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Brazil’s first hospital medicine congress offers promise, challenges

By Fernando Starosta de Waldemar, MD, Andre Wajner, MD, and Guilherme Brauner Barcellos, MD

From the August ACP Hospitalist, copyright © 2008 by the American College of Physicians

Sidebar: Attendee Profile

In May, the recently founded Brazilian Society of Hospital Medicine (SOBRAMH) held its first congress in Gramado, Rio Grande do Sul. It was the first organized attempt to gather together the key players who are individually trying to improve national hospital care in Brazil.

Brazil has over 6,000 hospitals, 20% of which are tertiary care facilities. The public health system, Sistema Ùnico de Saúde (SUS), is the largest universal health coverage system in the world, but despite recent advances, mostly in primary care, public medical care still suffers.

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Jamie Newman, FACP, addresses attendees at SOBRAMH’s first congress.

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The main objectives of the congress were to draw people’s attention to hospital medicine in Brazil, update participants on achievements in the past decade, and promote integration of scattered initiatives throughout the country. There were more than 600 attendees, including physicians from various specialties, nurses, hospital administrators, politicians and medical students (see chart). Members from the Brazilian Ministry of Health and the National Agency of Sanitary Vigilance (ANVISA) also were present. The meeting, which accepted no pharmaceutical sponsorship, was cosponsored by the Mayo Clinic in Rochester, Minn. and featured lectures by physicians from Mayo and other U.S. institutions. Jamie Newman, FACP, ACP Hospitalist’s editorial advisor and a hospitalist at the Mayo Clinic, helped coordinate the curriculum.

During the congress, it became clear that the challenges faced by our hospitals, both public and private, are similar to those faced by U.S. hospitals. It’s now easier for Brazilians to understand why hospitalist care means quality, improved patient safety, shorter stays and reduced costs.

Some directors of Brazil’s most prestigious private hospitals are advocating initiation of hospital medicine services as soon as possible because of a predicted lack of skilled physicians in the near future. SOBRAMH is helping these facilities adjust hospitalists’ schedules to comply with Brazilian work laws.

Although significant growth in the field is expected, hospital medicine in Brazil still must overcome major hurdles. Measuring results and evaluating outcomes are not regular practices at our hospitals. Private payers are reluctant to endow hospitalists and are even more cautious about adapting reimbursement. Many primary care physicians remain unfamiliar with hospital medicine and still consider it a threat rather than a benefit.

Nevertheless, we believe the hospital medicine movement in Brazil shows great promise. We predict that American hospitalists soon will notice growing numbers of Brazilian colleagues at their meetings, along with increased interest in more formal training programs. We plan to publish more studies on the work being done in Brazil. In two years, we will hold our second congress, hopefully with even better results than the first.

Drs. de Waldemar and Wajner are specialists in internal medicine and emergency medicine. Dr. Barcellos is a specialist in internal medicine, emergency medicine, and critical care and an internal medicine professor at Hospital Conceição. More information on SOBRAMH is available at www.medicinahospitalar.com.br.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated