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[Clinico-epidemiologic profile of Chagas disease patients attending an ambulatory referral center and proposal of a model of care for the Chagas patient under the perspective of a comprehensive health care].

A case-control study to analyse clinical and epidemiological data of 842 patientes seen in an outpatient ward reference center for chagas disease in Belo Horizonte, Brazil, from 1985 to 1992. It was verified that these patients were in a average age of 37.78 years; lower literacy regardless of race, and, performed activities that demanded greater muscle effort (p < 0.05). The main mechanism for disease transmission proved to be the vectorial route. Disease-especific complaints prevailed in the above mentioned patients (p < 0.05). The most important abnormalities found in clinical examination were with cardiac sounds (OR: 2.96 95% CI: 1.29-4.09) and the presence of extrasystole (OR: 7.16 95% CI: 1.59-45.07). Imunofluorescence Test was more sensitive (94%) and specific (96%). It also had a PPV of 99% and e NPV of 83%. ELISA test carried out in 43 patientes did not yield false results. Indeterminate chronic phase (56%) or early stages of the disease prevailed. The findings of normal EKGs and abnormalities in 30% of the Holter tests, 41% of the exercise tests, 33% of the ECO tests and, 48% of normal chest x-ray with abnormal ECO, high lights the importance of caring out more detailed exams in specific situations. We hereby propose a care model for the Chagas disease patient, integrated to our State Health Plan stressing serologic tests, and training capable human resources committed to the development of integrated health care and the optimization of our referral and counter-referral system, thus issuing total care to the Chagas disease patient.

Adult↗
PubMed2004

[Comprehensive health care and integrated health services: challenges for evaluating the implementation of a "system without walls"].

The premise of this paper is that comprehensive health care is a major component in the investigation and evaluation of health services and systems, structured as inter-organizational health care networks articulating clinical, functional, normative, and systemic dimensions in their operationalization and based on the understanding that no organization combines all the necessary resources and capabilities to solve the health problems of a population with its various life cycles. Given the complex nature of this "system without walls", eliminating barriers to access in the various health care levels in response to local and regional health, we take this opportunity to share a few "preliminary lessons" from our experience and from the literature on integrated health services which may interest researchers and managers concerned with the implementation of such services.

Comprehensive Health Care↗
PubMed1983

Comprehensive health care for the elderly.

Health care for the elderly in the United States remains fragmentary and noncomprehensive despite concern for the needs of an expanding elderly population and a new emphasis on geriatrics. Model health care programs for the elderly have been few and not generally applicable to central city populations. A model health care program has been designed to offer a continuum of comprehensive, multidisciplinary health care to Milwaukee elderly. An acute care unit for the elderly, rehabilitation-oriented nursing home, outpatient clinic, home care service, outreach clinics, rehabilitation day hospital, Alzheimer's Disease Day Care program, and acute geriatric psychiatric unit have been developed and integrated into one continuum of care. The program serves chiefly the frail elderly, who are demonstrated to be markedly impaired physically, mentally, and socially, requiring the services of multiple professionals to enable the patients to achieve maximum independence. Alternatives to institutionalization are emphasized, and geriatric education and research programs are part of the model program.

Aged↗