais justa e equitativa. Esta investigação pretende refletir e levar a refletir sobre uma alternativa tecnológica muito recentemente adotada em algumas unidades de saúde a nível mundial, com o intuito de equilibrar gastos. É uma tomada de decisão crítica e a sua a avaliação/reavaliação é pertinente e deve incidir sobre atos de clínica cirúrgica, invasivos, onde a segurança do doente deve ser acautelada, e os princípios bioéticos inerentes à gestão da saúde não devem ser comprometidos. Diz respeito ao estudo da utilização de Dispositivos Médicos de Uso Único (DMUU) após reprocessamento. O contexto da investigação foi posicionado no Centro Hospitalar de S. João (CHSJ) no Porto, enquanto estrutura orgânica e hospitalar estatal inserida numa comunidade universitária, e enquanto palco onde ocorrem e se desenvolvem práticas de estudo, aprendizagem e investigação. A recolha de dados foi facultada a partir de uma base de dados informática desenvolvida por este Centro Hospitalar (HVital), o que evidencia a importância da inovação e do recurso a novas tecnologias facilitadoras de estudos transversais a vários saberes das ciências médicas e sociais. Recorremos a metodologia quantitativa a partir de uma amostra de 2344 pacientes intervencionados nos Bloco Operatório Central deste Centro Hospitalar. Constam na amostra, diversas Técnicas/Procedimentos Cirúrgicos, abrangendo patologias de todas as áreas de especialidade clínica, durante os anos 2014 e 2015.
Os resultados da componente empírica desta investigação pretendem configurar uma Avaliação de Tecnologias em Saúde (ATS) em contexto cirúrgico, e como tal, medir consequências desta opção tecnológica para que se adquiram mais certezas, e se possível e necessário, se proponham melhorias. Para este objetivo, as questões de investigação foram: 1) qual o nível de segurança eficácia e efetividade do protocolo de reprocessamento dos DMUU; 2) a utilização de material reprocessado é uma tomada de decisão economicamente compensatória; 3) é uma estratégia de gestão que vai de encontro aos princípios éticos; 4) os pacientes são informados das condições e alternativas dos equipamentos com que são intervencionados e dos riscos a que são submetidos.
Os resultados apontam para que se considere o Reprocessamento de DMUU um procedimento de risco. Apesar de grande parte das variáveis relativas ao acompanhamento clínico dos pacientes intervencionados nos grupos de estudo (cirurgias realizadas com DMUU novo Versus cirurgias realizadas com DMUU reprocessado), não evidenciarem diferenças significativas para estes dois grupos, outras variáveis apresentam resultados que indicam, que ao contrário do que foi dado como requisitos experimentais uniformes e isentos, ou seja, a aleatoriedade de seleção de pacientes para cada um destes grupos, não foi o que se verificou na prática de ensaio. Este facto levanta alguma perplexidade sobre as causas que terão levado a esta mudança de condições experimentais. Outra constatação pertinente é a comprovada necessidade de aperfeiçoamento do Processo de Reprocessamento que ainda apresenta lacunas que carecem de uma abordagem pragmática e que continuam a constituir preocupação para entidades governamentais e privadas a nível nacional e internacional.
As respostas e resultados relativamente à salvaguarda dos princípios da bioética evidenciaram a urgência de um trabalho de fundo sistematizado, pelo que encontramos de algum facilitismo e desrespeito por esta área. Há um longo caminho a percorrer na sensibilização das organizações, sobre a importância de que se reveste o cumprimento dos princípios e valores éticos na área da saúde, para uma eficaz e eficiente humanização organizacional.
The financial sustainability of Health Systems represents a current problem. In Portugal, exacerbated by the financial crises and to control expenses, policy-makers and healthcare professionals sought solutions and new management practices which encourage a more equitable and reasonable distribution of resources. With the goal of balancing expenses, this research intends to reflect and lead to reflection upon a recently adopted technological alternative in some healthcare units worldwide. It is a critical decision and its evaluation / re-evaluation is relevant. It should focus on invasive clinical practices, where the safety of patients should be safeguarded, and the bioethical principles inherent in health management should not be compromised. This concerns the usage of Single-use Medical Devices (SUDs) after reprocessing. The research was carried out in the Centro Hospitalar de São João (CHSJ) in Oporto, a state institution with an organic characteristic structure that, in itself, is an essential part of a large university community where learning, research and study inherently take place as its context. The data collection was provided from a computer database developed by this Hospital (HVital), which highlights the importance of innovation and the use of new simplifying technologies of cross–sectional studies in the several domains of medical and social sciences. A quantitative methodology was based on a sample of 2344 patients operated on in the Central Surgery Block of this Hospital Center. Several Surgical Techniques/Procedures are present in the sample, covering pathologies of all clinical specialties, throughout 2014 and 2015. The results of the empirical component of this research aim to arrange a Health Technology Assessment (HTA) in a surgical context and, therefore, measure the consequences of this technological option so that more convictions are acquired and, if possible and necessary, suggest enhancements. Consequently, the research questions were: 1) what the level of safety, efficacy and effectiveness of the SUDs reprocessing protocol is; 2) is the use of reprocessed material a decision which is economically compensatory; 3) is it a management strategy which meets ethical principles; 4) are patients informed of the conditions and alternatives of the equipment with which they are operated on and of the risks they are submitted to. The results indicate that the reprocessing of SUDs is considered a risk procedure. Although a large part of the variables related to the clinical follow-up of the patients within the study groups (surgeries performed with new SUDs versus the surgery performed with reprocessed SUDs) no significant differences were shown for these two groups, other variables present results indicating the contrast which was given as uniform and exempt experimental requisites, put differently, the randomness of patient selection for each of these groups was not what was verified in the practice test.This fact raises perplexity over the causes that led to this change of the experimental conditions. Another relevant finding is the established need to improve the Reprocessing Process that continuously presents gaps which need a pragmatic approach and which continue to threaten national and international governmental and private institutions. The replies and results regarding the upholding of bioethical principles have highlighted the urgent need of an in depth systematized work since some degree of unobservant complacency was evidenced in this area. Organization have a long way to go in raising awareness on the importance in the compliance of ethical principles and values in healthcare, for a effective and efficient organizational humanization.
The financial sustainability of Health Systems represents a current problem. In Portugal, exacerbated by the financial crises and to control expenses, policy-makers and healthcare professionals sought solutions and new management practices which encourage a more equitable and reasonable distribution of resources. With the goal of balancing expenses, this research intends to reflect and lead to reflection upon a recently adopted technological alternative in some healthcare units worldwide. It is a critical decision and its evaluation / re-evaluation is relevant. It should focus on invasive clinical practices, where the safety of patients should be safeguarded, and the bioethical principles inherent in health management should not be compromised. This concerns the usage of Single-use Medical Devices (SUDs) after reprocessing. The research was carried out in the Centro Hospitalar de São João (CHSJ) in Oporto, a state institution with an organic characteristic structure that, in itself, is an essential part of a large university community where learning, research and study inherently take place as its context. The data collection was provided from a computer database developed by this Hospital (HVital), which highlights the importance of innovation and the use of new simplifying technologies of cross–sectional studies in the several domains of medical and social sciences. A quantitative methodology was based on a sample of 2344 patients operated on in the Central Surgery Block of this Hospital Center. Several Surgical Techniques/Procedures are present in the sample, covering pathologies of all clinical specialties, throughout 2014 and 2015. The results of the empirical component of this research aim to arrange a Health Technology Assessment (HTA) in a surgical context and, therefore, measure the consequences of this technological option so that more convictions are acquired and, if possible and necessary, suggest enhancements. Consequently, the research questions were: 1) what the level of safety, efficacy and effectiveness of the SUDs reprocessing protocol is; 2) is the use of reprocessed material a decision which is economically compensatory; 3) is it a management strategy which meets ethical principles; 4) are patients informed of the conditions and alternatives of the equipment with which they are operated on and of the risks they are submitted to. The results indicate that the reprocessing of SUDs is considered a risk procedure. Although a large part of the variables related to the clinical follow-up of the patients within the study groups (surgeries performed with new SUDs versus the surgery performed with reprocessed SUDs) no significant differences were shown for these two groups, other variables present results indicating the contrast which was given as uniform and exempt experimental requisites, put differently, the randomness of patient selection for each of these groups was not what was verified in the practice test.This fact raises perplexity over the causes that led to this change of the experimental conditions. Another relevant finding is the established need to improve the Reprocessing Process that continuously presents gaps which need a pragmatic approach and which continue to threaten national and international governmental and private institutions. The replies and results regarding the upholding of bioethical principles have highlighted the urgent need of an in depth systematized work since some degree of unobservant complacency was evidenced in this area. Organization have a long way to go in raising awareness on the importance in the compliance of ethical principles and values in healthcare, for a effective and efficient organizational humanization.
Description
Keywords
Bioética Gestão Reprocessamento DMUU Bioethics Management Reprocessing SUDs