Luciane Loures dos Santos

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

Necessidade de aprimoramento do atendimento à saúde no sistema carcerário

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.

Chronic liver disease prevention strategies and liver transplantation

OBJECTIVE To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.OBJETIVO Analisar a estrutura fisica, as condicoes de trabalho dos profissionais da saude e o delineamento de processos estabelecidos em unidades prisionais. METODOS Foram analisados 34 centros de detencao provisoria e 69 unidades prisionais masculinas e seis femininas do Estado de Sao Paulo, Brasil, em 2009. Foi desenvolvido instrumento autoaplicativo para coleta de dados quantitativos sobre as caracteristicas de estrutura, equipamento e pessoal para atendimento a saude nas unidades prisionais. A analise de variância (ANOVA) ou equivalente nao parametrico e os testes de Qui-quadrado ou Fisher foram utilizados para comparacao de variaveis continuas ou categoricas, respectivamente, entre os grupos estudados. RESULTADOS Os principais problemas foram o retardo nos resultados de exames laboratoriais e de imagem. Quanto as equipes, grande maioria apresentou condicoes proximas da proposta pela Comissao InterGestores Bipartite 2013, mas sem que isso se refletisse em melhoria dos indicadores. Com relacao ao processo, observou-se que mais de 60,0% das unidades prisionais estao localizadas em cidades pequenas, sem condicoes estruturais de saude para garantir o atendimento secundario ou terciario para continuidade do processo de tratamento. CONCLUSOES O perfil apresentado das unidades prisionais do Pais podera ser utilizado para planejamento e acompanhamento de acoes futuras para melhoria continua das condicoes estruturais de saude.

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

Chronic liver disease is a considerable burden on society, being one of the three main causes of death in certain regions of Africa and Asia. Liver transplant is the only treatment option for cirrhosis, which is the end stage of many chronic liver diseases. This article reviews the preventable causes of cirrhosis and the preventive strategies which could be implemented in order to avoid the catastrophic consequences of cirrhosis. With small variations around the world, 70 to 80% of the end stage liver diseases are caused by excessive alcohol consumption and by viral hepatitis, both of which are potentially preventable. Excessive alcohol consumption has important public health consequences because of its involvement not only with cirrhosis, but also with motor vehicle accidents, unemployment, domestic violence etc. Among the viral causes, Hepatitis Virus B and C have the greatest impact on public health. Effective vaccine is available for Hepatitis Virus B and must be put in use. While a vaccine for Hepatitis Virus C is awaited, effective preventive strategies should be undertaken to avoid the preventable cases of end stage liver disease.As doencas hepaticas cronicas estao entre as tres principais causas de morte na Africa e Asia.O transplante de figado e o unico tratamento curativo para esta doenca hepatica de carater terminal.O presente artigo tem como objetivo apresentar as causas passiveis de prevencao de cirrose e as estrategias que podem ser utilizadas no sentido de preveni-las. Com pequenas variacoes ao redor do mundo, 70 a 80 % das doencas hepaticas terminais sao causadas por consumo excessivo de alcool e por hepatites virais que sao doencas passiveis de prevencao.O consumo excessivo de alcool e importante problema de saude publica, pois envolve violencia domestica, acidentes de trânsito, alem da possivel evolucao para cirrose e suas consequencias. Entre as causas virais as hepatites pelo virus B e C tem o maior impacto na saude publica. Para a hepatite B ja ha vacinas disponiveis. Enquanto a vacina para a hepatite C e ainda aguardada, estrategias efetivas de prevencao devem ser efetuadas com o objetivo precipuo de se evitar, por consequencia, casos de hepatopatias cronicas desta natureza.

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.

Clinical and regulatory protocols for the management of impaired vision in the public health care network

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.

Interface saúde da família & saúde mental: uma estratégia para o cuidado

PURPOSE To describe the procedures used in developing Clinical and Regulatory Protocols for primary care teams to use in the management of the most common scenarios of impaired vision in Southern Brazil. METHODS A retrospective review of 1.333 referral forms from all primary care practitioners was performed in Ribeirão Preto city, during a 30-day period. The major ophthalmic diagnostic categories were evaluated from those referrals forms. The Clinical and Regulatory Protocols development process was held afterwards and involved scientific cooperation between a university and the health care system, in the form of workshops attended by primary care practitioners and regulatory system team members composed of health care administrators, ophthalmologists, and professors of ophthalmology and social medicine. RESULTS The management of impaired vision was chosen as the theme, since it accounted for 43.6% of the ophthalmology-related referrals from primary care providers of Ribeirão Preto. The Clinical and Regulatory Protocols developed involve distinctive diagnostic and therapeutic interventions that can be performed at the primary care level and in different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of the Clinical and Regulatory Protocols by health care practitioners. CONCLUSIONS These Clinical and Regulatory Protocols could represent a useful tool for health systems with universal access, as well as for health care networks based on primary care and for regulatory system teams. Implementation of these Clinical and Regulatory Protocols can minimize the disparity between the needs of patients with impaired vision and the treatment modalities offered, resulting in a more cooperative health care network.