Monique Azevedo Esperidião

Avaliação de satisfação de usuários: considerações teórico-conceituais

The present article develops a critical analysis of the scientific output on user satisfaction in health services, focusing specifically on theoretical and conceptual aspects. The article discusses the understanding of satisfaction as a concept and its theoretical references and determinants and application of the concept to the field of services. A total of 56 articles were analyzed, published mainly in periodicals indexed in MEDLINE and Web of Science from 1970 to 2005. The concepts identified in this literature review come mainly from marketing and social psychology, emphasizing the theory of attitude, fulfillment of expectations or needs, and equity. There is a loss of analytical usefulness in the concept of satisfaction insofar as it is extended to various dimensions of health services.

Avaliação de satisfação de usuários

Este estudo e uma revisao de literatura com sintese qualitativa dos estudos voltados para a analise metodologica das avaliacoes de satisfacao de usuarios com servicos de saude. Foram analisados 54 artigos publicados principalmente em revistas indexadas pelo Medline e Web of Science no periodo de 1970 a 2005. Sao discutidos os metodos de abordagem das pesquisas, as tecnicas e instrumentos e a operacionalizacao do conceito de satisfacao. Sao apresentados, ainda, os diferentes tipos de vieses das pesquisas e alternativas para sua superacao. Observa-se que os metodos e tecnicas variam em um largo escopo, havendo pouco consenso entre os pesquisadores. O metodo mais utilizado e de natureza quantitativa, com predominio de questionarios e escalas. Os metodos qualitativos sao valorizados como aqueles capazes de trabalhar os dados subjetivos da satisfacao. Critica-se bastante a falta de padronizacao dos instrumentos, o que compromete a comparacao dos achados. Reflete-se sobre a pertinencia do desenvolvimento de um referencial proprio de pesquisa de satisfacao para o Brasil.

Accessibility to primary healthcare in the capital city of a northeastern state of Brazil: an evaluation of the results of a programme

Background Organisational barriers to primary healthcare are still relevant in developing countries. Although descriptive reports of some experiences focusing on improving accessibility have been published, few studies have evaluated specific interventions aimed at overcoming the organisational obstacles. Objective To evaluate the results of a project designed to improve accessibility to healthcare services in Salvador, Bahia, Brazil. Methodology An evaluative, cross-sectional, ex post facto study that included a control group was carried out in a random sample of 710 users of 25 healthcare units of the primary municipal healthcare network. The association between the project implementation degree and outcome variables was measured by prevalence ratios (PR) and statistical inference was based on Taylor series 95% CIs. Results Better access to primary healthcare was found in units in which the intervention had been implemented than in those in which it had not been implemented, particularly with respect to reducing avoidable queues, the waiting time for scheduling a consultation (PR=0.23; 95% CI 0.15 to 0.34); the time of arrival in the queue (PR=0.16; 95% CI 0.09 to 0.31) and the introduction of a system for scheduling appointments by telephone (PR=0.76; 95% CI 0.70 to 0.83). Conclusion Owing to the simplicity of the programme and the impact it achieved, it may be reproduced in other underdeveloped countries to improve access to healthcare services. In addition, some of the instruments may be used in routine programme evaluation.

Sentidos e práticas da humanização na Estratégia de Saúde da Família: a visão de usuários em seis municípios do Nordeste

O presente artigo desenvolve uma analise do processo de humanizacao em saude no âmbito da Estrategia de Saude da Familia (ESF). Sao focalizados, particularmente, os sentidos atribuidos pelos usuarios a nocao de humanizacao em saude e suas avaliacoes sobre condicoes objetivas (infraestrutura e organizacao) e relacionais (relacao / comunicacao profissional-usuario) presentes na ESF. Neste sentido, a analise privilegia os processos de acolhimento e construcao do vinculo. Para alcance dos objetivos, foi realizado um estudo de casos multiplos (seis) de tipo quali-quanti, com primazia do enfoque qualitativo, contemplando municipios de pequeno e grande porte dos estados da Bahia, Sergipe e Ceara. Apreende-se do discurso dos usuarios o reconhecimento do empenho das equipes em fomentar relacoes mais solidarias, dialogicas e horizontais no cuidado, o que reforca a valorizacao da dimensao subjetiva das praticas de saude, as quais ganham espaco na estrategia de saude da familia e repercutem nas iniciativas da humanizacao da atencao.

Avaliação da implantação de programa voltado para melhoria da acessibilidade e humanização do acolhimento aos usuários na rede básica: Salvador, 2005-2008

OBJECTIVES: to evaluate and monitor the implementation of a project aiming to broaden access and humanization of user embracement for users of the primary health care in Salvador, Brazil, between November 2005 and May 2008. METHODS: the implementation of the project was evaluated at three points in time, both externally, by a team of consultants, and internally as part of a self-evaluation by Unit Managers. An intervention logic model was designed for this purpose and a set of evaluation criteria derived from this. RESULTS: at the end of the first year, the implementation of program components varied from 45% to 82% of units. Six months later, implementation was more extensive. In the third and last year, in 2008, an evaluation carried out in a sample of 24 units revealed continued implementation of the project, albeit with a considerable setbacks. CONCLUSIONS: the high degree of implementation observed, with a reduction in the size of avoidable waiting queues and improvement in access to health units in the first year, may be related to the implementation strategy adopted and to some of the specific features of municipal administration. The authors also discuss the possible reasons for the obstacles encountered within the municipal administration of the Brazilian National Health System.

[Work and education in health in Brazil: trends in scientific output between 1990-2010].

The scope of this article is to analyze the characteristics of scientific literature on work and education in health in Brazil from 1990 to 2010. A synthetic study was conducted from abstracts published in Brazilian journal articles selected from the SCIELO and LILACS databases. Five hundred and thirty-two articles were selected, categorized according to their origin, year of publication, theme, and type of study. The publication of these scientific articles increased during the period analyzed, particularly from 2007 onwards. The main areas researched were education and training of health professionals, and the majority of works in these areas examine curriculum reform, methods of learning and teaching, and teaching in-service experiences. Besides these issues, others questions were addressed such as the labor market configuration and trends in health, and characteristics of the work process in several areas, like primary healthcare units. It was also observed that there are only a small number of studies related to policy, planning and management of work in public and private health institutions, as well as a scarcity of studies presenting reflections on theoretical and conceptual aspects of this theme.

A intersetorialidade no Programa Saúde na Escola: avaliação do processo político-gerencial e das práticas de trabalho

This study analyzed inter-sectoral activities between the health and education sectors in implementing the Health in Schools program in a city within a metropolitan region in northeast Brazil. Analysis of the political-management process looked at the following dimensions: professional practices and subject understanding of intersectorality. The results show that subjects define intersectorality as partnership and joint efforts. Regarding decision making and resource mobilization, during program implementation we noticed that healthcare leads, and education tends to play a more peripheral role. Health activities in the schools use a biomedical approach and primarily consist of lectures. We believe that the program strengthened the relationship between these two sectors. However, intersectoral coordination in the political-management process and practices show weaknesses and limitations.This study analyzed inter-sectoral activities between the health and education sectors in implementing the Health in Schools program in a city within a metropolitan region in northeast Brazil. Analysis of the political-management process looked at the following dimensions: professional practices and subject understanding of intersectorality. The results show that subjects define intersectorality as partnership and joint efforts. Regarding decision making and resource mobilization, during program implementation we noticed that healthcare leads, and education tends to play a more peripheral role. Health activities in the schools use a biomedical approach and primarily consist of lectures. We believe that the program strengthened the relationship between these two sectors. However, intersectoral coordination in the political-management process and practices show weaknesses and limitations.

Trabalho e educação em saúde no Brasil: tendências da produção científica entre 1990-2010

O objetivo deste artigo e analisar as caracteristicas da producao cientifica sobre educacao e trabalho em saude no Brasil no periodo de 1990 a 2010. Realizou-se um estudo de sintese a partir de resumos de artigos publicados em revistas brasileiras selecionados nas bases bibliograficas Scielo e Lilacs. Foram selecionados 532 trabalhos, categorizados a partir do ano de publicacao, tematica abordada e tipo de estudo. Observa-se o crescimento da producao de artigos no periodo analisado, mais especialmente a partir do ano de 2007. A principal tematica investigada e a formacao e a capacitacao de profissionais de saude, sendo que a maioria dos trabalhos nesta area analisa reformas curriculares, metodologias de ensino-aprendizagem e experiencia de articulacao ensino-servico. Alem deste tema, outras questoes sao estudadas tais como a configuracao e as tendencias do mercado de trabalho em saude e as caracteristicas do processo de trabalho em diversos espacos, a exemplo de unidades de atencao primaria a saude. Chama a atencao o numero reduzido de estudos relacionados a formulacao de politicas, planejamento e gestao do trabalho no âmbito das instituicoes publicas e privadas, bem como a escassez de trabalhos que apresentem reflexoes de carater teorico-conceitual acerca do tema.

Gestión participativa y co-responsabilidad en salud: límites y posibilidades en el ámbito de la Estrategia de Salud de la Familia

De acordo com a Politica Nacional de Humanizacao do SUS - HumanizaSUS - a gestao participativa implica o envolvimento dos trabalhadores da saude, gestores e usuarios em um pacto de corresponsabilidade baseado em contratos e compromissos com o sistema de saude. Este artigo discute limites e possibilidades de incorporacao da gestao participativa e incorporacao do principio da corresponsabilidade no âmbito da Estrategia Saude da Familia (ESF). Foi desenvolvido um estudo de casos multiplos, integrando estrategias qualitativas (dominante) e quantitativas, no qual se privilegiou a percepcao de profissionais e usuarios. Foram contemplados seis municipios da Bahia, Sergipe e Ceara. Evidenciou-se que o processo de participacao social e a incorporacao do principio da corresponsabilidade no escopo da gestao e atencao na ESF e bastante incipiente. Constatou-se que a participacao cidada nao e incentivada pelos profissionais e que muitos usuarios assumem uma atitude de gratidao diante dos servicos recebidos.

Atendimentos de crianças e adolescentes com transtornos por uso de substâncias psicoativas nos Centros de Atenção Psicossocial no Brasil, 2008-2012

OBJECTIVE to describe the profile of care for children and adolescents withpsychoactive substance use disorders performed by the Brazilian Psychosocial Care Centers (Centros de Atenção Psicossocial - CAPS) from 2008 to 2012. METHODS a descriptive study with data from the SUS Outpatient Information System (Sistema de Informações Ambulatoriais do Sistema Único de Saúde - SIA/SUS) and the system of National Registration of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde - CNES). RESULTS a total of 151.330 attendances were observed, 81.2% were males and 99.2% were in the age range of 10 to 19 years; the main causes were polydrug use (56.7%), cocaine (15.6%), marijuana (15.6%) and alcohol (9.0%); the CAPS for Alcohol and other Drugs (CAPS AD) accounted for 81.8% of the records; from 2008 to 2012, the attendance rate from 39.6 to 76.7/100 thousand inhabitants. CONCLUSION there was an increase in the attendance rates, observing the predominance of males, age range of 10 to 19 years and disorders due to polydrug use.