Unidade de Investigação - ciTechCare - Center for Innovative Care and Health Technology
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Percorrer Unidade de Investigação - ciTechCare - Center for Innovative Care and Health Technology por Domínios Científicos e Tecnológicos (FOS) "Ciências Médicas::Medicina Clínica"
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- HIV/AIDS length of stay in Portugal under financial constraints: a longitudinal study for public hospitals, 2009–2014Publication . Augusto, Gonçalo; Abrantes, Alexandre V.; Martins, Maria R.; Dias, SaraThe global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS: Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS: For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION: Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals
- Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paperPublication . Silva-Cardoso, José; Fonseca, Cândida; Franco Fátima; Morais, João; Ferreira, Jorge; Brito, DulceHeart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
- Psoriatic arthritis and ankylosing spondylitis impact on health-related quality of life and working life: a comparative population-based study.Publication . Rodrigues, Joana; Rodrigues, Ana Maria; Sousa, Rute Dinis; Branco, Jaime Cunha; Canhão, Helena; Dias, SaraPsoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic disorders that significantly impact patients' quality of life (QoL), health care systems and society. There is very limited data on the epidemiology and the impact of PsA and AS in Portugal, so in this study we aim to: 1) estimate the prevalence of PsA and AS in the adult Portuguese population; 2) compare health-related quality of life (QoL) of PsA and AS with the one of other rheumatic and musculoskeletal diseases (RMD) and with subjects with no rheuma - tic diseases; 3) compare early retirement and productivity loss among PsA and AS with other RMD. Methods: We used data from EpiReumaPt, a population-based survey, conducted from 2011 to 2013, in which 10661 subjects, over 18 years old, were screened for RMD. Spondyloarthritis (SpA) was defined by a posi tive expert opinion combined with the fulfillment of the Assessment of Spondyloarthritis International Socie ty (ASAS) criteria for axial and peripheral SpA. Estimates were computed as weighted proportions considering the study design. Logistic regressions were used to compare AS/PsA subjects with other RMD and the adult Portuguese population without rheumatic di - seases. Results: Prevalence rate of SpA was of 1.6% (95% CI 1.2% to 2.1%). Subjects with AS or PsA had worse QoL, reflected by EQ5D score when compared with the adult Portuguese population without rheumatic diseases (b=- 0.08; p=0.031). AS and PsA also had worse QoL when compared with participants with other RMD (b=-0.22; p>0.001). AS and in comparison to patients with other RMD, PsA subjects retired early due to their illness (OR=4.95; 95% CI 1.54% to 15.93%). A significant proportion of patients with SpA (13.6%) referred absenteeism in the previous 12 months to the interview. Conclusions: AS and PsA were found to be associated with poor QoL and a high rate of disease-related early retirement, emphasizing the burden of such rheuma tic conditions in Portugal.