The cost of alkaline solutions in ambulatory hemodialysis: an analysis about wasteful from the processes control.

INTRODUCTION There are few studies about costs of inputs used in hemodialysis and among these expenditures, the compounds that make up the dialysate are one of the values considered as representative of this therapy. However, there aren't costs studies that guiding solutions. OBJECTIVE The objective of this article is discuss whether there is wasteful of alkaline solutions in ambulatory hemodialysis and hence the possibility of reduction in cost from the standardization process simulation of establishment of dialysate flow in periods between shifts in hemodialysis outpatients. METHODS Starting from an observational analytic, a simulation was performed twenty case scenarios, which ten cases established by standardizing processes control on the dialysate flow in recession. The combination of data was performed using as a basis the prices of three suppliers of alkali liquid or powder. RESULTS It was observed among the scenarios with standardized processes, ranging between 7.7% and 33.3% savings in the alkaline solution cost (powder or liquid), by reducing waste. CONCLUSION It is possible to restrain the wasteful use of alkaline solutions, both powder and liquid. Consequently, its cost from the patterning on reducing the flow of dialysate during the intervals between shifts observed in the outpatient hemodialysis. However, these results are conditional upon the commitment of health professionals, mainly to supervision exercise and control of activities in quality function deployment.

[1]  I. Gomes,et al.  [Determinants of expenditures on dialysis in the Unified National Health System, Brazil, 2000 to 2004]. , 2010, Cadernos de saude publica.

[2]  R. Steinbrook Controlling health care costs in Massachusetts with a global spending target. , 2012, JAMA.

[3]  Desmond E. Williams,et al.  Medical costs of CKD in the Medicare population. , 2013, Journal of the American Society of Nephrology : JASN.

[4]  Agência Nacional de Vigilância Sanitária Manual de tecnovigilância: abordagens de vigilância sanitária de produtos para a saúde comercializados no Brasil , 2010 .

[5]  R. Ramos,et al.  Nuevos modelos de gestión de asistencia integral en nefrología , 2013 .

[6]  Marluci Andrade Conceição Stipp,et al.  Série histórica de custos com terapia de substituição renal no município do Rio de Janeiro (1995-2009) , 2013 .

[7]  Elias Mossialos,et al.  Health care cost containment strategies used in four other high-income countries hold lessons for the United States. , 2013, Health affairs.

[8]  E. Mendes O cuidado das condições crônicas na atenção primária à saúde: o imperativo da consolidação da estratégia da saúde da família , 2018 .

[9]  S. A. Fisher Essentials of Cost Accounting for Health Care Organizations , 1996 .

[10]  Regulamento Técnico,et al.  Agência Nacional de Vigilância Sanitária , 2004 .

[11]  R. D. Mello AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA , 2002 .

[12]  Rodrigo da Silva Moreira,et al.  Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise , 2012 .

[13]  M. Porter,et al.  The Strategy That Will Fix Health Care , 2013 .

[14]  Uche Nwabueze In and out of vogue: the case of BPR in the NHS , 2000 .

[15]  Robert Johnston,et al.  Administração da Produção , 2009 .

[16]  Miyeko Hayashida,et al.  Estudo da sobrevida de pacientes submetidos a hemodiálise e estimativa de gastos no município de Ribeirão Preto-SP , 2002 .

[17]  G. Caetano Repensando a saúde. Estratégias para melhorar a qualidade e reduzir os custos. Michael E. Porter e Elizabeth Olmsted Teisberg. Tradução de Cristina Bazan. Porto Alegre: Bookman, 2007 , 2007 .

[18]  A. A. Lopes,et al.  Diálise crônica no Brasil - Relatório do Censo Brasileiro de Diálise, 2011 , 2012 .

[19]  Mônica Viegas Andrade,et al.  [Determinants of expenditures on dialysis in the Unified National Health System, Brazil, 2000 to 2004]. , 2010, Cadernos de saude publica.

[20]  L. Schraiber,et al.  Planejamento, gestão e avaliação em saúde: identificando problemas , 1999 .

[21]  J. Frenk Bridging the divide: global lessons from evidence-based health policy in Mexico , 2006, The Lancet.

[22]  Leyla Gomes Sancho,et al.  Análise de custo-efetividade em relação às terapias renais substitutivas: como pensar estudos em relação a essas intervenções no Brasil? , 2008 .

[23]  Rick Iedema,et al.  Managing clinical processes in health services , 2008 .