RESUMO
ABSTRACT Objective: To analyze the length of stay of the professionals who work in the Tuberculosis Control Program in Basic Health Units of the city of Rio de Janeiro/RJ. Method: Sectional study, developed in eight Health Units of the Maré Complex/RJ. Physicians, nurses, nursing technicians and Community Health Agents of the Family Health Teams were interviewed. The Kruskal-Wallis test was used to verify the existence of groups with the same distribution, and Dunn's multiple comparison test with Bonferroni correction, to identify which group presented a difference. Results: Among Health Units, a significant difference was observed in the length of work (p-value = 0.0005909) and in the dwell time (p-value = 0.0003598). Conclusion: It was observed low length of stay of the professionals that work in the Basic Health Units. This result points to challenges inherent in the control of tuberculosis at the local level.
RESUMEN Objetivo: Analizar el tiempo de permanencia de los profesionales que actúan en el Programa de Control de la Tuberculosis en Unidades Básicas de Salud del municipio de Río de Janeiro/RJ. Método: Estudio seccional, desarrollado en ocho Unidades de Salud del Complejo de la Maré/RJ. Entrevistaron médicos, enfermeros, técnicos de enfermería y Agentes Comunitarios de Salud de los Equipos de Salud de la Familia. Se optó por la prueba de Kruskal-Wallis para verificar la existencia de grupos con la misma distribución, y prueba de comparaciones múltiples de Dunn, con corrección de Bonferroni, para identificar qué grupo presentaba diferencia. Resultados: Entre las Unidades de Salud, se comprueba diferencia significativa en el tiempo de ejercicio de la función (p-value = 0,0005909) y en el tiempo de permanencia (p-value = 0,0003598). Conclusión: Se constató bajo tiempo de permanencia de los profesionales que actúan en las Unidades Básicas de Salud. Este resultado apunta a desafíos inherentes al control de la tuberculosis a nivel local.
RESUMO Objetivo: Analisar o tempo de permanência dos profissionais que atuam no Programa de Controle da Tuberculose em Unidades Básicas de Saúde do município do Rio de Janeiro/RJ. Método: Estudo seccional, desenvolvido em oito Unidades de Saúde do Complexo da Maré/RJ. Entrevistaram-se médicos, enfermeiros, técnicos de enfermagem e Agentes Comunitários de Saúde das Equipes de Saúde da Família. Optou-se pelo teste de Kruskal-Wallis para verificar a existência de grupos com a mesma distribuição, e teste de comparações múltiplas de Dunn, com correção de Bonferroni, para identificar qual grupo apresentava diferença. Resultados: Entre as Unidades de Saúde, comprova-se diferença significativa no tempo de exercício da função (p-value = 0,0005909) e no tempo de permanência (p-value = 0,0003598). Conclusão: Constatou-se baixo tempo de permanência dos profissionais que atuam nas Unidades Básicas de Saúde. Esse resultado aponta para desafios inerentes ao controle da tuberculose em nível local.
Assuntos
Humanos , Reorganização de Recursos Humanos/estatística & dados numéricos , Tuberculose/enfermagem , Pessoal de Saúde/psicologia , Brasil , Pessoal de Saúde/estatística & dados numéricos , Centros Comunitários de Saúde/normas , Centros Comunitários de Saúde/organização & administração , Satisfação no EmpregoRESUMO
OBJECTIVE: To analyze the length of stay of the professionals who work in the Tuberculosis Control Program in Basic Health Units of the city of Rio de Janeiro/RJ. METHOD: Sectional study, developed in eight Health Units of the Maré Complex/RJ. Physicians, nurses, nursing technicians and Community Health Agents of the Family Health Teams were interviewed. The Kruskal-Wallis test was used to verify the existence of groups with the same distribution, and Dunn's multiple comparison test with Bonferroni correction, to identify which group presented a difference. RESULTS: Among Health Units, a significant difference was observed in the length of work (p-value = 0.0005909) and in the dwell time (p-value = 0.0003598). CONCLUSION: It was observed low length of stay of the professionals that work in the Basic Health Units. This result points to challenges inherent in the control of tuberculosis at the local level.
Assuntos
Pessoal de Saúde/psicologia , Reorganização de Recursos Humanos/estatística & dados numéricos , Tuberculose/enfermagem , Brasil , Centros Comunitários de Saúde/organização & administração , Centros Comunitários de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Satisfação no EmpregoRESUMO
BACKGROUND: Mobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting. METHODS: We conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction. RESULTS: All of the participants were women, ranging from 18-64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas. CONCLUSION: In a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health.
Assuntos
Atitude do Pessoal de Saúde , Centros Comunitários de Saúde/normas , Atenção à Saúde/normas , Sistemas de Informação em Saúde/normas , Telemedicina/normas , Adolescente , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
RESUMO O estudo objetivou analisar as ações de prevenção do HIV e promoção à saúde no contexto da Aids desenvolvidas pela Estratégia Saúde da Família (ESF), em João Pessoa-PB. Trata-se de um estudo descritivo, com abordagem qualitativa, realizado com 16 enfermeiros atuantes na ESF. Para a obtenção dos dados, utilizouse um roteiro de entrevista semiestruturado e seguiu-se as etapas de análise de conteúdo temática. Os enfermeiros atuam no contexto da Aids com ações em educação em saúde e contextos do cuidar, além de vivenciar facilidades e dificuldades para que essas ações sejam implementadas com êxito. Concluiu-se que as ações voltadas para a prevenção do HIV e promoção à saúde no contexto da Aids estão presentes nas atividades dos profissionais enfermeiros atuantes na ESF, no entanto, não se constituem ações cotidianas e préestabelecidas, acontecendo, em sua maioria, em momentos pontuais e nas demandas durante as consultas de enfermagem.
RESUMEN El estudio tuvo como objetivo analizar las acciones de prevención del VIH y promoción de la salud en el contexto del SIDA desarrolladas por la Estrategia Salud de la Familia (ESF) en João Pessoa-PB. Se trata de un estudio descriptivo, con enfoque cualitativo, realizado con 16 enfermeros que trabajan en la ESF. Para la recogida de datos, se utilizó un guión de entrevista semiestructurado y fueron seguidos los pasos del análisis de contenido temático. Los enfermeros actúan en el contexto del SIDA con acciones en educación para la salud y contextos de la atención, además de vivir facilidades y dificultades para que esas acciones sean implementadas con éxito. Se concluyó que las acciones dirigidas a la prevención del VIH y promoción de la salud en el contexto del SIDA están presentes en las actividades de los profesionales de enfermería que trabajan en la ESF, sin embargo no se constituyen acciones cotidianas y preestablecidas, ocurriendo, sobre todo, en momentos puntuales y en las demandas durante las consultas de enfermería.
ABSTRACT The study aimed to analyze the prevention of the actions of HIV and health promotion in the context of AIDS developed by the Strategy Family Health (ESF) in João Pessoa-PB. This search is a descriptive study with qualitative approach, performed with 16 nurses working in the ESF, using a semi-structured interview guide and followed the steps of content analysis. Nurses work in the context of AIDS with actions in health education and care contexts, additionally ease and difficulties in these experiences for these actions are implemented successfully. It was concluded that the actions aimed at prevention of HIV and health promotion in the context of AIDS are present in the activities of professional nurses who are working in the ESF, however not constitute everyday actions and pre-established, happening mostly in special moments and the demands during nursing visits.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/tendências , Políticas, Planejamento e Administração em Saúde/organização & administração , Infecções por HIV/prevenção & controle , HIV/imunologia , Promoção da Saúde/normas , Atenção Primária à Saúde/normas , Educação em Saúde/normas , Soropositividade para HIV/enfermagem , Centros Comunitários de Saúde/normas , Enfermagem de Atenção Primária/normas , Epidemias/prevenção & controle , Enfermeiras e Enfermeiros/normasRESUMO
En la Atención Primaria de Salud (APS), conocer el nivel de satisfacción del paciente es sustancial para mejorar la calidad de asistencia. El objetivo del presente trabajo fue explorar el NS de los pacientes con tratamientos kinésicos en los Centros de Atención Primaria de la Salud (CAPS) de Corrientes. Metodología: Diseño descriptivo transversal, multicéntrico comparativo, con modalidad de encuestas realizadas a 180 pacientes en los CAPS Nº 1, 3, 8, 9, 10 y 14 durante 6 meses, en las dos primeras semanas de cada mes. Se estudiaron variables demográficas, la información brindada por el kinesiólogo y personal auxiliar, la accesibilidad al servicio y la valoración del equipo de salud, del entorno físico y del servicio. Los datos categóricos fueron analizados en tabla de contingencia para comparación de porcentajes y confrontados entre sí aplicando Chi-Cuadrado T. de Pearson, considerando nivel de significación: p < 0.05. Resultados: Existió asociación entre las respuestas y el CAPS de donde provinieron (P<0.0001) respecto a: la información, atención, trato por parte del kinesiólogo y personal administrativo, accesibilidad a los centros y la comodidad e higiene del gabinete. Por el contrario, no existió asociación entre las respuestas y el CAPS de donde provinieron respecto a: la accesibilidad estructural, el interés que demostró el kinesiólogo en resolver el problema de salud y la opción de volver al mismo lugar de rehabilitación. El NS de los pacientes en los CAPS Nº 1, 3 y 8 en la mayoría de los aspectos analizados fue mayor que en los CAPS Nº 9, 10 y 14. Conclusión: La percepción de satisfacción del paciente kinésico, en general fue buena en todos los centros; existiendo puntos diferentes dependiendo de cada CAPS. El desarrollo de programas de mejoramiento en la APS conociendo el problema y necesidades del usuario, mejoraría el nivel de satisfacción del paciente
SUMMARY: In Primary Health Care (PHC), knowing the patients level of satisfaction is crucial for improving care quality. The aim of this study was to explore the LS of patients with physiotherapy treatments at Primary Health Care Centers (PHCC) in Corrientes. Methodology: Descriptive, cross-sectional, multicenter comparative design, with surveys of 180 patients at the PHCCs No. 1, 3, 8, 9, 10 and 14 over 6 months, in the first two weeks of each month. We studied demographic variables, information provided by the physiotherapist and support staff, the accessibility of the service, the assessment of the healthcare team, the physical and the service environment. Categorical data were analyzed in a contingency table to compare percentages and compared with each other by applying Chi-square - Pearson's T-tests, with significance level: p < 0.05. Results: There was an association between the responses and the PHCC from which they came (P<0.0001) in terms of: information, care, relationship with the physiotherapist and administrative staff, center accessibility, and office comfort and hygiene. On the other hand, there was no association between the responses and the PHCC from which they came regarding: the structural accessibility, the interest the physiotherapist showed in resolving the health problem and the option of returning to the same place for rehabilitation. The LS of the patients at PHCCs No. 1, 3 and 8 in most of the aspects studied was greater than at PHCCs No. 9, 10 and 14. Conclusion: The perception of satisfaction of the physiotherapy patient was generally good at all the centers. There are different points depending on each PHCC. The development of PHC improvement programs taking into account the problems and needs of the user, would enhance the level of patient satisfaction
Assuntos
Masculino , Feminino , Humanos , Centros Comunitários de Saúde/normas , Níveis de Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Qualidade da Assistência à Saúde , ArgentinaRESUMO
OBJECTIVE: To determine provider compliance with protocols for the prevention of postpartum hemorrhage and provider characteristics associated with adherence and non-adherence. METHODS: A multicenter descriptive study was conducted involving 78 direct observations of provider-implemented protocols and 52 interviews with Peruvian maternal healthcare providers at 4 Peruvian clinical sites representing the local, regional, and national levels of care. Parturient participants planning a normal vaginal delivery were 17-49 years of age and 34-42 weeks pregnant. Primary outcomes were compared using χ2 testing, while quantitative survey data were evaluated using means, standard deviations, and Student t test or analysis of variance for statistical significance. RESULTS: There were 3 significant differences between the national, regional, and local levels of care: adherence to all 3 interventions (P<0.001); professional experience (P<0.04); and retention of healthcare providers (P<0.001). There were no differences in provider training (P<0.097), and the retention of experienced healthcare providers was not associated with greater adherence to protocols. There were no significant differences in parturient characteristics. CONCLUSION: Individual characteristics and institutional beliefs may have more influence than experience or training on adherence to protocols for prevention of postpartum hemorrhage; addressing these biases may improve patient safety in Peru and throughout Latin America.
Assuntos
Competência Clínica , Fidelidade a Diretrizes , Hemorragia Pós-Parto/prevenção & controle , Qualidade da Assistência à Saúde , Adolescente , Adulto , Atitude do Pessoal de Saúde , Centros Comunitários de Saúde/normas , Estudos Transversais , Feminino , Humanos , Capacitação em Serviço , Pessoa de Meia-Idade , Obstetrícia/educação , Cultura Organizacional , Segurança do Paciente , Reorganização de Recursos Humanos , Peru , Guias de Prática Clínica como Assunto , Gravidez , Centros de Cuidados de Saúde Secundários/normas , Centros de Atenção Terciária/normas , Adulto JovemRESUMO
OBJECTIVE: Health care quality improvement (QI) efforts commonly use self-assessment to measure compliance with quality standards. This study investigates the validity of self-assessment of quality indicators. DESIGN: Cross sectional. SETTING: A maternal and newborn care improvement collaborative intervention conducted in health facilities in Ecuador in 2005. PARTICIPANTS: Four external evaluators were trained in abstracting medical records to calculate six indicators reflecting compliance with treatment standards. INTERVENTIONS: About 30 medical records per month were examined at 12 participating health facilities for a total of 1875 records. The same records had already been reviewed by QI teams at these facilities (self-assessment). MAIN OUTCOME MEASURES: Overall compliance, agreement (using the Kappa statistic), sensitivity and specificity were analyzed. We also examined patterns of disagreement and the effect of facility characteristics on levels of agreement. RESULTS: External evaluators reported compliance of 69-90%, while self-assessors reported 71-92%, with raw agreement of 71-95% and Kappa statistics ranging from fair to almost perfect agreement. Considering external evaluators as the gold standard, sensitivity of self-assessment ranged from 90 to 99% and specificity from 48 to 86%. Simpler indicators had fewer disagreements. When disagreements occurred between self-assessment and external valuators, the former tended to report more positive findings in five of six indicators, but this tendency was not of a magnitude to change program actions. Team leadership, understanding of the tools and facility size had no overall impact on the level of agreement. CONCLUSIONS: When compared with external evaluation (gold standard), self-assessment was found to be sufficiently valid for tracking QI team performance. Sensitivity was generally higher than specificity. Simplifying indicators may improve validity.
Assuntos
Comportamento Cooperativo , Fidelidade a Diretrizes , Garantia da Qualidade dos Cuidados de Saúde/normas , Centros Comunitários de Saúde/normas , Estudos Transversais , Equador , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna , Auditoria Médica , Enfermagem Neonatal/normas , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Reprodutibilidade dos TestesRESUMO
BACKGROUND: An estimated 12 million sexually transmitted infections (STIs) are documented in Brazil per year. Given the scope of this public health challenge and the importance of prompt treatment and follow-up counseling to reduce future STI/HIV-related risk behavior, we sought to qualitatively explore STI clinic experiences among individuals diagnosed with STIs via public clinics in Rio de Janeiro, Brazil. The study focused on eliciting the perspective of clinic users with regard to those factors influencing their STI care-seeking decisions and the health education and counseling which they received during their clinic visit. METHODS: Thirty semi-structured interviews were conducted with heterosexual men and women and men who have sex with men presenting with STIs at two public clinics. Content analysis was conducted by coding transcripts of audio-taped interviews for key domains of interest and comparing and synthesizing code output across participants and sub-groups. Thematic narratives were then developed per each of the study sub-groups. RESULTS: Salient themes that emerged from participant narratives included the importance of low STI-related knowledge and high perceived stigma, both STI-related and other types of social stigma, on STI care-seeking delays. However, there are indications in the data that the level of STI-related knowledge and the amount and types of stigma experienced vary across the study sub-groups suggesting the need for further research on the significance and program relevance of these potential differences. Interview findings also suggest that such barriers to care seeking are not adequately addressed through ongoing health education and counseling efforts at public STI clinics and in turn critical opportunities for STI/HIV prevention are currently being missed. CONCLUSION: Information, communication and education regarding early recognition and prompt care-seeking for STIs should be developed, with consideration given to the possibility of tailoring messages tailored to specific sub-groups. To promote prompt treatment-seeking, interventions must also address both STI-specific and other forms of social stigma which may limit access to care. Efforts to further assess and respond to barriers related to the delivery of quality health education and counseling within the context of public STI clinics are also needed.
Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Infecções Sexualmente Transmissíveis/terapia , Adolescente , Adulto , Brasil , Centros Comunitários de Saúde/normas , Feminino , Acessibilidade aos Serviços de Saúde , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Humanos , Entrevistas como Assunto , Masculino , Preconceito , Administração em Saúde Pública/normasRESUMO
Process evaluation was used to examine the implementation of a randomized, controlled trial of an education intervention that improved infant growth in Trujillo, Peru. Health personnel delivered the multi-component intervention as part of usual care in the government health centers. Quantitative and qualitative methods were used to examine process indicators, which included the extent of delivery (dose), fidelity to intervention protocol, barriers to implementation and context. Results demonstrated that most intervention components were delivered at a level of 50-90% of expectations. Fidelity to intervention protocol, where measured, was lower (28-70% of expectations). However, when compared with existing nutrition education, as represented by the control centers, significant improvements were demonstrated. This included both improved delivery of existing educational activities as well as delivery of new intervention components to strengthen overall nutrition education. Barriers to, and facilitators of, implementation were explored with health personnel and helped to explain results. This study demonstrates the importance of examining actual versus planned implementation in order to improve our understanding of how interventions succeed. The information gained from this study will inform future evaluation designs, and lead to the development and implementation of more effective intervention programs for child health.
Assuntos
Cuidadores/educação , Desenvolvimento Infantil/fisiologia , Serviços de Saúde da Criança/normas , Educação em Saúde/normas , Transtornos da Nutrição do Lactente/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Pais/educação , Serviços Urbanos de Saúde/normas , Serviços de Saúde da Criança/organização & administração , Centros Comunitários de Saúde/normas , Educação em Saúde/métodos , Humanos , Lactente , Cuidado do Lactente/economia , Cuidado do Lactente/métodos , Transtornos da Nutrição do Lactente/epidemiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Entrevistas como Assunto , Peru/epidemiologia , Áreas de Pobreza , Avaliação de Programas e Projetos de Saúde , Serviços Urbanos de Saúde/organização & administraçãoRESUMO
BACKGROUND: Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP) method for such evaluation. METHODS: 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher) and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after). Also the influence of doctors' characteristics was tested using non-parametric statistical methods. RESULTS: Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01). Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02). Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. CONCLUSION: This study illustrates provider-related obstacles adolescents often face when requesting contraception. The care provided during the voucher program improved for some important outcomes. The improvements were more pronounced among providers with the weakest initial performance. Shared decision-making and condom promotion were improvements that sustained after the program ended. The SP method is suitable and relatively easy to apply in monitoring clinics' performance, yielding important and relevant information. Objective assessment of change through the SP method is much more complex and expensive.