Alzira de Oliveira Jorge

Modelos assistenciais na saúde suplementar: o caso de uma operadora de autogestão

O trabalho analisa o modelo assistencial de uma operadora de planos de saude de autogestao. Adotou-se a metodologia de estudos de casos, sendo realizadas entrevistas, com diferentes atores: dirigentes da operadora e do call center, prestadores hospitalares e medicos, visando coletar informacoes sobre o modelo assistencial praticado. Procedeu-se a analise das entrevistas e foram adotadas as seguintes dimensoes na avaliacao das informacoes coletadas: objetivo dos atores, politica instituida, saberes tecnologicos instituidos, forma organizativa e assistencia prestada. Dentre os resultados, a operadora investigada apresentou objetivos distintos da logica do mercado, nao visando o lucro nas operacoes. A mesma tem buscado estrategias de mercado para a sobrevivencia, como por exemplo, captacao de novos clientes, adocao de medidas regulatorias, controle na introducao de novas tecnologias. A operadora tem incentivado a adocao de pratica de promocao da saude e vinculacao de clientela, especialmente junto a publicos especificos. Por tratar-se de estudo de caso, os resultados referem-se a operadora analisada, nao contemplando a totalidade das operadoras de planos.

Compreendendo o apoio matricial e o resultado da certificação de qualidade nas áreas de atenção à criança, mulher, diabetes/hipertensão e saúde mental

Este artigo apresenta a distribuicao do apoio matricial (AM) no Brasil, identificando relacoes entre as atividades de AM e a certificacao do PMAQ-AB. Utilizaram-se dois modelos de regressao logistica multipla. As atividades de AM na Atencao Basica sao significativas mas desiguais, com altos graus de AM em lugares desenvolvidos. Existe associacao positiva entre o grau de apoio e o resultado obtido na certificacao. Elevados graus de AM correspondem a 89%, 80%, 89% e 63% de chances de as equipes obterem uma melhor certificacao na atencao a mulher, crianca, hipertensao e diabetes e saude mental, respectivamente. O AM tem ajudado a melhorar a qualidade da Atencao Basica no Brasil.

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams. METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test. RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23). CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

Care coordination in PMAQ-AB: an Item Response Theory-based analysis

OBJETIVO Analisar a qualidade das variaveis do Programa de Melhoria do Acesso e da Qualidade da Atencao Basica para avaliar a coordenacao na atencao basica do cuidado. METODOS Estudo transversal baseado em dados de 17.202 equipes de atencao basica que participaram do Programa de Melhoria do Acesso e da Qualidade da Atencao Basica em 2012. […]

Coordenação do cuidado no PMAQ-AB: uma análise baseada na Teoria de Resposta ao Item

ABSTRACT OBJECTIVE Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care. METHODS A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima’s Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach’s alpha and Spearman’ coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels. RESULTS The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists’ contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach’ alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination. CONCLUSIONS The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care.

Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência

Resumo No estudo descrevem-se as caracteristicas das violencias praticadas contra os adolescentes atendidos em servicos de urgencia e emergencia participantes do inquerito Vigilância de Violencias e Acidentes (VIVA), em 2014, e analisar possiveis associacoes entre as variaveis. Foram analisados dados de 815 adolescentes na amostra e utilizada a analise de correspondencia, que consiste em analise exploratoria, visando identificar variaveis associadas de forma simultânea a violencia contra eles. A agressao praticada contra os adolescentes teve como vitimas mais frequentes o sexo masculino, o meio de agressao utilizado foi a arma de fogo e objeto perfuro cortante. Na faixa etaria de 15 a 19 anos, predominaram as ocorrencias praticadas nas vias publicas, por agressores desconhecidos e predominaram lesoes como fraturas e cortes. Entre as vitimas entre 10 e 14 anos, o local de ocorrencia foi a escola e o agressor foi o amigo, por meio de ameacas. Entre as vitimas do sexo feminino, as ocorrencias foram mais frequentes na residencia. Conclui-se que a violencia envolvendo adolescentes perpassa as mais importantes instituicoes socializadoras: a familia, a escola, apontando a necessidade de mobilizar toda a sociedade na perspectiva do seu enfrentamento.This study explored the characteristics of violence against adolescents who received treatment at urgent and emergency care centers participating in the 2014 Violence and Accident Surveillance System (Sistema de Vigilância de Violências e Acidentes, VIVA) survey and determined the association between demographic variables and the characteristics of violent events. The sample was composed of 815 adolescents who responded to the 2014 VIVA survey. Correspondence analysis was used to determine possible associations between the variables. Victims were predominantly males and the most common form of aggression was the use of firearms and sharp objects. Among males aged between 15 and 19 years, violent acts were predominantly committed in public thoroughfares and by strangers, and the most common injuries consisted of fractures and cuts, while among younger adolescents aged between 10 and 14 years the most common form of aggression was threats made by friends at school. The most common place of occurrence among females was the home. It is concluded that violence against adolescents permeates the chief agencies of socialization - the family and school - demonstrating the need to mobilize the whole society in tackling this problem.