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Clinical laboratory test results are integral to patient management. Important aspects of laboratory tests’ contributions are the use of the test information and the role they have in facilitating efficient and effective use of healthcare resources. Methods of measuring those contributions were examined using quantitative HCV RNA test results (HCV VL) in therapeutic management decisions as a model. Test precision is important in those decisions; therefore, the clinical use was evaluated by studying the impact that knowledge of inherent assay imprecision had on clinicians’ decisions. A survey describing a simulated patient at a decision point for HCV triple-combination therapy management was sent to 1491 hepatology clinicians. Participants saw HCV RNA results at five different levels and were asked to choose to: continue therapy, discontinue therapy, or repeat the test. Test results were presented both with and without the 95% confidence intervals (CIs). Three of the VLs had CIs that overlapped the therapeutic decision level. Participants saw both sets of results in random order. Demographics and practice preferences were also surveyed. One-hundred-thirty-eight responses were received. Adherence to clinical guidelines was demonstrated in self-reported behaviors and in most decisions. However, participants chose to repeat the test up to 37% of the time. The impact of the knowledge of assay imprecision did not have a statistically significant effect on clinicians’ decisions. To determine economic value, an analytic decision-tree model was developed. Transition probabilities, costs, and Quality of Life values were derived from published literature. Survey respondents’ decisions were used as model inputs. Across all HCV VL levels, the calculated test value was approximately $2600, with up to $17,000 in treatment-related cost savings per patient at higher HCV VLs. The test value prevailed regardless of the presence or absence of CIs, and despite repeat testing. The calculated value in cost savings/patient was up to 100 times the investment for HCV VL testing. Laboratory tests are investments in efficient uses of healthcare resources. Proper interpretation and use of their information is integral to that value. This type of analysis can inform institutional decisions and higher level policy discussions.

Made available in DSpace on 2016-04-25T20:21:18Z (GMT). No. of bitstreams: 1 Maria Elisa Gonzalez Manso.pdf: 1100752 bytes, checksum: a79f3c4334cb3dc3edbfbcb83487718d (MD5) Previous issue date: 2015-02-05 / This research aims to understand the explanatory model and the therapeutic itinerary of a group of patients affected by chronic diseases who are assisted by disease management programs carried out by operators of health plans and identify strategies of self-care that relate with the explanatory model. The thesis that moves this study is that the route that the patient uses for its treatment has deep roots in his own culture, being much larger than the model used by health professionals, also generated by the culture, but restricted by the biomedical vision. The meanings of terms such as health, cure, treatment, disability, dependence and others are not always equal in both models. If the meaning is too different, adherence to the treatment will be impaired, but the patient may still have obtained relief from their suffering. The methodology applied is qualitative, gathered through interviews with people with confirmed previous medical diagnosis of chronic disease who were already undergoing treatment, accompanied by chronic diseases management programs, which, according to the hegemonic healthy model, should know the diseases that affect them with a sufficient degree of information that would allow their full compliance. Because these are people linked to health plans, with a higher socioeconomic strata, they would fit the criteria of information, income, education and access to health care that would turn them into ideal patients and adherent to therapy. Reasons for non-adherence to treatment among these participants are what motivated this research and generated the hypothesis that the therapeutic itinerary of these patients, generated and engraved in their culture, originates from an explanatory model of the illness process much wider than the hegemonic model. So these diseased would present strategies of self-care, as part of this layman model, which allows them to carry on and manage their treatment both within and without the current prevailing model, strategies those that can be seen by health professionals as noncompliance. We believe that this study achieved its objectives, supporting the initial hypothesis of the research, showing that even in a theoretically disciplined group within criteria taken as ideal for joining the biomedical model of illness and treatment, people are immersed in their culture and find loopholes for the exercise of self-care. The work also showed that the crisis of the biomedical model, in this case, stems from the microphysics power relations and from the structural conditions of the health system and the people in the group are able to identify some of these flaws. We hope this research will contribute to this relevant nowadays debate as well as collaborate in the reflections on medicine and health education, broadening the discussion to incorporate the experiences and narratives of this group of patients / Esta pesquisa tem como objetivo perceber o modelo explicativo e o itinerário terapêutico de um grupo de doentes acometidos por afecções crônicas assistidos por programas de gerenciamento de doenças realizados por operadoras de planos de saúde e identificar estratégias de cuidar de si que se inter-relacionam com seu modelo explicativo. A tese que move este estudo é de que o itinerário que o doente utiliza para seu tratamento tem profundas raízes na cultura, sendo muito mais amplo do que o modelo dos profissionais de saúde, por sua vez também gerado na cultura, porém restringido pela visão da biomedicina. Os significados de termos como saúde, cura, tratamento, incapacidade, dependência, entre outros, nem sempre são correspondentes em ambos os modelos. Caso o significado seja muito diferente, a adesão ao tratamento ficará prejudicada, mas o doente pode ter obtido alívio para seu sofrimento. A metodologia empregada é qualitativa, realizada mediante entrevistas com pessoas com diagnóstico médico prévio confirmado de doença crônica e que já se encontravam em tratamento, acompanhadas por programas de gerenciamento de doenças crônicas, as quais, segundo o modelo de atenção à saúde hegemônico, deveriam conhecer as doenças que os acometem com um grau de informação suficiente que permitisse sua adesão plena ao tratamento. Por se tratarem de pessoas vinculadas a planos de saúde, portanto de estratos socioeconômicos mais elevados, preencheriam os quesitos de informação, renda, educação e acessibilidade ao sistema de saúde que os transformaria em pacientes ideais e aderentes à terapêutica. O porquê da não adesão ao tratamento entre estes participantes é que despertou esta pesquisa e gerou a hipótese de que o itinerário terapêutico destes enfermos, gerado e inscrito na cultura, origina-se de um modelo explicativo do processo de adoecer mais amplo do que o modelo hegemônico. Estes adoecidos apresentariam assim estratégias de cuidar de si próprios, como parte deste modelo dito leigo, que faz com que convivam e gerenciem seu tratamento tanto dentro quanto à revelia do modelo predominante, estratégias estas que podem ser vistas pelos profissionais de saúde como não adesão. Acreditamos que esta pesquisa atingiu seus objetivos, corroborando a hipótese inicial do trabalho, demonstrando que, mesmo em um grupo teoricamente disciplinado dentro de critérios tidos como ideais para a adesão ao modelo biomédico de adoecimento e tratamento, as pessoas estão imersas na cultura e encontram brechas para o exercício do cuidar de si. O trabalho mostrou ainda que a crise do modelo biomédico, neste caso, advém tanto das relações microfísicas de poder quanto das condições estruturais do sistema de saúde e que as pessoas do grupo conseguem identificar algumas destas falhas. Esperamos que esta pesquisa possa contribuir para este debate tão atual, além de colaborar nas reflexões sobre a medicina e sobre o ensino na saúde, ampliando a discussão ao incorporar as experiências e narrativas deste grupo de enfermos

Made available in DSpace on 2016-04-26T14:55:07Z (GMT). No. of bitstreams: 1 Maria Elisa Gonzalez Manso.pdf: 1100752 bytes, checksum: a79f3c4334cb3dc3edbfbcb83487718d (MD5) Previous issue date: 2015-02-05 / This research aims to understand the explanatory model and the therapeutic itinerary of a group of patients affected by chronic diseases who are assisted by disease management programs carried out by operators of health plans and identify strategies of self-care that relate with the explanatory model. The thesis that moves this study is that the route that the patient uses for its treatment has deep roots in his own culture, being much larger than the model used by health professionals, also generated by the culture, but restricted by the biomedical vision. The meanings of terms such as health, cure, treatment, disability, dependence and others are not always equal in both models. If the meaning is too different, adherence to the treatment will be impaired, but the patient may still have obtained relief from their suffering. The methodology applied is qualitative, gathered through interviews with people with confirmed previous medical diagnosis of chronic disease who were already undergoing treatment, accompanied by chronic diseases management programs, which, according to the hegemonic healthy model, should know the diseases that affect them with a sufficient degree of information that would allow their full compliance. Because these are people linked to health plans, with a higher socioeconomic strata, they would fit the criteria of information, income, education and access to health care that would turn them into ideal patients and adherent to therapy. Reasons for non-adherence to treatment among these participants are what motivated this research and generated the hypothesis that the therapeutic itinerary of these patients, generated and engraved in their culture, originates from an explanatory model of the illness process much wider than the hegemonic model. So these diseased would present strategies of self-care, as part of this layman model, which allows them to carry on and manage their treatment both within and without the current prevailing model, strategies those that can be seen by health professionals as noncompliance. We believe that this study achieved its objectives, supporting the initial hypothesis of the research, showing that even in a theoretically disciplined group within criteria taken as ideal for joining the biomedical model of illness and treatment, people are immersed in their culture and find loopholes for the exercise of self-care. The work also showed that the crisis of the biomedical model, in this case, stems from the microphysics power relations and from the structural conditions of the health system and the people in the group are able to identify some of these flaws. We hope this research will contribute to this relevant nowadays debate as well as collaborate in the reflections on medicine and health education, broadening the discussion to incorporate the experiences and narratives of this group of patients / Esta pesquisa tem como objetivo perceber o modelo explicativo e o itinerário terapêutico de um grupo de doentes acometidos por afecções crônicas assistidos por programas de gerenciamento de doenças realizados por operadoras de planos de saúde e identificar estratégias de cuidar de si que se inter-relacionam com seu modelo explicativo. A tese que move este estudo é de que o itinerário que o doente utiliza para seu tratamento tem profundas raízes na cultura, sendo muito mais amplo do que o modelo dos profissionais de saúde, por sua vez também gerado na cultura, porém restringido pela visão da biomedicina. Os significados de termos como saúde, cura, tratamento, incapacidade, dependência, entre outros, nem sempre são correspondentes em ambos os modelos. Caso o significado seja muito diferente, a adesão ao tratamento ficará prejudicada, mas o doente pode ter obtido alívio para seu sofrimento. A metodologia empregada é qualitativa, realizada mediante entrevistas com pessoas com diagnóstico médico prévio confirmado de doença crônica e que já se encontravam em tratamento, acompanhadas por programas de gerenciamento de doenças crônicas, as quais, segundo o modelo de atenção à saúde hegemônico, deveriam conhecer as doenças que os acometem com um grau de informação suficiente que permitisse sua adesão plena ao tratamento. Por se tratarem de pessoas vinculadas a planos de saúde, portanto de estratos socioeconômicos mais elevados, preencheriam os quesitos de informação, renda, educação e acessibilidade ao sistema de saúde que os transformaria em pacientes ideais e aderentes à terapêutica. O porquê da não adesão ao tratamento entre estes participantes é que despertou esta pesquisa e gerou a hipótese de que o itinerário terapêutico destes enfermos, gerado e inscrito na cultura, origina-se de um modelo explicativo do processo de adoecer mais amplo do que o modelo hegemônico. Estes adoecidos apresentariam assim estratégias de cuidar de si próprios, como parte deste modelo dito leigo, que faz com que convivam e gerenciem seu tratamento tanto dentro quanto à revelia do modelo predominante, estratégias estas que podem ser vistas pelos profissionais de saúde como não adesão. Acreditamos que esta pesquisa atingiu seus objetivos, corroborando a hipótese inicial do trabalho, demonstrando que, mesmo em um grupo teoricamente disciplinado dentro de critérios tidos como ideais para a adesão ao modelo biomédico de adoecimento e tratamento, as pessoas estão imersas na cultura e encontram brechas para o exercício do cuidar de si. O trabalho mostrou ainda que a crise do modelo biomédico, neste caso, advém tanto das relações microfísicas de poder quanto das condições estruturais do sistema de saúde e que as pessoas do grupo conseguem identificar algumas destas falhas. Esperamos que esta pesquisa possa contribuir para este debate tão atual, além de colaborar nas reflexões sobre a medicina e sobre o ensino na saúde, ampliando a discussão ao incorporar as experiências e narrativas deste grupo de enfermos