RESUMO
BACKGROUND: The Choosing Wisely® Campaign (CWC) was launched in 2012. Five recommendations to reduce the use of "low-value" services in hospitalized children were published in 2013. OBJECTIVES: The aim of this study was to estimate the frequency and trends of utilization of these services in tertiary children's hospitals five years before and after the publication of the recommendations. METHODS: We conducted a retrospective, longitudinal analysis of hospitalizations to 36 children's hospitals from 2008 to 2017. The "low-value" services included (1) chest radiograph (CXR) for asthma, (2) CXR for bronchiolitis, (3) relievers for bronchiolitis, (4) systemic steroids for lower respiratory tract infection (LRTI), and (5) acid suppressor therapy for uncomplicated gastroesophageal reflux (GER). We estimated the annual percentages of the use of these services after risk adjustment, followed by an interrupted time series (ITS) analysis to compare trends before and after the publication of the recommendations. RESULTS: The absolute decreases in utilization were 36.6% in relievers and 31.5% in CXR for bronchiolitis, 24.1% in acid suppressors for GER, 20.8% in CXR for asthma, and 2.9% in steroids for LRTI. Trend analysis showed that one "low-value" service declined significantly immediately (use of CXR for asthma), and another decreased significantly over time (relievers for bronchiolitis) after the CWC. CONCLUSIONS: There was some decrease in the utilization of "low-value" services from 2008 to 2017. Limited changes in trends occurred after the publication of the recommendations. These findings suggest a limited impact of the CWC on clinical practice in these areas. Additional interventions are required for a more effective dissemination of the CWC recommendations for hospitalized children.
Assuntos
Criança Hospitalizada , Guias como Assunto/normas , Hospitais Pediátricos/normas , Hospitais Pediátricos/tendências , Adolescente , Asma/terapia , Bronquiolite/terapia , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos/economia , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Infecções Respiratórias/terapia , Estudos RetrospectivosRESUMO
OBJETIVO: Analisar a satisfação de idosos octogenários com os serviços de Atenção Primária à Saúde. MÉTODO: Estudo descritivo, com abordagem quantitativa, realizado com 30 idosos usuários da Estratégia Saúde da Família, selecionados por amostra não probabilística. Os dados foram coletados em domicílio, através dos seguintes questionários: Mini-exame do estado mental, questionário sociodemográfico, condições de saúde e acesso aos serviços e questionário de Satisfação com os Cuidados Primários de Saúde. Os dados foram analisados por meio de estatística descritiva. RESULTADO: A análise da satisfação evidenciou que os idosos octogenários estão satisfeitos quanto à atenção ( X´=6,0;±1,5X´=6,0;±1,5 ) e ao interesse que os agentes comunitários dispendem a eles ( X´=5,9;±1,6X´=5,9;±1,6 ) e a disponibilidade do Enfermeiro para lhes tratar ( X´=5,9;±1,1X´=5,9;±1,1 ). Os aspectos relacionados ao tempo de espera pelo atendimento dos Enfermeiros ( X´=4,6;±1,6X´=4,6;±1,6 ) e Médicos ( X´=4,9;±1,6X´=4,9;±1,6 ), instalações para deficientes ( X´=4,6;±1,4X´=4,6;±1,4 ) e percepção de que a unidade está próxima de uma unidade de saúde perfeita ( X´=4,6;±1,8X´=4,6;±1,8 ). CONCLUSÃO: os achados evidenciaram boa avaliação dos serviços e refletem a importância de se considerar a perspectiva dos usuários octogenários no planejamento das ações em saúde, já que a avaliação da qualidade desses serviços é capaz de instituir mudanças e direcionar as ações de forma a fazer sentido às realidades de vida dos usuários com maiores chances de efetividade, em especial direcionadas a população idosa octogenária.
METHOD: a descriptive study, with a quantitative approach, was carried out with 30 older users of the Family Health Strategy, selected by a non-probabilistic sample. Data were collected at home, using the following questionnaires: the mini-mental state exam, a questionnaire on sociodemographic factors, health conditions and access to services, and a questionnaire on satisfaction with Primary Health Care. Data were analyzed using descriptive statistics. RESULT: The satisfaction analysis showed that the elderly octogenarians are satisfied in terms of care ( X´=6,0;±1,5X´=6,0;±1,5 ) and the interest that community agents demonstrate in them ( X´=5,9;±1,6X´=5,9;±1,6 ) and the availability of nurses for their treatment ( X´=5,9;±1,1X´=5,9;±1,1 ). Aspects related to the waiting time for nurses ( X´=4,6;±1,6X´=4,6;±1,6 ) and doctors ( X´=4,9;±1,6X´=4,9;±1,6 ), facilities for the disabled ( X´=4,6;±1,4X´=4,6;±1,4 ) and the perception that the unit is close to a perfect health unit ( X´=4,6;±1,8X´=4,6;±1,8 ). CONCLUSION: The services were positively evaluated, reflecting the importance of considering the perspective of octogenarian users in the planning of healthcare actions, since the evaluation of the quality of these services can lead to changes and guide actions in a way that is coherent with the lives of users, increasing their effectiveness, especially regarding actions aimed at the octogenarian population.
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Atenção Primária à Saúde , Satisfação do Paciente , Nível de Saúde , Estudos Transversais , Inquéritos e Questionários , Acessibilidade aos Serviços de SaúdeRESUMO
INTRODUCTION: This study evaluated knowledge about HIV/AIDS in elders using the services of Family Health Strategy. METHODS: Cross-sectional, descriptive, and analytical study involving 238 participants. Mini-Mental State Examination and QHIV3I were applied. RESULTS: About 30% of participants had active sexual lives and 5.5% used condoms consistently. The question with the highest score of right answers was about transmission through needles (95%) and the lowest (52.5%) was about whether individuals infected with the virus always displayed symptoms. CONCLUSIONS: It is necessary to train health professionals to develop actions that encourage elders to take preventive measures.
Assuntos
Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/psicologia , Síndrome da Imunodeficiência Adquirida/transmissão , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , População UrbanaRESUMO
Abstract INTRODUCTION: This study evaluated knowledge about HIV/AIDS in elders using the services of Family Health Strategy. METHODS: Cross-sectional, descriptive, and analytical study involving 238 participants. Mini-Mental State Examination and QHIV3I were applied. RESULTS: About 30% of participants had active sexual lives and 5.5% used condoms consistently. The question with the highest score of right answers was about transmission through needles (95%) and the lowest (52.5%) was about whether individuals infected with the virus always displayed symptoms. CONCLUSIONS: It is necessary to train health professionals to develop actions that encourage elders to take preventive measures.