Janise Braga Barros Ferreira

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.

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

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.

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.

Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model

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.

A research agenda for Primary Health Care in the state of Sao Paulo, Brazil: the ELECT study

PURPOSE To reduce the percentage of cesareans among pregnant women at UNIMED Jaboticabal by redesigning the care delivery model. METHODS Descriptive study conducted at an institution in São Paulo State starting in 2012 to propose the redesign of the care mode based on Continued Improvement Science adapted to the health area. To measure the results of changes we selected nine indicators and their targets. RESULTS The percentage of natural births reached the target of 40% after seven months of implementation of the interventions. The percentage of natural births reached 66% among pregnant women in SUS. The perinatal mortality rate decreased by 25% from 2012 to 2014, and the prematurity rate was 3 per 100 live births in 2014. The percentage of pregnant women from UNIMED with six or more prenatal consultations reached 95%. The hospital costs for childbirth care decreased by 27% compared to 2012 and 2013. This reduction was not sustainable and the per capita cost returned to the same level in 2014. The remuneration of all obstetricians increased by 72% from 2012 to 2014. Unimeds costs attributed to the neonatal intensive care unit (NICU) decreased by 61% from 2012 to 2013. The cost was the same for 2013 as it was for 2014 while the admission rate among newborns at UNIMED decreased by 55%. The percentage of pregnant women participating in courses to prepare for birth did not reach the goal set at 80%. The percentage of pregnant women satisfied and very satisfied with care delivery reached 86%. CONCLUSION This project achieved its objectives by reducing the percentage of C-sections among pregnant women of UNIMED Jaboticabal representing a concrete example of achieving the Triple Aim in health: to improve the experience of care and the health outcomes of populations and individuals and to perform these two tasks at a lower cost.

Collaborative care model in community eye health: benefits to Family Health teams

The consolidation of Primary Health Care (PHC) requires public policies based on scientific evidence. This paper presents the ELECT study, aimed to identify priority research themes for strengthening PHC in the state of Sao Paulo, Brazil. A list of the twenty main obstacles and ten priority research themes in PHC were obtained with participation of specialists and a focus group with users. The results point to problems and research issues related to organizational management, training of professionals and managers, professional development, creation of cooperation mechanisms between health teams and computerization of resources. It is expected to stimulate debate in the context of the PHC on the role of research prioritization, its obstacles and research propositions. It also aims to encourage the adoption of more participatory models of selection of research topics.A consolidacao da Atencao Primaria a Saude (APS) requer politicas publicas embasadas por evidencias cientificas. Este artigo apresenta o estudo ELECT, cujo objetivo foi identificar temas prioritarios de pesquisa para a fortalecimento da APS no estado de Sao Paulo, Brasil. Com a participacao de especialistas e de um grupo focal com usuarios, foi obtida uma lista com os vinte principais obstaculos, bem como dez temas de pesquisa prioritarios, na APS. Os resultados apontam para problemas e temas de pesquisas relacionados a: organizacao da gestao, capacitacao de profissionais e gestores, valorizacao profissional, criacao de mecanismos de colaboracao entre equipes de saude e informatizacao dos recursos. Espera-se, assim, estimular o debate no contexto da APS sobre o papel da priorizacao de pesquisas, seus obstaculos e proposicoes de pesquisa. Almeja-se, tambem, estimular a adocao de modelos mais participativos de selecao de temas de pesquisa.

Uma agenda de pesquisa para a Atenção Primária à Saúde no estado de São Paulo, Brasil: o estudo ELECT

Dear Editor, Limited access to medical assistance impacts on the prevalence of blindness and visual impairment in a population [1,2]. Ineffective ophthalmologic interventions and limited knowledge of community eye health on the part of primary care providers have led to various problems related to both local treatment and referral of ophthalmologic cases. More educational efforts are required to increase health workers’ knowledge about eye health [1,3]. To initiate new approaches to eye health education in Brazil (study/develop enhanced education in eye health), we assessed the effects of a training programme in Ophthalmology (TPO) on the agreement between presumptive diagnoses listed on referral forms from primary health care facilities in southeastern Brazil with those established by a local ophthalmologic public service using ICD-10 categories. We further evaluated the impact of the TPO on the number of referrals from the primary health care facilities. The sample consisted of records of 53 patients in Family Health Units (G1) and 193 patients (G2) in other basic health units, referred to a single reference service in ophthalmology before (n = 108) and six months after (n = 138) the TPO (performed exclusively to G1). After the TPO, the G1 had a lower proportion of referrals (8/138) than G2 (130/138) (p < 0.0001). The agreement between the diagnostic hypotheses of referrals and the diagnoses in the reference service was 47 and 50% for G1 and 25 and 37% for G2, before and after training program respectively. Primary health care (PHC) meets an essential population health need and does not negate the importance of medical specialties since a subset of practitioners with advanced expertise in specific fields is necessary [4]. Improving eye care at the level of the primary care physician would benefit the entire health care system by improving initial management of eye diseases and decreasing the number of specialty referrals [3]. Also, reducing unnecessary referrals will improve care for those patients who need an immediate specialist consultation for nosological conditions in which a long waiting period may result in poor outcomes. Our study was an attempt to utilise the concept of improved health education to enhance the PHC skills of practitioners. We aimed to increase the local case resolution capabilities for simple eye diseases and to expedite the referral of patients. Educational health programs are mostly the combination of learning experiences and activities to promote health, leading to a transformation of competencies and preexistent attitudes of both health care workers and patients [3]. The results presented herein reinforce the importance of integration between PHC and specialised care to obtain better results in health [5]. The close interaction of experts with primary care professionals in a collaborative care model may increase the resoluteness of the PHC, promoting exchanges of the ophthalmological knowledge throughout the network health care. Moreover, this integration may help the resolution, the access and, consequently, the comprehensive care of ocular disorders in non-specialised scenarios [5]. The TPO did result in a lower number of referrals from the Family Health Units participating in this program. The outcomes of this study suggest that training for better management of ophthalmologic conditions in loco both improves the resolution of PHC and reduces unnecessary referring to the ophthalmologists. Our findings have a significant social relevance, considering the high volume of patients and the complexity of the health care network in Brazil.

Una agenda de investigación para la Atención Primaria de Salud en el estado de Sao Paulo, Brasil: el estudio ELECT

The consolidation of Primary Health Care (PHC) requires public policies based on scientific evidence. This paper presents the ELECT study, aimed to identify priority research themes for strengthening PHC in the state of Sao Paulo, Brazil. A list of the twenty main obstacles and ten priority research themes in PHC were obtained with participation of specialists and a focus group with users. The results point to problems and research issues related to organizational management, training of professionals and managers, professional development, creation of cooperation mechanisms between health teams and computerization of resources. It is expected to stimulate debate in the context of the PHC on the role of research prioritization, its obstacles and research propositions. It also aims to encourage the adoption of more participatory models of selection of research topics.A consolidacao da Atencao Primaria a Saude (APS) requer politicas publicas embasadas por evidencias cientificas. Este artigo apresenta o estudo ELECT, cujo objetivo foi identificar temas prioritarios de pesquisa para a fortalecimento da APS no estado de Sao Paulo, Brasil. Com a participacao de especialistas e de um grupo focal com usuarios, foi obtida uma lista com os vinte principais obstaculos, bem como dez temas de pesquisa prioritarios, na APS. Os resultados apontam para problemas e temas de pesquisas relacionados a: organizacao da gestao, capacitacao de profissionais e gestores, valorizacao profissional, criacao de mecanismos de colaboracao entre equipes de saude e informatizacao dos recursos. Espera-se, assim, estimular o debate no contexto da APS sobre o papel da priorizacao de pesquisas, seus obstaculos e proposicoes de pesquisa. Almeja-se, tambem, estimular a adocao de modelos mais participativos de selecao de temas de pesquisa.

Avaliação de resultados da atenção aos agravos cardiovasculares como traçador do princípio de integralidade

The consolidation of Primary Health Care (PHC) requires public policies based on scientific evidence. This paper presents the ELECT study, aimed to identify priority research themes for strengthening PHC in the state of Sao Paulo, Brazil. A list of the twenty main obstacles and ten priority research themes in PHC were obtained with participation of specialists and a focus group with users. The results point to problems and research issues related to organizational management, training of professionals and managers, professional development, creation of cooperation mechanisms between health teams and computerization of resources. It is expected to stimulate debate in the context of the PHC on the role of research prioritization, its obstacles and research propositions. It also aims to encourage the adoption of more participatory models of selection of research topics.A consolidacao da Atencao Primaria a Saude (APS) requer politicas publicas embasadas por evidencias cientificas. Este artigo apresenta o estudo ELECT, cujo objetivo foi identificar temas prioritarios de pesquisa para a fortalecimento da APS no estado de Sao Paulo, Brasil. Com a participacao de especialistas e de um grupo focal com usuarios, foi obtida uma lista com os vinte principais obstaculos, bem como dez temas de pesquisa prioritarios, na APS. Os resultados apontam para problemas e temas de pesquisas relacionados a: organizacao da gestao, capacitacao de profissionais e gestores, valorizacao profissional, criacao de mecanismos de colaboracao entre equipes de saude e informatizacao dos recursos. Espera-se, assim, estimular o debate no contexto da APS sobre o papel da priorizacao de pesquisas, seus obstaculos e proposicoes de pesquisa. Almeja-se, tambem, estimular a adocao de modelos mais participativos de selecao de temas de pesquisa.