Aldaísa Cassanho Forster

Percepção e avaliação dos alunos do curso de medicina de uma escola médica pública sobre a importância do estágio em saúde da família na sua formação

Primary Care (PC) centered on family medicine started to be taught at the Faculty of Medicine of Ribeirao Preto, Sao Paulo University (FMRP-USP), in 1997. The teaching strategy consists in introducing students into Family Health teams, where they are encouraged to participate in the routine Family Practice, taking part in group activities, team meetings, household visits, and discussions of individual and family cases. Disease prevention, health promotion and the relationship with the user of the care delivery system are emphasized in an effort to deliver comprehensive care. The objective of this study was to evaluate to which extent, in the viewpoint of 5th year medical students of FMRP-USP, the Family health experience contributed to their Primary Care training. A structured questionnaire was applied to 103 students before and after the training. The training contributed positively to the education of the students, especially as refers to the aspects integration with the health team, patient-centeredness, and awareness of the main principles of family medicine such as team work, long-term care, accessibility and preventive care. After the training the students passed do give more importance to the social and economic aspects of the individual and to see the patient as bio-psychosocial being.

Internações por condições sensíveis à atenção primária à saúde em uma região de saúde paulista, 2008 a 2010

Objective: describe hospital admissions for ambulatory sensitive conditions (ACS) in the Sao Jose do Rio Preto health region, Sao Paulo State, Brazil. Methods. a descriptive study using data from the Unified Health System’s Hospital Admissions Information System, 2008-2010. Results: the ACS coefficient for this health region was around 13.0/1000 inhabitants each year. The five most common diagnoses were heart failure, angina, urinary tract infections, infectious gastroenteritis and cerebrovascular diseases. Circulatory system diseases were the primary diagnosis recorded in 41.5% of these admissions. ACS expenditure was R

O complexo regulador da assistência à saúde na perspectiva de seus sujeitos operadores

30,370,691.08, corresponding to 17% of the total costs of hospital admissions in this health region. Conclusion: the occurrence potentially preventable ACS indicates the need for further investigations about possible factors that may be interfering with the organization and outcomes of primary care in the region studied.

Assessment of informatization for the dispensing of medications at a university hospital

This investigation aimed to evaluate aspects of the outcome from implementing the Regulatory Complex (RC) for public healthcare system organization in Ribeirao Preto, Brazil. The functional domain of the RC formed the scenario. Interviews were conducted with workers in different categories, within the administrative and operation al levels of the RC. The material was analyzed using thematic analysis. The findings showed that t he RC caused changes to the organizational accessibility and equity of the healthcare network, for both outpatient and hospital care. The need to create a resolutive and humanized network was highl ighted. The RC was shown to be a useful evaluation and management tool. Its implementation changed the subjects’ work processes and had little recognition among SUS users (Brazilian Unifi ed Health System).The evaluation showed that, despite the short time since implementation, the RC strategy has the strength to collaborate towards SUS sustainability, although investment, disseminat ion and improvement are needed.Trata-se de pesquisa avaliativa objetivando avaliar aspectos do resultado da implantacao do Complexo Regulador (CR) na organizacao do sistema publico de saude de Ribeirao Preto-SP. O cenario foi o espaco funcional do CR. Foram entrevistados trabalhadores de diferentes categorias que atuavam na gestao e no nivel operacional do CR e o material analisado segundo analise tematica. Os achados mostram que o CR provocou alteracoes na acessibilidade organizacional e equidade da rede de saude, tanto na atencao ambulatorial quanto hospitalar; destacou a necessidade de constituicao de rede resolutiva e humanizada e mostrou ser ferramenta proficua de avaliacao e gestao. A implantacao alterou o processo de trabalho dos sujeitos e teve pouco reconhecimento junto aos usuarios do SUS. A avaliacao apontou que, apesar do pouco tempo de implantacao, a estrategia do CR tem potencia para colaborar na sustentabilidade do SUS, mas se fazem necessarios: investimento, divulgacao e aperfeicoamento.

Caracterização das Casas de Apoio a portadores de HIV/Aids em Ribeirão Preto (São Paulo, Brasil) e suas práticas de administração

INTRODUCTION Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy. OBJECTIVES To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003. MATERIALS AND METHODS In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization). RESULTS The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications. CONCLUSIONS The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity.

Metodología de aprendizaje en atención primaria y medicina de familia

Objetivou-se conhecer a organizacao, o funcionamento e a prestacao da assistencia de tres Casas de Apoio a portadores de HIV/Aids em Ribeirao Preto-SP. Foram feitas entrevistas semi-estruturadas com as coordenadoras a respeito de suas funcoes, aplicou-se um questionario sobre os aspectos estruturais do local e registraram-se observacoes do cotidiano das instituicoes. Legalmente, eram organizacoes regidas por entidades de cunho assistencialista-humanitario e procuravam adequar-se as normas tecnicas e exigencias para seu funcionamento. Recebiam subvencao da prefeitura local, mas eram sustentadas, sobretudo, por doacoes da sociedade civil. As coordenacoes eram desempenhadas por mulheres, predominantes nos quadros de funcionarios e voluntarios. Em suas falas, observou-se uma postura administrativa multifuncional e dificuldade para realizar a inclusao social dos moradores, devido a preconceito ou regras de funcionamento das casas. Conclui-se que, administrativamente as Casas correspondiam ao que se propunham, mas deveriam atentar para a necessidade, como agentes sociais, de fomentar a inclusao social.

A dinâmica de três colegiados de gestão regional: um olhar sobre a regionalização e pactuação

En los últimos 30 años la universidad, para estructurar la formación pregraduada y posgraduada en medicina, viene enfrentando el reto de adecuarla al ámbito dinámico de los sistemas sanitarios, desde proporcionar «a los estudiantes experiencia en la teoría y en la práctica de un modelo de salud integrado», y que ésta les permita la vivencia con el enfoque global de los problemas de salud, hasta los aspectos preventivos y de promoción de la salud, del nivel de atención primaria (AP)1. Los informes técnicos sobre la formación médica de pregrado apuntan una tendencia de la enseñanza-aprendizaje en la comunidad a su práctica en estructuras asistenciales comunitarias y ambulatorias2,3. Según la opinión de médicos prácticos, las facultades con el currículo orientado a la comunidad fueron las que mejor atendieron sus necesidades de formación en comparación con las tradicionales4. En Brasil, los programas de salud pública y el Programa de Salud de la Familia (PSF)5 son algunos servicios con los cuales el estudiante de medicina ha tenido escaso contacto en el plan de estudios. En la Faculdade de Medicina de Ribeirão Preto de la Universidade de São Paulo (FMRP-USP) la enseñanza de la AP se ha incrementado desde los años cincuenta, aunque la experiencia en medicina de familia empezó en 1997, tras el marco de la política sanitaria del Ministerio de Saúde de Brasil, con el PSF (1994). Con la reforma curricular del plan de estudios de la FMRP en 1993, se creó una unidad docente multidisciplinaria, el Centro de Atención Primaria y Salud de la Familia, interdepartamental, que ha ido impulsando la docencia e investigación en AP y PSF desde 1997. Este trabajo analiza la implementación de una guía de prácticas de AP según su viabilidad operativa en la enseñanza pregraduada de medicina y presenta una propuesta de metodología de aprendizaje orientada hacia la evaluación y la autoevaluación del alumno de medicina, basada en normas de AP y salud de la familia.

The regulatory complex for healthcare from the perspective of its operational players

Este estudo teve por objetivo compreender a dinâmica dos Colegiados de Gestao Regional do Departamento Regional de Saude XIII (Ribeirao Preto-SP) no que diz respeito a dinâmica e relacao entre os entes federados ali representados. Utilizou-se a abordagem qualitativa, por meio de entrevistas semiestruturadas e analise de conteudo. Surgiram questoes pertinentes as relacoes entre os entes, com a presenca de logicas e relacoes por vezes solidarias e por vezes marcadas pelas diferencas de poder. Capturaram-se as diferentes visoes e perspectivas dos diversos atores em cena, ressaltando a importância do planejamento em situacao de poder compartido para a construcao da regionalizacao e do SUS.

Attitudes towards interprofessional collaboration of Primary Care teams participating in the ‘More Doctors’ (Mais Médicos) program

This investigation aimed to evaluate aspects of the outcome from implementing the Regulatory Complex (RC) for public healthcare system organization in Ribeirao Preto, Brazil. The functional domain of the RC formed the scenario. Interviews were conducted with workers in different categories, within the administrative and operation al levels of the RC. The material was analyzed using thematic analysis. The findings showed that t he RC caused changes to the organizational accessibility and equity of the healthcare network, for both outpatient and hospital care. The need to create a resolutive and humanized network was highl ighted. The RC was shown to be a useful evaluation and management tool. Its implementation changed the subjects’ work processes and had little recognition among SUS users (Brazilian Unifi ed Health System).The evaluation showed that, despite the short time since implementation, the RC strategy has the strength to collaborate towards SUS sustainability, although investment, disseminat ion and improvement are needed.Trata-se de pesquisa avaliativa objetivando avaliar aspectos do resultado da implantacao do Complexo Regulador (CR) na organizacao do sistema publico de saude de Ribeirao Preto-SP. O cenario foi o espaco funcional do CR. Foram entrevistados trabalhadores de diferentes categorias que atuavam na gestao e no nivel operacional do CR e o material analisado segundo analise tematica. Os achados mostram que o CR provocou alteracoes na acessibilidade organizacional e equidade da rede de saude, tanto na atencao ambulatorial quanto hospitalar; destacou a necessidade de constituicao de rede resolutiva e humanizada e mostrou ser ferramenta proficua de avaliacao e gestao. A implantacao alterou o processo de trabalho dos sujeitos e teve pouco reconhecimento junto aos usuarios do SUS. A avaliacao apontou que, apesar do pouco tempo de implantacao, a estrategia do CR tem potencia para colaborar na sustentabilidade do SUS, mas se fazem necessarios: investimento, divulgacao e aperfeicoamento.

New national curricula guidelines that support the use of interprofessional education in the Brazilian context: An analysis of key documents

ABSTRACT Objectives: to compare the attitudes regarding interprofessional collaboration of health professionals that make up the Family Health Strategy teams participating in the ‘More Doctors’ (Mais Médicos) program; and to identify factors associated with attitudes of interprofessional collaboration. Method: a descriptive, transversal and comparative study developed with 63 health professionals who responded to the Jefferson Scale of Attitudes Toward Interprofessional Collaboration. The data were statistically analyzed. Results: the sum of the scale items ranged from 88 to 139 points. The analysis of all the Family Health teams indicated statistically significant differences between the scores of the scale and the professional category and between the scores and the education level, suggesting that nurses and professionals with higher education are more inclined towards collaborative practice. The analysis according to the profile of the doctor - Brazilian, Cuban or foreign exchange doctor - found no statistical differences regarding the physicians’ scores, nor in the scores of the components of teams with different profiles. Conclusion: the profile did not suggest a statistically significant greater or lesser inclination of the doctors or teams toward interprofessional work. This study can support new studies which will contribute to the analysis of inter-professional collaboration and the impact of the Mais Médicos program.