Implementação do programa de Patient Blood Management (PBM) na Fundação Hemominas: uma análise de série temporal interrompida

Abstract

Given the increasing demand for blood component transfusions and the concomitant decline in blood donations, the World Health Organization (WHO) has highlighted the urgent need to implement Patient Blood Management (PBM) policies and programs, which are characterized by reduce the use of blood or promoting its rational use through an evidence-based multidisciplinary approach with patient-focused actions. Objectives: To analyze the effects of implementing the PBM program (cases) on the demand for blood components in 12 health facilities that contracted the blood component supply services of the Hemominas Foundation and adhered to the PBM-Hemominas program, compared with 12 contracting health facilities that did not adhere to the PBM-Hemominas program (controls). Methodology: A review of the international literature was carried out on the main challenges, from the perspective of evolutionary microeconomics, for the implementation of PBM programs. A pilot study was conducted with three public hospitals in the city of Belo Horizonte, in which the time series of the use of blood components per hospital admission were analyzed. The transfusion profile database and the time series database of 24 units contracting the Foundation's hemotherapy services were constructed, 12 of which were members and 12 were non-members of the PBM-Hemominas program. Data on the use of blood components by units and hospital admission data obtained from the Hospital Information System of the Unified Health System (SIH-SUS) for the period between January 2021 and December 2023 were used, considering two periods: pre-intervention (January 2021 to June 2022 and post-intervention (July 2022 to December 2023). The interrupted time series methodology was used, through which the hypothesis of modification of the behavior of the time series of the use of blood components in units adhering and non-adhering to the PBM-Hemominas program was tested, via a segmented regression model. Results: In the literature review study, at least eight reasons were identified why PBM programs are still underutilized in the health market. In the pilot study, the average monthly percentages of transfusions of blood components use per hospital admission were found 45.5%, 26.9% and 26.3% in the three hospitals analyzed. As a result of the evaluation of the implementation of PBM-Hemominas, among 12 hospitals that adhered to the program, two stood out positively regarding the change in trend after the intervention period. In turn, the incipience of the establishment of the program was identified, requiring monitoring of its implementation for a longer period and the expansion of the program's adherence by hospitals with low levels of complexity and intensification of the program's adherence by the group of hospitals with level 5 of complexity. Conclusions: This study, in partnership with the Hemominas Foundation, will contribute to the dissemination of the implementation of the PBM-Hemominas program and will encourage the scientific community and society to access information, attributes necessary for the construction of health policies and the possible future replication of the adoption of PBM programs by other components and organizations of society in Minas Gerais and Brazil. Furthermore, it addresses the public health problem in Brazil and around the world regarding the reduction in blood donation rates and the increase in demand for blood components due to population aging.