RESUMO
The structural typology of Brazil's 38,812 primary healthcare units (UBS) was elaborated on the basis of the results from a survey in cycle 1 of the National Program for Improvement in Access and Quality of Primary Care. Type of team, range of professionals, shifts open to the public, available services, and installations and inputs were the sub-dimensions used. For each sub-dimension, a reference standard was defined and a standardized score was calculated, with 1 as the best. The final score was calculated by factor analysis. The final mean score of Brazilian UBS was 0.732. The sub-dimension with the worst score was "installations and inputs" and the best was "shifts open to the public". The primary healthcare units were classified according to their final score in five groups, from best to worst: A, B, C, D, and E. Only 4.8% of the Brazilian UBS attained the maximum score. The typology showed specific characteristics and a regional distribution pattern: units D and/or E accounted for nearly one-third of the units in the North, and two-thirds of units A were situated in the South and Southeast of Brazil. Based on the typology, primary healthcare units were classified according to their infrastructure conditions and possible strategies for intervention, as follows: failed, rudimentary, limited, fair, and reference (benchmark). The lack of equipment and inputs in all the units except for type A limits their scope of action and case-resolution capacity, thus restricting their ability to respond to health problems. The typology presented here can be a useful tool for temporal and spatial monitoring of the quality of infrastructure in UBS in Brazil.
Assuntos
Atenção à Saúde/organização & administração , Instalações de Saúde/classificação , Acessibilidade aos Serviços de Saúde/organização & administração , Regionalização da Saúde/organização & administração , Brasil , Atenção à Saúde/estatística & dados numéricos , Análise Fatorial , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Atenção Primária à Saúde , Regionalização da Saúde/estatística & dados numéricosRESUMO
Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.
Assuntos
Instalações de Saúde/economia , Setor Privado/economia , Setor Público/economia , Brasil , Pesquisas sobre Atenção à Saúde/economia , Instalações de Saúde/classificação , Instalações de Saúde/legislação & jurisprudência , Administração de Instituições de Saúde , Humanos , Setor Privado/legislação & jurisprudência , Setor Público/legislação & jurisprudênciaRESUMO
BACKGROUND: The fulfillment and satisfaction regarding the expectations of the patients at services of obstetrics and gynecology, it is related to the quality of care. Failure to meet these expectations will rise to the dissatisfaction and enhances the culture of demand, with these considerations this presents study were developed, researching the patients complaints reported by the State Commission o Medical Arbitration of Oaxaca in 2007 with the aim of identifying the medical complaint emphasis on obstetrics care. OBJECTIVE: To identify the medical lawsuits to Gineco-obstetricians in Oaxaca. MATERIAL AND METHOD: We conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2007 activity report; 100% of selected records were medical complaints in the specialty of gynecology-obstetrics. RESULTS: The attention given to 10.5% are disagreements or complaints which medical complaints in gynecology-obstetrics specialty are second with 21% and the report file complaints state ranks first with 12.3% of cases, 70% of medical care is provided by gynecologists and total complaints, 40% were confined to expert medical advice. CONCLUSIONS: Complaints in gynecological and obstetric care rank first places relative to other specialties, the attention given in the two-thirds is provided by medical specialists in obstetrics and gynecology, and less than the half were certified by the Board and expert medical opinions reported evidence of malpractice and corporate responsibility in the complaints.
Assuntos
Ginecologia , Imperícia/estatística & dados numéricos , Obstetrícia , Satisfação do Paciente , Qualidade da Assistência à Saúde , Estudos Transversais , Feminino , Instalações de Saúde/classificação , Instalações de Saúde/estatística & dados numéricos , Humanos , México , Negociação , Estudos RetrospectivosRESUMO
In order to estimate the prevalence of treatment non-adherence and associated factors among individuals with systemic arterial hypertension treated at family health care facilities, a cross-sectional study was performed with 595 patients. The dependent variable non-adherence was measured with a Medication Adherence Questionnaire (MAQ). A hierarchical logistic regression model was used to analyze socioeconomic, health care-related, personal, and treatment-related variables. Prevalence of non-adherence was 53%. Variables associated with non-adherence were: (1) socioeconomic--belonging to economic classes C, D, or E; work market participation in unskilled labor; (2) health care--out-of-pocket payment for medication; more than six months since last physician consultation; and (3) personal and treatment characteristics--previous interruption of treatment; being on treatment for less than three years; and presence of a common mental disorder. The study of determinants of non-adherence articulated in a hierarchical model suggests that social inequalities are either directly associated with non-adherence or mediated by personal and health services factors.
Assuntos
Anti-Hipertensivos/uso terapêutico , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Métodos Epidemiológicos , Saúde da Família , Instalações de Saúde/classificação , Características Humanas , Humanos , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
OBJECTIVE: Estimates of vaccination costs usually provide only point estimates at national level with no information on cost variation. In practice, however, such information is necessary for programme managers. This paper presents information on the variations in costs of delivering routine immunization services in three diverse districts of Peru: Ayacucho (a mountainous area), San Martin (a jungle area) and Lima (a coastal area). METHODS: We consider the impact of variability on predictions of cost and reflect on the likely impact on expected cost-effectiveness ratios, policy decisions and future research practice. All costs are in 2002 prices in US dollars and include the costs of providing vaccination services incurred by 19 government health facilities during the January-December 2002 financial year. Vaccine wastage rates have been estimated using stock records. FINDINGS: The cost per fully vaccinated child ranged from 16.63-24.52 U.S. Dollars in Ayacucho, 21.79-36.69 U.S. Dollars in San Martin and 9.58-20.31 U.S. Dollars in Lima. The volume of vaccines administered and wastage rates are determinants of the variation in costs of delivering routine immunization services. CONCLUSION: This study shows there is considerable variation in the costs of providing vaccines across geographical regions and different types of facilities. Information on how costs vary can be used as a basis from which to generalize to other settings and provide more accurate estimates for decision-makers who do not have disaggregated data on local costs. Future studies should include sufficiently large sample sizes and ensure that regions are carefully selected in order to maximize the interpretation of cost variation.
Assuntos
Custos e Análise de Custo , Programas de Imunização/economia , Pré-Escolar , Feminino , Instalações de Saúde/classificação , Instalações de Saúde/economia , Pesquisa sobre Serviços de Saúde , Humanos , Programas de Imunização/organização & administração , Lactente , Recém-Nascido , Masculino , PeruRESUMO
Contenido: 2. Marco Teórico, 2. 1 Generalidades sobre Administración Hospitalaria, 2. 2 Planificación del Siatema, 2. 3 Actividades hacia el exterior del hospital, 2. 4 Planeación y programación, 2. 5 Mejoramiento en la calidad de los funcionarios, 2. 6 Olanificación estrategica en hospitales, 2. 7 Evaluación Integral, 2. 8 Evaluación de la calidad de atención, 2. 9 Medición de la calidad, 2. 10 El proceso de la Planificación, 2. 11 Dirección del cambio, 2. 12 Proceso de cambio, 2. 13 Control de calidad centrado en la acreditación, 3. Metodologia
Assuntos
Instalações de Saúde/classificação , Serviço Hospitalar de Fisioterapia/classificação , Modalidades de Fisioterapia/educaçãoRESUMO
En Venezuela es notoria la poca capacidad de respuesta de las instituciones de salud y nutrición ante los cambios que se han generado sin existir verdaderos planes integrales de desarrollo. Las acciones de gobierno han estado destinadas al desarrollo de programas de impacto político inmediato, debido a que es el criterio partidista el que ha imperado a la hora de escoger la alta dirección de las instituciones, desestimándose la necesidad de conocer la realidad para planificar a futuro con la participación armónica de tantos sectores, cuyos objetivos deben integrarse y sus acciones coordinarse, ajustando progresivamente dicha planificación a los múltiples cambios que ocurren, a veces con más rapidez en esta parte del mundo. Ante las circunstancias propias del proceso descentralizador de la administración pública se propone un nuevo modelo gestion para el sector, con una concentración mucho más dinámica y participativa, en el cual deben jugar papel fundamental las universidades y las unidades o centros de investigación a nivel regional
Assuntos
Educação/classificação , Saúde , Instalações de Saúde/classificação , Ciências da Nutrição/educaçãoRESUMO
Es conocido por aquellos que se han incorporado al trabajo en el Sector Salud en America Latina, que entre los puntos críticos para el funcionamiento del sector están el desarrollo de la fuerza de trabajo, formación de recursos humanos e identificación de alternativas de acción. En los últimos años, la magnitud del trabajo en actividades relacionadas con Ciencia y Tecnología, han cambiado significativamente en America Latina. En la década de los noventa, la mayoría de los países del área han modificado las estrategias de desarrollo y se han propuesto la integración de las actividades docentes, asistenciales y de investigación, con objetivos bien definidos como son: Continuar con el desarrollo de nuevas tecnologías mediante investigaciones y docencia; desarrollar un efectivo control de calidad a través de sistemas de indicadores confiables; y priorizar el enfoque epidemiológico en el análisis de los problemas que caracterizan el estado de salud de la población. El Instituto Nacional de Higiene "Rafael Rangel" estructuró una Unidad de Docencia que sirvió para retomar uno de los objetivos establecidos en el Decreto de Creación del Instituto. A partir de 1989, la actual gestión inició un enfoque institucional, el cual está enmarcado dentro del concepto de Calidad Total. Como apoyo a esta concepción se crea la División de Investigación y Docencia, ella a través de una programación completa de Cursos Nacionales e Internacionales, pasantias de entrenamiento y proyectos de investigación, contribuye a mejorar la calidad de los procesos de cada una de las áreas involucradas, todo ello enmarcado dentro del concepto de Calidad Total
Assuntos
Emprego , Instalações de Saúde/classificação , Mão de Obra em Saúde/classificação , Mão de Obra em Saúde/estatística & dados numéricos , América LatinaRESUMO
En este trabajo se presenta una reflexión sobre la transición de la respuesta social organizada en salud con énfasis en los sistemas locales de salud Después de revisar algunas definiciones básicas (sistema de salud, sistema local de salud, sistema de atención a la salud, sistema institucional de servicios de salud), el autor se centra en el análisis de la transición en salud (transición del concepto salud-enfermedad transición tecnológica, transición epidemiológica, transición demográfica, transición del sistema de atención a la salud) y de la importancia que en ella se ha adjudicado a los sistemas locales en México.
This paper discusses the transition of the organized social response in health with emphasis on local health systems. After reviewing a few basic definitions (health system, local health system, health care system, institutional system of health services), the author discusses the health transition (transition of the concept health-disease, technological transition, epidemiological transition, demographic transition, health care system transition) and the importance attributed to local health systems in Mexico.