Publications by authors named "Micheline Meiners"

6 Publications

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The Use of Assessment of Chronic Illness Care Technology to Evaluate the Institutional Capacity for HIV/AIDS Management.

Front Pharmacol 2019 27;10:165. Epub 2019 Feb 27.

Tropical Medicine, Faculty of Medicine, University of Brasília, Brasília, Brazil.

The effectiveness of antiretroviral therapy has rendered HIV infection a manageable chronic condition. Currently, the health systems face the challenge of adopting organizational healthcare models capable of ensuring the delivery of comprehensive care. The Chronic Care Model has been reported for its effectiveness, particularly in terms of delivery system design. In this study, the Assessment of Chronic Illness Care (ACIC) questionnaire, a soft technology widely used for other chronic conditions, was employed on a teaching hospital to evaluate healthcare provided to people living with HIV/AIDS. The ACIC technology is a self-explanatory instrument which diagnoses, among the six components of the Chronic Care Model Framework, areas for quality improvements, indicating at the same time, intervention strategies and achievements. These components are , and From May to October 2014, the tool was applied to the multidisciplinary teamwork at the points of care identified, as well as to the hospital management board. Respondents broadly rated care as basic. A pronounced contrast was observed from evaluation by management board and health professional staff in some components like and The and were the components best evaluated by the multidisciplinary team. Combined with the array of services offered, the entry points available at the hospital can ensure healthcare comprehensiveness. However, some gaps were detected, precluding the delivery of an effective care. The ACIC was considered an adequate technology to provide knowledge of the gaps, to promote productive discussions and reflections within teams and to indicate actions to achieve improvements on healthcare for people living with HIV/AIDS.
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http://dx.doi.org/10.3389/fphar.2019.00165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400989PMC
February 2019

Characterization of the selection of medicines for the Brazilian primary health care.

Rev Saude Publica 2017 Nov 13;51(suppl 2):9s. Epub 2017 Nov 13.

Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil.

Objective: To characterize the process of selection of medicines for primary health care in the Brazilian regions.

Methods: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05.

Results: The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands.

Conclusions: As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.
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http://dx.doi.org/10.11606/S1518-8787.2017051007065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676384PMC
November 2017

Access and adherence to medication among people with diabetes in Brazil: evidences from PNAUM.

Rev Bras Epidemiol 2017 Jul-Sep;20(3):445-459

Programa de Pós-graduação em Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília - Brasília (DF), Brasil.

Objective: To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs.

Methods: Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%.

Results: We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions.

Conclusion: Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.
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http://dx.doi.org/10.1590/1980-5497201700030008DOI Listing
August 2018

Adverse drug reactions among patients admitted with infectious diseases at a Brazilian hospital.

Rev Soc Bras Med Trop 2016 Nov-Dec;49(6):763-767

Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil.

Introduction: : Despite the therapeutic benefits of drugs, adverse drug reactions (ADRs) occur. Method: We assessed a series of suspected ADRs identified from notifications and intensive monitoring of inpatients from March 2013 to March 2014.

Results:: Skin reactions predominated (31%). Systemic anti-infective agents were implicated in 16 (72%) reactions. Fifteen (68%) ADRs were classified as possible. The implicated drug was not correctly identified by the healthcare team in 12 cases.

Conclusions: : Some reactions were not correctly attributed to the causative drug(s), suggesting that the use of a validated evaluation method can promote successful identification of causal links between ADRs and drugs.
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http://dx.doi.org/10.1590/0037-8682-0238-2016DOI Listing
April 2017

Diabetes education program with emphasis on physical exercise in subjects with type 2 diabetes: a community-based quasi-experimental study.

J Sports Med Phys Fitness 2017 Jun 24;57(6):850-858. Epub 2016 May 24.

College of Physical Education, University of Brasília, Brasília, Brazil.

Background: Diabetes mellitus (DM) requires permanent multidisciplinary treatment. This study investigated the effects of an educational program with emphasis on physical exercise on biological health markers of subjects with type 2 DM (T2DM).

Methods: This was a quasi-experimental study with subjects who attended a diabetes education program over one year. At the beginning, middle and end of the annual cycle, glycated hemoglobin (HbA1c), lipid profile and anthropometry were measured. The program offered two hours of educational and exercise interventions twice a week. Before and after each session capillary blood glucose (BG) was measured. Statistical analysis used Pearson's χ2, paired t, ANOVA-RM and MANOVA tests to compare results with significance levels set at P<0.05.

Results: Data of 103 subjects (73% women) were analyzed. Mean age was 64.1±10.8 years and 23% of participants were on insulin therapy. As an acute effect mean BG decreased significantly (P<0.001) from 157.5±61.5 mg/dL to 128.5±47.5 mg/dL after the intervention sessions, also resulting in increased prevalence of normoglycemic BG (from 44.0% to 68.6%). Chronic effects of participation in the program could be perceived through significant reduction (P<0.05) from beginning to end of the study of mean BG (from 144.8±5.0 mg/dL to 135.3±3.1 mg/dL), HbA1c (from 7.3±1.3% to 7.1±1.0%) and triglycerides (from 177.9±121.3 mg/dL to 150.5±130.9 mg/dL). There were no significant changes in anthropometric variables.

Conclusions: A diabetes education program with emphasis on supervised physical exercise improved triglycerides and glycemic control in subjects with T2DM.
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http://dx.doi.org/10.23736/S0022-4707.16.06261-7DOI Listing
June 2017

Using collaborative learning to improve diabetes care and outcomes: the VIDA project.

Prim Care Diabetes 2010 Oct 15;4(3):145-53. Epub 2010 May 15.

Pan American Health Organization, Washington, DC 20037-2895, USA.

Unlabelled: The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology.

Methods: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure.

Results: The proportion of people with good glycemic control (A1c<7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p<0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p=0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes.

Conclusions: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.
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http://dx.doi.org/10.1016/j.pcd.2010.04.005DOI Listing
October 2010
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