[Financing and management: the technical efficiency in public health expenditures of small-scale municipalities in the state of Santa Catarina]. / Financiamento e gestão: a eficiência técnica dos municípios catarinenses de pequeno porte nos gastos públicos com saúde.

In a context of budget constraints and fiscal austerity measures, the discussion of issues related to the efficient management of public resources is a major challenge. The scope of this study was to assess the technical efficiency of municipalities of the State of Santa Catarina in public health expenditures and its relationship with health management conditions in the years 2009 and 2015. In order to measure efficiency, the decision was made to use Data Envelopment Analysis. The G Index was used to analyze the spatial efficiency autocorrelation. For the evaluation of the conditions for health management, the model proposed by Calvo et al. was adopted. Of the total number of municipalities analyzed, 35.5% and 29% were considered efficient, for the years 2009 and 2015, respectively. The results suggest that there is no association between the conditions for health management and technical efficiency in the State of Santa Catarina. The study revealed the need to move forward in the quest for better results in terms of efficiency in the State of Santa Catarina, taking into consideration the spatial distribution of these results over the territory, focusing on clusters of inefficiency that may explain the poor performance in health of some regions of the state.

Em um contexto de restrição orçamentária e de medidas de austeridade fiscal, discutir aspectos relacionados à gestão eficiente dos recursos públicos é um desafio. O objetivo deste estudo foi avaliar a eficiência técnica de municípios catarinenses nos gastos públicos com saúde e sua relação com as condições para a gestão em saúde nos anos de 2009 e 2015. Para medir a eficiência, optou-se pela Análise Envoltória de Dados. O Índice G foi empregado para analisar a autocorrelação espacial da eficiência. Para a avaliação das condições para a gestão em saúde, adotou-se o modelo proposto por Calvo et al. Do total de municípios analisados, 35,5% e 29% foram considerados eficientes, respectivamente para os anos de 2009 e 2015. Os resultados sugerem não haver associação entre as condições para a gestão em saúde e a eficiência técnica no estado de Santa Catarina. O estudo revelou a necessidade de se avançar na busca por melhores resultados de eficiência em Santa Catarina, devendo ser considerada a distribuição espacial destes resultados sobre o território, com enfoque sobre os clusters de ineficiência que podem explicar o fraco desempenho em saúde de algumas regiões do estado.

Modelo para avaliação da efetividade da atuação fisioterapêutica na atenção básica / Model for evaluating the effectiveness of physiotherapeutic activities in primary care

RESUMO A pesquisa objetivou elaborar um modelo para avaliação da efetividade da atuação fisioterapêutica na atenção básica. O modelo foi elaborado com base na literatura, em entrevistas com experts envolvidos na atuação fisioterapêutica na Atenção Básica à Saúde e conferência de consenso para validação com especialistas. A matriz avaliativa proposta é composta por três dimensões - ações assistenciais, de gestão e de promoção de saúde - e nove indicadores. Esse modelo proposto será posteriormente aplicado para verificar sua aplicabilidade, necessidade de ajustes e possibilidade de replicação em diferentes contextos.

ABSTRACT The research aimed to develop a model to evaluate the effectiveness of physiotherapeutic activities in primary care. The model was elaborated based on the literature, through interviews with experts involved in physiotherapeutic activities in Primary Health Care and a consensus conference for validation with specialists. The proposed evaluation matrix is composed of three dimensions - care, management and health promotion actions - and nine indicators. This proposed model will be later applied to verify its applicability, the need for adjustments and the possibility of replication in different contexts.

Financiamento e gestão: a eficiência técnica dos municípios catarinenses de pequeno porte nos gastos públicos com saúde / Financing and management: the technical efficiency in public health expenditures of small-scale municipalities in the state of Santa Catarina

Resumo Em um contexto de restrição orçamentária e de medidas de austeridade fiscal, discutir aspectos relacionados à gestão eficiente dos recursos públicos é um desafio. O objetivo deste estudo foi avaliar a eficiência técnica de municípios catarinenses nos gastos públicos com saúde e sua relação com as condições para a gestão em saúde nos anos de 2009 e 2015. Para medir a eficiência, optou-se pela Análise Envoltória de Dados. O Índice G foi empregado para analisar a autocorrelação espacial da eficiência. Para a avaliação das condições para a gestão em saúde, adotou-se o modelo proposto por Calvo et al. Do total de municípios analisados, 35,5% e 29% foram considerados eficientes, respectivamente para os anos de 2009 e 2015. Os resultados sugerem não haver associação entre as condições para a gestão em saúde e a eficiência técnica no estado de Santa Catarina. O estudo revelou a necessidade de se avançar na busca por melhores resultados de eficiência em Santa Catarina, devendo ser considerada a distribuição espacial destes resultados sobre o território, com enfoque sobre os clusters de ineficiência que podem explicar o fraco desempenho em saúde de algumas regiões do estado.

Abstract In a context of budget constraints and fiscal austerity measures, the discussion of issues related to the efficient management of public resources is a major challenge. The scope of this study was to assess the technical efficiency of municipalities of the State of Santa Catarina in public health expenditures and its relationship with health management conditions in the years 2009 and 2015. In order to measure efficiency, the decision was made to use Data Envelopment Analysis. The G Index was used to analyze the spatial efficiency autocorrelation. For the evaluation of the conditions for health management, the model proposed by Calvo et al. was adopted. Of the total number of municipalities analyzed, 35.5% and 29% were considered efficient, for the years 2009 and 2015, respectively. The results suggest that there is no association between the conditions for health management and technical efficiency in the State of Santa Catarina. The study revealed the need to move forward in the quest for better results in terms of efficiency in the State of Santa Catarina, taking into consideration the spatial distribution of these results over the territory, focusing on clusters of inefficiency that may explain the poor performance in health of some regions of the state.

Depression associated variables among lower limb amputees in Santa Catarina State - Brazil / Fatores associados à depressão em pacientes amputados de membros inferiores no Estado de Santa Catarina - Brasil

The amputation of the lower limbs and depression has been studied by different groups with a wide prevalence range and some variables were related to depressive symptoms. Depression and anxiety have been related with a major impact on adherence to rehabilitation, functional prognosis, and quality of life. Knowing the patients at highest odds of presenting depressive symptoms may favor an early approach and treatment, ultimately optimizing the rehabilitation process and social reintegration. Depression can be related to a lower rate of adaptation to the prosthesis and its use. Objective: To determine the association among demographic, socioeconomic, clinical variables with depressive symptoms in amputees before the prosthetic adaptation. Methods: A case-control study was performed to analyze variables associated with depression (Beck Depression Inventory-II) in lower limb amputees. Results: Patients with previous depression (OR= 17,08; CI95:2,14-136,28) and low socioeconomic class (OR= 3,04; CI95:1,24-7,47) are at highest odds of depression after amputation in the state of Santa Catarina. The model explained 71,4% of cases, classifying 88,1% of negative and 23,8% of positive cases. According to our model amputees recruited rarely presented the diagnosis of depression if they belong to a higher socioeconomic class and have no previous depression. On the other hand, patients who presented Brazilian low socioeconomic class D-E, and previous depression should be referenced to a psychological evaluation because they have a chance of depression, close to 1 in 4 cases. Conclusion: Previous depression and low social class were associated with the highest odds of depression after amputation in our population.

Sintomas depressivos em pacientes com amputação de membros inferiores foram foco de diversos estudos, com amplos intervalos de prevalência encontrados, e algumas variáveis foram relacionadas com os sintomas depressivos. Depressão e ansiedade têm grande impacto na aderência à reabilitação, no prognóstico funcional e na qualidade de vida. Conhecer os pacientes que têm maior risco de apresentar sintomas depressivos pode favorecer uma abordagem precoce e seu tratamento, potencializando a reabilitação, a reinserção social, a adaptação à prótese e seu uso. Objetivo: Determinar associação entre fatores demográficos, socioeconômicos, e clínicos com sintomas depressivos em pacientes amputados antes da protetização. Métodos: Estudo tipo caso-controle para avaliar fatores associados - dados demográficos, socioeconômicos e comorbidades - à depressão (utilizando escala de depressão de Beck-II) em pacientes com amputação de membro inferior. Resultados: Pacientes com depressão prévia (OR= 17,08, IC95:2,14-136,28) e baixa classe social (OR= 3,04, IC95:1,24-7,47) apresentam alta chance de depressão após amputação em Santa Catarina. O modelo explica 71.4% dos casos, classificando adequadamente 88,1% dos negativos e 23,8% dos positivos. E encontrou-se maior capacidade de predizer casos negativos - amputados raramente apresentaram diagnóstico de depressão se pertenciam a uma classe social mais alta e se não tinham diagnóstico prévio de depressão. Pacientes de classes sociais D-E, e diagnóstico prévio de depressão devem ser referenciados para avaliação psicológica devido à chance de depressão próxima de 1 a cada 4 casos. Conclusão: Depressão prévia à amputação e classes sociais mais baixas apresentaram maior chance de desenvolver sintomas depressivos após amputação na população estudada.

[Serum lipids in school kids and adolescents from Florianópolis, SC, Brazil--Healthy Floripa 2040 study]. / Lípides séricos em crianças e adolescentes de Florianópolis, SC--Estudo Floripa saudável 2040.

OBJECTIVE: To determine the distribution of serum lipids in children and adolescents of Florianopolis, Santa Catarina State, Brazil. To determine the association between undesirable levels for total cholesterol (>170 mg/dL) and others coronary heart disease risks factors. METHODS: A questionnaire, physical examination and blood analyses were collected from randomized sample from school kids aged range from 7 to 18 years old. RESULTS: 1,053 students participated, aged between 7 and 18 years old. They presented a total cholesterol mean of 162+/-28 mg/dl, triglyceride mean of 93+/-47 mg/dl, HDL-cholesterol mean of 53+/-10 mg/dl, LDL-cholesterol mean of 92+/-24 mg/dl and non-HDL cholesterol mean of 109+/-26 mg/dl. The TC/HDL and LDL/HDL mean rates were, respectively, 3.1+/-0.6 and 1.8+/-0.5. Findings showed that private school children, 10 years old or less, girls and black children had higher lipids values. Overall findings suggest that the best logistic regression model which explained abnormal total cholesterol levels included: obesity, stroke and heart attack familial history, feminine gender, age of 10 years old or less and overweight body image determined on inspection. CONCLUSION: In comparison to international literature, our results, showed intermediated total cholesterol, lower LDL-cholesterol and non-HDL-cholesterol and higher HDL-cholesterol. Therefore, primary prevention programs are needed to be carrying out, especially among overweight children and adolescents so to prevent ischemic heart disease as adulthood.

[Epidemiological aspects of oral health among the elderly in Brazil]. / Aspectos epidemiológicos da saúde bucal do idoso no Brasil.

All indexed articles in BBO, LILACS, and MEDLINE databases from January 1998 to July 2001 were searched to analyze information on oral health among the elderly in Brazil. The year 1998 was used as a starting point, since this was the year the National Epidemiological Survey was published. Twenty-nine articles were found, of which 7 were analyzed in detail regarding key methodological aspects (age, sampling, data presentation) and the results were presented (DMFT index, proportion of missing teeth, edentulousness rate, and use and need of dental prostheses). DMFT ranged from 26.8 to 31.0, with approximately 84% of teeth missing. Prevalence of edentulousness was 68%. Few elderly did not need or use any kind of prosthesis. Denture use was more frequent in the upper than in the lower jaw. Lack of standardized data hampered an understanding of some key aspects of data analysis. Both data presentation and methodology must be improved in future research in this area. Despite all these caveats, the literature review confirmed the poor oral health of the Brazilian elderly population.

[Intra-urban differentials in Florianópolis, Santa Catarina State, Brazil, and their potential use in health services planning]. / Diferenciais intra-urbanos no Município de Florianópolis, Santa Catarina, Brasil: potencial de uso para o planejamento em saúde.

Based on the premise that spatial occupation by the population is a socially constructed process, the present study identified and grouped homogeneous sectors vis-à-vis living conditions in the municipality of Florianópolis, Santa Catarina State, Brazil. Among socioeconomic variables from the Brazilian national census, the study identified and selected those which best represent the intra-urban differentials in living conditions in Florianópolis. The variables were categorized according to uniformity in the groups and orientation from the literature. Factor correspondence analysis was used for sector grouping. High income, low income, high schooling, illiteracy, and sub-standard garbage collection were the variables used to define grouping. As a result, the authors were able to divide the municipality into four homogeneous groups: two opposite groups having the best and worst schooling and income, and two median groups in which access to public services defines the hierarchical level. The northern and southern regions of Florianópolis were identified as receiving the greatest attention from the city administration. A heterogeneous distribution of households within sectors was identified, whereby Florianópolis was characterized as not presenting large agglomerations of poverty; however, this should not be interpreted as the absence of a poor population in the municipality.

Model for the evaluation of drug-dispensing services in primary health care.

OBJECTIVE: To develop a model for evaluating the efficacy of drug-dispensing service in primary health care. METHODS: An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires. RESULTS: The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension. CONCLUSIONS: Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system.

Conflitos com o paciente, cor/raça e concepções de estudantes de Odontologia: uma análise com graduandos no Sul do Brasil / Conflicts with the patient, race and conceptions held by Dental students: The case of undergraduates from Southern Brazil

Resumo Os processos sócio-históricos ocorridos no Brasil resultaram em desigualdades de saúde entre diferentes grupos étnico-raciais. A fim de investigar tais desigualdades na Odontologia, este estudo buscou avaliar se concepções de seus graduandos variam em função da cor/raça de um paciente, quando confrontados com a discordância dele e a necessidade de identificar fatores responsáveis pelo insucesso do tratamento. Os dados foram coletados com um questionário autopreenchível, respondido por 166 alunos matriculados em um curso de Odontologia no Sul do Brasil. Apresentou-se um caso clínico hipotético aos estudantes em dois momentos distintos: no primeiro, o paciente foi caracterizado com a cor negra; no segundo, branca. Os casos demandavam tratamento de um problema dental idêntico, após o qual foram aplicadas perguntas abertas, cujas respostas foram examinadas por meio da Análise de Conteúdo Temática. Os resultados sugerem um comportamento menos respeitoso e menos autonomia dada ao paciente negro em relação ao branco. Os pacientes negros também foram mais responsabilizados por falhas no tratamento, quando comparados a seus pares brancos. Com base nesses resultados, sugerimos que a formação dos profissionais de saúde se concentre no tema das desigualdades raciais, para melhor equipá-los para a construção de uma sociedade menos desigual.

Abstract The socio-historical processes that occurred in Brazil resulted in health inequalities between different ethnic and racial groups. This study aimed to assess whether the conceptions held by Dental students vary according to the patient's race, when a hypothetic patient disagrees with the proposed treatment, as well as when the treatment fails. Data were collected with a self-completed questionnaire, which was administered to 166 undergraduate students living in Southern Brazil. The questionnaire was presented with a hypothetical clinical scenario on two different occasions; in the first one, the patient was black and, in the second one, white. On both occasions, the case asked about treatment decisions of a similarly affected tooth, after which the respondent had to answer some open-ended items. The answers were analyzed with Thematic Content Analysis. Results suggest a less respectful behavior towards and less autonomy given to the black patient, as compared with the white one. Black patients were also more responsible for treatment failures as compared to their white peers. Based on these results, we suggest that the training of health professionals should focus on the issue of racial inequalities, to better equip them to build a less unequal society.

[The development of evaluation capacity in primary healthcare management: a case study in Santa Catarina State, Brazil, 2008-2011]. / Desenvolvimento da capacidade avaliativa na gestão da atenção básica: um estudo de caso exemplar em Santa Catarina, Brasil, de 2008 a 2011.

This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved.

[Evaluation of municipal management of the Brazilian National School Nutrition Program in the largest cities of Santa Catarina State, Brazil]. / Avaliação da gestão municipal do Programa Nacional de Alimentação Escolar nos maiores municípios de Santa Catarina, Brasil.

This article reports on an evaluative study of municipal management of the Brazilian National School Nutrition Program in the largest cities in Santa Catarina State, Brazil. The matrix of indicators included two dimensions: political-organizational, with the sub-dimensions resources, inter-sector action, and social control, and operational-technical, organized in nutritional and feeding efficacy, nutritional monitoring, and educational activities for a healthy diet. A total of 22 indicators were determined, and data were collected through interviews with nutritionists. The political-organizational dimension showed 60% of fair cases and 40% of poor cases, while the operational-technical dimension showed 90% of poor cases, resulting from low performance in monitoring and educational activities. Although the cases showed unsatisfactory results, the evaluation provides important data on the management of the Brazilian National School Nutrition Program. The study emphasizes the importance of evaluation for alerting managers to the relevance of reviewing and upgrading activities.

The Linear Programming to evaluate the performance of Oral Health in Primary Care.

OBJECTIVE: To show the use of Linear Programming to evaluate the performance of Oral Health in Primary Care. METHODS: This study used data from 19 municipalities of Santa Catarina city that participated of the state evaluation in 2009 and have more than 50,000 habitants. A total of 40 indicators were evaluated, calculated using the Microsoft Excel 2007, and converted to the interval [0, 1] in ascending order (one indicating the best situation and zero indicating the worst situation). Applying the Linear Programming technique municipalities were assessed and compared among them according to performance curve named "quality estimated frontier". Municipalities included in the frontier were classified as excellent. Indicators were gathered, and became synthetic indicators. RESULTS: The majority of municipalities not included in the quality frontier (values different of 1.0) had lower values than 0.5, indicating poor performance. The model applied to the municipalities of Santa Catarina city assessed municipal management and local priorities rather than the goals imposed by pre-defined parameters. In the final analysis three municipalities were included in the "perceived quality frontier". CONCLUSION: The Linear Programming technique allowed to identify gaps that must be addressed by city managers to enhance actions taken. It also enabled to observe each municipal performance and compare results among similar municipalities.

Execução financeira dos blocos de financiamento da saúde nos municípios de Santa Catarina, Brasil / Financial execution of health financing blocks in the municipalities of Santa Catarina, Brazil

RESUMO Foi analisada a utilização dos recursos transferidos de outras instâncias federativas aos blocos de financiamento da saúde pelos municípios de Santa Catarina. Trata-se de um estudo descritivo dos anos de 2009 e 2015. Observou-se que os municípios investem recursos próprios em saúde muito além do recomendado legalmente, no entanto, não conseguem fazer uso integral dos recursos de transferência direta efetuados pelo estado e pela União aos blocos de financiamento da saúde. Nota-se, porém, diminuição expressiva no montante de recurso subutilizado no período analisado, o que sinaliza a melhoria da capacidade de gestão dos recursos de transferência direta.

ABSTRACT The use of the resources transferred from other federative instances to health financing blocks by the municipalities of Santa Catarina was analyzed. This is a descriptive study of the years 2009 and 2015. It was observed that municipalities invest their own health resources well beyond what is legally recommended, however, they cannot make full use of the direct transfer resources made by the state and the Union to the blocks of health financing. It is noted, however, a significant reduction in the amount of resources underutilized in the analyzed period, which indicates an improvement in the capacity to manage direct transfer resources.

Avaliação do grau da implantação das práticas integrativas e complementares na Atenção Básica em Santa Catarina, Brasil / Implementation level assessment of integrative and complementary practices in Primary Health Care in Santa Catarina, Brazil

RESUMO Esta pesquisa desenvolveu e aplicou um modelo de avaliação do grau de implantação das Práticas Integrativas e Complementares (PIC) na Atenção Básica nos municípios de Santa Catarina (SC) utilizando dados do segundo ciclo da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). O modelo demonstrou viabilidade de aplicação nos 293 municípios de SC, classificando-os por graus de implantação: 35 municípios (11,9%) apresentaram implantação incipiente; 46 (15,7%) estavam parcialmente implantados; 50 (17,1%), implantados; e 162 (55,3%) municípios não ofertavam PIC. Este modelo serve para avaliar as PIC em outros estados do Brasil.

ABSTRACT This research developed and applied and assessment model of implementation levels as for the Integrative and Complementary Practices (PIC) in Primary Care in the municipalities of the State of Santa Catarina by means of data provided by the second phase of National Program for Access and Quality Improvement in Primary Care - PMAQ-AB's database. The empirical application of the model demonstrated to be feasible in the 293 municipalities of Santa Catarina since it was able to classify them as to levels of implementation: 35 municipalities (11.9%) revealed incipient level of implementation; 46 (15.7%) had partially implemented; 50 (17.1%) had fully implemented; and 162 (55.3%) municipalities did not deploy the service. The model here designed is adequate to evaluate the implementation of the PIC in other Brazilian states.

Modelo para avaliação da integração ensino-serviço em Unidades Docentes Assistenciais na Atenção Básica / Model for assessment of teaching-service integration in Teaching Service Units in Primary Care

RESUMO A pesquisa objetivou elaborar um modelo para avaliação da efetividade da integração ensino-serviço na Atenção Básica. O modelo foi elaborado com base na literatura, consulta aos atores envolvidos na integração (gestão, serviço, comunidade e ensino) e técnicas de consenso com discussão de especialistas para validação. O modelo teórico-lógico foi construído com suporte na legislação da saúde e educação. A matriz avaliativa proposta é composta por quatro dimensões e dez indicadores. Posteriormente o modelo proposto será utilizado no intuito de verificar sua aplicabilidade, a necessidade de ajustes e a possibilidade de replicação em diferentes contextos.

ABSTRACT This research aimed to develop a model for evaluating the effectiveness of the teaching-service integration in Primary Health Care. The model was based on literature, consult with the actors involved in the integration (management, service community and education) and consensus techniques with discussion of experts for validation. The theoretical-logical model was built with support in health and education legislation. The proposed evaluative matrix is composed of four dimensions and ten indicators. Posteriorly, the proposed model will be used to verify its applicability, the need for adjustment and the possibility of replication in different contexts.

To Extract or to Restore the Tooth? Color/Race and Clinical Decision Making among Undergraduate Dental Students from Southern Brazil

Objective: To evaluate whether the color/race of a hypothetical patient is associated with the clinical decision to extract or restore a specific tooth, as well as with the recommendation for additional procedures for its adequate treatment. Material and Methods: Respondents assessed an anterior tooth with an extensive carious lesion and were asked: whether it should be extracted or restored; how much time should be spent in the first consultation; whether or not root canal retreatment was necessary; and whether complementary exams should be requested. While a Black hypothetical patient was assessed in the first stage of data collection, a White individual was subsequently shown to the study respondents. Results: The clinical decision on whether to extract or restore the decayed tooth was not associated with the patient's color/race (p=0.64). The mean time estimated for the first clinical consultation (p=0.28), the need for root canal retreatment (p=0.56), as well as the request for complementary exams were not associated with the patient's color/race (p=0.82). Analyses stratified by the participants' characteristics confirmed the lack of such an association. Conclusion: As opposed to previously published findings in Brazil, the patient's color/race was not associated with clinical decision making among undergraduate dental students.

Integração ensino-serviço e suas perspectivas avaliativas: a percepção dos envolvidos / Education-service integration and evaluative perspectives: the perception of the involved / Integración enseño-servicio y sus perspectivas evaluativas: la percepcion de los participantes

O estudo tem como objetivos identificar os elementos fundamentais para a efetividade da integração ensino-serviço e conhecer seus indicadores de avaliação, com base na percepção dos indivíduos envolvidos no processo. Trata-se de pesquisa exploratória, que utilizou entrevistas e questionários, aplicados aos representantes da gestão, da universidade, dos profissionais do serviço e da comunidade. Após análise e categorização foram identificados como condicionantes para uma efetiva integração: a institucionalização; a longitudinalidade da atenção; o compromisso com o Sistema Único de Saúde; a estrutura, o planejamento e a avaliação permanente. Os resultados indicaram que as unidades de saúde que possuem integração ensino-serviço têm mais qualidade e efetividade quando: ampliam os conceitos de saúde dos envolvidos; propiciam satisfação ao serviço prestado e ao ambiente de trabalho; contribuem para o aumento da motivação e formação permanente dos indivíduos; e expandem seus índices de resolubilidade. Concluiu-se que, frente aos desafios da integração ensino-serviço no país, a concepção de incorporar a participação dos atores do processo na construção de indicadores avaliativos e de uma matriz de avaliação tende a qualificar ainda mais as práticas e experiências realizadas.

The study aims to identify the key elements for the effectiveness of teaching-service integration and its evaluation indicators, based on the perception of the individuals involved in the process. This is an exploratory research, which used interviews and questionnaires, applied to management representatives, of university, service professionals and community. After analysis and categorization, as conditions for effective integration, were identified: the institutionalization; longitudinality of attention; commitment to Unified Health System; structure, planning and permanent evaluation. The results indicated that the health facilities with teaching-service integration have more quality and effectiveness when: expand the concepts of health of those involved; provide satisfaction in service and in the work environment; contribute to increasing the motivation and ongoing training of individuals and expand their solving indices. In conclusion, considering the challenges of teaching-service integration in the country, the conception of incorporating the participation of process' actors in the construction of evaluative indicators and of an evaluation matrix tends to qualify even more the practices and experiences carried out.

El estudio tiene como objetivos identificar los elementos fundamentales para la efectividad de la integración de la enseño-servicio y conocer sus indicadores de evaluación, basado en la percepción de los individuos implicados en el proceso. Tratase de una investigación exploratoria, que utilizó entrevistas y cuestionarios, aplicados a los representantes de la gestión, de la universidad, de los profesionales del servicio y de la comunidad. Después del análisis y categorización fueron identificados como condicionantes para una efectiva integración: la institucionalización; la longitudinalidad de la atención; el compromiso con el Sistema Único de Salud; la estructura, la planificación y la evaluación permanente. Los resultados indicaron que los establecimientos de salud que cuentan con la integración enseño-servicio tienen más calidad y eficacia cuando: extienden los conceptos de salud de las personas implicadas; proveen satisfacción al servicio prestado y al ambiente de trabajo; contribuyen para el aumento de la motivación y formación permanente de individuos y amplían sus índices de solución. Concluyóse que, frente a los desafíos de la integración enseño-servicio en el país, la concepción de incorporar la participación de los actores del proceso en la construcción de indicadores evaluativos y de una matriz de evaluación tiende a calificar aún más las prácticas y experiencias realizadas.

Evaluation of actions concerning systemic arterial hypertension in primary healthcare.

OBJECTIVE: To evaluate the efficiency of the Family Health Strategy in actions related to hypertension. METHODS: Evaluative, cross-sectional quantitative research based on secondary data of 66 small municipalities located in the state of Santa Catarina, Southern Brazil, with maximum potential coverage of 100% by the Family Health Strategy in 2007. Input indicators, products and results were evaluated. The municipalities' efficiency of services production and results production was compared through data envelopment analysis. RESULTS: The municipalities were more efficient in services production (37.8%) than in results production (16.6%). Forty-one municipalities (62.2%) were inefficient in the services: enrolment in the Hypertension and Diabetes Information System, individual assistance and home visit for hypertensive users, and 55 (83.3%) were inefficient in the production of impact against hypertension. CONCLUSIONS: The evaluation model used in this study proved to be capable of measuring efficiency in primary healthcare by evaluating the productivity of services and results.

Model for the evaluation of drug-dispensing services in primary health care / Modelo para avaliação do serviço de dispensação de medicamentos na atenção básica à saúde

OBJECTIVE To develop a model for evaluating the efficacy of drug-dispensing service in primary health care. METHODS An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires. RESULTS The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension. CONCLUSIONS Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system. .

OBJETIVO Elaborar modelo para avaliação da eficácia do serviço de dispensação de medicamentos na atenção básica à saúde.. MÉTODOS Foi adotado critério de eficácia para verificar o grau em que são alcançados os objetivos do serviço. O modelo de avaliação foi elaborado com base na literatura sobre o tema e na discussão com especialistas. O teste de aplicabilidade do modelo foi realizado em Florianópolis, SC, em 2010, em 15 unidades de saúde, com observação direta em formulário próprio para coleta de dados.. RESULTADOS O modelo apresentou-se adequado para avaliação da eficácia do serviço, elaborado com cinco dimensões de análise, permitindo identificar os pontos críticos de cada uma das dimensões do serviço.. CONCLUSÕES Adaptações à técnica de coleta de dados poderão ser necessárias para a realidade e necessidade de cada situação. A qualificação da dispensação deve propiciar o acesso qualificado aos medicamentos disponibilizados pela rede pública. .

Desenvolvimento da capacidade avaliativa na gestão da atenção básica: um estudo de caso exemplar em Santa Catarina, Brasil, de 2008 a 2011 / The development of evaluation capacity in primary healthcare management: a case study in Santa Catarina State, Brazil, 2008-2011 / Desarrollo de la capacidad de evaluación en la gestión de la atención primaria: un estudio de un ejemplo de caso en Santa Catarina, Brasil, 2008 a 2011

O artigo analisa o desenvolvimento da capacidade avaliativa em um caso exemplar de uma Secretaria de Estado da Saúde (SES) participante do Projeto de Fortalecimento da Capacidade Técnica das Secretarias Estaduais de Saúde em Monitoramento e Avaliação da Atenção Básica. Estudo de caso de abordagem mista, com informações provenientes de documentos, entrevistas semiestruturadas e da avaliação da atenção básica realizada pela SES no período de 2008-2011. Empregou-se a análise de processos para identificar os eventos lógicos que contribuíram para o desenvolvimento da capacidade avaliativa, com duas categorias: eventos de construção da capacidade avaliativa e eventos de construção de estrutura organizacional. A pactuação em instâncias deliberativas para a continuidade da avaliação, a coleta e análise dos dados realizada pela SES, a iniciativa de mudança de indicadores e reestruturação da matriz avaliativa e a comunicação dos resultados aos municípios formaram a cadeia lógica de eventos. A análise triangulada demonstrou que o objetivo de desenvolver a capacidade avaliativa foi alcançado.

This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved.

El artículo analiza el desarrollo de la capacidad de evaluación en un ejemplo de caso con una Secretaría de Estado de Salud (SES), participante en el Proyecto Fortalecimiento de la Capacidad Técnica de Vigilancia de la Salud del Estado y Evaluación de la Atención Primaria. Posee un enfoque de estudio de caso con información mixta de documentos, entrevistas semi-estructuradas y evaluación de la atención primaria, realizado por la SES en el período 2008-2011. Se aplicó un proceso de análisis para identificar eventos lógicos que contribuyeron al desarrollo de la capacidad de evaluación, con dos categorías: evaluación de construcción eventos de creación de capacidad y estructura organizativa del pacto en los cuerpos deliberativos para continuar con el proceso de evaluación, recopilación y análisis de datos en poder de la SES. Las iniciativas para cambiar los indicadores y la restructuración matriz de evaluación, además de informar sobre los resultados a los municipios, forman la cadena lógica de los acontecimientos. El análisis triangulado demostró que se ha alcanzado el objetivo de desarrollar una capacidad de evaluación.