Maria Altenfelder Santos

Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007

OBJETIVO: Avaliar os servicos do Sistema Unico de Saude brasileiro de assistencia ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliacao de 2001. METODOS: Os 636 servicos cadastrados no Ministerio da Saude em 2007 foram convidados a responder a um questionario previamente validado (Questionario Qualiaids) com 107 questoes de multipla escolha sobre a organizacao da assistencia prestada. Analisaram-se as frequencias das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variacao percentual (VP). RESULTADOS: Responderam o questionario 504 (79,2%) servicos. Cerca de 100,0% dos respondentes relataram ter pelo menos um medico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Varios aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de numero de faltas a consulta medica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no inicio da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participacao organizada do usuario (de 5,9 para 16,7%, VP: 183,1%). Houve manutencao de dificuldades: pequena variacao na disponibilidade de exames especializados em ate 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo medio despendido nas consultas medicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSOES: A avaliacao de 2007 mostrou que os servicos contam com os recursos essenciais para a assistencia ambulatorial. Houve melhoras em muitos aspectos em relacao a 2001, mas persistem desafios. Pouco tempo dedicado a consulta medica pode estar vinculado ao numero insuficiente de medicos e/ou a baixa capacidade de escuta e dialogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Unico de Saude.OBJECTIVE To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and users organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.

Assessment of outpatient services for AIDS patients, Brazil: comparative study 2001/2007

OBJETIVO: Avaliar os servicos do Sistema Unico de Saude brasileiro de assistencia ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliacao de 2001. METODOS: Os 636 servicos cadastrados no Ministerio da Saude em 2007 foram convidados a responder a um questionario previamente validado (Questionario Qualiaids) com 107 questoes de multipla escolha sobre a organizacao da assistencia prestada. Analisaram-se as frequencias das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variacao percentual (VP). RESULTADOS: Responderam o questionario 504 (79,2%) servicos. Cerca de 100,0% dos respondentes relataram ter pelo menos um medico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Varios aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de numero de faltas a consulta medica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no inicio da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participacao organizada do usuario (de 5,9 para 16,7%, VP: 183,1%). Houve manutencao de dificuldades: pequena variacao na disponibilidade de exames especializados em ate 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo medio despendido nas consultas medicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSOES: A avaliacao de 2007 mostrou que os servicos contam com os recursos essenciais para a assistencia ambulatorial. Houve melhoras em muitos aspectos em relacao a 2001, mas persistem desafios. Pouco tempo dedicado a consulta medica pode estar vinculado ao numero insuficiente de medicos e/ou a baixa capacidade de escuta e dialogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Unico de Saude.OBJECTIVE To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and users organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.

Intervenção em adesão baseada na abordagem construcionista do cuidado: perspectiva dos profissionais de saúde

An individual psychosocial intervention geared to improve adherence to antiretroviral therapy. It was designed based on the concept of Care, on the constructionist perspective and on the vulnerability and human rights framework. This intervention was tested as part of a research project and was conducted by three previously trained health professionals in an STD/AIDS reference health facility in Sao Paulo. These three professionals were interviewed, both individually and as a group in order to assess the intervention’s feasibility. We described and discussed the contents addressed by them regarding the following themes: training and supervision activities; intervention conducting; impact on professional practice and user care; and future intervention implementation. The interviewees reported that this intervention caused them to refl ect on their previous practices regarding HIV healthcare. This promoted a better appreciation of the singularity of each user and also more substantial conversations about aspects of the users’ daily life concerning their treatment. They considered that the dialogical and horizontal relationship established during the intervention increased users’ participation regarding choices concerning paths to self-care. They reported that one of the main diffi culties encountered was related to bonding with some users and highlighted the importance of the fact that the intervention strategies made sense to the people under treatment according to their life circumstances and context. They said they believed in the feasibility of future intervention implementation in other health facilities and also pointed the need to involve managers and different professionals during this process.

Desenvolvimento e validação do Questionário WebAd-Q para monitorar adesão à terapia do HIV

ABSTRACT OBJECTIVE To present the development and validation of the WebAd-Q Questionnaire, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/AIDS centers in Brazil. METHODS The WebAd-Q is an electronic questionnaire that has three questions about the use of antiretrovirals in the last week. It was constructed from interviews and focus groups with 38 patients. Its validity was tested in a study with a sample of 90 adult patients on antiretroviral therapy for at least three months. We used electronic monitoring bottles, pill counting, and self-report interview to compare adherence. The WebAd-Q was answered on the sixtieth day, twice, with at least one hour of interval. The viral load of the patients was obtained from the service records. We have analyzed the agreement between the answers to the WebAd-Q, the associations, and the correlations with viral load and performance compared to other measures of adherence. RESULTS Among the invited patients, 74 (82.2%) answered the WebAd-Q. No difficulties were reported to answer the questionnaire. The average answer time was 5 min 47 sec. The set of three questions of the WebAd-Q obtained agreement of 89.8%, with Kappa of 0.77 (95%CI 0.61–0.94). The non-adherence answers of the WebAd-Q were associated with detectable viral load. We obtained moderate viral load correlations with the non-adherence scale according to the WebAd-Q. For the three questions of the WebAd-Q, patients with non-adherence answers were also reported as less adherent according to the other measures of adherence. CONCLUSIONS The WebAd-Q answered all the issues considered relevant in the validation of questionnaires, was well understood by patients, was associated with viral load, and obtained good agreement and good performance compared to the other measures. The feasibility analysis of its implementation still depends on a national study on its applicability.

Adherence Intervention Based on Constructionist Care Approach: The Health Professionals' Perspective

An individual psychosocial intervention geared to improve adherence to antiretroviral therapy. It was designed based on the concept of Care, on the constructionist perspective and on the vulnerability and human rights framework. This intervention was tested as part of a research project and was conducted by three previously trained health professionals in an STD/AIDS reference health facility in Sao Paulo. These three professionals were interviewed, both individually and as a group in order to assess the intervention’s feasibility. We described and discussed the contents addressed by them regarding the following themes: training and supervision activities; intervention conducting; impact on professional practice and user care; and future intervention implementation. The interviewees reported that this intervention caused them to refl ect on their previous practices regarding HIV healthcare. This promoted a better appreciation of the singularity of each user and also more substantial conversations about aspects of the users’ daily life concerning their treatment. They considered that the dialogical and horizontal relationship established during the intervention increased users’ participation regarding choices concerning paths to self-care. They reported that one of the main diffi culties encountered was related to bonding with some users and highlighted the importance of the fact that the intervention strategies made sense to the people under treatment according to their life circumstances and context. They said they believed in

Evaluación de servicios de asistencia ambulatoria en sida, Brasil: estudio comparativo 2001/2007

OBJETIVO: Avaliar os servicos do Sistema Unico de Saude brasileiro de assistencia ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliacao de 2001. METODOS: Os 636 servicos cadastrados no Ministerio da Saude em 2007 foram convidados a responder a um questionario previamente validado (Questionario Qualiaids) com 107 questoes de multipla escolha sobre a organizacao da assistencia prestada. Analisaram-se as frequencias das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variacao percentual (VP). RESULTADOS: Responderam o questionario 504 (79,2%) servicos. Cerca de 100,0% dos respondentes relataram ter pelo menos um medico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Varios aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de numero de faltas a consulta medica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no inicio da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participacao organizada do usuario (de 5,9 para 16,7%, VP: 183,1%). Houve manutencao de dificuldades: pequena variacao na disponibilidade de exames especializados em ate 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo medio despendido nas consultas medicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSOES: A avaliacao de 2007 mostrou que os servicos contam com os recursos essenciais para a assistencia ambulatorial. Houve melhoras em muitos aspectos em relacao a 2001, mas persistem desafios. Pouco tempo dedicado a consulta medica pode estar vinculado ao numero insuficiente de medicos e/ou a baixa capacidade de escuta e dialogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Unico de Saude.OBJECTIVE To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and users organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.