RTPI — Saude a Mesa
20261011 220500 UTC
376 transcript segments
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[00:00:00] with Herman José because I was thinking I have things to say and
[00:00:04] the world, I feel that the world wants to hear me
[00:00:06] immediately returns this Wednesday
[00:00:10] night on RTP Mundo.
[00:00:39] Hello, good evening, how are you at home? Once again, I come into
[00:00:43] your homes to talk about some topics that I consider interesting.
[00:00:47] Today's topic apparently has nothing to do with food, we will prove
[00:00:51] throughout the program that it does indeed have a lot to do with food and people's well-being,
[00:00:55] particularly in situations of illness. So today we're going to talk about
[00:00:58] home hospitalization.
[00:01:00] We will define throughout the program what that
[00:01:02] the sick family member, and now we are means, its objectives, to whom it is directed,
[00:01:05] this type of service provision,
[00:01:09] the implementation of the same here in Madeira which has been growing, also some
[00:01:13] numbers in terms of the country, to talk about this we have next to me,
[00:01:16] on my left, Dr. Marias, and more than
[00:01:19] anyone else, she is the face of home hospitalization, she has been the one
[00:01:23] who has fought for this service since the beginning, let's say, which is another
[00:01:27] hospital service for the population, next to me... we have Chef Jaime
[00:01:31] Cruz, more than well-known, no need to say
[00:01:34] anything, going to Jaime's restaurant is
[00:01:38] something that is always an experience of eating well,
[00:01:41] so his presence fits perfectly in this program, I would start
[00:01:45] by asking Maria da Luz, what, in your
[00:01:48] perspective, let's first define the object of this program, what do you
[00:01:51] define as home hospitalization? Well, first of all,
[00:01:54] I would like to greet the people at home, a good evening and thank
[00:01:58] them for thinking of... this topic, which is really what you
[00:02:02] say, it's a topic that for me is the apple of my eye, so it's a topic I've
[00:02:05] always fought for and that is finally implemented in the region. Now,
[00:02:08] allow, just like you saw the home hospitalization is, as the
[00:02:11] name implies, the provision of hospital-level healthcare
[00:02:15] at the patient's home, so
[00:02:18] it's an activity that we started, more
[00:02:21] precisely, in March 2023 here in
[00:02:24] Madeira and we practically take the hospital to the patient's
[00:02:28] home, so it's directed at acute or chronic
[00:02:32] acute patients who, having
[00:02:35] criteria to be admitted to the hospital, also meet criteria that allow them to
[00:02:39] be at home and be, in essence, daily observed by us,
[00:02:43] a multidisciplinary team and who goes daily to the patient's
[00:02:46] home. Your technical responsibility and your work
[00:02:50] team also implies a prior assessment of the total conditions of the home
[00:02:53] to suggest hospitalization. Some
[00:02:56] perspectives that you would like to highlight regarding this, is that it?
[00:03:00] That's why I said at the beginning that patients had to have clinical,
[00:03:03] geographical, social criteria,
[00:03:06] this is always done with informed consent, always with the patient's
[00:03:10] and their family's consent, so there are
[00:03:14] social criteria, from the moment they ask us to observe these patients,
[00:03:17] we have teams, two teams
[00:03:21] working daily, one that goes to the patient's home and another that stays at the hospital to
[00:03:24] recruit patients, in essence recruit patients, so whenever
[00:03:28] they ask us to observe... a patient who has an indication, we go to see if
[00:03:32] the patient has clinical criteria, an acute illness, so our
[00:03:35] intervention always goes to the acute phase, because then
[00:03:39] the patient is, in essence, this is, in essence, a continuity of care,
[00:03:42] then we will pass the patient to primary healthcare when they leave the acute phase,
[00:03:46] in essence, what we do in the hospital, the patient is then discharged, during the acute
[00:03:50] phase they are under our
[00:03:52] is it to tutelage, so we
[00:03:54] when we are called, so if there is a clinical criterion,
[00:03:58] then the social worker who also... is part of our team will also talk
[00:04:02] to the patient's family, the patient must have a family, must have living
[00:04:05] conditions and must have a phone to be in daily
[00:04:09] and permanent contact with us. Then we have
[00:04:12] a nutritionist, a pharmacist, we have the medical and nursing team
[00:04:15] and we have all the specialists from the hospital who give us incredible help,
[00:04:19] that is, whenever I need a patient, to contact a
[00:04:23] colleague from any specialty, they are always available to help us. In terms of IT, this
[00:04:26] home hospitalization service is linked to the entire hospital network, yes. And once
[00:04:30] the patient is chosen for this type of service, they can rest assured,
[00:04:34] because they will have everything they would have if they were
[00:04:37] within the walls of a hospital, and the same quality, right?
[00:04:40] Right. Jaime, what do you have to say about this? I mean, for
[00:04:44] me, the advantage of this in technical terms of the patient being
[00:04:48] at home, with the involvement of the family, in their own space, all these
[00:04:51] things, is an important aspect, but for me, another perspective joins this,
[00:04:55] which is the food, which, being healthy, is their
[00:04:59] own food. It's not hospital food, clinic food, or whatever, it's their
[00:05:02] own food. What do you think of this perspective? I think it's very interesting because I think it's
[00:05:06] an extraordinary idea, that is, nowadays, as we
[00:05:09] know, and you more than anyone, the overcrowding that exists... in hospitals,
[00:05:13] people don't have beds, they're on stretchers,
[00:05:16] they can be in their homes
[00:05:20] with the comfort of their home, and on top of that, supervised by
[00:05:24] such a good technical and medical team. In terms of
[00:05:27] food, even better, because they can, with the
[00:05:30] nutritionists and with the
[00:05:33] doctors, say what they should eat and what they can't
[00:05:36] eat, it has a very big advantage, and even
[00:05:40] more so, the comfort of the family. I've already been hospitalized, I've been in the hospital too,
[00:05:44] and I know that I think that from the comfort of the family, it's already
[00:05:47] a natural comfort, it's
[00:05:50] an extra pill, isn't it?
[00:05:53] This also, in my perspective, I'm sometimes exotic in my
[00:05:57] ways of thinking, this is a bit of a step back in relation to the
[00:06:01] family's responsibility in the family's illness, that is, for a long time,
[00:06:04] particularly in rural environments, the patient
[00:06:08] was cared for in their family environment, then it moved to hospitals and the family
[00:06:12] almost... divorced themselves from the patient, from
[00:06:15] returning a little to the origins, don't you think? So it's a
[00:06:19] question, it's an increase in the responsibility of the family environment towards a
[00:06:22] sick family member who has the good fortune of being sick, it's also an increase in
[00:06:25] responsibility, don't you think? I usually say that this type of care provision
[00:06:29] is true humanization in health, we actually
[00:06:32] take the hospital to the patient's home, we are available for that
[00:06:35] patient, the patient feels that they have the
[00:06:39] family feels that and you said something very important, which is
[00:06:42] regarding the family's involvement in
[00:06:46] the illness and we do that, that health literacy, we educate
[00:06:49] the patient in their own place, they have their things, we explain what
[00:06:53] kind of food they have to eat, we do a very important thing, which is
[00:06:56] therapeutic reconciliation, that's why we also have a pharmacist who goes and sees
[00:07:00] patients what medication, many times we have
[00:07:03] surprises, we have patients with the same medication
[00:07:07] with several names, but the patient doesn't know it's the same and, therefore,
[00:07:10] they may even run the risk of... taking the same medication twice and therefore
[00:07:14] and we, on site, we will know where things are
[00:07:18] and in reality that's it, the family also feels more
[00:07:21] supported, because the family also has some fear of all this
[00:07:24] and if they feel supported and you said something that also
[00:07:28] calmed me down a bit, that's what I think, from the moment they are with us and are at home, they have to be
[00:07:32] safe, they have to feel safe, then they also feel that they can treat
[00:07:36] their family member, that's it, and many times when we discharge them, they say, "Oh, if
[00:07:40] anything happens, they'll contact us," and we say, "Don't worry."
[00:07:48] hospital, just a call from you if necessary, I think it's a huge
[00:07:51] added value, uh, the political management of health has also
[00:07:54] cherished this a lot, particularly in recent times to the point of wanting to
[00:07:58] extend it to more geographical areas, particularly the south, the south
[00:08:02] of the island, uh, this
[00:08:05] expansion of the area of influence also implies an increase in resources, obviously, this has to be
[00:08:09] thought out and prepared in advance, not only the resources, but also the... number of
[00:08:12] cars available and all that, right? So there is a certain
[00:08:15] programming.
[00:08:17] I think this is one of the important bets here from our
[00:08:21] superiors hierarchically in political terms, I think everyone
[00:08:24] agrees and I feel it, I feel that they are with us and that
[00:08:28] they are concerned and that they really want to and because it was also
[00:08:32] realized that this is really an important way to bring
[00:08:35] health to the patient and and there is national
[00:08:39] and already worldwide data, this has not existed since... now
[00:08:43] do we have an idea of how much availability or installed capacity at
[00:08:46] a national level exists at this moment? At this moment we have a hospital
[00:08:50] without walls with 362 beds at this moment there are, these are recent data
[00:08:54] from our SNS, 36 home hospitalization units in the
[00:08:58] country. I haven't quite understood yet, I have a question and you do
[00:09:01] the triage and
[00:09:04] urgency first or is it like that?
[00:09:08] The triage for the unit is done in several ways, we are
[00:09:11] contacted. And we are contacted how? Either through the
[00:09:14] emergency room, a patient who goes to the emergency room and has an indication to be hospitalized and who meets these
[00:09:18] criteria, the emergency doctor asks us to go see them.
[00:09:21] Hospitalized patients who are hospitalized and who can continue, so they have been there
[00:09:25] for 5 days, maybe they would have stayed there for 10 days, but they can already go home
[00:09:29] because they can finish their treatment at home and we go home,
[00:09:33] special care units, excuse me but they're getting me in order
[00:09:36] regarding the program. I'll stick to the routine anyway,
[00:09:40] one of the first interviews you did with the patients at home, you asked if they were
[00:09:44] well impressed with it and he said with
[00:09:47] a lot of humor, "If I'm well impressed, then here I have a doctor just for me,
[00:09:51] if I were in the hospital it would be one doctor for so many people." So just this
[00:13:45] clarified butter, loves, let's give Jane a little break so he doesn't get
[00:13:49] flustered, so continue. The Madeiran
[00:13:52] health care has an increasing variety of available
[00:13:56] home health services, yes.
[00:13:59] All of a sudden, there are so many, all with different characteristics and
[00:14:03] objectives in terms of treatment
[00:14:07] and coverage of different health needs. Home hospitalization, I would say,
[00:14:11] is top-tier among all this, no, no, all
[00:14:14] care is important, okay? All care is important, okay? But the last conclusion
[00:14:18] then there are the home visits from general and
[00:14:21] family medicine colleagues, then there are the home visits. From
[00:14:25] pain therapy too, sometimes they have equipment that needs revision,
[00:14:28] then finally there are the home visits from palliative
[00:14:32] care, so all of this is a resource for
[00:14:35] home assistance, so I think this is spectacular, I mean, the patient
[00:14:39] less and less has to worry about their illness,
[00:14:42] knowing that they are well at home and will have everything they need at home, of course, there
[00:14:46] has been throughout this implementation of HD,
[00:14:49] a good relationship and articulation with all these
[00:14:53] support visits for the home.
[00:14:55] And it's essential that this happens, because in reality, patients have
[00:14:58] to have continuity in their trajectory through
[00:15:02] the services. There's no
[00:15:05] overlap of the functions from my point of
[00:15:09] view, no, no, because in reality our patient is our
[00:15:12] patient, our activity is limited to the acute phase, it's an acute
[00:15:16] or acute chronic patient, right? Who, in essence, has a pathology
[00:15:20] that indicates hospital admission, so these patients
[00:15:23] would be hospitalized. From our services, I'm asking this
[00:15:27] because I also know, and I witnessed some of your conversations at an initial
[00:15:30] stage, some friction in the relationship with
[00:15:34] other specialties, namely family medicine. But
[00:15:37] this has all been diluted over time, I think it's only by talking
[00:15:41] that one understands, in reality, everyone understands
[00:15:45] that in your daily activity you have a, we are all important, you have a
[00:15:48] briefing, you have a briefing every day with that work team in order
[00:15:52] to plan the work day. We plan before leaving, we
[00:15:56] always have contact, we are always in contact, all of us know the patients who are at home,
[00:16:00] anyone from my team at this moment knows who the patients are, we have a way of
[00:16:03] communicating with each other and that we have, sorry
[00:16:06] for interrupting. It is fundamental because we are
[00:16:08] permanently with these patients while they are at
[00:16:12] home in HD, as it is called,
[00:16:15] hospitalization, the patients are with us. In terms of
[00:16:19] costs and sustainability of the system, which is something that managers really like
[00:16:23] and that we also have to pay attention to,
[00:16:26] it is advantageous. So the costs are advantageous, they show that
[00:16:30] there is really a reduction in costs because daily costs become
[00:16:33] lower. We start by seeing that the patient's bed is at home, exactly.
[00:16:37] So the hospital part, so the bed is at home, so, but
[00:16:41] but more important here is really a thing that Jaime
[00:16:45] talked about there, which is really the comfort for the patient, being at their
[00:16:48] home, with their own things, we notice in elderly people often when they are
[00:16:52] hospitalized in the first few days, I don't know if you also had that in your
[00:16:55] service and you have, they get confused, hospitalization is always a
[00:16:59] critical phase, it's a lack of reference, being at home there's no possible confusion,
[00:17:02] they're in their own place, it's a lack of references not only human but also of physical
[00:17:06] spaces, that is, it's their bathroom, their kitchen, their car.
[00:17:09] A great advantage and the other is the reduction of infections, at home
[00:17:13] there are fewer infections, patients are proven to recover more
[00:17:17] quickly, that's an important aspect, lower mortality, that's an important aspect,
[00:17:20] infections are always a drama for a patient, for a surgical patient much
[00:17:23] more than for a medical patient, but for a medical patient, infections and
[00:17:27] superinfections are increasingly common, if they can be avoided or
[00:17:30] minimized in the home situation, I think it's excellent, but look,
[00:18:57] uh, let's suppose a patient has a respiratory
[00:19:00] infection that causes some motor incapacity,
[00:19:03] uh, you also have in this
[00:19:07] rehabilitation and kinesiotherapy programs also rehabilitation that goes to the patient's
[00:19:11] home, yes, that's an important aspect, we do kinesiotherapy at home, yes,
[00:19:14] yes, every patient who is at home has the same conditions as a patient who is
[00:20:15] season. One thing that patients often do when they are in a
[00:20:18] hospital environment is if they have alcoholic or tobacco
[00:20:22] habits, they go to the balcony to smoke. Do you have
[00:20:25] any restrictions on those things for the patient who is
[00:20:29] at home? It's out of our control, so they can have a respiratory
[00:20:32] infection, first of all, just to tell you that one of the exclusion
[00:20:36] criteria is alcohol.
[00:20:39] Ah, we cannot have a patient with active alcoholism safely at home.
[00:20:42] That's unthinkable. A patient who is at home is
[00:20:45] safe because they met all the criteria to go home.
[00:20:49] And so they are
[00:23:50] An important aspect, Luz, in these things of delivering the patient home,
[00:23:54] unfortunately, we have to be attentive to something that sometimes
[00:23:58] afflicts families without us realizing that there is family violence at
[00:24:01] home, sometimes we can have a patient who doesn't report it because they are afraid to
[00:24:05] report it, man or woman, it doesn't matter, and in the meantime, you
[00:24:08] put the patient in the lion's den, so to
[00:24:11] speak. There are prospects of care, relationship, that's why
[00:24:15] the patient goes home with the patient's consent from the
[00:24:17] family, yes, there is a term. And we
[00:24:21] go home daily, if we feel that, there was a
[00:24:25] there was a ready person feels that, if they feel it, we
[00:24:28] talk to the family and sometimes a conversation helps a lot because sometimes
[00:24:32] that, I even think in that aspect we even helped the
[00:24:36] family a little bit in that, to heal a little bit that violence because in the end they
[00:24:40] and then they feel completely involved
[00:24:43] they think they are doing something very important for the
[00:29:43] as another one says taste it
[00:29:46] to see if we need salt or not. When you send a patient for home hospitalization,
[00:29:50] you predict a certain period of hospitalization, but sometimes things
[00:29:54] don't go as linearly and it's always an unknown
[00:29:57] exactly, the hospitalization has to be prolonged.
[00:29:59] entreinamento.
[00:30:02] of selection, so what, what? The time, no, it won't
[00:30:06] be necessary, we have patients receiving antibiotic therapy, for example,
[00:34:13] us to come back to the dish later, but I wanted now, at this almost
[00:34:17] final stage of the program, for you to express what you felt in this program and
[00:34:20] if you were indeed useful to those at home,
[00:34:24] if you were useful in terms of disseminating, on the one hand, home
[00:34:28] hospitalization, a great advantage for those who are sick at
[00:34:31] home, and on the other hand, in transferring some food
[00:34:35] information to those on the other side to also innovate. I am
[00:34:39] radiant, firstly, for this
[00:34:42] novelty, which is something extraordinary, isn't it? I think
[00:34:46] I, as a patient that I have been and
[00:34:49] will certainly be because we all
[00:34:52] get sick, absolutely, we can't escape it unless we are a super
[00:34:56] sum, eh, to have that advantage, a divine
[00:34:59] advantage, to be in the hospital, hospitalized, at the end
[00:35:03] of the fifth or sixth day to say look, you're going home and
[00:35:07] you'll continue with this, with this, with this, with this, and man, I think it's extraordinary,
[00:35:11] extraordinary, I, I, I have to say thank
[00:35:14] you, thank you, it's commendable, that's something divine, when
[00:35:18] I thought about talking about auxiliary hospitalization in this program,
[00:35:21] it made so many things clear in my head, so many things that can be
[00:35:24] associated with it, talking about food as we are doing
[00:35:28] here, I'm happy that we achieved that, what do you think? Were you able
[00:35:32] to pass information about your HD at
[00:35:35] the same time we talked about food that can
[00:35:39] be implemented in the homes of the elements that you them to be
[00:35:43] above all two things. To understand that everyone has the right to
[00:35:47] this type of, this type of, it's not quality of life, unfortunately at
[00:35:50] this moment we only have a capacity of five beds because we only have
[00:35:54] one van, right, but fortunately we will have
[00:35:57] soon, I think still this month, it's starting now, we
[00:36:01] will have two, and therefore we can increase the sum of the
[00:36:04] profitability of these five beds to this date. How many patients, since you just completed
[00:36:08] a year, five? Ah, we with one, with one
[00:36:11] van, five beds at home, we treated
[00:36:15] 145 patients, 145 patients, so there were 145
[00:36:18] citizens of our land who, in a terrible phase of
[00:36:21] illness, which for all of us is always a hassle, had the possibility of at
[00:36:25] least half of the treatment done
[00:36:27] in their home, in their home environment, with their home food, with their
[00:36:31] smells, I think that's spectacular. The
[00:36:34] incentive for more island coverage will imply more human resources,
[00:36:38] but things are being prepared, I think it's perfectly possible.
[00:36:42] Another important aspect is that we have to captivate
[00:36:45] on the other side, obviously, the citizen who has the right to this benefit, we are
[00:36:49] talking about the difficulties of implementation on this side, technical, cars, human
[00:36:52] resources, and who is part of your team, I'm thinking of the
[00:36:56] doctors, you feel the...
[00:36:59] Initially there was some resistance, people hesitated, and today, after
[00:37:02] a year of treating 140 patients under this regime, do you feel that people are increasingly
[00:37:06] committed to it? In fact, they almost almost make a point of
[00:37:10] getting into this type of treatment, people, people like it
[00:37:13] very much because this, as I say, has benefits for patients,
[00:37:17] so it's associated with greater satisfaction of patients
[00:37:20] and families, but also ours. I notice that my
[00:37:23] team is all committed, everyone is happy,
[00:37:26] for sure, very important because this is something different, it's, it's
[00:37:30] basically something outside the box that we, in the hospital
[00:37:34] box, we are at the patient's home and we take it to the patient,
[00:37:37] we notice that the patients eh have
[00:37:40] affection for us and we have that moment, we spend about 20 to
[00:37:43] 40 minutes with each patient at home every day, it is
[00:37:47] indeed a personalization there and in the 24 hours, that's what I want to make clear
[00:37:50] here, in the 24 hours of the day we are available for those patients
[00:37:54] and therefore they know that, they feel safe, that's what we want them to... so
[00:37:57] safe, we have something very spectacular here in Medari, we have to
[00:38:01] really thank them because we had that privilege that
[00:38:05] initially not all units in the country had telemonitoring, that is,
[00:38:08] we can remotely see the patient at home,
[00:38:12] know at every moment what they have, it's even possible to do an electrocardiogram
[00:38:16] remotely, it's possible to know the patient's attention, it's necessary to know everything for
[00:38:19] us to know, it's very important, this is very reassuring,
[00:38:23] we, we worry a lot about patient safety, the patient also feels that.
[00:38:27] More secure too. HD at this moment is having new
[00:38:30] structures in the hospital or the prospect of new structures that will
[00:38:36] control room here, there is a control room for monitoring patients who are at home, there are
[00:38:40] telemetry data that are transmitted there, the person is seeing the pulse, the
[00:38:43] electrocardiogram, I think this is spectacular, we just have to increase and
[00:38:47] increase our availability. Well,
[00:38:50] unfortunately we are reaching the end of the program, we had conversation for much
[00:38:53] longer, I wanted to thank your availability, Luz, and
[00:38:56] to give... regarding your initiative, the resilience, which
[00:39:00] is a very modern word now, that you had throughout this time, I think it was
[00:39:04] spectacular. As for you, Jaime, the usual, you are always
[00:39:07] with us, always, always together, not only for friendship, but also for
[00:39:11] these initiatives. And for those at
[00:39:13] home, I wanted and you must always feel
[00:39:17] a little sadness on my face when I'm saying goodbye, because in fact this is something
[00:39:21] I have to admit I do with pleasure, with availability, without
[00:39:24] any kind of stress, so it always gives me great pleasure
[00:39:28] to talk about these topics. I hope for those at home that the treatment of this topic was useful
[00:39:31] for you in terms of information about what
[00:39:35] HD is, what it can bring into your lives when you have the misfortune of
[00:39:39] illness, and now also to add the pleasure of eating well even during
[00:39:43] illness, this time at home, in your kitchen, in your
[00:39:46] corners, on your couch. Thank you very much for your presence, eh, we will have
[00:39:50] more programs next with other topics, thank you very much and good night, thank you, very good
[00:42:19] I've been working on this street for 57 years
[00:42:23] and, therefore, I came here to
[00:42:26] a shoe store I had up here, which is no longer a
[00:42:29] shoe store, and now I come here to this store,
[00:42:32] so at that time there was a vacant space
[00:42:36] and now I've been in this store for 40
[00:42:40] and... 2 years, 42 years this September,
[00:42:42] so my life is this, isn't it? So
[00:42:46] let's keep going here and see, let's survive, so
[00:42:50] I'm going to enter here, I
[00:42:53] have to straighten these shoes, man, there are many
[00:42:56] and some older ones, aren't they, they're quite?