RAMB - Maio / Junho 2016

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and

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232

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2016; 62(3):231-235

malnutrition, with a large increase in the number of obese

and/or overweight people, increasing the CDNCD. The

World Health Organization (WHO)

defines CDNCD as

primarily cerebrovascular and cardiovascular diseases,

di-

abetes mellitus

, obstructive lung diseases, asthma and neo-

plasms, in addition to mental and neurological disorders;

oral, bone and joint procedures; genetic disorders; eye

and hearing pathologies. This set of diseases has various

common non-modifiable risk and behavioral factors that

can be managed together.

Economic evaluations

According to Alliota,

multidisciplinary chronic disease

management care programs (CDMCP) produce 60% re-

duction in demand for hospital services, 50% reduction

in hospitalizations, and increased user satisfaction. In

this context, according to Lynce 2007,

5% of chronical-

ly ill patients consumed 30% of inpatient costs in Portu-

gal. With quality management it is possible to obtain val-

ues as significant as a 40% reduction in hospital admissions

due to chronic respiratory diseases, 25% reduction in hos-

pitalizations due to diabetes; 38% reduction in emergen-

cy calls to patients with asthma,

9-12

and 50% reduction in

the occurrence of absenteeism due to arthritis.

Thus, our study aimed to evaluate the epidemiolog-

ical profiles and total health care costs of a group of pa-

tients with CDNCD at a Brazilian supplementary health

service that was monitored by a CDMCP. As a secondary

objective, we compared their hospital admissions and to-

tal health care costs with a group of patients not moni-

tored by the program.

ethod

A cross-sectional observational study with data provided

by the CDMCP in the period from June 2010 to January

2012 (20 full months) was conducted. This program was

part of the health care services provided to users regis-

tered with a health provider (HP) (classified as self-man-

agement) from the Brazilian Supplementary Health Sec-

tor, in accordance with the current regulations from the

National Supplementary Health Agency (ANS).

The CD-

MCP in this study consisted of a managing physician and

a nursing assistant.

Sample

Only epidemiological data (gender, age group and ICD-

10 – International Classification of Diseases) and health

care costs of the CDMCP users were accessed, and no oth-

er data that could identify individual patients under mon-

itoring. This data was provided as computerized reports,

which were part of the information technology service of

the HP analyzed.

We selected 2107 users with CDNCD to take part in

the CDMCP. After being selected, the patients were sub-

divided into two groups: Those who had chosen volun-

tarily to participate in the CDMCP and users who chose

not to participate.

CDMCP inclusion criteria

Users were selected for having a CDNCD (according to

the WHO definition).

Users were invited to participate

in the program by the CDMCP team or could be referred

as instructed by the attending physician and/or other

programs from the provider (such as a family medicine

or home care service).

Users were invited for a consultation with the pro-

gram’s managing physician, and could freely choose to par-

ticipate in the CDMCP or not. Non-participation in the

program did not interfere or restrict user access to the ac-

credited care services made available by the HP in any way,

according to regulations of the Supplementary Health Sec-

tor.

User participation in the CDMCP did not imply any

pecuniary benefits of any kind to the patient.

CDMCP exclusion criteria

Users monitored by other programs offered by the HP

(e.g. HomeCare) were excluded from the CDMCP so as

not to interfere in the results of the CDMCP analyzed.

CDMCP care flowchart

The care flow of the CDMCP began with the identifica-

tion of appropriate cases for the program through health

care reports based on ICD-10 and indication of patients

from other professionals at the HP. After identification

of the target public, an initial consultation was sched-

uled with the managing physician of the program (pro-

vided with prescriptions and complementary examina-

tions). The evaluations were individualized, as well as the

user’s monitoring plan. The managing physician checked

the correlation between ICD-10 and the pathologies that

the user presented, and sought the most appropriate strat-

egy for each case, advising health education and self-man-

agement of the disease by the patient, encouraging them

to increase adherence to treatment and suggesting pos-

sible non-pharmacological behavioral changes (such as

healthy diet, weight control and regular physical activi-

ty) (WHO 2002).

15,16

Patients were monitored through

presential consultations (which could be weekly, fort-

nightly or monthly) and/or phone calls during the mon-

itoring period.