Estudo do perfil do atendimento telefônico (hotline) para hipertermia maligna
Arquivos
Data
2011-08-11
Autores
Almeida, Cléa dos Santos [UNIFESP]
Orientadores
Silva, Helga Cristina Almeida da [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução- Hipertermia Maligna (HM) é uma síndrome farmacogenética, autossômica dominante, que se manifesta nos músculos esqueléticos, desencadeado por anestésicos halogenados, relaxante muscular despolarizante como succinilcolina, situações como estresse, exercício físico intenso e o uso de drogas ilícitas como o êxtase. O sistema de serviço hotline é um tipo de aconselhamento por telefone que permite que os profissionais que fazem esse tipo de atendimento permaneçam num contato próximo com pessoas consulentes, principalmente em situações de crise e emergências. Assim, essa comunicação tem uma maior rapidez para as pessoas que necessitam da informação ou orientação. Objetivo Descrever o perfil das chamadas atendidas pela linha de hotline de HM, quanto a três aspectos básicos: conteúdo, consulente e consultor e a efetividade da linha de hotline do ponto de vista do consultor/consulente. Casuística e Método- Esse estudo foi um estudo descritivo do perfil do atendimento do hotline quanto a características das chamadas, consulentes e consultores. Foram utilizados três questionários. O primeiro questionário tinha como objetivo a coleta dos dados da ficha de atendimento, levantamento dos dados da pessoa que fez a consulta, dos problemas, se o problema foi resolvido e a solução apresentada. O segundo questionário foi aplicado no intuito de promover entrevista com as pessoas atendidas pelo hotline (consulentes). Esse questionário levantou informações relativas a dados demográficos, formação acadêmica, meio pelo qual conheceu o serviço de hotline, como conseguiu esse número e se foi fácil achá-lo, e se encontrou a resposta para o que procurava. O terceiro questionário foi utilizado para entrevistar os plantonistas que realizaram os atendimentos telefônicos do hotline. Esse questionário levantou dados relativos à formação médica dos consultores, sua opinião sobre a evolução do conhecimento médico sobre hipertermia maligna, se as informações passadas estão atualizadas, e o motivo pelo qual as pessoas procuram o serviço hotline mesmo com as informações sobre HM disponíveis no endereço eletrônico. Foram levantadas as fichas do hotline no período 2001 a 2008, com um total de 140 chamadas registradas, das quais todas foram analisadas para preencher o questionário número 1. Dessas 140 chamadas, 64 (45%) dos consulentes foram encontrados e contatados; o restante não foi encontrado. Dos 64 contatados, 39 (61% do total de chamadas dos contatados) não retornaram as ligações, 23 (36% do total de chamadas dos contatados) retornaram e aceitaram participar da pesquisa, 2 (3% do total de chamadas dos contatados) recusaram, mas não alegaram o motivo. Dos consultores que atenderam a linha de hotline, 89,28% (25) foram avaliados com o questionário três. Resultados: Características das chamadas do Hotline (questionário 1): no período avaliado de oito anos houve uma média de 17,5 + 8,05 chamadas por ano, com maior frequência de chamadas no primeiro e segundo anos de instalação do serviço. A maioria dos atendimentos era para profissionais médicos, provenientes de hospitais, na região sudeste.Observou-se, para a amostra como um todo, o predomínio de chamadas solicitando informação quanto a critério diagnóstico e tratamento para suspeita de crise aguda de HM (36,42,%), seguido por informação sobre onde fazer biópsia (23%), informações científicas sobre HM (15,71%), orientação para aquisição de dantrolene (11,42%), orientação quanto a procedimentos para uma cirurgia segura (3,57%), orientação sobre a lei da obrigatoriedade de ter o dantrolene (3,57%), informação sobre processo de notificação de crise de HM (2,14%), informação sobre dose de dantrolene (1,42%), notificação de crise de HM que resultou a óbito (1,42%). As chamadas solicitando informação quanto a critério diagnóstico e tratamento para suspeita de crise aguda de HM tiveram incremento no período de 2005-2007. Considerando os 78 médicos que consultaram o hotline, a maioria dos profissionais estava vivendo uma suspeita de crise de HM e procurava orientação diagnóstica e tratamento; eles foram seguidos pelos que queriam saber como realizar uma anestesia segura para seu paciente e como encaminhá-los para um especialista em HM que realizasse a biópsia. Observou-se que a maioria das soluções apresentadas pelo consultor foi adequada. O hotline recebeu no total 93 notificações relacionadas a crise de HM sendo 56 notificações de casos recentes e 37 notificações de crises ocorridas no passado. A maior parte das crises de HM ocorreu em homens, na segunda década de vida e esteve relacionada a cirurgias de cabeça e pescoço e ortopedia. Em sete casos inicialmente suspeitos de uma crise aguda de HM, na verdade diagnosticou-se a Síndrome Neuroléptica Maligna. Em relação aos agentes desencadeantes da HM, os halogenados foram os mais frequentes, seguidos pela succinilcolina. Os sinais mais frequentes relatados na crise de HM foram hipertermia, aumento de CPK e taquicardia. Na presente casuística, os principais diagnósticos diferenciais foram sepse, hipóxia, pneumotórax e obstrução do sistema ventilatório. Com relação ao Dantrolene, ele foi empregado em cerca de 20% dos casos. Este estudo também avaliou o atendimento realizado por nossos consultores médicos (questionário 2). Foram obtidos dados de menos de 20% da amostra total de consulentes. Os dados revelaram que grande parte dos consulentes era de médicos anestesiologistas formados em faculdades particulares, trabalhando em hospitais do SUS na região sudeste e que conheceram o serviço há mais de cinco anos e através do laboratório Cristália ®. A maioria dos consulentes conseguiu o número na internet e considerou fácil completar a ligação. Houve excelente (mais de 80%) contribuição do hotline ao atendimento das crises, na opinião dos consulentes, que ainda indicaram, na sua maioria, terem sido bem atendidos e não terem ficado com perguntas sem resposta. Os consulentes consideraram o atendimento objetivo. Os dados desse estudo revelaram que a maioria dos consulentes procurou atendimento precocemente durante a suspeita da crise de HM. Os consulentes sugeriram uma maior divulgação do serviço para diagnóstico e biópsia muscular, e um serviço de apoio ao profissional anestesista para notificação do resultado da investigação dos pacientes após encaminhamento ao CEDHIMA. O questionário 3 foi aplicado aos consultores. A maioria era do sexo masculino, na quarta década de vida, e formada por médicos intensivistas. A maioria dos consultores considerou que não houve dificuldades no atendimento, além de que o atendimento contribuiu para melhorar o conhecimento em HM e o recomendam, mas metade referiu ter deixado perguntas sem resposta e a maioria considerou que as informações não seriam atualizadas com os últimos progressos em HM. A maioria dos consultores considerou que a busca por segurança seria o principal motivo que levaria alguém a buscar o hotline, em vista de haver materiais disponíveis no endereço eletrônico e materiais impressos, além da percepção de que a maioria das pessoas que procuram o serviço do hotline já possui alguma informação sobre o assunto. Os consulentes apontaram como maior dificuldade a falta de educação médica continuada e experiência prática. As principais sugestões para melhoria do hotline foram ligadas à melhoria da atualização sobre HM e atendimento por consultores anestesiologistas. Conclusões: O número de chamadas é inferior ao esperado no hotline de HM, tanto em número total quanto em representatividade dos estados brasileiros, indicando necessidade de maior divulgação do serviço e de aprimoramento da educação médica continuada para HM. As chamadas se concentram no perfil básico esperado, de assistência adequada a médicos, para manejo de crises de HM, seguido pela informação de como investigar a suscetibilidade à HM no período pós-crise. As características das crises de HM relatadas ao hotline brasileiro mostram em geral padrão semelhante ao relatado em outros países, com exceção do sinal hipertermia, que foi mais frequente que a hipercapnia; isso pode indicar indisponibilidade de capnografia e diagnóstico mais tardio em nosso meio. O hotline, apesar de primariamente voltado para HM, é procurado para assistência em outra síndrome hipertérmica, no caso, a síndrome neuroléptica maligna. O perfil das chamadas atendidas pelo Hotline de HM, quanto ao consulente, revela facilidade de acesso e satisfação com o atendimento. O perfil das chamadas atendidas pelo hotline de HM, quanto ao consultor, revelam, ao lado de percepção de que o serviço contribui para o atendimento à HM, sugestões para aprimoramento organizacional do serviço. Do ponto de vista do consultor/consulente, o hotline de HM foi efetivo.
Introduction: Malignant hyperthermia (MH) is a pharmacogenetic syndrome, autosomal dominant, manifested in skeletal muscle, triggered by halogenated anesthetics, such as depolarizing muscle relaxant succinylcholine, situations such as stress, strenuous exercise and use of illicit drugs like ecstasy. The service system is a kind of hotline telephone counseling that allows professionals who do this type of care to remain in close contact with many consultants, especially in situations of crisis and emergencies. Therefore, this is a faster communication for people who need the information or advice. Objective To describe the profile of calls answered by the Hotline MH line, as the three basic aspects: content, advisor and consultant, and effectiveness of hotline from the viewpoint of the consultant / consulting. Materials and Methods-This study was a descriptive profile of the hotline service and the characteristics of the calls, consultants and advisors. Three questionnaires were used. The first questionnaire was designed to collect data from the patient chart, survey data of the person making the query, the problems, if the problem was solved and the solution presented. The second questionnaire was administered in order to promote an interview with the people served by the hotline (consultants). This questionnaire elicited information on demographics, academic background, in what ways the person found the service hotline, how he found this number, if it was easy to find it, and if he found the answer to what he wanted. The third questionnaire was used to interview physicians who performed the telephone service hotline. This questionnaire elicited information on medical education of consultants, their views on the evolution of medical knowledge about malignant hyperthermia, if the information given is current, and the reason people come to the same service hotline with information about HM available on the site The hotline forms were raised from 2001 to 2008, with a total of 140 recorded calls, all of which were analyzed to complete the questionnaire number one . Of these 140 calls, 64 (45%) of consultants were found and contacted, the rest was not found. Of the 64 contacted, 39 (61% of the total calls of those contacted) did not return calls, 23 (36% of the total calls of those contacted) agreed to participate and returned the survey, 2 (3% of the total calls of those contacted) refused but not the reason alleged. Among the consultants responsible for the hotline, 89.28% (25) were evaluated with the third questionnaire. Results: Characteristics of Hotline calls (questionnaire 1): in the eight-year study period there was an average of 17.5 + 8.05 calls per year, with more frequent calls on the first and second years of service installation. Most calls were for medical professionals from hospitals in the Southeast. The sample observed as a whole showed a preponderance of calls requesting information about diagnostic criteria and treatment for suspected acute MH (36.42,%), followed by information on where to biopsy (23%), scientific information about MH (15.71%), guidance for the acquisition of dantrolene (11.42%), guidance on procedures for a safe surgery (3.57%), guidance on the law's requirement of having dantrolene (3 57%), information about the notification process of crisis HM (2.14%), information about dose of dantrolene (1.42%), notification of MH crisis that resulted in death (1.42%). Calls requesting information about diagnostic criteria and treatment for suspected acute MH had increased in the period 2005-2007. Considering the 78 doctors who answered the hotline, the majority of the professionals were facing a suspicion of MH crisis and were also seeking diagnosis and treatment, they were followed by those who wanted to know how to perform a safe anesthesia for their patients and how to direct them to a MH expert in order to conduct a biopsy. It was observed that most of the solutions presented by the consultant were adequate. The hotline received a total of 93 notifications related to MH crisis with 56 recent crisis reports and 37 reports of crises that have occurred in the past. Most of MH crises occurred in men in the second decade of life and were related to head and neck surgery and orthopedics. Seven cases, initially suspected of an acute attack of MH, were actually diagnosed as neuroleptic malignant syndrome. In relation to the triggering agents of HM, the halogenated were the most frequent, followed by succinylcholine. The most frequent signs reported in MH crisis were hyperthermia, tachycardia, and increased CPK. In this series, the main differential diagnoses were sepsis, hypoxia, pneumothorax, and obstruction of the respiratory system. Regarding Dantrolene, it was employed in about 20% of cases. A) This study also evaluated the services provided by our medical consultants (questionnaire 2). Data were obtained from less than 20% of the total sample of consultants. The data revealed that most of the consultants were anesthesiologists trained in private universities, working in SUS hospitals in Southeast and who knew the MH service for more than five years and through the laboratory Cristália ®. Most consultants got the number on the internet and found easy to complete the connection. There was excellent (80%) contribution of hotline service to managing the crisis, according to the consultants, who have indicated that most of them have been well attended and have not been left with unanswered questions. The consultants considered the attendance good. The data from this study revealed that most consultants sought treatment early during the crisis of suspected MH. The consultants suggested a wider dissemination of the service for diagnosis and muscle biopsy, and a support service to the professional anesthetist for notification of the outcome of the investigation of patients after referral to the CEDHIMA. B) The third questionnaire was applied to the consultants. Most were male, in the fourth decade of life, and formed by critical care physicians. Most consultants felt that there was no difficulty in answering, and that the service helped to improve the knowledge and they would recommend it, but half reported having left unanswered questions and the majority considered that the information would not be updated with the latest advances in HM . Most consultants found that the quest for security would be the main reason that would lead one to seek the hotline, in view of having materials available at the website and printed materials, and they had the perception that most people seeking the service hotline already had some information on the subject. The consultants pointed out the lack of continuing medical education and practical experience as the greatest difficulties. The main suggestions for improving the hotline have been linked to improved update on MH and attendance by consultants anesthesiologists. Conclusions: The number of calls is lower than expected in MH hotline, both in number and in total representative of the Brazilian states, indicating a need for wider dissemination of the service and improvement of continuing medical education for HM. The calls focused on the basic profile expected of adequate assistance to physicians for management of MH crises, followed by information on how to investigate the susceptibility to MH in the post-crisis. The characteristics of crises reported to MH Brazilian hotline showed a generally similar pattern to that reported in other countries, except for the signal hyperthermia, which was more frequent than hypercapnia. This may indicate unavailability of capnography and MH diagnosed later in our country. Although the hotline primarily aimed at MH, it has been used for assistance in other hyperthermic syndrome, such as the neuroleptic malignant syndrome. The profile of calls answered by the MH Hotline, as the consultant, revealed ease of access and satisfaction with care. The profile of calls answered by HM hotline, as the consultant, showed, along with the perception that the service contributes to the MH management, suggestions for organizational improvement of the service. From the perspective of the adviser / consultant, the MH hotline was effective.
Introduction: Malignant hyperthermia (MH) is a pharmacogenetic syndrome, autosomal dominant, manifested in skeletal muscle, triggered by halogenated anesthetics, such as depolarizing muscle relaxant succinylcholine, situations such as stress, strenuous exercise and use of illicit drugs like ecstasy. The service system is a kind of hotline telephone counseling that allows professionals who do this type of care to remain in close contact with many consultants, especially in situations of crisis and emergencies. Therefore, this is a faster communication for people who need the information or advice. Objective To describe the profile of calls answered by the Hotline MH line, as the three basic aspects: content, advisor and consultant, and effectiveness of hotline from the viewpoint of the consultant / consulting. Materials and Methods-This study was a descriptive profile of the hotline service and the characteristics of the calls, consultants and advisors. Three questionnaires were used. The first questionnaire was designed to collect data from the patient chart, survey data of the person making the query, the problems, if the problem was solved and the solution presented. The second questionnaire was administered in order to promote an interview with the people served by the hotline (consultants). This questionnaire elicited information on demographics, academic background, in what ways the person found the service hotline, how he found this number, if it was easy to find it, and if he found the answer to what he wanted. The third questionnaire was used to interview physicians who performed the telephone service hotline. This questionnaire elicited information on medical education of consultants, their views on the evolution of medical knowledge about malignant hyperthermia, if the information given is current, and the reason people come to the same service hotline with information about HM available on the site The hotline forms were raised from 2001 to 2008, with a total of 140 recorded calls, all of which were analyzed to complete the questionnaire number one . Of these 140 calls, 64 (45%) of consultants were found and contacted, the rest was not found. Of the 64 contacted, 39 (61% of the total calls of those contacted) did not return calls, 23 (36% of the total calls of those contacted) agreed to participate and returned the survey, 2 (3% of the total calls of those contacted) refused but not the reason alleged. Among the consultants responsible for the hotline, 89.28% (25) were evaluated with the third questionnaire. Results: Characteristics of Hotline calls (questionnaire 1): in the eight-year study period there was an average of 17.5 + 8.05 calls per year, with more frequent calls on the first and second years of service installation. Most calls were for medical professionals from hospitals in the Southeast. The sample observed as a whole showed a preponderance of calls requesting information about diagnostic criteria and treatment for suspected acute MH (36.42,%), followed by information on where to biopsy (23%), scientific information about MH (15.71%), guidance for the acquisition of dantrolene (11.42%), guidance on procedures for a safe surgery (3.57%), guidance on the law's requirement of having dantrolene (3 57%), information about the notification process of crisis HM (2.14%), information about dose of dantrolene (1.42%), notification of MH crisis that resulted in death (1.42%). Calls requesting information about diagnostic criteria and treatment for suspected acute MH had increased in the period 2005-2007. Considering the 78 doctors who answered the hotline, the majority of the professionals were facing a suspicion of MH crisis and were also seeking diagnosis and treatment, they were followed by those who wanted to know how to perform a safe anesthesia for their patients and how to direct them to a MH expert in order to conduct a biopsy. It was observed that most of the solutions presented by the consultant were adequate. The hotline received a total of 93 notifications related to MH crisis with 56 recent crisis reports and 37 reports of crises that have occurred in the past. Most of MH crises occurred in men in the second decade of life and were related to head and neck surgery and orthopedics. Seven cases, initially suspected of an acute attack of MH, were actually diagnosed as neuroleptic malignant syndrome. In relation to the triggering agents of HM, the halogenated were the most frequent, followed by succinylcholine. The most frequent signs reported in MH crisis were hyperthermia, tachycardia, and increased CPK. In this series, the main differential diagnoses were sepsis, hypoxia, pneumothorax, and obstruction of the respiratory system. Regarding Dantrolene, it was employed in about 20% of cases. A) This study also evaluated the services provided by our medical consultants (questionnaire 2). Data were obtained from less than 20% of the total sample of consultants. The data revealed that most of the consultants were anesthesiologists trained in private universities, working in SUS hospitals in Southeast and who knew the MH service for more than five years and through the laboratory Cristália ®. Most consultants got the number on the internet and found easy to complete the connection. There was excellent (80%) contribution of hotline service to managing the crisis, according to the consultants, who have indicated that most of them have been well attended and have not been left with unanswered questions. The consultants considered the attendance good. The data from this study revealed that most consultants sought treatment early during the crisis of suspected MH. The consultants suggested a wider dissemination of the service for diagnosis and muscle biopsy, and a support service to the professional anesthetist for notification of the outcome of the investigation of patients after referral to the CEDHIMA. B) The third questionnaire was applied to the consultants. Most were male, in the fourth decade of life, and formed by critical care physicians. Most consultants felt that there was no difficulty in answering, and that the service helped to improve the knowledge and they would recommend it, but half reported having left unanswered questions and the majority considered that the information would not be updated with the latest advances in HM . Most consultants found that the quest for security would be the main reason that would lead one to seek the hotline, in view of having materials available at the website and printed materials, and they had the perception that most people seeking the service hotline already had some information on the subject. The consultants pointed out the lack of continuing medical education and practical experience as the greatest difficulties. The main suggestions for improving the hotline have been linked to improved update on MH and attendance by consultants anesthesiologists. Conclusions: The number of calls is lower than expected in MH hotline, both in number and in total representative of the Brazilian states, indicating a need for wider dissemination of the service and improvement of continuing medical education for HM. The calls focused on the basic profile expected of adequate assistance to physicians for management of MH crises, followed by information on how to investigate the susceptibility to MH in the post-crisis. The characteristics of crises reported to MH Brazilian hotline showed a generally similar pattern to that reported in other countries, except for the signal hyperthermia, which was more frequent than hypercapnia. This may indicate unavailability of capnography and MH diagnosed later in our country. Although the hotline primarily aimed at MH, it has been used for assistance in other hyperthermic syndrome, such as the neuroleptic malignant syndrome. The profile of calls answered by the MH Hotline, as the consultant, revealed ease of access and satisfaction with care. The profile of calls answered by HM hotline, as the consultant, showed, along with the perception that the service contributes to the MH management, suggestions for organizational improvement of the service. From the perspective of the adviser / consultant, the MH hotline was effective.