Actions of a cancer surveillance technical group based on the perspective of advocacy / Acciones de un grupo técnico de vigilancia del cáncer desde una perspectiva de advocacy / Ações de um grupo técnico de vigilância do câncer na perspectiva do advocacy

ABSTRACT Objective: To analyze epidemiological surveillance actions for people with cancer based on the perspective of advocacy. Method: Qualitative study, Convergent Care Research type, combined with the framework of health advocacy. It was carried out in the Epidemiological Surveillance of the Health Department of a municipality in the southern region of Brazil. Results: Eleven health service professionals participated in the study, from June 2020 to July 2021, making up 14 group meetings. Two aspects were discussed: (1) problems involving the management of the work process in the network services, directly influencing user assistance; and (2) issues related to the training management of the professional who works at these services, where the lack of knowledge regarding the legislation leads to serious consequences for the users. Conclusion: The advocacy strengthened health defense concepts and ideas, mobilizing actions related to cancer, acting as a bridge between the members of the group and the sectors holding power to change circumstances that prevent compliance with public policies and current legislation.

RESUMEN Objetivo: Analizar las acciones de vigilancia epidemiológica de personas con cáncer desde una perspectiva de advocacy. Método: Estudio cualitativo, del tipo Investigación Convergente Asistencial, combinado con el referente de advocacy en salud. Realizado en la Vigilancia Epidemiológica del Departamento de Salud de un municipio de la región sur de Brasil. Resultados: Participaron 11 profesionales de los servicios de salud, entre junio de 2020 y julio de 2021, conformando 14 encuentros grupales. Se discutieron dos aspectos: (1) problemas relacionados con la gestión del proceso de trabajo en los servicios de red, que influyen directamente en la atención al usuario; y (2) problemas relacionados con la gestión de la formación del profesional que atiende estos servicios, donde el desconocimiento de la legislación trae graves consecuencias para los usuarios. Conclusión: La advocacy fortaleció conceptos y concepciones de defensa de la salud, movilizando acciones relacionadas con el cáncer, actuando como puente entre los integrantes del grupo y los sectores que detentan el poder para modificar circunstancias que impiden el cumplimiento de las políticas públicas y la legislación vigente.

RESUMO Objetivo: Analisar as ações de vigilância epidemiológica para pessoas com câncer na perspectiva do advocacy. Método: Estudo qualitativo, do tipo Pesquisa Convergente Assistencial, aliado ao referencial da advocacia em saúde. Realizado na Vigilância Epidemiológica da Secretaria de Saúde de um município na região Sul do Brasil. Resultados: Participaram 11 profissionais de serviços de saúde, entre junho de 2020 a julho de 2021, perfazendo 14 reuniões do grupo. Discutiram-se dois aspectos: (1) problemas envolvendo a gestão do processo de trabalho nos serviços da rede, que influenciam diretamente na assistência ao usuário; e (2) problemas relacionados à gestão da formação do profissional que atende nestes serviços, onde o desconhecimento relativo às legislações traz consequências graves para os usuários. Conclusão O advocacy fortaleceu conceitos e concepções de defesa à saúde, mobilizando ações relativas ao câncer, atuando como uma ponte entre os membros do grupo e os setores que detêm poder para modificar circunstâncias que impeçam o cumprimento das políticas públicas e da legislação vigente.

Reducing the Emergency Department Revolving Door Syndrome for the Poor, Uninsured, and Chronically Ill Patient in Los Angeles: Process Improvement Recommendations from a County Health Program Evaluation.

My Health LA (MHLA), a Los Angeles countywide health program, connects eligible uninsured poor residents with partner primary care clinics and a range of free health care services. Nevertheless, primary care nonengagement and inadequate emergency department (ED) visits remained significant in this population in fiscal year 2015-2016. This evaluation examined the structure, process and outcomes of MHLA at select participating agencies to delineate pilot improvement models. Five sites were selected for the program evaluation, including a large urban ED, its affiliated urgent care clinic, and 3 partner primary care clinics. Data inquiry, interagency observations, and patient and workforce interviews were conducted. The structure, process, and outcomes of the program were evaluated and compared with other evidence-based interventions with similar populations. Successes identified in the enrollment pathway included free primary care services, use of a navigator in the ED, and perceived improvement to chronic illness management. Challenges identified included flawed program perceptions, patient communication gaps, and current program limitations. A 5-fold pilot process improvement model was proposed: enhancement of communication surrounding the patient, enhancement of communication with the patient at enrollment, enhancement of patient care coordination, initiation of financial incentives for clinics with satisfactory enrollee engagement, and expansion of service coverage. The proposed model can be applied to promote primary care engagement and adequate ED use for similar underserved populations elsewhere.