AIM: To conduct a systematic literature review on the existing literature on the prevalence of medication errors across the medicines management system in primary care; To explore the systems of error management in primary care; to investigate the prevalence and nature of medication errors in children, 0-12 years, and in older patients, ≥65 years, in primary care; and to explore community pharmacists' interventions on medicines-related problems. METHODS: 1) Systematic literature review; 2) Questionnaire survey of Primary Care Trusts (PCTs), Clinical Commissioning Groups (CCGs) and NHS Area Teams; 3) Retrospective review of the electronic medical records of a random sample of older patients, ≥65 years old, and children 0-12 years old, from 2 general practices in Luton and Bedford CCGs, England; 4) Prospective observation of community pharmacists' interventions on medicines-related problems and prescribing errors from 3 community pharmacies in Luton and Bedford CCGs in England. DATA ANALYSIS: Quantitative data from records review were analysed using Microsoft Excel on data extracted from an Access database. Statistical tests of significance were performed as necessary. Descriptive statistics were conducted on quantitative data from the studies and inductive qualitative analyses were conducted on aspects of the questionnaire survey. RESULTS: • The systematic literature review demonstrated that medication errors are common, and occur at every stage of the medication management system in primary care, with error rates between ≤1% and ≥90%, depending on the part of the system studied and the definitions and methods used. There is some evidence that the prescribing stage is the most susceptible, and that the elderly (over 65 years) and children (under 18 years) are more likely to experience significant errors, although very little research has focussed on these age groups. • The questionnaire survey of PCTS, CCGs and NHSE demonstrated that national and local systems for managing medication errors appeared chaotic, and need to be better integrated to improve error learning and prevention in general practice. • The retrospective review of patients' medical records in general practices demonstrated that prescribing and monitoring errors are common in older patients and in children. 2739 unique prescription items for 364 older patients ≥65 years old were reviewed, with prescribing and monitoring errors detected for 1 in 3 patients involving about 1 in 12 prescriptions. The factors associated with increased risk of errors were: number of unique medications prescribed, being ≥75 years old, being prescribed medications requiring monitoring, and medications from these therapeutic areas: corticosteroid, NSAID, diuretic, thyroid and antithyroid hormones, statins and ACE-I/ARB. 755 unique prescription items for 524 younger patients 0-12 years old were examined, with approximately 1 in 10 prescriptions and 1 in 5 patients being exposed to a prescribing error. Factors associated with increased risk of prescribing errors in younger patients were: being aged ≤10 years old, being prescribed three or more medications, and from similar therapeutic areas as above. Majority of the errors were of mild to moderate severity. • Community pharmacists performed critical interventions as the last healthcare professional defense within the medicines management system in primary care. However, this role is challenged by other dispensary duties including the physical aspects of dispensing and other administrative roles. CONCLUSION Prescribing and monitoring errors in general practice, and older patients and children may be more at risk compared to the rest of the population, though most errors detected were less severe. Factors associated with increased risk for errors in these age groups were multifaceted. The systems for periodic laboratory monitoring for routinely prescribed drugs, particularly in older patients, need to be reviewed and strengthened to reduce preventable hospital admissions. Antibiotic dosing in children in general practice needs to be regularly reviewed through continued professional developments and other avenues. As guidance on local arrangements for error reporting and learning systems are less standardised across primary care organisations, pertinent data from adverse prescribing events and near misses may be lost. Interventions for reducing errors should therefore explore how to strengthen local arrangements for error learning and clinical governance. Community pharmacists and/or primary care pharmacists provide an important defence within the medicines management system in primary care. Policy discussions and review around the role of the pharmacist in primary care are necessary to strengthen this defence, and harness the potential thereof.

La salud mental en el Perú ha cobrado importancia en las últimas décadas en base al percate de la gravedad de los problemas y estadísticas que giran en torno a este. Ante estos problemas, antiguamente se hubieran preferido construir más hospitales psiquiátricos, sin embargo, estudios globales con más de dos décadas demuestran mayor efectividad en el tratamiento del paciente mediante un modelo de salud mental comunitario y una infraestructura con la capacidad de influir en su bienestar. En el Perú, el MINSA implementa dicha modalidad desde el 2015 pero falla en resolver el problema de la infraestructura. Es por esto que se propone el diseño de un Modelo de Red de Salud Mental Comunitaria en Chosica, que a partir del entendimiento de su infraestructura como medio terapéutico, se pueda influir en el bienestar anímico de un usuario cuya población crece conforme pasan los años. / Mental health in Peru has gained notoriety in recent decades based on the awareness of the seriousness of the problems and statistics that revolve around it. Given these problems, in the past they would have preferred to build more psychiatric hospitals, however, global studies with more than two decades proved greater effectiveness in the treatment of the patient through a model of communal mental health and an infrastructure with the ability to influence their well-being. In Peru, the MINSA(acronym in spanish) has implemented this model since 2015 but fails to solve the infrastructure problem. That is why the design of a Communal Mental Health Network Model in Chosica is proposed, which, from the understanding of it’s infraestructure as a therapeutic tool, can influence the well-being of an user whose population is growinf more and more through the years. / Tesis

Introducción: En los últimos años, se ha informado de una variación climática importante que puede generar un impacto en la salud mental. Esta variación genera distintos eventos climáticos que tienden a aumentar el estrés en pacientes con trastornos mentales y desencadenarlo en personas que aún no están enfermas. Objetivo: El objetivo del estudio fue describir y relacionar la temperatura máxima y mínima, humedad relativa media y precipitación máxima con el número de atenciones por trastornos mentales en consulta externa en las redes de salud de las regiones de la costa desde 2002 hasta el 2018 en el Perú. Métodos: Se realizó un estudio ecológico exploratorio, donde la unidad de análisis fue red de salud – mes. El número de atenciones en consulta externa y las variables meteorológicas fueron reportadas por medianas y rangos intercuartílicos. Para el análisis bivariado y multivariado, se utilizó el coeficiente de Spearman y la regresión de Poisson, respectivamente. Resultados: La proporción del número de atenciones por las categorías F00-F09, F10-F19, F30-F39 y F40-48 aumentó a una mayor temperatura máxima y precipitación máxima. Las categorías F20-29, F30-39, F40-48 y F60-F69 mostraron un aumento en sus atenciones cuando incrementó la humedad. Conclusión: Se encontró relación entre una mayor temperatura máxima, humedad y precipitación máxima, y el incremento de la proporción del número de atenciones por trastorno mental en consulta externa. Es necesario realizar investigaciones que evalúen el efecto de las variaciones climáticas sobre los trastornos mentales para implementar estrategias de salud que permitan abordar la carga de la enfermedad. / Introduction: In recent years, significant climate variation has been reported can have an impact on mental health. This variation generates different climatic events that require increasing stress in patients with mental disorders and trigger it in people who are not yet sick. Objective: The aim of the study was to describe and relate the maximum and minimum temperature, average relative humidity and maximum precipitation with the number of attentions for mental disorders in outpatient care in the health networks of the coastal regions from 2002 to 2018 in Peru. Methods: An exploratory ecological study was conducted, where the unit of analysis was health network - month. The number of outpatient visits and meteorological variables were reported by medians and interquartile ranges. For bivariate and multivariate analysis, Spearman coefficient and Poisson regression were used, respectively. Results: The proportion of the number of attentions by categories F00-F09, F10-F19, F30-F39 and F40-48 increased at a higher maximum temperature and maximum precipitation. The categories F20-29, F30-39, F40-48 and F60-F69 showed an increase in their attentions when humidity increased. Conclusion: A relationship was found between a higher maximum temperature, humidity and maximum precipitation, and an increase in the proportion of the number of attentions for mental disorder in outpatient care. Research assessing the effect of climate variations on mental disorders is needed to implement health strategies that will address the burden of disease. / Tesis

No description available.

Sjukvården i Sverige står inför flertalet stora utmaningar i dag. Med en växande och åldrande befolkning ökar vårdbehovet i både komplexitet och volym. Samtidigt är resurserna begränsade vilket leder till att sjukvården måste bli mer effektiv i sitt vårderbjudande. Sjukvården har därför börjat titta på management-teorier från andra branscher, främst bilindustrin. Ambulanta vårdgivare, enheter som utför vårdtjänster utan egna inneliggande patienter, är centrala i produktivitets och effektiviseringsförbättringar i de system de agerar i. Denna studie har undersökt hur forskningens idéer kring produktionsplanering och kontroll kan användas av en ambulant vårdgivare. Detta examensarbete är baserat på en fallstudie genomförd på röntgenavdelningen på Danderyds sjukhus i Stockholms län. Fallstudien har utgjorts av framförallt kvalitativ datainsamling genom semistrukturerade intervjuer understödda av kvantitativ produktionsdata och en benchmarkingstudie på röntgenmottagningen på Universitetssjukhuset i Linköping. Det empiriska bidraget i fallstudien har inkluderat en kartläggning av arbetsprocessen i röntgenmottagningen på Danderyds sjukhus. Processen kunde delas upp i tre faser: 1. Förberedelser, 2. Undersökning, och 3. Diagnosticering och dokumentering. Utifrån den kartlagda processen och en utförlig litteraturstudie om produktionsplanering och kontroll kunde tre huvudsakliga slutsatser dras: (1) implementering av produktionsplanering och kontroll måste utgå från en grundlig förståelse för processerna hos vårdgivaren och syfta till att verka för både kliniska och operationella mål, (2) produktionsplanerings- och kontrollaktiviteter måste anpassas till vårdgivarens omgivning, och (3) kontinuerlig återkoppling från kvalitets och produktivitetsmål är oumbärliga för framgångsrik utnyttjning av produktionsplanerings och kontroll i en ambulant vårdgivare. Detta examensarbete kommer hjälpa ambulanta vårdgivare att möte de utmaningar och produktivitetskrav dessa står inför i Sverige genom att utnyttja potentialen med produktionsplanering och kontroll. / The healthcare sector in Sweden faces several challenges today: a growing and ageing population increases demand in terms of both volume and complexity whereas monetary resources available do not follow suit, forcing care givers to become more efficient in their operation. The healthcare sector has for this reason in recent years become more and more inclined to implement management theories developed in other industries, primarily the automotive industry. Ambulatory care service units, who provide care services on an outpatient basis, are vital in productivity improvements in the system they are acting in but have been somewhat neglected by both policy makers and academia. This study has therefore investigated how production planning and control theories, principles and methods can be utilised in an ambulatory care service unit in a major emergency hospital in Sweden. This thesis is based on a case study conducted at the radiology department at Danderyds sjukhus, an emergency hospital located in Stockholm County Council. The case study mainly consisted of qualitative data gathering using semi-structured interviews with aid from quantitative data on department performance. The empirical contributions of the case study included a process mapping of a generic process flow prevalent in all subunits of the department in the radiology department. The main process could be divided into three main phases: 1. Preparation, 2. Examination, and 3. Diagnosing and documentation. Using the mapped out process and a thorough literature review on production planning and control three main conclusions could be drawn: (1) an implementation of production planning and control should begin with a deep understanding of process flows in the unit and aim to promote both operational and medical objectives, (2) production planning and control activities should be adapted to the environment the unit is acting in, and (3) continuous feedback from performance measurements is vital to successful production planning and control initiatives. This study will help ambulatory care service units to meet the challenge of increased demand they currently face in Sweden by utilising the potential in production planning and control.

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M.A. (Heath Studies)

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M. A. (Heath Studies)

INTRODUÇÃO: Serviços de saúde desenvolvidos para a atenção à demanda espontânea de baixa complexidade como as Walk-in Clinics canadenses e britânicas estão sendo oferecidos no Brasil como alternativa à Estratégia de Saúde da Família (ESF). Em São Paulo, recebem o nome de Assistências Médicas Ambulatoriais (AMA). Entretanto, não há estudos comparativos entre eles. OBJETIVO: Comparar aspectos estruturais e processuais de uma Unidade Básica de Saúde (UBS), vinculada à ESF, e de uma AMA utilizando a ferramenta de avaliação PCATool. METODOLOGIA: Trata-se de um estudo transversal utilizando o instrumento para avaliação de qualidade de serviços de APS, Primary Care Assessment Tool, - versão validada para o Português (PCATool Brasil), em uma área da Zona Sul da cidade de São Paulo coberta por dois modelos de serviços voltados para a APS: uma Unidade Básica de Saúde (UBS), parte integrante da ESF, e uma AMA. Participaram da pesquisa 616 adultos maiores de 18 anos, residentes na área adstrita à UBS, cadastrados ou não à UBS. Foi considerado como fator de exclusão não estar afiliado a nenhum dos dois serviços de interesse do estudo, o que, na prática, se traduziu por não ter passado nenhuma vez em consulta na UBS ou na AMA durante último ano. Além do questionário do PCATool Brasil, composto por 87 perguntas focadas na mensuração dos atributos essenciais e derivados da APS, um questionário sociodemográfico foi aplicado para incluir dados como idade, sexo, profissão, escolaridade e classe social. A coleta dos dados aconteceu na casa dos usuários, em horários variados, entre novembro de 2013 e julho de 2014, por meio de entrevistadores capacitados previamente. Cada visita demorou entre 20 a 40 minutos. Não houve contato telefônico anterior. Os escores individuais do PCATool Brasil dos serviços AMA e UBS foram calculados conforme manual do instrumento. RESULTADOS: Dos 616 questionários, 76,3% eram afiliados à UBS e 12,3% a AMA. Os frequentadores da UBS pertenciam a uma classe social mais baixa comparados aos da AMA. A UBS apresentou escores essencial e geral maiores: 5,64 (IC95% 5,53-5,74) e 5,58 (IC95% 3,44-3,95), respectivamente, contra 3,70 (IC95% 3,44-3,95) e 3,38 (IC95% 3,08-3,59) da AMA. Teve médias superiores em quase todos os atributos, alcançando alta orientação à APS em dois: \"utilização\" (7,22 - IC95% 6,97-7,47) e \"sistemas de informação\" (7,31 - IC95% 7,15-7,47). A AMA apenas foi superior em relação à \"acessibilidade\" que apresentou escore de 3,68 (IC95% 3,38-3,98) contra 2,46 (IC95% 2,34-2,58) da UBS, mas não apresentou nenhum atributo com alta orientação à APS (nenhum atributo teve escore > 6,6). DISCUSSÃO: De maneira geral, os usuários avaliam mal os atributos de APS propostos por Starfield nos dois serviços, em um nível aquém do considerado satisfatório, embora os escores da UBS sejam mais elevados do que os da AMA em 8 dos 10 atributos. CONCLUSÃO: A UBS Luar do Sertão e a AMA Pq. Fernanda não estão cumprindo suas potencialidades de maneira satisfatória. Seus usuários percebem pouco os atributos de APS propostos por Starfield nos dois serviços avaliado pelo PCATool Brasil. Embora a UBS apresente uma performance melhor do que a AMA, ela ainda está muito abaixo do esperado, sendo necessária implementação de mudanças que melhorem seu desempenho, assim como o da AMA / INTRODUCTION: In Brazil, Health Care Services focused on low-complexity demand as the Canadian and British walk-in clinics are available in Brazil as an alternative option to the Family Health Strategy (FHS - Estratégia Saúde da Família). In the city of São Paulo, they are called Outpatient Medical Care units (Assistências Médicas Ambulatoriais - AMA). However, there are no studies comparing the performance of these two strategies. OBJECTIVE: To compare structural and procedural aspects of two services in the city of São Paulo: a Basic Health Unit (BHU) of the FHS, and an AMA using the Primary Care Assessment Tool - Portuguese validated version (PCATool Brazil). METHODS: A cross-sectional study to assess the presence and extent of primary health care (PHC) attributes in an area covered by two Primary Care units of São Paulo: a Basic Health Unit (Unidade Básica de Saúde - BHU), part of the FHS, and an AMA. PCATool Brazil questionnaire were applied to 616 adults older than 18 years, living in the area linked to the BHU, registered or not in the BHU. Individuals with affiliation to none of the two services, i.e., that did not used the units in the last year, were excluded from the analysis. Besides the PCATool Brazil questionnaire, composed by 87 questions focused on the measurement of the essential and derived PHC attributes, the researchers applied a sociodemographic questionnaire to evaluate sociodemographic characteristics such as age, sex, occupation, education and social class. Data collection occurred between November 2013 to July 2014 in the participant household at different schedules during the day by previously trained interviewers. Each visit demanded 20 to 40 minutes. There was no previous phone contact. PCATool Brazil scores for AMA and BHU units were calculated as instructed by PCATool\'s manual. RESULTS: Of the 616 questionnaires, 76.3% reported an affiliation with the BHU and 12.3% with the AMA. BHU users were from lower social level compared to the AMA. BHU presented higher essential and general scores: 5.64 (95%CI, 5.53 to 5.74) and 5.58 (95%CI, 3.44 to 3.95), respectively, compared to 3.70 (95%CI 3, 44 to 3.95) and 3.38 (95%CI 3.08 to 3.59) of the AMA. BHU showed higher average scores in almost all attributes, reaching high PHC orientation in two of them: \"First Contact - Utilization\" (7.22 - 95%CI, 6.97 to 7.47) and \"Coordination - information systems\" (7.31 - 95%CI, 7,15 to 7.47). In the AMA, the only attribute that scored higher than in BHU was \"accessibility\" with a score of 3.68 (95%CI, 3.38 to 3.98) compared to 2.46 (95% CI 2.34 to 2.58) in the BHU. Therefore, AMA did not present any attributes with high PHC orientation (no attributes had scores > 6.6). DISCUSSION: In general, the users identified a very low level of satisfactory development of PHC attributes in the two services evaluated, although BHU scores are higher than AMA\'s in 8 of the 10 attributes. CONCLUSION: UBS Luar do Sertão and AMA Pq. Fernanda did not fulfill all their possible potentials. Users realize few of the attributes proposed by Starfield for each one of the services. Although the UBS present a better performance compared to the AMA, it is lower than expected. It is necessary to make some changes to improve the performance of these units

INTRODUÇÃO: Distúrbios mentais, neurológicos e de uso de substâncias estão dentre os principais contribuintes para a morbidade e mortalidade prematura no mundo. Mesmo onde existem cuidados de saúde mental e tratamentos eficazes, muitas vezes eles não são acessíveis para aqueles que mais precisam, principalmente por causa da desigualdade na distribuição de serviços e recursos humanos dentro de um país. Devido aos avanços contínuos nas tecnologias de informação e comunicação e a disseminação crescente da internet na sociedade, o cuidado de saúde mental à distância via webconferência, denominado telepsiquiatria, tornou-se uma ferramenta promissora para o atendimento psiquiátrico. OBJETIVOS: O presente projeto visou avaliar a eficácia e a aplicabilidade do acompanhamento psiquiátrico ambulatorial por webconferência em ambientes clinicamente não supervisionados, comparando esta nova forma de acompanhamento com o cuidado padrão (presencial) em relação à evolução clínica (gravidade da depressão, estado de saúde mental, medicação, e recaídas), à satisfação com o tratamento, à relação terapêutica, à adesão ao tratamento (faltas e taxas de abandonos), e à adesão à medicação. MÉTODOS: Trata-se de um estudo clínico randomizado e controlado. Pacientes entre 18 e 55 anos, com depressão leve ou com quadro estabilizado, internet banda larga em casa, e em tratamento no Instituto de Psiquiatria do Hospital das Clínicas das Faculdade de Medicina da Universidade de São Paulo (IPq- HCFMUSP) foram alocados aleatoriamente em um grupo experimental ou controle. Enquanto o grupo controle recebeu consultas psiquiátricas mensais de forma presencial no IPq, o grupo experimental realizou consultas mensais com o psiquiatra por webconferência. Uma amostra de 107 pacientes foi recrutada. De forma aleatória, 54 pacientes foram colocados no grupo controle e 53 no grupo de webconferência. Não houve diferenças significantes entre os grupos com respeito aos dados sociodemográficos na avaliação inicial. Durante o acompanhamento, 950 consultas foram concluídas, 489 (51,5%) delas por webconferência. Além disso, 277 consultas de avaliação foram realizadas. No início, depois de 6 e 12 meses, a gravidade da depressão, o estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, e a adesão ao tratamento e à medicação foram avaliados. RESULTADOS: A gravidade da depressão diminuiu significativamente ao longo do acompanhamento de 12 meses em ambos os grupos. Os grupos diferiram significativamente em relação ao desenvolvimento da gravidade da depressão ao longo do período de seguimento, com melhores resultados para o acompanhamento por webconferência. Além disso, houve 4 recaídas no grupo controle e apenas uma no grupo de webconferência. Quanto a estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, a adesão ao tratamento, e a adesão à medicação não foram encontradas diferenças significantes entre os grupos. Contudo, depois de 6 meses, o número de abandonos foi significativamente maior no grupo controle (18,5 vs. 5,7%, p < 0,05). A satisfação com o acompanhamento por webconferência foi alta tanto para os pacientes como para os psiquiatras. CONCLUSÕES: O acompanhamento psiquiátrico por webconferência foi tão eficaz e viável quanto o acompanhamento presencial com respeito à evolução clínica, a satisfação dos pacientes, a relação terapêutica, adesão ao tratamento e à medicação. Esses achados apontam o potencial da telepsiquiatria estender a assistência psiquiátrica à população de lugares remotos e até então sem acesso ao atendimento especializado / INTRODUCTION: Mental, neurological and substance-use disorders are major contributors to morbidity and premature mortality worldwide. Even where mental health care and effective treatment exist, they are frequently not available to those in greatest need, mainly because of the unequal distribution of services and human resources within a country. Due to continuous advances in information and communication technologies and the growing spread of the Internet in society, remote mental health care via videoconferencing, called telepsychiatry, has become a promising tool for psychiatric attendance. OBJECTIVES: The present project aimed to evaluate the efficacy and feasibility of psychiatric outpatient care via videoconferencing in clinically unsupervised settings, comparing this new form of attendance with in-person standard care regarding to clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence. METHODS: This randomized controlled clinical trial allocated adult patients between 18 and 55 years old with mild depression or in remission state, treated at the Institute of Psychiatry of the University of São Paulo Medical School (IPq-HCFMUSP), and with broadband Internet access at home into a intervention and control group. Whereas the control group received monthly psychiatric consultations in person at the IPq, the intervention group realized monthly consultations with the psychiatrist via videoconferencing. At baseline and after 6 and 12 months, the severity of depression, mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence and medication compliance were assessed. RESULTS: A sample of 107 patients was recruited; 54 patients were randomly allocated to the control group, and 53 to the intervention group. Patients in both groups did not differ with respect to demographic data. During follow-up, 950 consultations were completed; 489 (51,5%) via videoconferencing. In addition, there were 277 assessment consultations. The severity of depression decreased significantly over the 12-month follow-up in both groups. There was a significant difference between groups regarding to the development of the severity of depression throughout the follow-up period, with better results for the attendance via videoconferencing. Further, there were 4 relapses in the control group and only one in the videoconferencing group. There were no significant differences between groups regarding to mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence, and medication compliance. Though, after 6 months, the number of dropouts was significantly higher in the control group (18,5 vs. 5,7%, p < 0,05). Satisfaction with attendance via videoconferencing was high among patients as well as among psychiatrists. CONCLUSIONS: Psychiatric attendance via videoconferencing can be considered applicable for the outpatient care at the IPq-HCFMUSP and as effective and viable as standard care (in person treatment) with respect to clinical outcomes, patient satisfaction, therapeutic relationship, treatment adherence and medication compliance. These results indicate the potential of telepsychiatry to extend the access to psychiatric care for remote and underserved populations

A implantação de políticas e programas para atender as pessoas com incapacidades e deficiências nos diferentes níveis da atenção à saúde continua desafiadora. O acesso a serviços de reabilitação nos equipamentos de saúde é limitado, assim como o uso das ações de cuidado em reabilitação e há dificuldades de articulação entre os equipamentos da Rede de Reabilitação. O objetivo deste estudo foi compreender a gestão do cuidado; identificar e analisar os fluxos relacionados à reabilitação nos equipamentos de saúde. O estudo foi desenvolvido na região do Butantã (São Paulo - SP), com população de 428.217 habitantes e buscou analisar as ações e fluxos relacionados à reabilitação dos equipamentos de saúde através de rodas de discussão com profissionais de seis equipamentos da Atenção Primária à Saúde e de Atenção Especializada, e de três entrevistas com usuários. Participaram das rodas de discussão 57 profissionais de diferentes categorias que elaboraram fluxogramas que posteriormente foram sobrepostos aos que representam as trajetórias dos usuários. Além disso foi realizada a análise do fluxo de encaminhamentos de demandas de reabilitação da Atenção Primária à Saúde para a Atenção Especializada no período de 2012 a 2016. Os relatos fizeram emergir reflexões sobre abordagens coletivas como ferramenta de cuidado em reabilitação; o papel e resolutividade da Atenção Especializada para o cuidado a longo prazo e queixas menos comuns; o olhar ampliado dos profissionais; o acesso às ações de cuidado, tendo em vista os grandes deslocamentos e o tempo de espera para inclusão; as redes informais como facilitadores do acesso a recursos tecnológicos; e as dificuldades de articulação da Rede. A média das idades dos usuários que aguardavam na lista de espera durante o período de 2012 a 2016 foi de 47,1 anos (DP = 22,5) e a mediana de 51 anos (idade mínima = 0 anos; idade máxima = 102 anos). Foram analisados 44.022 encaminhamentos de pessoas que residiam, majoritariamente no município de São Paulo (98,95%). As maiores demandas de encaminhamento para as especialidades encontradas foram para ortopedia (37,92%), fisioterapia (21,47%), pneumologia (13%), neurologia (9,22%), psiquiatria (5,79%) e acupuntura (3,58%). A facilitação do acesso às ações e atividades de reabilitação, bem como a articulação da rede de reabilitação e o reconhecimento de seus fluxos, podem potencializar o processo de reabilitação aumentando a resolutividade do cuidado / The implementation of policies and programs to care of people with disabilities at different levels of health care remains challenging. Access to rehabilitation services in health facilities is limited, as is the use of care actions in rehabilitation and there are difficulties of articulation between the equipment of the Rehabilitation Network. The objective of this study was to understand the management of care; identify and analyze the flows related to rehabilitation in health equipment. The study was carried out in the region of Butantã (SP), with a population of 428,217 inhabitants and sought to analyze the actions and flows related to the rehabilitation of health equipment through discussion wheels with professionals of six Primary Health Care and Ambulatory Care, and three interviews with users. 57 professionals from different categories participated in the discussion, who elaborated flowcharts that later were superimposed on those that represent the users\' trajectories. In addition, the analysis of the flow of referrals of rehabilitation demands from Primary Health Care to Specialized Care in the period from 2012 to 2016 was carried out. The reports have given rise to reflections on collective approaches as a care tool in rehabilitation; the role and resolve of Specialized Care for long-term care and less common complaints; the magnified look of professionals; access to care actions, in view of the large displacements and waiting time for inclusion; informal networks as facilitators of access to technological resources; and the articulation difficulties of Rehabilitation Network. The average age of users waiting in the list during the period from 2012 to 2016 was 47.1 years (SD = 22.5) and the median age was 51 years (minimum age = 0 years, maximum age = 102 years). Were analyzed 44,022 referrals and the highest demands for referrals for the specialties were orthopedics (37.92%), physiotherapy (21.47%), pneumology (13%), neurology (9.22%), psychiatry (5.79%) and acupuncture (3.58%). The facilitation of access to rehabilitation actions and activities, as well as the articulation of the rehabilitation network and the recognition of their flows, can potentiate the rehabilitation process by increasing the resolving of care