Saccilotto Indara C, Bittencourt Rosane Isabel, Fischer Camila C, Quevedo Amanda, Hirakata Vania N, Picon Paulo D
Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil.
Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama, 110, Farroupilha, Porto Alegre, RS, 90040-060, Brazil.
BMC Health Serv Res. 2015 Oct 5;15:455. doi: 10.1186/s12913-015-1123-6.
Within the Brazilian Unified Health System (SUS), Referral Centers (RCs) are care facilities that provide specialized services. The objective of this study was to evaluate the efficacy of care provided to patients with multiple myeloma (MM) at a specialized RC (Hospital de Clínicas de Porto Alegre Referral Center for Multiple Myeloma, CRMM-HCPA) and to compare quality of life between patients with MM treated at CRMM-HCPA and those treated at non-RC facilities.
A 6-month cohort study was conducted in patients with MM receiving thalidomide from the Rio Grande do Sul State Health Department and treated at CRMM-HCPA and patients receiving treatment at other, non-RC care facilities. Thirty-two patients were included in the study, 19 from CRMM-HCPA and 13 from other institutions. To analyze the efficacy of care provided at CRMM-HCPA, the main outcome measure was the time from diagnosis to referral for autologous hematopoietic stem cell transplantation (HSCT). This outcome measure was assessed using questionnaires specifically designed for this study. Quality of life was also assessed, using the SF-36 questionnaire.
Time from MM diagnosis to referral for autologous HSCT in each group was measured only in patients aged ≤ 65 years (n = 25); of these, 15 were recruited from CRMM-HCPA and 10 from other institutions. In this analysis, there was a significant difference (p = 0.036) in time elapsed between diagnosis and referral for autologous HSCT, which was significantly shorter for patients treated at CRMM-HCPA (median, 9 months; IQR, 8.5-14.5) than for those treated elsewhere (median, 24 months; IQR, 16-24). On quality of life analysis, there was a significant difference in the Social Functioning domain of the SF-36 questionnaire, which relates to performance of social activities (p = 0.02).
The Referral Center model provided seems to be a more efficient treatment strategy as compared with other health care facilities, as it enabled a reduction in time to transplantation. Patients treated at CRMM-HCPA demonstrated greater ease in performing social activities, with less interference from physical or emotional problems.
在巴西统一卫生系统（SUS）中，转诊中心（RCs）是提供专科服务的医疗机构。本研究的目的是评估一家专科转诊中心（阿雷格里港临床医院多发性骨髓瘤转诊中心，CRMM-HCPA）为多发性骨髓瘤（MM）患者提供的护理效果，并比较在CRMM-HCPA接受治疗的MM患者与在非转诊中心设施接受治疗的患者的生活质量。
对来自南里奥格兰德州卫生部且正在接受沙利度胺治疗并在CRMM-HCPA接受治疗的MM患者，以及在其他非转诊中心医疗机构接受治疗的患者进行了一项为期6个月的队列研究。32名患者纳入研究，其中19名来自CRMM-HCPA，13名来自其他机构。为分析CRMM-HCPA提供的护理效果，主要结局指标是从诊断到自体造血干细胞移植（HSCT）转诊的时间。该结局指标通过专门为本研究设计的问卷进行评估。生活质量也使用SF-36问卷进行了评估。
仅在年龄≤65岁的患者（n = 25）中测量了每组从MM诊断到自体HSCT转诊的时间；其中，15名从CRMM-HCPA招募，10名从其他机构招募。在该分析中，从诊断到自体HSCT转诊的时间存在显著差异（p = 0.036），在CRMM-HCPA接受治疗的患者（中位数为9个月；四分位间距为8.5 - 14.5）比在其他地方接受治疗的患者（中位数为24个月；四分位间距为16 - 24）明显更短。在生活质量分析中，SF-36问卷中与社交活动表现相关的社会功能领域存在显著差异（p = 0.02）。
与其他医疗保健机构相比，所提供的转诊中心模式似乎是一种更有效的治疗策略，因为它能够缩短移植时间。在CRMM-HCPA接受治疗的患者在进行社交活动时表现出更大的轻松程度，受到身体或情感问题的干扰更少。
