RESUMO
The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA ©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centres in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centres from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were: attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA© demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards.
Las secuencias integradas de cuidado para últimos días de vida proponen estándares de calidad para optimizar la atención de pacientes y familias. Se implementó el Programa Asistencial Multidisciplinario Pallium (PAMPA©) basado en estándares del International Collaborative for Best Care for the Dying Person en cuatro fases: inducción, implementación, diseminación y sustentabilidad, en cinco centros de salud en Argentina, entre 2008 y 2018. Se incluyeron 1237 pacientes adultos en situación de últimos días de vida, en seguimiento por equipos de cuidados paliativos entrenados en el PAMPA©. Se efectuó una auditoría antes y después de la ejecución del programa, aún en curso. El rango de medianas de permanencia en los cinco centros desde el inicio de la secuencia hasta el fallecimiento fue de 16 a 178 horas. Se compararon objetivos de cuidado: control de síntomas, comunicación, necesidades multidimensionales, hidratación y nutrición, documentación de intervenciones y cuidados post mortem. El análisis conjunto mostró una mejoría del número de registros (p = 0.001). La comunicación del plan de cuidados con el paciente no mostró diferencias (p = 0.173). Se realizó capacitación y supervisión permanente a los equipos profesionales de quienes se registraron percepciones de la implementación. Los principales emergentes de este análisis cualitativo fueron: actitudes ante el programa, aportes fundamentales, fortalezas, debilidades y definición subjetiva del programa, reconocimiento de las singularidades culturales institucionales y su influencia en el cuidado. El PAMPA© demostró la factibilidad de un modelo de atención para pacientes y familias en final de vida, basado en estándares de calidad internacionales.
Assuntos
Cuidados Paliativos/normas , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de Saúde/normas , Assistência Terminal/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Procedimentos Clínicos/normas , Feminino , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Reprodutibilidade dos Testes , Assistência Terminal/métodos , Fatores de TempoRESUMO
Las secuencias integradas de cuidado para ó;ºltimos días de vida proponen estándares de calidad para optimizar la atenció;n de pacientes y familias. Se implementó; el Programa Asistencial Multidisciplinario Pallium (PAMPA©) basado en estándares del International Collaborative for Best Care for the Dying Person en cuatro fases: inducció;n, implementació;n, diseminació;n y sustentabilidad, en cinco centros de salud en Argentina, entre 2008 y 2018. Se incluyeron 1237 pacientes adultos en situació;n de ó;ºltimos días de vida, en seguimiento por equipos de cuidados paliativos entrenados en el PAMPA©. Se efectuó; una auditoría antes y despuó;©s de la ejecució;n del programa, aó;ºn en curso. El rango de medianas de permanencia en los cinco centros desde el inicio de la secuencia hasta el fallecimiento fue de 16 a 178 horas. Se compararon objetivos de cuidado: control de síntomas, comunicació;n, necesidades multidimensionales, hidratació;n y nutrició;n, documentació;n de intervenciones y cuidados post mortem. El análisis conjunto mostró; una mejoría del nó;ºmero de registros (p = 0.001). La comunicació;n del plan de cuidados con el paciente no mostró; diferencias (p = 0.173). Se realizó; capacitació;n y supervisió;n permanente a los equipos profesionales de quienes se registraron percepciones de la implementació;n. Los principales emergentes de este análisis cualitativo fueron: actitudes ante el programa, aportes fundamentales, fortalezas, debilidades y definició;n subjetiva del programa, reconocimiento de las singularidades culturales institucionales y su influencia en el cuidado. El PAMPA© demostró; la factibilidad de un modelo de atenció;n para pacientes y familias en final de vida, basado en estándares de calidad internacionales.
The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centres in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centres from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were: attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA© demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Assistência Terminal/normas , Avaliação de Programas e Projetos de Saúde , Cuidados Paliativos/métodos , Argentina , Assistência Terminal/métodos , Fatores de Tempo , Reprodutibilidade dos Testes , Procedimentos Clínicos/normas , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/normasRESUMO
BACKGROUND: Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. METHODS AND FINDINGS: Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs' characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. CONCLUSIONS: The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.
Assuntos
Antituberculosos/uso terapêutico , Política de Saúde , Política Pública , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/economia , Argentina/epidemiologia , Estudos de Coortes , Feminino , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Política Pública/economia , Remuneração , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/economia , Tuberculose/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Nucleic acid testing (NAT) for virus detection during blood screening has helped to prevent transfusion-transmitted infections worldwide. In northern Brazil, NAT was implemented in 2012 for HIV and HCV and more recently, in January 2015, the screening for HBV was included and currently used concomitant with serological tests (HBsAg and anti-HBc). This study aims to evaluate the prevalence and the incidence of HBV infection among voluntary blood donors at ten regional blood centers of HEMOPA Foundation in Pará state and to compare the residual risk of transfusion-transmitted HBV infection before and after the Brazilian HBV-NAT implementation. METHODS: The prevalence (restricted to first time donors- FT) and seroconversion rate (restricted to repeat donors- RP) of HBV were calculated based on rates of confirmed positive samples. Residual risk was based on the incidence and window period (WP) model described by Schreiber and coauthors. Logistic and Poisson regression were used in the statistical analysis by SPSS v20.0. A p value <0.05 was considered statistically significant. RESULTS: HBV prevalence in the periods before and after the implementation of HBV-NAT were 247 and 251 per 100,000 donations, respectively. Seroconversion rates were 114 and 122 per 100,000 donations in the two periods, respectively. The residual risk (RR) for HBV decreased significantly in the posterior period to the HBV-NAT implementation, when compared to RR before implementation, with a reduction of 1:144,92 to 1:294,11 donations (p <0,001). CONCLUSIONS: The RR to HBV decreased after the implementation of HBV-NAT, increasing significantly the transfusional security in the North region of Brazil at HEMOPA Foundation.
Assuntos
DNA Viral/análise , Implementação de Plano de Saúde , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Programas de Rastreamento , Técnicas de Amplificação de Ácido Nucleico , Reação Transfusional/epidemiologia , Adolescente , Adulto , Idoso , Doadores de Sangue/estatística & dados numéricos , Segurança do Sangue/métodos , Segurança do Sangue/normas , Brasil/epidemiologia , DNA Viral/isolamento & purificação , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Implementação de Plano de Saúde/normas , Hepatite B/diagnóstico , Hepatite B/prevenção & controle , Hepatite B/transmissão , Vírus da Hepatite B/isolamento & purificação , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico/normas , Prevalência , Medição de Risco , Testes Sorológicos/métodos , Testes Sorológicos/normas , Reação Transfusional/diagnóstico , Reação Transfusional/prevenção & controle , Reação Transfusional/virologia , Adulto JovemRESUMO
Two articles recently published in Reproductive BioMedicine Online described how fertility centres in the USA and Brazil implemented air quality control to newly designed facilities. In both case scenarios, a highly efficient air filtration was achieved by installing a centred system supplying filtered air to the IVF laboratory and other critical areas, combining air particulate and volatile organic compound (VOC) filtration. Evaluating retrospective data of over 3000 cycles from both centres, live birth rates were increased by improvements in air quality and laboratory environment. This commentary discusses some of the key aspects of air contamination in the IVF settings, and highlights the fact that a risk management analysis taking into consideration all variables that play a role in air contamination is paramount for the reduction of the risk of poor IVF outcomes due to improper air quality conditions.
Assuntos
Ambiente Controlado , Implementação de Plano de Saúde , Laboratórios/normas , Técnicas de Reprodução Assistida/normas , Poluição do Ar em Ambientes Fechados/prevenção & controle , Brasil , Feminino , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Humanos , Masculino , Gravidez , Melhoria de Qualidade/organização & administração , Resultado do TratamentoRESUMO
The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.
A ocorrência de hanseníase tem diminuído no mundo apesar de que a perspectiva de sua eliminação tem sido questionada. Uma proposta para o controle da endemia é a quimioprofilaxia pós-exposição entre contatos (post-exposure chemoprophylaxis, PEP), embora ainda existam dúvidas quanto aos seus aspectos operacionais e generalização de resultados. Nesse texto nós discutimos as evidências disponíveis na literatura, explicamos alguns conceitos epidemiológicos comumente encontrados em pesquisa sobre PEP e a implantação da PEP no contexto brasileiro. Nós argumentamos que: (1) a estimativa em diferentes estudos do numero de contatos necessário para receber PEP para prevenir um novo caso de hanseníase (number needed to treat, NNT) não é facilmente generalizável; (2) áreas cobertas pelo programa de saúde da família são as áreas prioritárias onde PEP poderia ser implantado; (3) não existe necessidade de segunda dose da quimioprofilaxia; (4) o risco de resistência à droga usada na PEP parece ser muito pequeno; (5) questionamos a necessidade de teste sorológico para identificar indivíduos entre os contatos que tenham maior risco de doença. Nós opinamos que, se houver uma decisão para se iniciar PEP no Brasil, essa intervenção deveria ser iniciada em pequena escala e, à proporção que novas evidências são geradas sobre a factibilidade, sustentabilidade e impacto da intervenção, a intervenção com PEP poderia ou não ser usada em larga escala.
Assuntos
Humanos , Implementação de Plano de Saúde/normas , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , Profilaxia Pós-Exposição/métodos , Brasil/epidemiologia , Medicina Baseada em Evidências/normas , Saúde da Família , Programas Nacionais de Saúde , Números Necessários para Tratar/normas , Fatores de Risco , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricosRESUMO
La investigación desarrollada en enfermería en el último tiempo ha permitido generar conocimientos que aportan a mejorar el cuidado de salud que otorgan los profesionales, se han confeccionado protocolos y guías clínicas con la finalidad de ofrecer a los profesionales de la salud la mejor evidencia para la práctica clínica, viéndose beneficiadas con ello, principalmente, las personas que requieren cuidados y también las instituciones al disminuir sus costos. Para llegar a esta meta es indispensable la capacitación continua de los profesionales de la salud y la inclusión de la formación de estos contenidos en los programas de las instituciones formadoras. Objetivo: Este artículo presenta la experiencia de implementación de cuatro guías de buena práctica clínica elaboradas por Registered Nurses Association of Ontario (RNAO) en dos planes de formación que se encontraba desarrollando en el Departamento / Escuela de Enfermería de la Universidad de Chile para los profesionales de enfermería. Metodología: Para la metodología de implementación se consideró como marco de referencia el material elaborado para este fin por parte de la organización RNAO denominado Recursos para el Docente, se apoya en modelos de desarrollo y progresión del aprendizaje como el modelo de Patricia Benner para la elaboración de la hipótesis de progresión de los contenidos en el curriculum de Enfermería, como también la pirámide de Miller para la evaluación de las competencias. Conclusiones: se espera que los estudiantes una vez terminada su formación cuenten con las herramientas implementadas bajo esta metodología, las cuales les permitan un desempeño profesional fundamentado en cuidados de enfermería basados en la evidencia científica.
A pesquisa desenvolvida na enfermagem nos últimos tempos tem gerado conhecimentos que permitem melhorar os cuidados e a atenção que os profissionais da saúde prestam aos usuários; foram feitos protocolos e manuais clínicos a fim de prover aos profissionais de saúde melhores evidências para a prática clínica, sendo os mais beneficiados aqueles que necessitam dos cuidados e as instituições ao ver reduzidos os seus custos. Para alcançar este objetivo, é essencial a formação permanente de profissionais de saúde e, além disto, as instituições de formação devem incluir nos seus programas de treinamento tais conteúdos. Objetivo: Este artigo apresenta a experiência de implementação de quatro manuais de boas práticas clínicas desenvolvidas pela Registered Nurses Association of Ontario (RNAO) em dois programas de formação desenvolvidos no Departamento / Escola de Enfermagem da Universidade do Chile para profissionais de enfermagem. Metodologia: Para a metodologia de implementação foi considerado como um quadro de referência os materiais desenvolvidos para este fim pela organização RNAO chamado "Recursos para Professores" fundamentado nos modelos de desenvolvimento e progressão da aprendizagem como é o modelo Patricia Benner para o desenvolvimento da hipótese de progressão de conteúdos no currículo de Enfermagem e a pirâmide Miller para avaliação de competências. Conclusão: Espera-se que os alunos, ao finalizarem sua formação, adquiram as ferramentas implementadas no âmbito desta metodologia que lhes permitam um desempenho profissional fundamentado nos cuidados de enfermagem baseada na evidência científica.
The research developed in the recent time in nursing, has generated knowledge that improve health care provided by professionals, has generated clinical guidelines and protocols in order to provide health professionals with the best evidence for clinical practice, seeing that it benefits mainly the patients requiring care, and the care-providing institutions by reducing their costs. To reach this goal it is essential in the ongoing training of health professionals and training institutions to include in their training programs such content. Objective: This article presents the experience of implementing four guides of good clinical practices elaborated by Registered Nurses Association of Ontario (RNAO) in both training plans which in that moment the School of Nursing of Universidad de Chile was developing for the future professionals. Methodology: The methodology of implementation considered as reference the material elaborated by RNAO denominated Resources for the Teaching, which relies on models of development and progression of learning as the Patricia Benner model for the elaboration of the hypothesis of progression of the contents in the Nursing curriculum, as well as the Miller pyramid for the evaluation of the competences. Conclusions: It is expected that the students, once they finish their training, can count on these tools that allow them a professional performance giving nursing care based on the scientific evidence.
Assuntos
Humanos , Currículo , Educação Continuada em Enfermagem/métodos , Guias de Prática Clínica como Assunto/normas , Implementação de Plano de Saúde/normas , Padrões de Prática em Enfermagem/normas , Chile , Enfermagem Baseada em Evidências/educação , Implementação de Plano de Saúde/métodosRESUMO
OBJECTIVE: Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. METHOD: This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. RESULTS: We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. CONCLUSION: In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way.
Assuntos
Atenção à Saúde/normas , Implementação de Plano de Saúde/normas , Atenção Plena/normas , Atenção à Saúde/economia , Implementação de Plano de Saúde/economia , Humanos , Atenção Plena/economiaRESUMO
The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.
Assuntos
Implementação de Plano de Saúde/normas , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , Profilaxia Pós-Exposição/métodos , Brasil/epidemiologia , Medicina Baseada em Evidências/normas , Saúde da Família , Humanos , Programas Nacionais de Saúde , Números Necessários para Tratar/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVES: Following the 2010 earthquake in Haiti, infant and young child feeding was identified as a priority nutrition intervention. A new approach to support breastfeeding mothers and distribute ready-to-use infant formula (RUIF) to infants unable to breastfeed was established. The objective of the evaluation was to assess the implementation of infant feeding programs using RUIF in displaced persons camps in Port-au-Prince, Haiti during the humanitarian response. METHODS: A retrospective record review was conducted from April-July, 2010 to obtain data on infants receiving RUIF in 30 baby tents. A standardized data collection form was created based on data collected across baby tents and included: basic demographics, admission criteria, primary caretaker, feeding practices, and admission and follow-up anthropometrics. MAIN FINDINGS: Orphans and abandoned infants were the most frequent enrollees (41%) in the program. While the program targeted these groups, it is unlikely that this is a true reflection of population demographics. Despite programmatic guidance, admission criteria were not consistently applied across programs. Thirty-four percent of infants were undernourished (weight for age Z score <-2) at the time of admission. Defaulting accounted for 50% of all program exits and there was no follow-up of these children. Low data quality was a significant barrier. CONCLUSIONS: The design, implementation and magnitude of the 'baby tents' using RUIF was novel in response to infant and young child feeding (IYCF) in emergencies and presented multiple challenges that should not be overlooked, including adherence to protocols and the adaption of emergency programs to existing programs. The implementation of IYCF programs should be closely monitored to ensure that they achieve the objectives set by the humanitarian community and national government. IYCF is an often overlooked component of emergency preparedness; however to improve response, generic protocols and pre-emergency training and preparedness should be established for humanitarian agencies.
Assuntos
Cuidadores , Terremotos , Implementação de Plano de Saúde/normas , Promoção da Saúde , Fórmulas Infantis , Feminino , Haiti , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the implementation of the kangaroo mother method in hospitals trained by the Brazilian Ministry of Health. METHOD: Cross-sectional study, evaluating 176 (60.1%) out of 293 hospitals that were trained by the Brazilian Ministry of Health from 2000 to 2003 in Brazil. This study was conducted in two phases. The first phase consisted of sending a questionnaire to 293 hospitals; in the second phase an in loco visit was made in a sample of 29 among those hospitals. The instrument for data collection was sent to all hospitals by mail, fax or e-mail through the Ministry of Health and they addressed the three dimensions of the normative assessment: structure, processes, and results. The second phase consisted of an evaluation of the process, using a structured guide of non-participant observation. To estimate the reliability of the variable "deployment of the steps of the method" between questionnaire and site visit, we used the kappa test. RESULTS: The first stage of the kangaroo mother method was implemented in 84.9% of the hospitals, but only 47.3% of them implemented the three stages according to the Brazilian norm. The kappa test results indicated a moderate agreement for the first stage, and substantial for the second and third stages of the method. CONCLUSION: Hospital training was important for triggering the implementation process of the kangaroo mother method. However, they were not enough to promote the implementation of the three phases of the method.
Assuntos
Implementação de Plano de Saúde/estatística & dados numéricos , Cuidado do Lactente/métodos , Recém-Nascido de Baixo Peso , Brasil , Estudos Transversais , Implementação de Plano de Saúde/normas , Humanos , Cuidado do Lactente/organização & administração , Recém-Nascido , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/estatística & dados numéricosRESUMO
Objetivo: Avaliar a implantação do método canguru em hospitais capacitados pelo Ministério da Saúde (MS). Método: Estudo transversal que avaliou 176 (60,1 por cento) dos 293 hospitais maternidades (HM) capacitados entre 2000 e 2003 no Brasil. O estudo foi conduzido em duas fases. A primeira consistiu no envio de um questionário para os 293 HM, e a segunda fase realizou-se mediante visita in loco em uma amostra de 29 destes HM. O instrumento de coleta de dados da primeira fase foi enviado por correio, fax ou e-mail via Ministério da Saúde a todos os hospitais capacitados e abordava as dimensões da avaliação normativa: estrutura, processos e resultados. A segunda fase consistiu exclusivamente na avaliação de processo utilizando-se roteiro de observação não participante e estruturado. Para estimar a confiabilidade da variável implantação das etapas do método, entre o questionário e a visita local utilizou-se o teste de kappa. Resultados: A primeira etapa do método canguru foi implantada em 84,9 por cento dos hospitais, porém apenas 47,3 por cento implantaram as três etapas conforme regulamenta a norma brasileira. Os resultados do teste de kappa indicam concordância moderada para a primeira etapa e substancial para a segunda e terceira etapas do método. Conclusão: A capacitação foi importante para o início do processo de implantação do método canguru, mas não suficiente para promover a implantação das três fases do método.
Objective: To evaluate the implementation of the kangaroo mother method in hospitals trained by the Brazilian Ministry of Health. Method: Cross-sectional study, evaluating 176 (60.1 percent) out of 293 hospitals that were trained by the Brazilian Ministry of Health from 2000 to 2003 in Brazil. This study was conducted in two phases. The first phase consisted of sending a questionnaire to 293 hospitals; in the second phase an in loco visit was made in a sample of 29 among those hospitals. The instrument for data collection was sent to all hospitals by mail, fax or e-mail through the Ministry of Health and they addressed the three dimensions of the normative assessment: structure, processes, and results. The second phase consisted of an evaluation of the process, using a structured guide of non-participant observation. To estimate the reliability of the variable deployment of the steps of the method between questionnaire and site visit, we used the kappa test. Results: The first stage of the kangaroo mother method was implemented in 84.9 percent of the hospitals, but only 47.3 percent of them implemented the three stages according to the Brazilian norm. The kappa test results indicated a moderate agreement for the first stage, and substantial for the second and third stages of the method. Conclusion: Hospital training was important for triggering the implementation process of the kangaroo mother method. However, they were not enough to promote the implementation of the three phases of the method.
Assuntos
Humanos , Recém-Nascido , Implementação de Plano de Saúde/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Cuidado do Lactente/métodos , Brasil , Estudos Transversais , Implementação de Plano de Saúde/normas , Cuidado do Lactente/organização & administração , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/estatística & dados numéricosRESUMO
BACKGROUND: The BCRF II study presents a systematic review of the norms, recommendations and guidelines that are considered medical care standards (MCS) for breast cancer in 12 Latin American and Caribbean countries. Three key questions from the BCRF I survey data on early detection and diagnosis are presented to identify implementation practice patterns related to MCS. METHODS: Information related to MCS was requested from governmental health authorities, cancer institutes, and national scientific and professional societies in 12 Latin American and Caribbean countries. Documents received were reviewed by breast cancer experts from each respective country. Three key survey questions from the BCRF I survey on early detection and diagnosis were reprocessed to provide information related to implementation practice of existing MCS. RESULTS: All countries included in the BCRF II study had medical care standards (MCS) whether published by governmental authorities, national professional or scientific associations, cancer institutes, or adoption of international MCS. Experts reported different practice patterns at a Country level versus a Center level. Overall, 85% of the experts reported that less than 50% of the women with no symptoms undergo a mammography at the Country level compared to 43% at the Center level. For diagnostic suspicion of breast cancer, 80% of experts considered the diagnostic suspicion at a Country level to come from the patient compared to 50% at a Center level. About 30% of patients waited for more than 3 months for a diagnosis at the Country level compared to 7% at the Center level. CONCLUSION: All the Latin America and Caribbean countries in the study reported the use of similar MCS for breast cancer care. The reported difference between care practiced at a Country level versus a Center level suggests the challenge is not in generating new MCS, but in implementing policies and control mechanisms for compliance with existing MCS, guaranteeing their applicability to all populations.
Assuntos
Neoplasias da Mama/epidemiologia , Implementação de Plano de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Programas de Rastreamento/organização & administração , Serviços de Saúde da Mulher/organização & administração , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Região do Caribe/epidemiologia , Feminino , Implementação de Plano de Saúde/normas , Acessibilidade aos Serviços de Saúde/normas , Humanos , América Latina/epidemiologia , Masculino , Programas de Rastreamento/normas , Oncologia/organização & administração , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Fatores Socioeconômicos , Saúde da Mulher , Serviços de Saúde da Mulher/normasRESUMO
Since the 1990 s, international guidelines have recommended the incorporation of STD/AIDS prevention in primary care. In Brazil, the Ministry of Health has made investments to include such preventive activities. This in-depth case study is an evaluation of the implementation of these activities in a family health unit in Greater Metropolitan São Paulo. The study analyzed the unit's activities as a whole and the specific STD/ AIDS prevention activities by means of direct observations and semi-structured interviews with the unit's professional health staff. The unit's technological characteristics were similar to those of traditional Brazilian primary care services, with limited potential for achieving the principle of comprehensive care. STD/AIDS prevention activities had been incorporated, but were devoid of important technological meanings like dialogue and specific attention to users' uniqueness. This characteristic and others reveal a tension between the program's technological proposals and the current technological profile of primary care. However, the identification of this tension could favor reflection on new values in routine primary care, thereby favoring the achievement of more comprehensive technological arrangements.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Implementação de Plano de Saúde/normas , Pesquisa sobre Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Serviços de Planejamento Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Adulto JovemRESUMO
The aim of this study was to develop a tool to evaluate the implementation of a contraceptive program in health services and apply it to the 23 public health services in Maringá, Paraná State, Brazil. A theoretical-logical model was developed, corresponding to a 'target image' for the family planning program. Using the Delphi technique and consensus conference, six experts validated the program's target image, which included three dimensions and 60 evaluation criteria. A data collection instrument was prepared, in addition to a spreadsheet to evaluate the degree of the family planning program's implementation, constituting the Questionnaire for the Evaluation of Reproductive Health Services. The vast majority of the primary health units (91.3%) received an 'intermediate' score on implementation of the family planning program, while 8.7% were classified as 'incipient' and none were scored as 'advanced'. The 'advanced' degree of implementation in the structural dimension contrasted with the organizational and patient care dimensions. The instrument can be useful for evaluating reproductive health programs and is applicable to the health services planning and management processes.
Assuntos
Implementação de Plano de Saúde , Pesquisa sobre Serviços de Saúde , Serviços de Saúde Reprodutiva/organização & administração , Inquéritos e Questionários/normas , Adolescente , Adulto , Brasil , Técnica Delphi , Serviços de Planejamento Familiar/normas , Feminino , Implementação de Plano de Saúde/normas , Humanos , Serviços de Saúde Reprodutiva/normas , Adulto JovemRESUMO
This study's objective was to evaluate the degree of implementation of epidemiological surveillance activities by the Municipal Health Secretariat in Recife, Pernambuco State, Brazil. The design consisted of a case study with a normative approach. The logical model for epidemiological surveillance was outlined as the basis for selecting criteria that comprised a matrix submitted to specialists using the consensus technique or Delphi Method. This consensual matrix was used as the basis for the questionnaires used in the interviews. Three analytical levels were approached: the central level, 6 health districts, and 62 family health teams. According to the study, epidemiological surveillance has been partially implemented in the municipality, based on the degree of implementation at the three levels (already implemented at the central level and partially implemented in the health districts and family health teams). Despite the decentralization of epidemiological surveillance activities to the municipalities, different levels in the municipal system have different needs in dealing with the standards and norms, including the elaboration of internal guidelines to define responsibilities at the three levels.
Assuntos
Implementação de Plano de Saúde/organização & administração , Governo Local , Vigilância da População/métodos , Brasil , Implementação de Plano de Saúde/normas , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
O objetivo deste estudo foi avaliar o grau de implantação da vigilância epidemiológica na Secretaria Municipal de Saúde do Recife, Pernambuco, Brasil. A estratégia do trabalho consistiu num estudo de caso utilizando-se uma abordagem normativa. Foi delineado o modelo lógico da vigilância epidemiológica, a partir do qual foram selecionados critérios que compuseram uma matriz submetida a especialistas usando-se a técnica de consenso - método Delphos. Essa matriz consensuada originou os questionários das entrevistas. Foram abordados três níveis de análise: nível central, 6 distritos sanitários e 62 equipes de saúde da família. O estudo revelou que a vigilância epidemiológica está parcialmente implantada no município, a partir do grau de implantação dos três níveis de análise, sendo o nível central o único em que a vigilância epidemiológica encontra-se implantada, enquanto que nos distritos sanitários e nas equipes de saúde da família está parcialmente implantada. Em que pese a descentralização das ações de vigilância epidemiológica para os municípios, os níveis do sistema municipal possuem necessidades diferenciadas para atender ao que está normatizado, entre elas, a elaboração de normas internas especificando as atribuições dos três níveis.
This study's objective was to evaluate the degree of implementation of epidemiological surveillance activities by the Municipal Health Secretariat in Recife, Pernambuco State, Brazil. The design consisted of a case study with a normative approach. The logical model for epidemiological surveillance was outlined as the basis for selecting criteria that comprised a matrix submitted to specialists using the consensus technique or Delphi Method. This consensual matrix was used as the basis for the questionnaires used in the interviews. Three analytical levels were approached: the central level, 6 health districts, and 62 family health teams. According to the study, epidemiological surveillance has been partially implemented in the municipality, based on the degree of implementation at the three levels (already implemented at the central level and partially implemented in the health districts and family health teams). Despite the decentralization of epidemiological surveillance activities to the municipalities, different levels in the municipal system have different needs in dealing with the standards and norms, including the elaboration of internal guidelines to define responsibilities at the three levels.