Ana Laura Brandão

Avaliação da atenção básica pela perspectiva dos usuários: adaptação do instrumento EUROPEP para grandes centros urbanos brasileiros

Satisfaction with health care is a multidimensional concept that considers aspects such as access, organization and professional-user interaction. The aim of this study was to adapt and apply an instrument in the Family Health Strategy (FHS) to assess user satisfaction with Primary Health Care (PHC) based on the European Task Force on Patient Evaluation of General Practice Care (EUROPEP), which refers to user satisfaction wth general and family medicine services. The instrument consists of five dimensions of satisfaction: relationship and communication, medical care, information and support, continuity and cooperation, and organization of services. The study was divided into phases: review and adjustment of the instrument and application to a representative sample of users of the FHS in Rio de Janeiro. The averages of the proportions of answers for each indicator were calculated to analyze the results. Relationship and communication between professionals and users received the best evaluation and Organization of Services eceived the worst appraisal. Regarding education level, good self-perceived health and more elderly were more satisfied. The instrument proved to be easy to apply, can be routinely used for monitoring of the FHS, and is a tool for the institutionalization of evaluation.

Estudo sobre dimensões da avaliação da Estratégia Saúde da Família pela perspectiva do usuário

A satisfacao dos usuarios e um dos componentes basicos da qualidade de qualquer servico de saude. Tem sido crescente a incorporacao desse aspecto em estudos avaliativos de unidades e equipes de Atencao Basica a Saude. No Brasil, esse processo ainda e incipiente, com poucos instrumentos disponiveis, adequados e validados. O objetivo deste trabalho foi investigar as dimensoes mais valorizadas pelos usuarios. Sua metodologia contou com a realizacao de dois grupos focais em duas unidades basicas de saude (UBS) com contextos distintos para ampliar as possibilidades de resposta. Foram feitas analise de conteudo e categorizacao das falas em dimensoes e subdimensoes da satisfacao. Chegou-se a um total de 17 dimensoes, sendo as mais citadas: 1) acesso e disponibilidade do servico de saude; 2) organizacao dos processos de trabalho; 3) relacao com os profissionais de saude; 4) longitudinalidade do cuidado e estabelecimento de vinculo entre profissionais e usuarios; e 5) coordenacao do cuidado. Conclui-se que conhecer as dimensoes da satisfacao mais valorizadas pelo usuario e essencial para a construcao de instrumentos mais adequados ao contexto da ESF no pais.

Uma contribuição para a avaliação da Atenção Primária à Saúde pela perspectiva do usuário

The evaluation seen through the users perspective is an essential part of evaluations of health services. The final goal is knowing about the users perspective on the care received and offer subsidies to improve the quality of the service offered. The conceptual and methodological polysemy on this topic is wide and requires great efforts for theorizing. The purpose of this study was to contribute to the development of a methodology to evaluate, through the users perspective, the quality of services provided by the Primary Care. This way, a review about the dimensions and indicators and nine instruments of evaluation of user´s perspective. Then, they were subjected to expert judgment using the Delphi technique. Experts agreed on 14 dimensions and 56 measurement elements. The dimensions were judged by degrees of relevance, being considered as most relevant: access/accessibility / availability, professional-user relationship and information. An overview of the evaluation of methodologies, through the users perspective was made, as well as a framework for the construction of one or more instruments of evaluation in which the size of the instrument could be controlled based on the relevance of the items.

Trajetória histórica da organização sanitária da Cidade do Rio de Janeiro: 1916-2015. Cem anos de inovações e conquistas

By rebuilding the history of the facilities that constituted the city of Rio de Janeiros health system between 1916 and 2015, this article also pieces together one hundred years of the countrys public health system. Due to its important role, first as the countrys capital, then as a state, and later as the capital city of the State of Rio de Janeiro, this city had a major influence on the multiple events that led to the creation of Brazils Unified Health System. Periodization was used as a methodological resource to explore how factors that influenced the aims of the technical powers and government were turned into health services stemming from the ideology that underpinned the history of the health system. It is also evident that, despite its constant growth up to the creation of the Unified Health System, the network has always operated in parallel to, and independently from, the hospital and ambulatory network of the social security system and private and philanthropic services. The public health system in Brazil has always been focused at addressing problems related to inequality and social exclusion. The city of Rio de Janeiros primary care network has always played, and continues to play, an important role in disseminating a new organizational culture in Brazils national health system.By rebuilding the history of the facilities that constituted the city of Rio de Janeiro’s health system between 1916 and 2015, this article also pieces together one hundred years of the country’s public health system. Due to its important role, first as the country’s capital, then as a state, and later as the capital city of the State of Rio de Janeiro, this city had a major influence on the multiple events that led to the creation of Brazil’s Unified Health System. Periodization was used as a methodological resource to explore how factors that influenced the aims of the technical powers and government were turned into health services stemming from the ideology that underpinned the history of the health system. It is also evident that, despite its constant growth up to the creation of the Unified Health System, the network has always operated in parallel to, and independently from, the hospital and ambulatory network of the social security system and private and philanthropic services. The public health system in Brazil has always been focused at addressing problems related to inequality and social exclusion. The city of Rio de Janeiro’s primary care network has always played, and continues to play, an important role in disseminating a new organizational culture in Brazil’s national health system.