RESUMEN
BACKGROUND: COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. METHODS: Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. RESULTS: Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified at the local health system level. CONCLUSIONS: The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. TRIAL REGISTRATION: CRD42020202875.
Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Administradores de Instituciones de Salud/psicología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Internacionalidad , Actitud del Personal de Salud , Humanos , Liderazgo , SARS-CoV-2RESUMEN
La mayoría de literatura sobre bienestar subjetivo (BS) no está centrada en personas con discapacidad, lo cual se vuelve una necesidad para países en desarrollo al querer aportar datos a organizaciones o profesionales de la psicología para la toma decisiones basadas en evidencia en sus iniciativas o práctica profesional. El objetivo de este artículo es presentar, con un alcance descriptivo, la triangulación de indicadores cuantitativos y cualita-tivos del BS de personas con discapacidad, familiares y trabajadores de organizaciones de y para personas con discapacidad en el departamento de Sololá, Guatemala. El enfoque de la investigación fue mixto. Se recolectó información a través de una encuesta sociodemográfica, la Escala de Satisfacción Con la Vida (SWLS), la Escala de Afecto Positivo y Negativo (SPANAS), además una entrevista semiestructurada. Se evaluó 84 personas, 19 personas con discapacidad, 32 familiares de personas con discapacidad y 33 trabajadores. Las Escalas SWLS (ω de McDonald = .7) y SPANAS (ω de McDonald = .8) tienen un nivel aceptable de confiabilidad. La satisfac-ción con la vida correlacionó negativamente con el afecto negativo, pero la fuerza fue débil (rs = -.28, n = 97, p = .009). El 76% de la muestra se encontró en un nivel muy alto de satisfacción con la vida y 21% refirió un alto estado afectivo negativo. En el análisis cualitativo, se estableció que, la participación en actividades productivas o recreativas, la convivencia entre redes de apoyo y el cumplimiento de metas personales son situaciones que aportan en el bienestar subjetivo.
Most of the literature on subjective well-being (SWB) is not focused on people with disabilities, which be-comes a necessity for developing countries when they want to provide data to organizations or psychology professionals to make evidence-based decisions in their initiatives or professional practice. The aim of this study is to present, with a descriptive scope, the triangulation of quantitative and qualitative indicators of the SWB of people with disabilities, family members and workers of organizations of and for people with disabilities in the department of Sololá, Guatemala. The research was done with a mixed method approach. Data was collected through a sociodemographic survey, the Satisfaction With Life Scale (SWLS), the Positive and Negative Affect Scale (SPANAS), and a semi-structured interview. The sample consisted of 84 people were evaluated, 19 people with disabilities, 32 relatives of people with disabilities and 33 workers. The SWLS (McDonaldís ω = .7) and SPANAS (McDonaldís ω = .8) scales have an acceptable level of reliability. Satisfaction with life was negatively correlated with negative affect, but strength was weak (rs = -.28, n = 97, p = .009). Also, 76% of the sample had a very high level of satisfaction with life and 21% reported a high negative affective state. In the qualitative analysis, it was established that participation in productive or recreational activities, coexistence between support networks and the fulfillment of personal goals are situations that contribute to subjective well-being.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Satisfacción Personal , Calidad de Vida/psicología , Personas con Discapacidad/psicología , Familia/psicología , Personal de Salud/psicología , Afecto , Personal Docente/psicología , Administradores de Instituciones de Salud/psicologíaRESUMEN
BACKGROUND: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. METHODS: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. RESULTS: We found the concept of 'health sector crisis' to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. CONCLUSIONS: The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.
Asunto(s)
Personal Administrativo/psicología , Betacoronavirus , Infecciones por Coronavirus , Recesión Económica , Sector de Atención de Salud/economía , Administradores de Instituciones de Salud/psicología , Personal de Salud/psicología , Pandemias , Neumonía Viral , Sector Privado/economía , Sector Público/economía , Instituciones de Atención Ambulatoria/economía , Actitud del Personal de Salud , Brasil , COVID-19 , Servicios de Salud Comunitaria/economía , Países en Desarrollo , Humanos , Reembolso de Seguro de Salud , Entrevistas como Asunto , Médicos/psicología , Investigación Cualitativa , SARS-CoV-2 , Telemedicina , DesempleoRESUMEN
This paper analyzed the Burnout Syndrome (BS) among the managers of the Family Health Strategy (ESF) in the city of Rio de Janeiro and its associations with factors that influence the presence/absence of BS among these professionals. This is a descriptive study that used data from a questionnaire consisting of two parts: 1) manager profile and factors that could influence the presence of Burnout; 2) Maslach Burnout Inventory. The return rate was 63.5% (143) of the 225 questionnaires sent. The ESF managers are generally nurses (68.6%), young (63.6% under 39 years) female (76.9%), who have acted as managers for less than 5 years (85.2%). A BS presence was identified in 11.2% of the managers. The factors of an organizational nature were those that obtained the highest number of variables with an association. These data point to the need to make changes in the organizational practices of services and changes in work processes. Further studies on these issues can contribute to this.
Este artigo analisou a Síndrome de Burnout (SB) entre os gerentes da Estratégia de Saúde da Família (ESF) no Município do Rio de Janeiro e suas associações entre os fatores que influenciam a presença/ausência da SB nesses profissionais. Com natureza descritiva, ele utilizou um questionário, composto de duas partes: 1) perfil do gerente e fatores que possam influenciar a presença de Burnout; 2) Inventário Maslach Burnout Inventory. A taxa percentual de retorno foi de 63,5% (143) dos 225 enviados. Os gerentes da ESF são em geral, enfermeiros (68,6%), jovens (74,5% até 39 anos), do sexo feminino (76,9%) e que atuam na gerência há menos de 5 anos (85,2%). A presença da SB foi identificada em 11,2% dos gerentes. Os fatores de natureza organizacional foram os que obtiveram maior número de variáveis com associação. Esses dados apontam para necessidade de realização de mudanças nas práticas organizativas de serviços e de mudanças nos processos de trabalho. A realização de outros estudos, que aprofundem estas questões, pode contribuir neste sentido.
Asunto(s)
Agotamiento Profesional/epidemiología , Salud de la Familia , Administradores de Instituciones de Salud/psicología , Adulto , Factores de Edad , Brasil/epidemiología , Agotamiento Profesional/etiología , Ciudades/epidemiología , Estudios Transversales , Femenino , Administradores de Instituciones de Salud/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Masculino , Estado Civil , Persona de Mediana Edad , Cultura Organizacional , Factores Sexuales , Síndrome , Adulto JovenRESUMEN
Resumo Este artigo analisou a Síndrome de Burnout (SB) entre os gerentes da Estratégia de Saúde da Família (ESF) no Município do Rio de Janeiro e suas associações entre os fatores que influenciam a presença/ausência da SB nesses profissionais. Com natureza descritiva, ele utilizou um questionário, composto de duas partes: 1) perfil do gerente e fatores que possam influenciar a presença de Burnout; 2) Inventário Maslach Burnout Inventory. A taxa percentual de retorno foi de 63,5% (143) dos 225 enviados. Os gerentes da ESF são em geral, enfermeiros (68,6%), jovens (74,5% até 39 anos), do sexo feminino (76,9%) e que atuam na gerência há menos de 5 anos (85,2%). A presença da SB foi identificada em 11,2% dos gerentes. Os fatores de natureza organizacional foram os que obtiveram maior número de variáveis com associação. Esses dados apontam para necessidade de realização de mudanças nas práticas organizativas de serviços e de mudanças nos processos de trabalho. A realização de outros estudos, que aprofundem estas questões, pode contribuir neste sentido.
Abstract This paper analyzed the Burnout Syndrome (BS) among the managers of the Family Health Strategy (ESF) in the city of Rio de Janeiro and its associations with factors that influence the presence/absence of BS among these professionals. This is a descriptive study that used data from a questionnaire consisting of two parts: 1) manager profile and factors that could influence the presence of Burnout; 2) Maslach Burnout Inventory. The return rate was 63.5% (143) of the 225 questionnaires sent. The ESF managers are generally nurses (68.6%), young (63.6% under 39 years) female (76.9%), who have acted as managers for less than 5 years (85.2%). A BS presence was identified in 11.2% of the managers. The factors of an organizational nature were those that obtained the highest number of variables with an association. These data point to the need to make changes in the organizational practices of services and changes in work processes. Further studies on these issues can contribute to this.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Agotamiento Profesional/epidemiología , Salud de la Familia , Administradores de Instituciones de Salud/psicología , Síndrome , Brasil/epidemiología , Agotamiento Profesional/etiología , Cultura Organizacional , Factores Sexuales , Estudios Transversales , Encuestas Epidemiológicas/estadística & datos numéricos , Factores de Edad , Ciudades/epidemiología , Estado Civil , Administradores de Instituciones de Salud/estadística & datos numéricos , Persona de Mediana EdadRESUMEN
The aim of this paper is to examine the approach taken to regionalization in Ontario, Canada, and its impact on health system performance as perceived by managers and clinicians. This is a qualitative study, with thematic analysis, based on interviews with 23 managers and clinicians working in primary healthcare and emergency care in two regions of Ontario. Our findings demonstrate that both sets of actors see regional structures as contributing significantly to improving their respective health system although they also identify areas that require improvement. Managers and clinicians agreed on propositions to focus on health determinants, major considerations specific to the local context (population, geography) and support for a three-level system with well-defined functions. However, they also expressed differing propositions about the political power of hospitals.
Asunto(s)
Actitud del Personal de Salud , Política , Programas Médicos Regionales/organización & administración , Administradores de Instituciones de Salud/psicología , Humanos , Entrevistas como Asunto , Ontario , Personal de Hospital/psicología , Mejoramiento de la Calidad/organización & administraciónRESUMEN
OBJECTIVE: This study aimed to analyze the opinions of the coordinators of the Family Health Strategy (FHS) on the mental health care network in the city of Pelotas/RS. METHOD: Descriptive and exploratory study with a qualitative approach, carried out with six FHS coordinators, in 2012. Semi-structured interview was used in data collection, and the results were evaluated using the thematic analysis. RESULTS: The network designed by the coordinators consists of few formal services and is focused on the Psychosocial Care Centers (CAPS). The informal network has a greater number of care units. Exchange of information related to joint responsibilities in the care is scarce, with lack of dialogue. CONCLUSION: The coordinators have scarce knowledge on the formal care network and on care focused on the ESF and CAPS. They also recognize the importance public policies that value and expand the informal care spaces in the territory.
Asunto(s)
Servicios Comunitarios de Salud Mental , Redes Comunitarias , Salud de la Familia , Administradores de Instituciones de Salud/psicología , Adolescente , Servicios de Salud del Adolescente/organización & administración , Adulto , Actitud , Actitud del Personal de Salud , Brasil , Niño , Servicios de Salud del Niño/organización & administración , Ciudades , Comunicación , Servicios Comunitarios de Salud Mental/organización & administración , Redes Comunitarias/organización & administración , Reforma de la Atención de Salud , Humanos , Relaciones Interinstitucionales , Investigación Cualitativa , Responsabilidad Social , Centros de Tratamiento de Abuso de Sustancias/organización & administraciónRESUMEN
OBJECTIVE: To analyse the healthcare monitoring practices of the local government and its interfaces with nursing. METHODS: This is a descriptive, exploratory, and qualitative study conducted in six municipalities in the 10th health region of the state of Rio Grande do Sul. Data were collected through semi-structured interviews with six healthcare managers and one adviser, and subjected to content analysis. RESULTS: The results led to the final categories, "Monitoring practices in municipal healthcare management" and "Difficulties of managers in implementing monitoring". CONCLUSION: The managers pointed out potentialities and weaknesses in the monitoring practices of municipal healthcare. This process is critical for the practice of healthcare workers, especially nurses, since it encourages the use of new tools and innovations that support decision making.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Administradores de Instituciones de Salud/psicología , Enfermería/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , Salud Urbana , Brasil , Sistemas de Apoyo a Decisiones Administrativas , Personal de Salud , Implementación de Plan de Salud , Planificación en Salud , Humanos , Entrevistas como Asunto , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad/organización & administraciónRESUMEN
RESUMO Objetivo Objetivou-se analisar a visão de coordenadores da Estratégia Saúde da Família (ESF) sobre a conformação da rede de saúde mental no município de Pelotas/RS. Método Estudo descritivo e exploratório, com abordagem qualitativa, realizado com seis coordenadores de ESF no ano de 2012. Para a coleta dos dados, foi utilizada a entrevista semiestruturada, e os resultados foram avaliados por análise temática. Resultados A rede construída pelos coordenadores é composta por poucos serviços formais e focada no Centro de Atenção Psicossocial (CAPS), e a rede informal é descrita com maiores pontos de cuidado. As trocas de corresponsabilidade no cuidado em rede ocorrem de forma frágil, sem o diálogo necessário. Conclusão Os coordenadores demonstram pouco conhecimento da rede formal de cuidado e uma atenção focada nos serviços da ESF e no CAPS. Reconhecem a importância de haver políticas públicas que valorizem e ampliem os espaços informais de cuidado no território.
RESUMEN Objetivo Se tuvo como objetivo analizar la visión de coordinadores de la Estrategia Salud de la Familia (ESF) sobre la configuración de la red de salud mental en el Municipio de Pelotas/RS. Método Estudio descriptivo y exploratorio, cualitativo, realizado con seis coordinadores de ESF en 2012. Se utilizó la entrevista semestructurada y los datos fueron analizados con uso del análisis temático. Resultados La red señalada por los coordinadores posee pocos servicios formales, enfocada en el Centro de Atención Psicosocial (CAPS). La red informal es más diversificada, pero los cambios de corresponsabilidad en el cuidado es de modo frágil. Conclusión Los coordinadores tienen poco conocimiento de la red formal de cuidado, con énfasis en la ESF y en el CAPS. Reconocen la importancia de que haya políticas públicas que valoren y amplíen los espacios informales de cuidado en el territorio, algo necesario en el cuidado en salud mental.
ABSTRACT Objective This study aimed to analyze the opinions of the coordinators of the Family Health Strategy (FHS) on the mental health care network in the city of Pelotas/RS. Method Descriptive and exploratory study with a qualitative approach, carried out with six FHS coordinators, in 2012. Semi-structured interview was used in data collection, and the results were evaluated using the thematic analysis. Results The network designed by the coordinators consists of few formal services and is focused on the Psychosocial Care Centers (CAPS). The informal network has a greater number of care units. Exchange of information related to joint responsibilities in the care is scarce, with lack of dialogue. Conclusion The coordinators have scarce knowledge on the formal care network and on care focused on the ESF and CAPS. They also recognize the importance public policies that value and expand the informal care spaces in the territory.
Asunto(s)
Humanos , Niño , Adolescente , Adulto , Salud de la Familia , Administradores de Instituciones de Salud/psicología , Responsabilidad Social , Brasil , Actitud , Actitud del Personal de Salud , Servicios de Salud del Niño/organización & administración , Ciudades , Servicios de Salud del Adolescente/organización & administración , Reforma de la Atención de Salud , Comunicación , Centros de Tratamiento de Abuso de Sustancias/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Redes Comunitarias/organización & administración , Investigación Cualitativa , Relaciones InterinstitucionalesRESUMEN
RESUMO Objetivo Analisar as práticas de monitoramento desenvolvidas pelos municípios e as interfaces com a prática da Enfermagem. Métodos Estudo exploratório descritivo com abordagem qualitativa, realizado nos seis municípios da Região de Saúde 10 do Rio Grande do Sul. Foram realizadas entrevistas semiestruturadas junto a seis gestores de saúde e um assessor, com análise de conteúdo. Resultados As categorias finais que emergiram dos resultados foram “Práticas de monitoramento na gestão municipal em saúde” e “Dificuldades de implantação do monitoramento pelos gestores”. Conclusões Os gestores apontaram potencialidades e fragilidades nas práticas de monitoramento municipal de saúde. A incorporação deste processo é primordial à prática dos profissionais, especialmente da enfermagem, promovendo um incremento no uso de novas ferramentas que propiciam a inovação para subsidiar a tomada de decisão.
RESUMEN Objetivo Analizar las prácticas de monitoreo desarrolladas por los municipios y las interfaces con las prácticas de enfermería. Métodos Estudio exploratorio descriptivo con un enfoque cualitativo realizado en los 6 municipios de la Región de Salud 10 de Rio Grande del Sur. Fueron realizadas entrevistas semiestructuradas junto a seis gestores de salud y un asesor, con análisis de contenido. Resultados Las categorías finales que surgieron a partir de los resultados fueron “Prácticas de monitoreo en la gestión principal de salud” y “Dificultades de aplicación de monitoreo por los gestores”. Conclusiones Los gestores señalaron fortalezas y debilidades en las prácticas de monitoreo de salud municipales. La incorporación de ese proceso es primordial para la práctica de los profesionales, especialmente los de enfermería, promoviendo un incremento en el uso de nuevas herramientas que propician la innovación para subsidiar la toma de decisión.
ABSTRACT Objective To analyse the healthcare monitoring practices of the local government and its interfaces with nursing. Methods This is a descriptive, exploratory, and qualitative study conducted in six municipalities in the 10th health region of the state of Rio Grande do Sul. Data were collected through semi-structured interviews with six healthcare managers and one adviser, and subjected to content analysis. Results The results led to the final categories, “Monitoring practices in municipal healthcare management” and “Difficulties of managers in implementing monitoring”. Conclusion The managers pointed out potentialities and weaknesses in the monitoring practices of municipal healthcare. This process is critical for the practice of healthcare workers, especially nurses, since it encourages the use of new tools and innovations that support decision making.
Asunto(s)
Humanos , Garantía de la Calidad de Atención de Salud/organización & administración , Salud Urbana , Enfermería/organización & administración , Servicios de Salud Comunitaria/organización & administración , Administradores de Instituciones de Salud/psicología , Garantía de la Calidad de Atención de Salud/métodos , Sistemas de Apoyo a Decisiones Administrativas , Brasil , Evaluación de Programas y Proyectos de Salud , Entrevistas como Asunto , Personal de Salud , Investigación Cualitativa , Mejoramiento de la Calidad/organización & administración , Implementación de Plan de Salud , Planificación en SaludRESUMEN
OBJECTIVE: To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish). MATERIALS AND METHODS: We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire. RESULTS: The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment. CONCLUSION: The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.
Asunto(s)
Hospitales Públicos , Guías de Práctica Clínica como Asunto , Salud Pública , Academias e Institutos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/terapia , Adhesión a Directriz , Administradores de Instituciones de Salud/psicología , Personal de Salud/psicología , Implementación de Plan de Salud , Política de Salud , Recursos en Salud , Humanos , Entrevistas como Asunto , México/epidemiología , Investigación Cualitativa , Mejoramiento de la CalidadRESUMEN
Objetivo. Identificar, jerarquizar y relacionar barreras y facilitadores en la implantación de las Guías de Práctica Clínica (GPC). Material y métodos. Estudio cualitativo que compara la implantación de GPC a través de los dominios del marco consolidado para la investigación de implementación en hospitales de las tres principales instituciones públicas de una entidad. Se entrevistaron a funcionarios estatales y personal hospitalario. Resultados. Las principales barreras son ausencia de lineamientos, de capacitación, de recursos e incentivos. Los facilitadores se relacionan con las características de las GPC, percibidas con diseño adecuado, lenguaje sencillo y ventajas para mejorar el ambiente laboral. Conclusión. Las barreras deberán resolverse para alcanzar el objetivo de homologar el proceso en todo el sector; además, la buena percepción de las GPC deberá promover investigaciones para promover la actualización continua de las evidencias y una visión sectorial desde su elaboración para su implantación en los heterogéneos contexto que caracterizan a las instituciones de salud.
Objective. To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish). Materials and methods. We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire. Results. The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment. Conclusion. The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.
Asunto(s)
Humanos , Salud Pública , Guías de Práctica Clínica como Asunto , Hospitales Públicos , Personal de Salud/psicología , Adhesión a Directriz , Investigación Cualitativa , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/epidemiología , Academias e Institutos , Administradores de Instituciones de Salud/psicología , Implementación de Plan de Salud , Política de Salud , México/epidemiologíaRESUMEN
A atenção integral à saúde do trabalhador é competência do Sistema de Saúde, a qual visa não somente ações reparadoras, mas, sobretudo a promoção e a proteção da saúde dos trabalhadores e a redução da morbimortalidade decorrente dos modelos de desenvolvimento e dos processos produtivos, segundo as normas brasileiras. No Sistema Único de Saúde (SUS) a Atenção Primária à Saúde tem o papel de coordenadora do cuidado, a partir dela o usuário é direcionado a serviços especializados quando esgotam as suas possibilidades de cuidado. Para as questões relativas à relação trabalho-saúde existem serviços especializados na rede, como os Centros de Referencia em Saúde do Trabalhador. Contudo, a Saúde do Trabalhador (ST) é uma área complexa, com política recente no SUS, carregada de conflitos, dúvidas e desafios. Diante disso, se faz necessário realizar investigações que contribuam com subsídios técnico-científicos, a partir da compreensão da realidade da organização de redes de saúde, para a identificação e o enfrentamento de problemas no contexto da saúde do trabalhador. O objetivo é analisar a incorporação de ações de Saúde do Trabalhador na rede de Atenção Primária à Saúde em um município de médio porte na região metropolitana da capital do estado de São Paulo. Desenvolveu-se um estudo qualitativo, no qual foram realizadas entrevistas com gestores da Secretaria Municipal de Saúde e utilizou-se um questionário auto aplicativo para a coleta de dados com profissionais das Unidades Básicas de Saúde (UBS).
The full attention to workers health is responsibility of the Health System, which aim not only remedial actions, but, mainly the promotion and protection of workers health and the reduction of morbidity and mortality due to development models and production processes, according to Brazilian standards. In the Unified Health System, the Primary Health Care has the role of coordinating the caution, from this, the user is directed to specialized services when its possibilities of care are exhausted. However, the Workers Health (WH) is a complex area with recent policy in SUS, fraught of conflicts, doubts and challenges. Therefore, it is necessary to conduct investigations that contribute to technical and scientific aids, from the understanding of reality of the health network organization, for identifying and tackling problems inside the context of workers health. The aim is to analyze the incorporation of workers health actions in the network of Primary Health Care in a medium-sized city in the metropolitan region of capital of state of São Paulo. It was developed a qualitative study, whereupon interviews were conducted with managers of the Municipal Health Secretary and it was used a self application questionnaire to collect data with the professionals of Basic Health Units (BHU).
Asunto(s)
Humanos , Masculino , Femenino , Atención Primaria de Salud/organización & administración , Salud Laboral , Evaluación de Procesos y Resultados en Atención de Salud , Sistema Único de Salud , Administradores de Instituciones de Salud/psicología , Agentes Comunitarios de Salud/psicología , Brasil , Médicos/psicología , Investigación Cualitativa , Vigilancia de la Salud del TrabajadorRESUMEN
OBJETIVO: Identificar prioridades de investigación en políticas y sistemas de salud relacionadas con los recursos humanos en países de América Latina y el Caribe. MÉTODOS: Se estructuró una encuesta virtual basada en una búsqueda en PubMed, biblioteca Cochrane y LILACS que aportaran preguntas de investigación previamente priorizadas. Los encuestados, principalmente investigadores y tomadores de decisiones, fueron identificados mediante diversas fuentes. La primera ronda fue dirigida a investigadores, buscando refinar y adicionar preguntas de investigación y priorizar aquellas que los investigadores consideraron como relevantes o muy relevantes. La segunda ronda fue dirigida a los investigadores y a los decisores. Cada pregunta se priorizó cuando el 50% (o más) de los encuestados la calificó como "relevante" o "muy relevante". RESULTADOS: En la primera ronda se enviaron 20 preguntas sobre recursos humanos y 33/66 investigadores respondieron. Se agregaron preguntas sugeridas por los investigadores, quedando finalmente 26 preguntas para la segunda ronda que fueron enviadas a 121 investigadores y decisores. La representación de los respondientes por países fue homogénea en ambas rondas. En la segunda ronda 14/26 (54%) preguntas fueron calificadas como muy relevantes; se priorizaron temas relacionados con la regulación del mercado, integración de la formación y las necesidades de atención, y distribución del recurso humano. La tasa de respuesta en la primera ronda fue de 50% (33/66) mientras que en la segunda fue de 34% (41/121). CONCLUSIONES: Los resultados de este ejercicio proveen un punto de inicio en la movilización de recursos para la investigación en políticas y sistemas de salud. La identificación de prioridades de investigación en sistemas de salud es una estrategia eficaz y eficiente para reorientar los esfuerzos políticos y financieros, de gestión y de organización social para alcanzar la cobertura universal en salud.
OBJECTIVE: Identify priorities for health policy and systems research related to human resources in Latin America and Caribbean countries. METHODS: An online survey was designed based on a search in PubMed, Cochrane Library, and LILACS that contributed previously prioritized research questions. Respondents, mainly researchers and decision-makers, were identified through various sources. The first round, directed at researchers, aimed at refining and adding research questions and prioritizing questions that researchers regarded as relevant or very relevant. The second round was directed at researchers and decision-makers. A question was considered a priority when 50% (or more) of respondents described it as "relevant" or "very relevant." RESULTS: The first round included 20 questions on human resources and 33/66 researchers responded. Questions suggested by the researchers were added, resulting in 26 questions for the second round, which were sent to 121 researchers and decision-makers. Respondent representation by country was uniform in both rounds. In the second round, 14/26 (54%) questions were described as very relevant. Priority issues related to regulation of the market, integration of education and health care needs, and distribution of human resources. The response rate was 50% in the first round (33/66), and 34% in the second round (41/121). CONCLUSIONS: The results of this exercise provide a starting point for mobilization of resources for health policy and systems research. Identification of health systems research priorities is an effective and efficient strategy for reorienting political, financial, management, and social organization efforts for attaining universal health coverage.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Encuestas de Atención de la Salud , Política de Salud , Prioridades en Salud , Recursos en Salud , Investigación sobre Servicios de Salud , Región del Caribe , Administradores de Instituciones de Salud/psicología , Recursos en Salud/economía , Recursos en Salud/provisión & distribución , América Latina , Garantía de la Calidad de Atención de Salud , Encuestas y Cuestionarios , Investigadores/psicologíaRESUMEN
The aim of this study was to analyze what professionals from a team within the Family Health Strategy (FHS) understand mental health to be. This descriptive and exploratory study with a qualitative approach was conducted with 16 professionals from a FHS team in the city of Guaiúba, CE, Brazil. Data were collected during January and February 2011 through focal groups in which the dialogues were recorded and later transcribed for analysis. The following categories emerged from content analysis: "Talking about mental health vs. Thinking about mental disorder" and "Understanding mental health more broadly". Some professionals revealed restricted mental disorder-centered conceptions, while others understood mental health more broadly, recognizing the dynamics of the health-disease continuum and identifying aspects that influence one's mental health.
Asunto(s)
Actitud del Personal de Salud , Salud de la Familia , Salud Mental , Técnicos Medios en Salud/psicología , Brasil , Comprensión , Odontólogos/psicología , Grupos Focales , Programas de Gobierno/organización & administración , Administradores de Instituciones de Salud/psicología , Promoción de la Salud/organización & administración , Humanos , Comunicación Interdisciplinaria , Enfermeras y Enfermeros/psicología , Asistentes de Enfermería/psicología , Médicos/psicología , Investigación CualitativaRESUMEN
A pesquisa objetivou analisar as concepções dos profissionais de uma equipe de Estratégia Saúde da Família (ESF) acerca do que entendem por saúde mental. Estudo descritivo-exploratório, com abordagem qualitativa, realizado com 16 profissionais de uma equipe de ESF do município de Guaiúba, CE. A coleta de dados ocorreu durante os meses de janeiro e fevereiro de 2011, por meio do grupo focal no qual os diálogos foram audiogravados e transcritos. Após, utilizou-se a análise de conteúdo, na qual emergiram as categorias: "Falando de saúde mental x Pensando em transtorno mental" e "Compreendendo a saúde mental de forma ampliada". Constatou-se que alguns profissionais revelam ter concepções restritas, centradas no transtorno mental, e outros entendem saúde mental de forma mais ampliada, reconhecendo a dinamicidade do processo saúde-doença mental, com a identificação de aspectos que influenciam na saúde mental das pessoas.
La investigación tuvo como objetivo analizar los conceptos de los profesionales de un equipo de Estrategia de Salud de la Familia (ESF) sobre lo que ellos entienden por salud mental. Se trató de un estudio de carácter descriptivo-investigador con abordaje cualitativo, realizado con 16 profesionales de un equipo de ESF de la ciudad de Guaiúba, estado de Ceará. La recolección de datos se llevó a cabo durante los meses de enero y febrero de 2011, por medio de grupo focal en el cual los diálogos fueron grabados y transcritos. Se utilizó el análisis de contenido del cual emergieron las categorías: "Hablando de salud mental versus Pensando en trastorno mental" y "Comprendiendo la salud mental de forma amplia". Se constató que algunos profesionales tienen conceptos restrictos, centrados en el trastorno mental, y otros entienden la salud mental de forma más amplia, reconociendo la dinámica del proceso salud- enfermedad mental.
The aim of this study was to analyze what professionals from a team within the Family Health Strategy (FHS) understand mental health to be. This descriptive and exploratory study with a qualitative approach was conducted with 16 professionals from a FHS team in the city of Guaiúba, CE, Brazil. Data were collected during January and February 2011 through focal groups in which the dialogues were recorded and later transcribed for analysis. The following categories emerged from content analysis: "Talking about mental health vs. Thinking about mental disorder" and "Understanding mental health more broadly". Some professionals revealed restricted, mental disorder-centered conceptions, while others understood mental health more broadly, recognizing the dynamics of the health-disease continuum and identifying aspects that influence one's mental health.
Asunto(s)
Humanos , Actitud del Personal de Salud , Salud de la Familia , Salud Mental , Técnicos Medios en Salud/psicología , Brasil , Comprensión , Odontólogos/psicología , Grupos Focales , Programas de Gobierno/organización & administración , Administradores de Instituciones de Salud/psicología , Promoción de la Salud/organización & administración , Comunicación Interdisciplinaria , Asistentes de Enfermería/psicología , Enfermeras y Enfermeros/psicología , Médicos/psicología , Investigación CualitativaRESUMEN
The evaluation of interventions is becoming increasing common and now often seeks to involve managers in the process. Such practical participatory evaluation (PPE) aims to increase the use of evaluation results through the participation of stakeholders. This study focuses on the propensity of health managers for PPE, as measured through the components of learning, working in groups, use of judgment and use of systematic methods. We interviewed 16 health managers to determine the meaning they ascribe to these four components in their practice in a developing country, Haïti. We found that learning was often informal and that all managers attached a negative meaning to the use of judgment. Working in groups was favored by all managers, while the health managers viewed the use of systematic methods differently than do evaluators. The administrative health managers generally ranked lower in propensity for PPE than did their clinical colleagues. Implications for the practice of evaluation are discussed in relation to the work styles exhibited by managers in everyday practice, the proactive repetition of actions, the control exercised by formal procedures, and the collective versus "solitary" image of one's environment of action.
Asunto(s)
Actitud del Personal de Salud , Investigación Participativa Basada en la Comunidad/organización & administración , Administradores de Instituciones de Salud/psicología , Investigación Participativa Basada en la Comunidad/métodos , Países en Desarrollo , Femenino , Procesos de Grupo , Haití , Administradores de Instituciones de Salud/normas , Humanos , Juicio , Aprendizaje , Masculino , Evaluación de Programas y Proyectos de Salud/métodos , Puntaje de PropensiónRESUMEN
OBJECTIVE: To identify and analyze the characteristics of consultations provided by the Unified Health System (SUS) to Brazilians living abroad in the cities of Ponta Porã, Coronel Sapucaia, Paranhos, and Sete Quedas, located on the border of the state of Mato Grosso do Sul and Paraguay. METHODS. Data were collected during a 30-day period using a form filled out for each consultation provided. All the SUS facilities in the four cities were studied (14 primary family health care units, four primary health care units, five hospitals and four laboratories). Semi-structured interviews were also performed with key informants (city health secretaries, health care unit managers, and city health council representatives). RESULTS: The highest demand from Brazilians living abroad was related to primary health care services: 11.9% of the primary family health care consultations in Coronel Sapucaia, 1.1% in Sete Quedas, 3.5% in Paranhos, and 3.5% in Ponta Porã. In primary health care units, the percent of consultations to non-resident Brazilian citizens was 21.1%, 43.8%, 14.7%, and 2.3%, respectively. The interviews supported the perception that a major number of Brazilians living abroad seek health care in public services of Brazilian border cities. CONCLUSIONS: Despite the considerable number of Brazilians living abroad who seek health care provided by SUS in Brazil, this demand is not taken into consideration in the planning of services and may have an impact on the quality of the health care provided.
Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Laboratorios/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Brasil , Emigrantes e Inmigrantes/psicología , Encuestas de Atención de la Salud , Administradores de Instituciones de Salud/psicología , Planificación en Salud , Humanos , Programas Nacionales de Salud/organización & administración , Paraguay , Administración en Salud Pública , Población UrbanaRESUMEN
OBJETIVO: Identificar e analisar as características dos atendimentos realizados no Sistema Único de Saúde (SUS) a brasileiros residentes no exterior em Ponta Porã, Coronel Sapucaia, Paranhos e Sete Quedas, municípios fronteiriços de Mato Grosso do Sul com o Paraguai. MÉTODOS: Os dados foram colhidos durante 30 dias através de um formulário para cada atendimento efetuado. Foram estudados todos os serviços de saúde do SUS disponíveis nos quatro municípios (14 unidades básicas de saúde da família, quatro unidades básicas de saúde, cinco hospitais e quatro laboratórios). Também foram realizadas entrevistas semiestruturadas com informantes-chave (secretários de saúde, gerentes das unidades de saúde e representantes do conselho municipal de saúde). RESULTADOS: Constatou-se que a maior demanda de atendimentos a brasileiros não residentes no País foi nos serviços de atenção básica: 11,9 por cento nas unidades básicas de saúde da família de Coronel Sapucaia, 1,1 por cento nas de Sete Quedas, 3,5 por cento em Paranhos e 3,5 por cento em Ponta Porã. Nas unidades básicas de saúde, o percentual foi de 21,1, 43,8, 14,7 e 2,3 por cento, respectivamente. As entrevistas confirmaram a percepção de que existe um número importante de brasileiros que moram no exterior recebendo atenção pelo SUS nessas cidades. CONCLUSÕES: Uma proporção considerável de brasileiros não residentes no País busca atendimento pelo SUS nos municípios brasileiros. Entretanto, essa demanda não é considerada no planejamento dos serviços e pode causar impacto na qualidade da atenção prestada.
OBJECTIVE: To identify and analyze the characteristics of consultations provided by the Unified Health System (SUS) to Brazilians living abroad in the cities of Ponta Porã, Coronel Sapucaia, Paranhos, and Sete Quedas, located on the border of the state of Mato Grosso do Sul and Paraguay. METHODS. Data were collected during a 30-day period using a form filled out for each consultation provided. All the SUS facilities in the four cities were studied (14 primary family health care units, four primary health care units, five hospitals and four laboratories). Semi-structured interviews were also performed with key informants (city health secretaries, health care unit managers, and city health council representatives). RESULTS: The highest demand from Brazilians living abroad was related to primary health care services: 11.9 percent of the primary family health care consultations in Coronel Sapucaia, 1.1 percent in Sete Quedas, 3.5 percent in Paranhos, and 3.5 percent in Ponta Porã. In primary health care units, the percent of consultations to non-resident Brazilian citizens was 21.1 percent, 43.8 percent, 14.7 percent, and 2.3 percent, respectively. The interviews supported the perception that a major number of Brazilians living abroad seek health care in public services of Brazilian border cities. CONCLUSIONS: Despite the considerable number of Brazilians living abroad who seek health care provided by SUS in Brazil, this demand is not taken into consideration in the planning of services and may have an impact on the quality of the health care provided.
Asunto(s)
Humanos , Emigrantes e Inmigrantes/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud , Hospitales , Laboratorios , Programas Nacionales de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Brasil , Emigrantes e Inmigrantes/psicología , Encuestas de Atención de la Salud , Administradores de Instituciones de Salud/psicología , Planificación en Salud , Programas Nacionales de Salud/organización & administración , Paraguay , Administración en Salud Pública , Población UrbanaRESUMEN
OBJETIVO: Analisar as mudanças decorrentes do processo de descentralização do Sistema Único de Saúde na governança do setor saúde no âmbito do poder local entre 1996 e 2006. MÉTODOS: Um questionário foi aplicado aos gestores municipais de saúde de todo o Brasil em 1996 e novamente em 2006. Foram coletadas informações sobre as características de inovação da gestão em três dimensões: social, gerencial e assistencial. O presente artigo analisa resultados referentes à dimensão social da gestão (relação entre a gestão municipal e os diferentes atores da sociedade) a partir de quatro atributos: elaboração do orçamento (qual o grau de influência de atores variados), estabelecimento de prioridades, prestação de contas e fluxo de informações para a sociedade. RESULTADOS: Aumentou a influência dos secretários e dos conselhos municipais de saúde na elaboração do orçamento, em detrimento da influência dos políticos locais. Na definição de prioridades em saúde, reduziu-se a solicitação dos políticos locais e a demanda espontânea e fortaleceram-se o parecer do corpo técnico e as propostas dos conselhos e das conferências de saúde. Observa-se a institucionalização da prática de prestação de contas em virtude da diversificação do conjunto de atores a que se direciona (especialmente câmara de vereadores e conselho de saúde) e dos mecanismos utilizados, embora continue prevalecendo o uso de balancete periódico (que implica em conhecimento técnico para interpretação dos resultados). Por fim, as informações oferecidas à população ainda se referem acima de tudo às ações e campanhas de saúde e ao funcionamento de serviços, embora tenha crescido a divulgação de informações inovadoras à sociedade. Esse padrão se observa em todas as regiões e portes populacionais, com tendências mais progressivas na região Sul. CONCLUSÕES: A relação entre estado e sociedade modificou-se em direção a um padrão mais democrático de governança local, embora tenham sido mantidas práticas governamentais concentradoras de poder na tomada de decisão. O processo de descentralização ainda encontra obstáculos importantes para a concretização de um modelo de maior participação, controle social, responsabilização e interação entre Estado e sociedade.
OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society.