Fatores associados à qualidade do atendimento a pacientes com doenças inflamatórias intestinais, sob a ótica médica especializada
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Data
2022-08-02
Autores
Craveiro, Marcela Maria Silvino
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Universidade Estadual Paulista (Unesp)
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Introdução: As doenças inflamatórias intestinais (DII) são afecções inflamatórias crônicas de caráter recorrente, cujas taxas de incidência e prevalência têm aumentado mundialmente, inclusive no Brasil, com importante impacto na qualidade de vida e morbidade destes pacientes. Sabemos que o diagnóstico precoce e o início rápido do tratamento adequado alteram a história natural da doença prevenindo complicações, por isso é necessário traçar o perfil dos médicos que atendem esses pacientes com DII no Brasil e como em seu dia a dia esse tratamento é realizado, principalmente entender as dificuldades no atendimento e avaliá-las em relação a outras variáveis. Objetivo: Analisar estatisticamente o banco de dados pertencente ao Grupo de Estudos da Doença Inflamatória Intestinal do Brasil (GEDIIB), composto por médicos especialistas em DII, e avaliar como é realizado esse atendimento em todas as regiões brasileiras, além de analisar qual sua relação com o IDH e a demografia médica de cada região para obtermos resultados que possam ser úteis na melhoria do atendimento nas DII no país. Metodologia: Trata-se de um estudo transversal que analisou de forma descritiva o banco de dados pré-existente do GEDIIB e observou através desta a realidade do atendimento das DII no país. Através desses dados conseguimos avaliar o perfil dos médicos que atendem esses pacientes, avaliar o acesso a medicações para o tratamento e a disponibilidade de exames complementares e relacionar essas variáveis com a presença de recursos humanos ao IDH e demografia médica de cada região. Foi realizada análise descritiva e estatística apropriada para a relação das variáveis e o nível de significância definido foi p<0.05. Resultados: Na análise descritiva os resultados foram: Os médicos que responderam ao questionário se concentram mais na região Sudeste, com maior participação dos médicos residentes no estado de São Paulo e na cidade do Rio de Janeiro, a maioria dos profissionais tem menos de 20 anos de formados na faculdade e na especialidade, a gastroenterologia seguido pela coloproctologia foram as especialidades que mais contribuíram com as respostas. Em relação ao local de trabalho a clínica privada expressivamente foi o lugar mais comum. Quanto à dificuldade de acesso a medicação a terapia biológica seguida pelos imunossupressores foram os primeiros colocados tanto na RCU e na DC, enquanto que a nutrição e a enteroscopia por duplo balão foi à especialidade e o exame complementar respectivamente de mais difícil acesso. No que diz respeito ao número de pacientes atendidos pelos profissionais a maioria possui 11-50 pacientes com diagnóstico de DC e RCU, os mesmo prescrevem mais os imunossupressores e a terapia biológica para o tratamento da DC e os derivados 5-ASA na terapêutica da RCU. A maioria dos profissionais se sente seguro no uso da terapia biológica, sendo o infliximabe a primeira escolha para o tratamento da DC e da RCU, enquanto que como segunda opção para DC o ustequinumabe merece destaque como o vedolizumabe na RCU. A falha da terapia biológica foi o principal tema que os médicos gostariam de abordar em discussões futuras. Os resultados foram analisados estatisticamente e relacionado ao IDH médio dos estados, sendo os resultados estatisticamente significativos às correlações para as seguintes variáveis: local de trabalho em clínica privada especializada em DII, dificuldade de acesso a medicações como corticóide, metrotexato e 6-mercaptopurina, encaminhamento para a avaliação da enfermagem, e acesso a enteroscopia por duplo-balão. Na análise da associação das variáveis com a razão médica os resultados foram significativos quanto ao: hospital privado e ambulatório público, dificuldade de acesso a medicações como azatioprina, 6-mercaptopurina e terapia biológica, ao acesso a exames complementares como marcadores fecais, enterotomografia, colonoscopia, cápsula endoscópica e enteroscopia por duplo balão. Conclusão: Através desse estudo, pudemos ter um retrato do perfil atual dos médicos que atendem DII que participaram deste levantamento do GEDIIB. Além da análise e descrição do perfil do médico e de suas dificuldades, relacionamos os principais aspectos que prejudicam tanto ao diagnóstico e o tratamento, atribuídos a fatores externos, independente da nossa realidade e competência. Esses resultados sugerem e demonstram que para o atendimento adequado ao paciente com DII, diversas variáveis externas além do conhecimento e capacidade médica revelam-se necessários. Desta forma, políticas públicas de saúde mais eficazes devem ser planejadas e ampliadas, com atenção especial aos índices e resultados citados acima, visando um crescimento e adequação do sistema de saúde brasileiro voltado as DII.
Introduction: Inflammatory bowel diseases (IBD) are chronic, recurrent inflammatory conditions, whose incidence and prevalence rates have increased worldwide, including in Brazil, with an important impact on the quality of life and morbidity of these patients. We know that early diagnosis and prompt start of adequate treatment alters the natural history of the disease, preventing complications, so it is necessary to outline the profile of doctors who treat these patients with IBD in Brazil and how this treatment is performed in their routine, mainly to understand the difficulties in care and evaluate them in relation to other variables. Aim: To statistically analyze the database of the Inflammatory Bowel Disease Study Group in Brazil (GEDIIB), composed of expert physicians in IBD, and to evaluate how this service is performed in all Brazilian regions, in addition to analyzing its relationship with the Human Development Index (HDI) and medical demography of each region to obtain results that can be useful in improving IBD care in the country. Methods: This is a cross-sectional study that descriptively analyzed the pre-existing GEDIIB database and observed through it the reality of IBD care in Brazil. Through these data we were able to assess the profile of physicians who care for these patients, the availability to medication for treatment and complementary exams, and to relate these variables to the presence of human resources to the HDI and medical demography of each region. Descriptive and appropriate statistical analysis was performed for the relationship of variables and the significance level defined was p<0.05. Results: In the descriptive analysis, the results were: Physicians who answered the questionnaire are more concentrated in the Southeast region, with greater participation of physicians residing in the state of São Paulo and in the city of Rio de Janeiro, most professionals are under 20 years old of medical school and residency graduation, gastroenterology followed by coloproctology were the specialties that most contributed to the responses. Regarding the workplace, the private clinic was significantly the most common place. Regarding the difficulty in accessing medication, biological therapy followed by immunosuppressants were the first placed in both UC and CD, while nutrition and double balloon enteroscopy were the specialty and complementary exam, respectively, of most difficult access. Regarding the number of patients seen by professionals, most have 11-50 patients diagnosed with CD and UC, they prescribe more immunosuppressants and biological therapy for the treatment of CD and 5-ASA derivatives in the therapy of UC. Most professionals feel confident in the use of biological therapy, with infliximab being the first choice for the treatment of CD and UC, while as a second option for CD, ustekinumab deserves to be highlighted like vedolizumab in UC. The failure of biological therapy was the main topic that clinicians would like to address in future discussions. The results were statistically analyzed and related to the average HDI of the states, and were statistically significant to the correlations for the following variables: workplace in a private clinic specializing in IBD, difficulty in accessing medications such as corticosteroids, methotrexate and 6-mercaptopurine, referral for nursing assessment, and access to double-balloon enteroscopy. In the analysis of the association of the variables with the medical reason, the results were significant regarding: private hospital and public outpatient clinic, difficulty in accessing medications such as azathioprine, 6-mercaptopurine and biological therapy, access to complementary exams such as fecal markers, enterotomography, colonoscopy, capsule endoscopy and double balloon enteroscopy. Conclusion: Through this study, we were able to have a picture of the current profile of doctors who attend IBD who participated in this GEDIIB survey. In addition to the analysis and description of the physician's profile and its difficulties, we list the main aspects that affect both diagnosis and treatment, attributed to external factors, regardless of our reality and competence. These results suggest and demonstrate that for adequate care for patients with IBD, several external variables in addition to medical knowledge and capacity are necessary. In this way, more effective public health policies should be planned and expanded, with special attention to the indices and results mentioned above, aiming at a growth and adequacy of the Brazilian health system focused on IBD
Introduction: Inflammatory bowel diseases (IBD) are chronic, recurrent inflammatory conditions, whose incidence and prevalence rates have increased worldwide, including in Brazil, with an important impact on the quality of life and morbidity of these patients. We know that early diagnosis and prompt start of adequate treatment alters the natural history of the disease, preventing complications, so it is necessary to outline the profile of doctors who treat these patients with IBD in Brazil and how this treatment is performed in their routine, mainly to understand the difficulties in care and evaluate them in relation to other variables. Aim: To statistically analyze the database of the Inflammatory Bowel Disease Study Group in Brazil (GEDIIB), composed of expert physicians in IBD, and to evaluate how this service is performed in all Brazilian regions, in addition to analyzing its relationship with the Human Development Index (HDI) and medical demography of each region to obtain results that can be useful in improving IBD care in the country. Methods: This is a cross-sectional study that descriptively analyzed the pre-existing GEDIIB database and observed through it the reality of IBD care in Brazil. Through these data we were able to assess the profile of physicians who care for these patients, the availability to medication for treatment and complementary exams, and to relate these variables to the presence of human resources to the HDI and medical demography of each region. Descriptive and appropriate statistical analysis was performed for the relationship of variables and the significance level defined was p<0.05. Results: In the descriptive analysis, the results were: Physicians who answered the questionnaire are more concentrated in the Southeast region, with greater participation of physicians residing in the state of São Paulo and in the city of Rio de Janeiro, most professionals are under 20 years old of medical school and residency graduation, gastroenterology followed by coloproctology were the specialties that most contributed to the responses. Regarding the workplace, the private clinic was significantly the most common place. Regarding the difficulty in accessing medication, biological therapy followed by immunosuppressants were the first placed in both UC and CD, while nutrition and double balloon enteroscopy were the specialty and complementary exam, respectively, of most difficult access. Regarding the number of patients seen by professionals, most have 11-50 patients diagnosed with CD and UC, they prescribe more immunosuppressants and biological therapy for the treatment of CD and 5-ASA derivatives in the therapy of UC. Most professionals feel confident in the use of biological therapy, with infliximab being the first choice for the treatment of CD and UC, while as a second option for CD, ustekinumab deserves to be highlighted like vedolizumab in UC. The failure of biological therapy was the main topic that clinicians would like to address in future discussions. The results were statistically analyzed and related to the average HDI of the states, and were statistically significant to the correlations for the following variables: workplace in a private clinic specializing in IBD, difficulty in accessing medications such as corticosteroids, methotrexate and 6-mercaptopurine, referral for nursing assessment, and access to double-balloon enteroscopy. In the analysis of the association of the variables with the medical reason, the results were significant regarding: private hospital and public outpatient clinic, difficulty in accessing medications such as azathioprine, 6-mercaptopurine and biological therapy, access to complementary exams such as fecal markers, enterotomography, colonoscopy, capsule endoscopy and double balloon enteroscopy. Conclusion: Through this study, we were able to have a picture of the current profile of doctors who attend IBD who participated in this GEDIIB survey. In addition to the analysis and description of the physician's profile and its difficulties, we list the main aspects that affect both diagnosis and treatment, attributed to external factors, regardless of our reality and competence. These results suggest and demonstrate that for adequate care for patients with IBD, several external variables in addition to medical knowledge and capacity are necessary. In this way, more effective public health policies should be planned and expanded, with special attention to the indices and results mentioned above, aiming at a growth and adequacy of the Brazilian health system focused on IBD
Descrição
Palavras-chave
Qualidade de atendimento a saúde, Doença de Crohn, Retocolite ulcerativa, Doença inflamatória intestinal, Quality of health care, Crohn´s disease, Ulcerative colitis, Inflammatory bowel disease