Absenteísmo de usuários como fator de desperdício: desafio para sustentabilidade em sistema universal de saúde

Health technologies for tackling client absenteeism in primary and secondary care services

BACKGROUND

Tackling client absenteeism in primary and secondary care settings is crucial to ensure the continuity of care for individuals, families and communities, as well as preventing waste of resources within healthcare systems.

METHODOLOGY

This article is an integrative review to identify advancements in health technologies that address client absenteeism in primary and secondary care. The databases Medical Literature and Retrieval System Online (MEDLINE/PubMed®), Scientific Electronic Library Online and Virtual Health Library were consulted. The inclusion criteria were as follows: full papers, published between 2013 and 2023, in English, Portuguese or Spanish. The descriptors used were the following: patients, mobile applications, health services management, absenteeism and primary care, and secondary care. Eleven articles published from 2014 to 2021 were included.

RESULTS

Most articles were identified in the MEDLINE/PUBMED database, employed a randomized controlled trial methodology (36.36%), and were published between 2019 and 2021 (90.0%) in English (63.7%). The applications had managerial, assistive and/or educational purposes. In addition to absenteeism control, these applications strived to promote client engagement with health services, increase health literacy and tackle structural barriers to care, such as language barriers.

CONCLUSION

Efforts are needed to ensure that providers receive training to educate clients on the applications. Moreover, community-based participatory studies to ensure the feasibility of applications are warranted.

Analysis of the costs of teleconsultation for the treatment of diabetes mellitus in the SUS

OBJECTIVE

To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager's perspective, the article also presents estimates from the patient's perspective, based on the transportation costs associated with each type of consultation.

METHOD

Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively.

RESULTS

Considering only the local SUS manager's perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation.

CONCLUSION

The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

Factors associated with the absence of Brazilians in specialized dental centers

Aim

To identify the individual and contextual factors associated with the absence of Brazilians at a scheduled appointment in Dental Specialties Centers (DSC).

Methods

This cross-sectional design uses the National Program for Improving Access and Quality of Dental Specialties Centers database, 2018. The outcome was the users' lack of at least one of the scheduled appointments. Contextual and individual independent variables were used, considering Andersen's behavioural model. The analyses were performed with the R Core Team and SAS (Studio 3.8, Institute Inc, North Carolina, U.S, 2019) programs.

Results

Of the 10,391 patients interviewed, 27.7% missed at least one of the consultations. In the adjusted multivariate model, the interpretation based on the effect size and 95% CI showed that the behaviour individual predisposing factors such as age ≤ 42 years (OR = 1.10; 95%CI:1.01–1.21), individual need factors such as participation in the “Bolsa Família” program (OR = 1,14; 95%CI:1.02–1.27), not being covered by the Family Health Strategy (OR = 1.15; 95% CI:1.02–1.30), and users of periodontics services (OR = 1.22;95%CI:1.05–1.40) were associated with absences. The behavioural factor associated with the outcome was that the DSC facilities were not in good condition (OR = 1.18; 95%CI:1.03–1.34). DSC located in the capital (OR = 1.12; 95% CI: 0.92–1.48) were 12% more likely to have dental absences than those in the interior region.

Conclusion

There are individual and contextual barriers associated with patients not attending specialised public dental consultations. DSC should offer adequate hours to patients, especially young adults and vulnerable people.

Absenteeism of diabetics to appointments with an endocrinologist and its relationship with access to health services

Objective: To analyze the association between absenteeism and access to specialized consultations for diabetics, in the Unified Health System (SUS) in Espírito Santo (ES). Methods: Cross-sectional study conducted using primary and secondary data with 472 diabetics ≥ 18 years old scheduled in consultation with endocrinologist in the System of Regulation Centers of ES. The variables of the dimensions of access - availability, financial viability, and acceptability - were used to estimate the association with absenteeism. Logistic regression was used for the crude and adjusted analyses. Results: An association was found between absenteeism of diabetics and the variables living less than 10 km from the provider (OR: 1.81; 95%CI: 1.16 - 2.82, p = 0.01), need for transportation (OR: 4.89; 95%CI: 2.54 - 9.42, p < 0.001), and having financial expenses to attend the appointment (OR: 2.06; 95%CI: 1.23 - 3.44; p = 0.01). Conclusion: The main barriers of access to health services that contribute to the high prevalence of absenteeism from appointments with endocrinologists can be understood as a proxy for the socioeconomic status of diabetics and show close relationship with the social determinants of health.

Patient absenteeism in outpatient consultations: an integrative literature review

OBJECTIVE

To identify and analyze the production of knowledge in national and international literature on patient absenteeism in scheduled medical consultations.

METHOD

This is an integrative literature review in the databases PubMed, Embase, Scopus, Web of Science, CINAHL, Medline, LILACS, Virtual Health Library of the São Paulo State Department of Health and Spanish Bibliographic Index in Health Sciences, accessed through the Virtual Health Library Portal, based on the guiding question.

RESULTS

A total of 767 articles was found and nine were selected. Forgetfulness predominated among the reasons for absence. Other findings regarding the cost to the health service and strategies for solving the problem are highlighted.

CONCLUSION

As the focus of the studies, the concern with the quality of care, increased treatment queues and high demand, as well as the cost of absent patients, are evident. Despite the relevance of the theme for the health services organization, the literature is still scarce.