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ABSTRACT The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.
RESUMO O 35º Congresso Brasileiro de Cirurgia foi marcado por discussões inovadoras para a educação cirúrgica no país. Pela primeira vez, o Colégio Brasileiro de Cirurgiões incluiu a Cirurgia Global na pauta principal do congresso, proporcionando uma oportunidade única de repensar como as habilidades cirúrgicas são ensinadas a partir de uma perspectiva de saúde pública. Essa discussão nos leva a considerar por que e como o ensino da Cirurgia Global deve ser expandido no Brasil. Embora pesquisadores e instituições brasileiras tenham contribuído para a expansão do campo desde 2015, as iniciativas de educação em Cirurgia Global ainda são incipientes em nosso país. Basear-se em estratégias bem-sucedidas pode ser um ponto de partida para promover a área entre os profissionais de cirurgia nacionais. Neste editorial, discutimos potenciais estratégias para expandir as oportunidades de educação em Cirurgia Global e propomos uma série de recomendações a nível nacional.
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ABSTRACT Objective: The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols. Methods: A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections. Results: Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%. Conclusion: Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.
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O Previne Brasil se mostra como novo modelo de financiamento de custeio da Atenção Primária à Saúde. Em reunião com uma Equipe de Saúde da Família (ESF) em Barão de Cocais, MG; realizada em outubro de 2021, identificou-se que os profissionais tinham dificuldades no uso do e-SUS, o que se traduzia em resultados desfavoráveis na avaliação dos indicadores de saúde. Com o objetivo de capacitar os profissionais das ESF no uso das ferramentas do e-SUS para alcançar os indicadores de Previne Brasil, surgiu um programa de Educação Permanente. A atividade de educação permanente foi orientada pelas concepções de metodologias ativas, utilizando-se como instrumento a problematização. Desenvolvida entre outubro e dezembro de 2021 teve como objeto da ação os profissionais da saúde das ESF. Após a realização da atividade e implementação dos conteúdos foi identificado identificamos que a meta foi alcançada em 57,14% dos indicadores avaliados, os que ainda não foram alcançados no primeiro quadrimestre do ano mostraram aumento e tendência a progressão para o resto do ano, conforme dados contidos no quadro 1. A experiência foi ampliada para o resto dos profissionais do município permitindo alcançar melhores resultados.
Previne Brasil is a new funding model for Basic Primary Health Care. In a work meeting with a Family Health Team ESF in Barão de Cocais, MG; carried out in October 2021, it was identified that the professionals had difficulties in using the e-SUS, which led to translated into unfavorable results in the evaluation of health indicators. So a Permanent Education Program was created to provide improvement on Previne Brasil indicators by training the professionals on using e-SUS tools. With the aim of training ESF professionals in the use of e-SUS tools to achieve the Previne Brasil indicators, a Permanent Education program was created. The permanent education activity was guided by the conceptions of active methodologies using problematization as an instrument. It took place Developed between October and December 2021, and the object of the action was health professionals from the Basic Health Care the ESF. After carrying out the activity and implementing the contents, it was identified that the goal was achieved reached in 57.14% of the evaluated indicators. The indicators those that were not reached in the first quarter four months of the year have shown an increase and a tendency to progress for the rest of the year, according to data contained in Table 1. The experience was passed on extended to other teams of the city, which provided better results. the rest of the professionals in the municipality, allowing better results to be achieved.
Sujets)
Indicateurs qualité santé , Systèmes d'information sur la santé , Formation continueRésumé
Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud
Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article's objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care
Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde
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Pratique factuelle , , Mécanismes d'évaluation des soins de santé , Indicateurs qualité santé , Science de la mise en oeuvreRésumé
ABSTRACT Objectives: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. Method: cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. Results: there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. Conclusion: the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.
RESUMO Objetivo: analisar o impacto do uso de checklists no tempo médio dos processos operatórios de pacientes submetidos a artroplastias de quadril e joelho. Método: pesquisa transversal e analítica realizada entre novembro/2020 e março/2022 com consulta retrospectiva em amostra aleatória simples de 291 prontuários, distribuídos em três períodos (2010/2013/2016). Utilizou-se estatística descritiva e inferencial para análise dos dados; valores de p=0,05 indicaram significância. Resultados: houve redução do tempo de entrada-saída da sala cirúrgica (p=0,002), de cirurgia (p<0,001) e entre o início-anestesia e início-incisão (p=0,021). Não houve diferença no tempo entre os pacientes com e sem o uso dos checklists (p=0,05) com relação às variáveis início-anestesia, início-incisão, tempo de anestesia e de cirurgia. Conclusão: a implantação de checklists potencialmente contribuiu para reduzir o tempo de uso da sala cirúrgica. A não associação de seu uso ao aumento do tempo médio dos processos no centro cirúrgico mostra que sua aplicação não interfere negativamente nesse indicador.
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Objetivo: identificar os indicadores relacionados ao processo transfusional. Método: revisão integrativa de literatura realizada entre março e maio de 2022, em nove fontes de informação no período de 2001 a 2021. Como estratégia de busca, utilizaram-se os descritores "Indicadores de Qualidade em Assistência à Saúde", "Indicadores de Serviços", "Indicadores Básicos de Saúde", "Serviço de Hemoterapia", "Transfusão de Sangue", "Segurança do Sangue", com os operadores boleanos "AND" e "OR" em três idiomas, sendo analisados 49 artigos. Resultados: foram identificados 53 indicadores, os quais se agruparam para: gestão do estoque de hemocomponentes, de produção do processo transfusional, para avaliação do processo transfusional e de suporte do processo transfusional. Conclusão: os indicadores identificados possibilitam avaliação do processo transfusional, apesar de atividades, como a avaliação do cuidado, apresentarem poucos indicadores, evidenciando a necessidade de estudos sobre a temática e construção de novos indicadores para dar sustentação à avaliação mais aprimorada do processo transfusional.
Objective: to identify transfusion-related indicators. Method: an integrative literature review carried out between March and May 2022, in nine sources of information from 2001 to 2021. As a search strategy, the descriptors "Quality Indicators in Health Care", "Service Indicators", "Basic Health Indicators", "Hemotherapy Service", "Blood Transfusion", "Blood Safety" were used, with Boolean operators "AND" and "OR" in three languages, with 49 articles being analyzed. Results: a total of 53 indicators were identified, which were grouped for: blood component stock management, transfusion process production, transfusion process assessment and transfusion process support. Conclusion: the identified indicators make it possible to assess the transfusion process, although activities, such as care assessment, present few indicators, highlighting the need for studies on the subject and the construction of new indicators to support a more improved transfusion process assessment.
Objetivo: identificar indicadores relacionados con el proceso de transfusión. Método: revisión integrativa de la literatura, realizada entre marzo y mayo de 2022, en nueve fuentes de información de 2001 a 2021. Como estrategia de busca, se utilizaron los descriptores "Indicadores de Calidad en la Atención de Salud", "Indicadores de Servicio", "Indicadores Básicos de Salud", "Servicio de Hemoterapia", "Transfusión de Sangre", "Seguridad de la Sangre", con operadores booleanos "AND" y "OR" en tres idiomas, analizando 49 artículos. Resultados: se identificaron 53 indicadores, los cuales fueron agrupados en: gestión del stock de hemocomponentes, producción del proceso transfusional, evaluación del proceso transfusional y apoyo al proceso transfusional. Conclusión: los indicadores identificados posibilitan la evaluación del proceso transfusional, aunque actividades, como la evaluación del cuidado, presenten pocos indicadores, destacando la necesidad de estudios sobre el tema y la construcción de nuevos indicadores que apoyen una evaluación más perfeccionada del proceso de transfusión.
Sujets)
Humains , Transfusion sanguine , Indicateurs des Services de Santé , Indicateurs qualité santé , Service D'hémothérapie , Sécurité transfusionnelleRésumé
ABSTRACT Objective: To analyze the quality of data collected during prenatal care recorded in the Integrated Health Care Management System (SIGA) of the Municipal Department of Health of São Paulo from 2012 to 2020. Methods: Descriptive study using SIGA data and the variables: maternal height (cm), weight (kg) measured throughout pregnancy, gestational age at prenatal consultation, systolic (SBP) and diastolic (DBP) blood pressure (in mmHg), and body mass index (BMI) at the beginning of pregnancy (up to 8 weeks). Quality analysis was carried out by calculating the indicators: percentage of incompleteness and zero values of all variables studied, percentage of implausible values for height, weight, BMI; preference for terminal digit of weight and height, and normality of distributions. Results: The database of pregnant women made available for analysis included 8,046,608 records and 1,174,115 women. The percentage of incompleteness and zero values was low (<1%) in all original variables of the system. There are more records at the end of pregnancy. For the four original variables of interest in the database (weight, height, SBP, DBP), there is a clear preference for the terminal digit. The variables of interest did not present an approximately normal distribution during the evaluated period. Conclusion: The quality analysis showed the need for improving the standardization of information collection and recording, the rounding of measurements and the need for encouraging pregnant women to start prenatal care as soon as possible, in such a way that it is important to invest in data quality, through educational resources for professionals who work in health care.
RESUMO Objetivo: Analisar a qualidade dos dados coletados no acompanhamento pré-natal registrados no Sistema Integrado de Gestão da Assistência à Saúde (SIGA) da Secretaria Municipal de Saúde de São Paulo de 2012 a 2020. Métodos: Estudo descritivo utilizando dados do SIGA e as variáveis: altura materna (cm), peso (kg) medido ao longo da gestação, idade gestacional na consulta pré-natal, pressão arterial (em mmHg) sistólica (PAS) e diastólica (PAD), e índice de massa corporal (IMC) no início da gestação (até 8 semanas). A análise da qualidade foi realizada por meio do cálculo dos indicadores: percentual de incompletude e valores zero de todas as variáveis estudadas, percentual de valores implausíveis de estatura, peso, IMC; preferência por dígito terminal do peso e estatura, e normalidade das distribuições. Resultados: Base de dados de gestantes disponibilizada para análise incluía 8.046.608 registros e 1.174.115 mulheres. O percentual de incompletude e valores zeros foi baixo (<1%) em todas as variáveis originais do sistema. Existe maior número de registros ao final da gestação. Para as quatro variáveis de interesse originais do banco de dados (peso, altura, PAS, PAD), existe clara preferência por dígito terminal. As variáveis de interesse não apresentaram distribuição aproximadamente normal durante o período avaliado. Conclusão: A análise da qualidade mostrou necessidade de melhoria na padronização da coleta e do registro das informações, no arredondamento das medidas e na necessidade de incentivar as gestantes a iniciar o pré-natal o quanto antes; por isso, é importante investir na qualidade do dado, por meio de recursos educativos para profissionais que atuam na assistência.
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Introducción: Las infecciones asociadas con la asistencia sanitaria se acompañan de altas tasas de morbilidad y mortalidad, incremento en los días de hospitalización y costos directos e indirectos, que constituyen un evento negativo para el paciente y la institución. Objetivo: Evaluar el programa nacional de prevención y control de las infecciones asociadas con la asistencia sanitaria en el Servicio de Terapia Intensiva Polivalente del Hospital Pediátrico Provincial Eduardo Agramonte Piña, según indicadores de estructura, proceso y resultados. Métodos: Se realizó una investigación en sistemas y servicios de salud, de tipo transversal. El universo de estudio estuvo constituido por todos los hospitales de la provincia Camagüey con más de 100 camas y la muestra a discreción por el Servicio de Intensiva Polivalente Pediátrica. La fuente de obtención de datos primarios estuvo conformada por un cuestionario aplicado por las autoras. Resultados: De los diez indicadores de estructura nueve con buena evaluación, de los cinco indicadores de proceso todos recibieron una buena evaluación al igual que los siete indicadores de la dimensión de resultados. Un total de 22 parámetros, de ellos 21 con evaluación de bien y uno de mal. Conclusiones: La evaluación final del programa de prevención y control de las infecciones asociadas con la asistencia sanitaria fue de satisfactoria debido a que sus tres dimensiones obtuvieron resultado adecuado.
Introduction: Infections associated with health care are accompanied by high morbidity and mortality rates, which translates into an increase in hospital days and care costs, which constitute a negative event for the patient and the institution. Objective: To evaluate the national program for the prevention and control of infections associated with health care in the Multipurpose Intensive Care Service of the Eduardo Agramonte Piña Provincial Pediatric Hospital, according to indicators of structure, process and results. Methods: A cross-sectional investigation was carried out on health systems and services. The universe of study was made up of all the hospitals in the Camagüey province with more than 100 beds and the sample at the discretion of the Pediatric Polyvalent Intensive Care Service. The primary data source was made up of a questionnaire applied by the authors. Results: Of the ten structure indicators, nine with a good evaluation, of the five process indicators, all received a good evaluation, as well as the seven indicators of the results dimension. A total of 22 parameters, of which 21 evaluated as good and one evaluated as bad. Conclusions: The final evaluation of the program for the prevention and control of infections associated with health care was satisfactory because its three dimensions obtained adequate results.
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Abstract Background International publications have shown that the COVID-19 pandemic has negatively impacted the indicators of care for ST-segment elevation acute myocardial infarction (STEMI), with a potential increase in morbidity and mortality. Objectives To compare mortality, time from symptom onset to primary angioplasty (total delay [TD]), time from symptom onset to initial medical contact (patient delay [PD]), and time from initial medical contact to guidewire insertion in the hemodynamics laboratory (system delay [SD]) among patients admitted for STEMI at the Hemodynamics Service of Santa Casa de Passos, Minas Gerais, Brazil before and after the declaration of the COVID-19 pandemic by the World Health Organization, assessing the impact of the COVID-19 pandemic on STEMI care indicators. Methods This is a before-and-after study involving patients hospitalized with STEMI undergoing primary angioplasty. Data were collected retrospectively through medical record review. Clinical and demographic profiles and outcomes between the pre-pandemic and pandemic groups were compared using the chi-square test for categorical variables or Student's t-test for continuous variables. A significance level of p < 0.05 was adopted. Results There were no differences in TD (pre-pandemic: 300 min [± 159 min], 95% CI 277.1 to 322.6; pandemic: 300 min [± 148 min], 95% CI 274.3 to 326.6, p = 0.97). However, there was an increase in SD (pre-pandemic: 145 min [± 97 min], 95% CI 122.7 to 167.9; pandemic: 178 min [± 96 min], 95% CI 157.4 to 197.9, p = 0.037). There was no increase in PD (pre-pandemic: 145 min ± 133 min; pandemic: 130 min ± 117 min, p = 0.44), and no differences in mortality were observed (pre-pandemic: 9.7%; pandemic: 12%, p = 0.49). Conclusion The COVID-19 pandemic increased SD in the management of STEMI in the region of Passos, Minas Gerais. There were no differences in PD, TD, and in-hospital mortality.
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Objetivo: Analizar la tendencia de la prevalencia de úlceras por presión en Chile y sus regiones de acuerdo con los egresos hospitalarios. Material y Método: Estudio ecológico de series temporales, que analizó la prevalencia de úlceras por presión entre 2001 y 2019. Se realizó un análisis descriptivo, bivariante y lineal de tendencias. Este último con método de autorregresión Prais Winsten, calculando el cambio porcentual anual (APC) y sus intervalos de confianza al 95% (IC-95%). Resultados: La muestra fue de 11.060 casos. El 55,2% (6.103) fueron hombres, la media de edad fue 60 años (± 27.5) y la estancia hospitalaria fue 21,80 (± 35,084) días, siendo significativamente mayor en quienes presentaban lesiones por presión (p< 0,001). Existe una tendencia creciente y significativa en la prevalencia de úlceras por presión en Chile y todas sus regiones, teniendo promedio de un 11,33% de crecimiento interanual (APC= 0,0019; IC:95%= 0,0016-0,0022). Conclusión: Los resultados no son alentadores a pesar del aumento de la notificación de medidas de prevención y estandarización en los cuidados.
Objective: To analyze the trend in the prevalence of pressure ulcers in Chile and its regions according to hospital discharges. Material and Method: Ecological time series study, which analyzed the prevalence of pressure ulcers between 2001 and 2019. A descriptive, bivariate and linear analysis of trends was carried out. The latter with the Prais Winsten auto-regression method, calculating the annual percentage change (APC) and its 95% confidence intervals (95% CI). Results: The sample was 11,060 cases. 55.2% (6,103) were men, the average age was 60 years (± 27.5) and the hospital stay was 21.80 (± 35,084) days, being significantly longer in those with pressure injuries (p< 0.001). There is a growing and significant trend in the prevalence of pressure ulcers in Chile and all its regions, with an average of 11.33% interannual growth (APC= 0.0019; 95% CI= 0.0016-0.0022). Conclusion: The results are not encouraging despite the increase in notification of prevention measures and standardization of care.
Objetivo: Analisar a tendência da prevalência de úlceras por pressão no Chile e suas regiões de acordo com as altas hospitalares. Material e Método: Estudo ecológico de série temporal, que analisou a prevalência de úlceras por pressão entre 2001 e 2019. Foi realizada análise descritiva, bivariada e linear de tendências. Este último com o método de autorregressão de Prais Winsten, calculando a variação percentual anual (APC) e seus intervalos de confiança de 95% (IC 95%). Resultados: A amostra foi de 11.060 casos. 55,2% (6.103) eram homens, a idade média foi de 60 anos (± 27,5) e o tempo de internação foi de 21,80 (± 35.084) dias, sendo significativamente maior naqueles com lesão por pressão (p< 0,001). Há uma tendência crescente e significativa na prevalência de úlceras por pressão no Chile e em todas as suas regiões, com uma média de crescimento interanual de 11,33% (APC= 0,0019; IC 95%= 0,0016-0,0022). Conclusão: Os resultados não são animadores apesar do aumento da notificação de medidas de prevenção e da padronização dos cuidados.
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Objective:To analyze the changing trends in maternal mortality ratios (MMRs) and the main cause-specific MMRs in China from 2010 to 2020, evaluate the association between MMRs and pregnancy healthcare and predict the MMRs for the next five years.Methods:Data on MMRs, the main cause-specific MMRs, and maternal healthcare in China from 2010 to 2020 were collected from China Health Statistical Yearbook. Estimated annual percent changes (EAPCs) were used to analyze the trends in MMRs and the main cause-specific MMRs in China. Average growth rate was used to describe the trend of perinatal healthcare indicators, and spearman rank correlation was used to analyze the correlation between MMRs and perinatal healthcare indicators. GM (1,1) model was established to predict the MMRs for the following five years. Results:(1) From 2010 to 2020, the EAPCs were-5.16%,-6.24%, and-4.28%, respectively, indicating downward trends in MMRs in the whole nation, urban and rural areas ( t=-0.98,-12.42 and-8.96, all P<0.001). (2) From 2010 to 2020, the main cause-specific MMRs in China from obstetric hemorrhage, hypertension during pregnancy, amniotic fluid embolism, and liver disease were all in downward trends ( t=-12.42,-5.44,-3.98 and-3.63, all P<0.001). Except for the MMR from hypertension during pregnancy in urban areas (average growth rate =0.51%), all main cause-specific MMRs in both urban and rural areas decreased significantly, especially the MMRs from hepatopathy in urban and rural areas (average growth rate=-10.40% and-13.96%). (3) The nation wide MMR was negatively correlated with maternal system management rate ( r s=-0.80, P=0.003), prenatal examination rate ( r s=-0.97, P<0.001), postpartum visit rate ( r s=-0.82, P=0.002) and hospital delivery rate ( r s=-0.98, P<0.001). Negative correlations were also found between the MMR and hospital delivery rate in both urban ( r s=-0.82, P=0.002) and rural areas ( r s=-0.95, P<0.001). (4) The GM (1, 1) models for forecasting MMRs in the whole nation, urban and rural areas were established with an accuracy of level 1. The MMR was predicted to show a downward trend in the following five years. The MMRs in China were 15.86/100 000 in 2021 and 15.13/100 000 in 2022 through prediction, similar to the 16.1/100 000 and 15.7/100 000 as announced by the government. Conclusions:The overall MMR in China shows a downward trend, and it dropped faster in urban areas than the rural areas. In addition, it is predicted that the MMR will continue to decline in the following five years, but the gap between urban and rural areas will remain.
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Objetivo: Descrever e comparar ações de atenção e reabilitação na Atenção Primaria à Saúde (APS) direcionados à Pessoa com Deficiência (PCD) no Brasil. Métodos: Dados do Programa de Avaliação da Qualidade na Atenção Básica (PMAQ-AB). Foi realizada uma análise com base no Módulo IV do 2º (2015) e do 3º (2018) Ciclo do PMAQ-AB. Foram realizadas comparações da avaliação positiva ("sim") dos cuidados prestados à PCD na APS, através do cálculo a Razão de Prevalência (RP), admitindo o 2º Ciclo como categoria de referência e considerando dados nacionais e das cinco regiões geográficas. Resultados: A prevalência de repostas afirmativas para atenção à PCD aumentou no 3º ciclo no cenário nacional em relação ao apoio em ações direcionadas à PCD, avaliação e adaptação no domicílio e promoção da inserção da PCD em atividades de esporte e lazer. A prevalência de ações de reabilitação na APS no Brasil também aumentou. O cenário das mudanças no cuidado à PCD foi diferente entre as regiões brasileiras. A região Nordeste foi a que mais aumentou o percentual de ações de atenção à PCD, seguindo o padrão nacional, e ainda incluindo aumento no encaminhamento para uso de próteses/órteses e dispositivos de auxílio. Conclusão: Para a maioria das atividades avaliadas, houve aumento da prevalência de sua realização entre as avaliações do 2º e 3º ciclos do PMAQ-AB, entretanto há necessidade ainda de ampliar a oferta e o serviço de algumas atividades na maioria das regiões do país, favorecendo o cuidado integral à PCD.
Objective: Describe and compare actions of attention and rehabilitation in Primary Health Care (PHC) addressed to Persons with Disabilities (PWD) in Brazil. Methods: Retrospective data from Quality Assessment Program in Primary Care (PMAQ-AB, in Portuguese) were collected and analyzed considering Module IV of the 2nd (2015) and 3rd (2018) Cycles of the PMAQ-AB. Comparisons of the positive answers (yes) of the attention provided to PWD in the PHC were conducted by establishing the Prevalence Ratio (PR). The 2nd Cycle was the reference category, and the data were analyzed as national or regional samples. Results: The prevalence of positive answers for PWD care increased in the 3rd Cycle in the national sample concerning support in activities addressed to PWD, assessment and home adaptations, and promotion of the inclusion of PWD in sports and leisure activities. The prevalence of rehabilitation actions in PHC in Brazil has also increased. Changes in PWD care were found in the different geographical regions of Brazil. The Northeast region had the highest increase in attention activities for PWD, following the national trend, including an increase in referral for prostheses/orthotics and assistive devices. Conclusion: For most of the activities evaluated, there was an increase in performance prevalence between the assessments of the 2nd and 3rd Cycles of the PMAQ-AB. However, there is still a need to expand the offer of services in most regions of the country, favoring integral care for PWD
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Resumo Introdução Há escassos estudos sobre qualidade da atenção em saúde bucal. Objetivo Avaliar associações entre condições de estrutura e processo com indicadores de desempenho em saúde bucal na Estratégia Saúde da Família do Recife. Métodos Estudo transversal, quantitativo e avaliativo, usando dados secundários de 2014 do Ministério da Saúde. Foram calculados testes de Qui-Quadrado e estimativas de Odds Ratio, com regressão logística simples e múltipla, considerando nível de significância de 5% e intervalo de confiança de 95%. Resultados Das 112 equipes de saúde bucal (ESB) avaliadas, equiparação das ESB com as equipes mínimas da Estratégia Saúde da Família e possuir levantamento de escolares com necessidades de saúde bucal, associaram-se ao maior valor de cobertura de primeira consulta odontológica programática (OR = 4,30, IC = 1,33−13,93; OR = 27,47, IC = 2,24−336,34, respectivamente), enquanto estar equiparada, ser ESB modalidade II e garantir agendamento de retorno para a continuidade do tratamento associaram-se ao maior valor da razão entre tratamentos concluídos e primeiras consultas odontológicas programáticas (OR = 5,35, IC = 2,01−14,20; OR = 3,70, IC =1,33−10,27; OR = 5,03, IC = 1,42−17,78, respectivamente). Conclusão Os resultados sugerem que tais padrões de qualidade sejam priorizados para potencializar maior acesso e resolutividade das ESB.
Abstract Background Only a few studies have addressed the quality of oral health care. Objective To assess the association of the structure and process conditions with oral health performance indicators in the Family Health Strategy of Recife. Method A cross-sectional quantitative and evaluative study based on secondary data referring to 2014 from the Ministry of Health. The Chi-Square test and the Odds Ratio, with simple and multiple regression, were calculated considering a significance level of 5% and confidence interval of 95%. Results Among the 112 oral health teams (OHT) assessed, there was an association of the OHT parity with the minimum Family Health Strategy teams and the survey of schoolchildren with oral health needs with the highest coverage value of the first dental programmatic appointment (OR = 4.30 = CI = 1.33-13.93, OR = 27.47, IC = 2.24-336.34, respectively). In turn, the presence of parity, modality II OHT, and scheduled guarantee return for the treatment continuity were associated with the highest ratio between completed treatment and first dental appointment (OR = 5.35, CI = 2.01-14.20; OR = 3.70, CI = 1,33-10,27; OR = 5,03, CI = 1,42-17,78, respectively). Conclusion The results suggest the targeting of such quality standards to enhance both the access and resilience of the OHT.
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RESUMEN INTRODUCCIÓN: La evaluación de la calidad de la atención del ataque cerebrovascular (ACV) es una prioridad para los sistemas de salud, debido a su relación con la disminución de la discapacidad y la muerte. En este estudio se analizan los marcadores de calidad en ACV en un hospital de referencia en Nariño, Colombia. OBJETIVO: Evaluar los marcadores de calidad de atención en ACV en el Hospital Universitario Departamental de Nariño E. S. E., entre junio del 2018 y diciembre del 2019. Como referencia se comparó con los registros de Colombia en la plataforma RES-Q. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo de pacientes con ACV atendidos intrahospitalariamente. La recolección de datos se realizó mediante la plataforma RES-Q, en tanto que el análisis se efectuó por medio de estadísticos descriptivos y frecuencias absolutas y relativas y las diferencias con pruebas analíticas. RESULTADOS: Se evaluaron 457 pacientes con predominio de ACV isquémico y se llevó a cabo trombólisis endovenosa al 7,2% en el 2018 y al 9,2 % en el 2019, el 27,7 % con tiempo puerta aguja menor a 60 minutos en el 2018 y el 42,8 % en el 2019. Entre los marcadores de calidad, se encontró mejoría en realización de NIHSS, evaluación de disfagia en las primeras 24 horas, realización de doppler carotideo en los primeros siete días. En comparación con Colombia, se encontró un porcentaje inferior en trombólisis endovenosa y trombectomía. La mayoría de los indicadores de atención en ACV es similar al promedio nacional. CONCLUSIONES: La mejoría en el cumplimiento de marcadores de calidad en ACV refleja el impacto de programas de atención en ACV. El monitoreo de los parámetros de calidad permite generar programas para fortalecer la atención integral del ataque cerebrovascular en la región.
ABSTRACT INTRODUCTION: The evaluation of the quality of care for Stroke is a priority for health systems, given its relationship with disability and death. In this study, Stroke quality markers are analyzed in stroke in a referral hospital in Narino, Colombia. OBJECTIVE: To evaluate the markers of quality of care in stroke in the Hospital Departamental Universitario de Narino E.S.E between June 2018 and December 2019. As a reference, the outcomes were compared with the Colombian registries on RES-Q platform. MATERIALS AND METHODS: A retrospective descriptive study of patients treated in-hospital with stroke, data collection was performed using the RES-Q platform. The analysis was carried out using descriptive statistics and absolute and relative frequencies and the differences with analytical tests. RESULTS: 457patients were evaluated, with ischemic stroke predominance, endovenous thrombolysis was performed in 7.2 % in 2018, and 9.2 % in 2019, 27.7 % of patients had door to needle time less than 60 minutes in 2018 and 42.8 % in 2019. Among the quality markers evaluated, an improvement was found in the performance of NIHSS, dysphagia evaluation, and carotid doppler performance in ischemic stroke. Compared with Colombian registry, a lower percentage was found in endovenous thrombolysis and thrombectomy. Most of Stroke Care Markers are similar to national average. CONCLUSIONS: The improvement in compliance of standard of Stroke Care Quality Markers reflects the impact of stroke care programs. The monitoring of quality parameters allows the generation of comprehensivestroke care programs in the region.
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Humains , Mâle , Femelle , Sujet âgé , Indicateurs qualité santé , Accident vasculaire cérébral , Traitement thrombolytique , Études transversales , Études rétrospectives , Activateur tissulaire du plasminogène/usage thérapeutique , Colombie , Accident vasculaire cérébral/traitement médicamenteuxRésumé
RESUMO: Introdução: Por se tratar de um setor complexo e que compreende grande parte dos custos de um hospital, o centro cirúrgico demanda uma contínua avaliação de suas atividades, com o objetivo de propiciar uma melhora da sua eficiência e da segurança dos pacientes. Uma estratégia interessante para se realizar tal avaliação é a utilização de um conjunto de indicadores de qualidade preestabelecidos, dividindo os atributos do serviço em estrutura, processos e resultados. Para que isso seja possível, é necessário que o serviço analisado possua uma fonte de dados bem estruturada, tendo o Núcleo Interno de Regulação um papel importante nesse processo. Objetivo: Este estudo teve como objetivo a análise de índices de gestão do centro cirúrgico de um hospital terciário especializado em cirurgias eletivas através da mensuração de dados referentes a indicadores de qualidade. Metodologia: Trata-se de um estudo observacional descritivo feito de forma retrospectiva em um hospital escola público do interior do estado de São Paulo. Foram mensurados 18 indicadores referentes ao período de 01/06/2019 a 31/12/2019, a partir de consultas a diferentes setores administrativos do local. Os resultados passaram por uma análise estatística descritiva ao final da coleta de dados. Resultados: Os principais resultados encontrados foram: taxa de cumprimento da agenda cirúrgica de 95,8%, taxa de cancelamento de 4,1%, taxa de ocupação de 47,9%, turnover de 23,1 minutos, tempo médio de atraso no início das cirurgias de 32,8 minutos, tempo de permanência na sala de recuperação pós-anestésica de 37,4 minutos, taxa de absenteísmo dos profissionais de 8,94% e as taxas de infecção do sítio cirúrgico, de mortalidade operatória e de acidente de trabalho foram todas 0%. Conclusões: Apesar da alta taxa de cumprimento da agenda cirúrgica, a taxa de ocupação se encontrou aquém do ideal, sugerindo que o agendamento das cirurgias pode ser melhorado. Além disso, demonstrou-se que a estratégia de "cirurgias reservas" adotada no hospital auxilia no cumprimento da meta de cirurgias programadas e no aumento da taxa de ocupação. (AU)
ABSTRACT: Introduction: As a complex sector that results in a large part of the costs in a hospital, the operating room demands a continuous evaluation of its activities, with the objective of providing an improvement in its efficiency and in patient safety. An interesting strategy to carry out such an evaluation is using a set of pre-established quality indicators, by the division of the service's attributes into structure, processes and results, which can provide a broad perspective of the activities developed and facilitate decision-making by the hospital manager. In this analysis process, it is necessary that the service has a well-structured data source, where the Internal Regulation Center plays an important role. Objective: The objective of this study was to analyze, through the measurement of data related to quality indicators, the management indexes of the operating room of a tertiary-level hospital specialized in elective surgeries. Methodology: This is a descriptive observational study that was conducted retrospectively at a public teaching hospital. In this research, 18 indicators, related to the period from 06/01/2019 to 12/31/2019, were measured based on consultations to different administrative sectors of the hospital. The results went through a descriptive statistical analysis at the end of data collection. Results:The main results found were as follows: the fulfillment rate of the surgical schedule was 95.8%, the cancellation rate was 4.1%, the occupancy rate was 47.9%, the turnover time was 23.1 minutes, the mean delay time in the start of surgeries was 32.8 minutes, length of stay in the post-anesthesia care unit was 37.4 minutes, the professionals' absenteeism rate was 8.94%, and the rates of surgical site infection, operative mortality and work accident were all 0%. Conclusions: Despite the high fulfillment rate of the surgical schedule, the occupancy rate was below the ideal, suggesting that scheduling of surgeries can be improved. In addition, it was shown that the "reserve surgeries" strategy adopted at the hospital helped to reach the goal of scheduled surgeries and to increase the occupancy rate. (AU)
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Département hospitalier de chirurgie , Indicateurs qualité santéRésumé
Objective@#To establish a risk assessment index system for epidemic infectious diseases in primary and secondary schools, for early warning and prevention of school infectious diseases accurately and timely.@*Methods@#Through literature review, the indicators pool was established by consulting relevant experts and referring to practical experience. Then two rounds of expert consultation using the Delphi method were conducted(13 experts of round 1, and 20 experts of round 2). The concentration of expert opinions (the average, the percentage of full marks) and the coordination of expert opinions (the coefficient of variation, the coordination coefficient W ) were calculated and analyzed. The coordination coefficient W was obtained by nonparametric Kendall s W test of multiple samples. According to the experts feedback, necessary addition, reduction and modification of the indicators were carried out to determine the evaluation index system, and the analytic hierarchy process (AHP) was used to calculate the weight of each indicator.@*Results@#The expert authority coefficients of the two rounds of consultation were 0.89 and 0.88, respectively, and the form recovery rate was 100%. The range of the variation coefficient of each three level indicator was 0.07-0.31 and 0.06-0.19, and the coordination coefficient W was 0.25 and 0.47, respectively, indicating that the consistency and credibility of expert opinions were good. Finally, the risk assessment index system of infectious diseases in primary and secondary schools was established, which was composed of 5 first level indexes, 23 second level indexes and 86 third level indexes. The AHP was used to calculate the intra level weight of the index. The variation coefficient of five first level indicators of school health management and security system, school health personnel facilities, health monitoring and cognition level, severity and coping measures were 0.09, 0.06, 0.08, 0.12 and 0.06 , respectively, and the weight coefficients were 20.42%, 21.19%, 19.87%, 17.45% and 21.08%, respectively.@*Conclusion@#The risk assessment index system of school infectious diseases is applicable to primary and secondary schools. The initiative, coordination and authority of experts in this system are all high. It is of practical guiding significance for the early warning of infectious diseases in primary and secondary schools.
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Objective:By reviewing and analyzing the results of external quality assessment of pre-test quality indicators related to the acceptability of microbiology laboratory sample from 2016-2021, we aimed to understand the acceptability of microbiology laboratory sample and therefore to provide a reference for establishing preliminary quality specifications.Methods:The National Center for Clinical Laboratories organized 31 provinces (including autonomous regions and municipalities directly under the Central Government) and the Xinjiang production and Construction Corps centers to launch a synchronous Quality Indicators (QIs)-External Quality Assessment (EQA) program and the collected data were reported via an online EQA system. The essential information of the clinical laboratories and the data of quality indicators from 2016 to 2021 were collected and the data from overall, continuous return laboratories were analyzed. Sigma values were calculated to assess the quality level of laboratory.Results:The median of the 13 quality indicators of national laboratories for all years was 0 (except for the first microbiological contaminated sample rate in 2018). Ten of the quality indicators (incorrect fill level rate, sample loss rate, misidentified sample rate, unsuitable sample for storage rate before analysis, sample damaged rate during transportation, sample transported at inappropriate temperature rate, sample with excessive transportation time rate, inappropriate time in sample collection rate, sample recollection rate for error due to laboratory staff, sample recollection rate for error not due to laboratory staff) had quartiles of 0 for all years, reaching six sigma level. The results of the median (upper quartile) of each year of the three quality indicators of continuous return laboratories for tertiary hospitals show that the incorrect sample container rate was the lowest, followed by the incorrect sample type rate, and the microbiological contaminated sample rate was the highest. The highest values of corresponding median (upper quartile) results were 0.047% (0.191%), 0.059% (0.252%), 0.251% (0.6%) respectively. The median incorrect sample type rate and median incorrect sample container rate in 2016/1 and 2021/1 tertiary hospitals were ranked by province respectively. The median for the incorrect sample type rate of Liaoning, Hebei, Jiangxi, Tianjin, Beijing, Guizhou, Gansu, Qinghai and Ningxia tertiary hospitals in 2021/1 was significantly lower than the respective values in 2016/1, and the median for incorrect sample container rate of Liaoning, Sichuan, Zhejiang, Hubei, Shanxi, Tianjin, Chongqing, Guizhou, Ningxia and Hunan tertiary hospitals in 2021/1 was significantly lower than those respective values in 2016/1.Conclusions:The results of the sample acceptability of microbial laboratory are generally acceptable. The laboratories should explore and establish their own quality indicators system, strengthen the long-term monitoring of key quality indicators and improve their service quality.
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ABSTRACT Objective: Brazil is a country with universal health coverage, yet access to surgery among remote rural populations remains understudied. This study assesses surgical care capacity among hospitals providing care for the rural populations in the Amazonas state of Brazil through in-depth facility assessments. Methods: a stratified randomized cross-sectional evaluation of hospitals that self-report providing surgical care in Amazonas was conducted from July 2016 to March 2017. The Surgical Assessment Tool (SAT) developed by the World Health Organization and the Program in Global Surgery and Social Change at Harvard Medical School was administered at remote hospitals, including a retrospective review of medical records and operative logbooks. Results: 18 hospitals were surveyed. Three hospitals (16.6%) had no operating rooms and 12 (66%) had 1-2 operating rooms. 14 hospitals (77.8%) reported monitoring by pulse oximetry was always present and six hospitals (33%) never have a professional anesthesiologist available. Inhaled general anesthesia was available in 12 hospitals (66.7%), but 77.8% did not have any mechanical ventilation device. An average of 257 procedures per 100,000 were performed. 10 hospitals (55.6%) do not have a specific post-anesthesia care unit. For the regions covered by the 18 hospitals, with a population of 497,492 inhabitants, the average surgeon, anesthetist, obstetric workforce density was 6.4. Conclusion: populations living in rural areas in Brazil face significant disparities in access to surgical care, despite the presence of universal health coverage. Development of a state plan for the implementation of surgery is necessary to ensure access to surgical care for rural populations.
RESUMO Objetivo: o Brasil é um país com cobertura universal de saúde, mas o acesso à cirurgia entre populações remotas permanece pouco estudado. Este estudo avalia a capacidade cirúrgica em hospitais que servem populações rurais no estado do Amazonas, Brasil, por meio de avaliações aprofundadas das instalações. Métodos: foi realizada avaliação estratificada randomizada transversal de hospitais que relataram prestar assistência cirúrgica de julho de 2016 a março de 2017. A Ferramenta de Avaliação Cirúrgica desenvolvida pela Organização Mundial da Saúde e o Programa de Cirurgia Global e Mudança Social da Harvard Medical School foi administrada em hospitais remotos, incluindo uma revisão retrospectiva de registros médicos e livros cirúrgicos. Resultados: 18 hospitais foram pesquisados. Três hospitais (16,6%) não tinham salas cirúrgicas e 12 (66%) tinham 1-2. 14 hospitais (77,8%) relataram que a oximetria de pulso estava "sempre presente" e seis hospitais (33%) nunca têm um anestesiologista disponível. A anestesia inalatória estava disponível em 12 hospitais (66,7%), 77,8% não possuíam dispositivo de ventilação mecânica. Em média, 257 procedimentos por 100.000 foram realizados. 10 hospitais (55,6%) não possuem unidade de recuperação anestésica. Para as regiões de abrangência dos 18 hospitais, com população de 497.492 habitantes, a densidade média de força de trabalho cirúrgica, anestesista e obstétrica foi de 6,4. Conclusão: as populações que vivem em áreas rurais no Brasil enfrentam disparidades significativas no acesso à assistência cirúrgica, apesar da presença de cobertura universal de saúde. O desenvolvimento de um plano estadual de cirurgia é necessário para garantir acesso à assistência cirúrgica às populações rurais.
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ABSTRACT Objective: to understand the perception of the multiprofessional team about the quality of health care provided to patients in palliative care in the Intensive Care Unit. Method: qualitative study, anchored to Donabedian's theoretical framework, through semi-structured interviews with 35 professionals working in the Intensive Care Unit. For data analysis, the Content Analysis technique was used. Results: three categories were pre-established: structure, process, and outcome, from which five subcategories emerged: Deficit in terms of numbers of workers and professional qualification; Ambience and palliative care; (In)existence of assistance based on the principles of palliative care; Failures in communication and in the interdisciplinary approach and Repercussions of (lack of) assistance. Conclusion: the study allowed understanding the institutional weaknesses for the operationalization of care provided to patients eligible for palliative care in the Intensive Care Unit setting. Thus, for this philosophy of care to be propagated, the co-participation of managers, professionals, patients, and family members is required, since these gaps cannot be filled without collective involvement.
RESUMEN Objetivo: comprender la percepción del equipo multiprofesional sobre la calidad de la asistencia a la salud destinada a pacientes en cuidados paliativos en UCI. Método: estudio cualitativo, basado en el referencial teórico de Donabedian, por medio de entrevistas semiestructuradas realizadas con 35 profesionales que actúan en Unidad de Cuidados Intensivos. Para análisis de los datos, se utilizó la técnica de Análisis de Contenido. Resultados: Fueron inicialmente establecidas tres clases: estructura, proceso y resultado, de las cuales emergieron cinco subclases: Déficit en el cuantitativo y en la calificación profesional; Ambiencia y cuidados paliativos; Inexistencia de una asistencia pautada en los principios de los cuidados paliativos; Fallos en la comunicación y en el abordaje interdisciplinar y repercusiones de la desasistencia. Conclusión: El estudio nos llevó a comprender las debilidades institucionales para poner en funcionamiento la asistencia dispensada a los pacientes elegibles para cuidados paliativos en el escenario de la UCI. Así, para que esa filosofía de cuidado sea propagada, se necesita la coparticipación de los gestores, profesionales, pacientes y familiares, una vez que esas debilidades no lograrán ser resueltas sin que haya una participación colectiva.
RESUMO Objetivo: compreender a percepção da equipe multiprofissional sobre a qualidade da assistência à saúde prestada a pacientes em cuidados paliativos em Unidade de Terapia Intensiva. Método: estudo qualitativo, ancorado no referencial teórico de Donabedian, por meio de entrevistas semiestruturadas realizadas com 35 profissionais que atuam em Unidade de Terapia Intensiva. Para análise dos dados, utilizou-se a técnica de Análise de Conteúdo. Resultados: foram pré-estabelecidas três categorias: estrutura, processo e resultado, das quais emergiram cinco subcategorias: Déficit no quantitativo e na qualificação profissional; Ambiência e cuidados paliativos; (In)existência de uma assistência pautada nos princípios dos cuidados paliativos; Falhas na comunicação e na abordagem interdisciplinar; e Repercussões da (des)assistência. Conclusão: o estudo permitiu compreender as fragilidades institucionais para a operacionalização da assistência dispensada aos pacientes elegíveis para cuidados paliativos no cenário da Unidade de Terapia Intensiva. Dessa forma, para que essa filosofia de cuidado seja propagada, necessita-se da coparticipação dos gestores, profissionais, pacientes e familiares, uma vez que essas lacunas não conseguem ser supridas sem que haja um envolvimento coletivo.
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Soins palliatifs , Unités de soins intensifs , Équipe soignante , Indicateurs qualité santé , Gestionnaire de la Santé , Sécurité des patientsRésumé
Resumo Objetivo Verificar como se expressa a cultura da Segurança do Paciente na visão de profissionais da Atenção Primária à Saúde, a partir da análise de produções científicas que aplicaram o instrumento Medical Office Survey on Patient Culture. Métodos Revisão integrativa, elaborada com base na metodologia scoping review, com busca em banco de dados online da Biblioteca Virtual em Saúde, da Web of Science, do PubMed®, do Cummulative Index to Nursing and Allied Health Literature e do Scopus, utilizando a palavra-chave "Medical Office Survey on Patient Safety Culture". Resultados Foram analisados 13 artigos quanto à aplicação do instrumento. Constatou-se avaliação geral positiva sobre Segurança do Paciente (32% a 83%). As dimensões "trabalho em equipe" e "pressão e ritmo de trabalho" foram vistas como as de melhor e pior escore, respectivamente. Conclusão A revisão integrativa da literatura possibilitou a análise crítica de estudos que demonstram a visão dos profissionais de saúde de diferentes países, ao avaliarem dimensões de cultura de Segurança do Paciente conforme o instrumento aplicado, indicando áreas consideradas positivas, bem como aquelas que demandam maior atenção e valorização. Tais evidências contribuem para o avanço na compreensão do multifacetado fenômeno investigado nos diversos ambientes da Atenção Primária.
Resumen Objetivo Verificar cómo se expresa la cultura de la Seguridad del Paciente bajo la mirada de profesionales de la Atención Primaria en Salud, a partir del análisis de producciones científicas que aplicaron el instrumento Medical Office Survey on Patient Culture. Métodos Revisión integradora, elaborada con base en la metodología scoping review y búsqueda en banco de datos en línea de la Biblioteca Virtual de Salud, de la Web of Science, de PubMed®, del Cummulative Index to Nursing and Allied Health Literature y de Scopus, utilizando la palabra clave "Medical Office Survey on Patient Safety Culture". Resultados Se analizaron 13 artículos con relación a la aplicación del instrumento. Se constató una evaluación general positiva sobre la Seguridad del Paciente (32 % a 83 %). Las dimensiones "trabajo en equipo" y "presión y ritmo de trabajo" fueron las que tuvieron mejor y peor puntuación, respectivamente. Conclusión La revisión integradora de la literatura posibilitó el análisis crítico de estudios que demuestran la visión de los profesionales de salud de distintos países, al evaluar las dimensiones de la cultura de la Seguridad del Paciente de acuerdo con el instrumento aplicado, indicando áreas consideradas positivas, así como las que demandan más atención y valorización. Esas evidencias contribuyen para el avance de la comprensión del multifacético fenómeno investigado en los diversos ambientes de la Atención Primaria.
Abstract Objective To assess how the Patient Safety culture is expressed in the view of Primary Health Care professionals, based on the analysis of scientific productions in which the Medical Office Survey on Patient Culture instrument was applied. Methods Integrative review based on the scoping review methodology with search in online databases of the Virtual Health Library, Web of Science, PubMed®, Cumulative Index to Nursing and Allied Health Literature and Scopus using the keyword "Medical Office Survey on Patient Safety Culture". Results Thirteen articles were analyzed in relation to the application of the instrument. There was a positive overall assessment of Patient Safety (32%-83%). The "teamwork" and "work pressure and pace" dimensions were seen as the best and worst scores, respectively. Conclusion The integrative literature review allowed the critical analysis of studies that showed the view of health professionals from different countries when evaluating dimensions of the Patient Safety culture according to the instrument applied, indicating areas considered as positive, and those demanding greater attention and appreciation. Such evidence contributes to advance the understanding of the multifaceted phenomenon investigated in different Primary Care settings.