Leyla Gomes Sancho

Análise de custo-efetividade em relação às terapias renais substitutivas: como pensar estudos em relação a essas intervenções no Brasil?

This study aims to contribute to the discussion on the possibility of applying health economics assessment, specifically the cost-effectiveness technique, to renal replacement therapies for end-stage renal failure. A review was conducted on the interventions and their alternative courses from the perspective of the various methodological proposals in the literature, considering the availability of data and information in Brazil to back this type of research.

Avaliação em Saúde e Avaliação Econômica em Saúde: introdução ao debate sobre seus pontos de interseção

The study aims to infer the existence of a continuum between Health Assessment and Economic Assessment in Health, by highlighting points of intersection of these forms of appraisal. To achieve this, a review of the theoretical foundations, methods and approaches of both forms of assessment was conducted. It was based on the theoretical model of health evaluation as reported by Hartz et al and economic assessment in health approaches reported by Brouwer et al. It was seen that there is a continuum between the theoretical model of evaluative research and the extrawelfarist approach for economic assessment in health, and between the normative theoretical model for health assessment and the welfarist approaches for economic assessment in health. However, in practice the assessment is still conducted using the normative theoretical model and with a welfarist approach.

Avaliação econômica em Saúde na esfera de atenção local à saúde

This work aims to contribute to the discussion about the possibility of applying health economic evaluations at local level government healthcare system, and consequently use the results of this study into decision making. In order to subside this reflexion, it was analyzed the SAMU/192 Program costs evaluation in the city of Belo Horizonte, as well as data concerning effectiveness of the program and a review on electronic databases (SciELO and Medline) about the application of studies in decision making. The analysis showed that even for a simple evaluation on expenditure, there are still unsolved problems of data availability as well as of data effectiveness on information systems definition and association. It showed that decision makers do not use the result of studies for decision making either. So, we conclude that there is no possibility to apply a health economic evaluation research and have the results used in a local level government health care system.

Rotatividade na força de trabalho da rede municipal de saúde de Belo Horizonte, Minas Gerais: um estudo de caso

Given the scarcity of studies on workforce turnover rates in the public health care industry in Brazil, the purpose of this study was to assess this rate in the municipal health care network of Belo Horizonte, Minas Gerais. Based on the acknowledged inclusion of a turnover rate parameter for the hospital area in the literature and on the frequency distribution noticed in this study, a new parameter for the outpatient network and values for the cutoff points were made formal to classify turnover on the qualiquantitative levels. These values are the base for the analysis of the turnover rate concerning these variables: employment contracts, sanitary districts, health care services, professional categories and primary and secondary health care. The overall turnover rate in the municipal network in the studied period (July 2008 to June 2009) was 8.35% which, even considering the difficulties faced to build the database which derived from distinct sources of information has internal validity in statistical terms.

Between flows and therapeutic projects: revisiting the notions of lines of care in health and therapeutic itineraries

This essay discusses the possibilities of conceptual and practical connections between the ideas of line of care and therapeutic itineraries, beginning with the theoretical contributions that lay the foundations for the Line of Integrated Healthcare and the hermeneutic approaches to Care. The implementation of lines of care tuned to individual and collective health needs can be glimpsed in the construction of therapeutic projects, inasmuch as they privilege the particularities of each situation in the agreement of flows of appointments, exams, and other procedures. The therapeutic project - taken as an arrangement, strategy, device, or basic dimension of Care in the work process in health - can be seen as an image that lays out a possibility of the future, which in turn is a projection conditioned by past experiences of health, illness, and life. From the criticism of explanatory models, preponderant in the studies of therapeutic itineraries, we defend the investment in approaches that privilege interpretation and understanding, capable of recuperating, contextualizing, and reconstructing trajectories, beginning with the subjects involved in the care process.

Testagem anti-HIV: indagações sobre a expansão da oferta sob a perspectiva do acesso e da construção da demanda

Reconhecendo a relevância do incremento na oferta de testagem anti-HIV, problematiza-se a concepcao de oferta a luz dos conceitos de acesso e demanda. O mero foco na oferta da testagem mostra-se insuficiente frente a complexidade e dinamicidade do processo, desde a identificacao da sua necessidade ate a realizacao do teste e seus possiveis desdobramentos, incluindo o tratamento. Ademais, o modelo de campanha para incentivo a testagem nao se coaduna com proposicoes que valorizem o protagonismo social dos cidadaos nem atendam as especificidades da disseminacao da epidemia de AIDS. Postula-se a importância de desenvolver estudos que focalizem mais detidamente a demanda por testagem anti-HIV.

O processo de regionalização da saúde sob a ótica da teoria dos custos de transação

This study analyzes the incidence of transaction costs in the regionalization process of health policies in the Brazilian federal system. In this work, regionalized health actions contracted and agreed between federal agencies have assumed a transactional nature. A conceptual theoretical essay of reflective nature was prepared with the purpose of questioning and proposing new approaches to improve the health regionalization process. The main considerations suggest that institutional management tools proposed by the standards and regulations of the Unified Health System have a low potential to reduce transaction costs, especially due to hardships in reconciling common goals among the entities, environment surrounded by uncertainty, asymmetries and incomplete information, bounded rationality and conflict of interest. However, regionalization can reduce the incidence of social and/or operational costs, through improved access to health and the construction of more efficient governance models.

O acesso de homens a diagnóstico e tratamento de doenças sexualmente transmissíveis na perspectiva multidimensional e relacional da vulnerabilidade

Discute-se a nocao de acesso de homens a atencao a saude, especificamente para diagnostico e tratamento de doencas sexualmente transmissiveis - DST. Considerando que o acesso a saude esta imbricado em uma rede de interacoes e contextos sociais que ultrapassa o binomio demanda-oferta, postula-se a pertinencia de desenvolver o tema sob o conceito multidimensional e dinâmico de vulnerabilidade.

Avaliação da efetividade da rede municipal pública de apoio diagnóstico em patologia clínica: o caso de Belo Horizonte (MG)

The organization of public clinical laboratories is experiencing changes without, however, an organizational assessment of its effectiveness. The study aimed to determine a parameter of effectiveness for public clinical laboratories of Belo Horizonte, Minas Gerais State, and set cut-off points for the sections of these laboratories. In order to do so, the total production and number of hours worked during a period of 7 months in the year 2008 were consolidated. Due to the entrance of the workers in the mode of production in the laboratories network, it could be observed a variability regarding the performance of these workers. The effectiveness parameter of the network was established in 29.90 tests per hour. As a consequence of this first analysis, the cut-off points are: 15.50 for the hematology section; 67.29 for chemistry; 6.45 for parasitology; 11.35 for urinalysis; 4.94 for microbiology and 19.03 for immunology. From these results, it was concluded that the working process in laboratories can generate a decrease in effectiveness.

Da apreensão de informações aos itinerários terapêuticos de homens diante de suspeita ou com diagnóstico de infecções sexualmente transmissíveis. A internet em pauta

This paper aims to explore how men, in the presence of suspect or diagnosis, can assimilate information about sexually transmitted diseases (STD) and how this comprehension can integrate with their therapeutic itineraries. This study is part of a larger research about the access to diagnosis and treatment of STD (excluding HIV/Aids). It involved 18 individual in-depth interviews with men attending in health services, and four focus groups with service workers. All participants have access to information on STD by lectures and campaigns, especially about Aids. Information has different meanings when there is lack of signs/symptoms or when there is the presence of STDs: feeling of invulnerability or doubts, fears and shame, respectively. The secrecy that internet can provide became a prime source of information when there is a suspicion/diagnosis of STD, but this information can reproduce the biomedical discourses, and do not give answers able to mitigate moral judgments and STDs stigma. Men choose the doctor as the mainly way of treatment and care, which justifies the persistence to look for health care services. Besides the range of services, it seems seasonable that information follows health communication, according to the populations needs, and digital inclusion can be synonymous with digital citizenship.