Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study.

BACKGROUND: Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. OBJECTIVE: In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. METHODS: Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users' choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. RESULTS: The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. CONCLUSIONS: These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively.

El impacto de la pandemia de COVID-19 en los nuevos casos de tuberculosis en pacientes hospitalizados / The Impact of COVID-19 Pandemic on New Active Tuberculosis in Hospitalized Patients

Objectives: The COVID-19 pandemic has affected the global fight against Tuberculosis, although its impact is not fully known. We aimed to analyse the impact of the COVID-19 pandemic on the diagnosis and hospital care of tuberculosis patients. Material and Method: We conducted a retrospective study in a Portuguese 804-bed hospital between March 2019 and March 2021. We compared the number of new diagnoses of active Tuberculosis in hospitalized patients in the 12-month period before (group A) and after (group B) the surge of COVID-19 in Portugal (March 2020), as well as patients’ clinical characteristics. Results: There were a total of 24.675 hospital admissions, of which 158 were due to new active tuberculosis. There were 60 new diagnoses of active tuberculosis in the first year of the COVID-19 pandemic (group B), compared to 98 in the previous year (group A) (0.5% vs. 0.8%, respectively, p=0.004). Gender distribution, age, symptoms at presentation and affected organs were similar in both groups. During the COVID-19 pandemic, there was a significant median 3-day delay in diagnosis after hospital admission (p=0.047) and a total of 18% of tuberculosis cases were co-infected with SARS-CoV-2 in the first month of antituberculosis therapy. Conclusion: During the first year of the COVID-19 pandemic, hospitalised patients were 37% less likely to have a diagnosis of new active TB, compared to the previous year. Our study highlights the concern about underdiagnosis and diagnostic delay of active TB during the COVID-19 pandemic and the need for studies and policies addressing this matter. (AU)

Objetivos: Analizar el impacto de la pandemia de COVID-19 en el diagnóstico y la atención hospitalaria de los pacientes con tuberculosis. Método: Estudio retrospectivo en un hospital portugués de 804 camas entre marzo de 2019 y marzo de 2021. Comparamos el número de nuevos diagnósticos de tuberculosis activa en pacientes hospitalizados en el período de 12 meses antes y después el repunte de la COVID-19 en Portugal (marzo 2020), así como las características clínicas de los pacientes. Resultados: Se incluyeron 24.675 ingresos hospitalarios, de los cuales 158 fueron por tuberculosis activa nueva. Se observó 60 nuevos diagnósticos de tuberculosis activa en el primer año de la pandemia COVID-19 (grupo B), frente a los 98 del año anterior (grupo A) (p=0,004). La distribución por género, edad, presentación y órganos afectados fueron similares. Durante la pandemia de COVID-19, hubo una mediana de retraso significativo de 3 días en el diagnóstico después del ingreso hospitalario (p=0,047) y un total del 18 % de los casos de tuberculosis se infectaron con SARS-CoV-2 en el primer mes de terapia antituberculosa. Conclusión: Durante el primer año de la pandemia COVID-19, los pacientes hospitalizados tuvieron 37% menos de probabilidad de tener un diagnóstico nuevo de TB. Nuestro estudio destaca la preocupación por el infradiagnóstico y el retraso en el diagnóstico de la TB activa durante la pandemia COVID-19 y la necesidad de estudios y políticas que aborden este tema. (AU)

Notifications of work-related injuries and diseases: an observational study on a mining disaster.

INTRODUCTION: Accidents at work are events that endanger the health and life of workers. They are considered a public health problem, being the object of studies and actions in the Brazilian health system. The collapsed of the ore tailings dam in the municipality of Brumadinho, Brazil, in January 2019, shocked the world due to the proportion of environmental and human damage caused. In this context, concern for the health of workers gained prominence. This paper evaluated the impact of the collapse of the mining tailings dam in Brumadinho, on notifications of occupational health problems before and after the disaster. METHODS: An observational, longitudinal and retrospective study, of the time series type with a statistical approach was carried out on notifications of work-related injuries and diseases, available in the local database of the Notifiable Diseases Information System between January 2017 and December 2021. RESULTS: During the study period, 520 notifications of work-related injuries and conditions were registered. Of this total, 67.3% were serious work accidents, 26.0% mental disorders, 12.3% accidents with biological material and 2.9% repetitive strain injuries/musculoskeletal disorders, occupational dermatoses and induced hearing loss by noise. Occurrences were more frequent in 2019, the year in which the mining disaster occurred, recording 65.2% of total notifications. Regarding the volume of notifications after the disaster, there was a statistically significant reduction (p < 0.001) for accidents with biological material; significant increase for severe work accident and mental disorder. The average time between the occurrence of the injury and the notification showed a statistically significant reduction for accidents involving biological material (p = 0.001) and a significant increase for serious accidents at work (p = 0.016). CONCLUSIONS: It was demonstrated that there were changes in the number of notifications when comparing the period before and after the mining disaster, with a consequent impact on the health of workers, which may persist over the years.

The managerial role of healthcare professionals in public hospitals: a time-driven analysis of their activities.

BACKGROUND: New Public Management theory affected reforms of public sectors worldwide. In Italy, an important reform of the healthcare sector changed the profile of public hospitals, creating new management related positions in 1992. The reform defined the role of the clinician-manager: a hybrid figure, in charge of managing an entire unit. This paper aims to investigate how much clinician-managers feel like managers and how much they still feel like professionals, using time as a driver to conduct the analysis. METHODS: A survey-questionnaire was administered to a set of 2,011 clinician-managers employed in public hospitals, with a response rate of 60.42%. The managerial role of healthcare professionals in public hospitals: A time-driven analysis of their activities. The questionnaire aimed to identify the difference between how much time clinician-managers actually spend on daily activities and how much time they would think be appropriate. To better cluster different type of management styles, subgroups were identified based on the type of organisations respondents work for, geographical location, and professional specialty. RESULTS: Findings suggest that clinician-managers spend more time on clinical activities than management. Clear differences are found according to professional specialty, and there are fewer differences in geographical location and the type of organisation. CONCLUSIONS: The absence of clear differences in the responses between different geographical areas implies that a shared organisational culture characterizes the whole sector. However, differences in how the clinician-manager role is perceived based on the professional specialty suggest that closer integration may be needed.

Avaliação do desempenho de um contrato de gestão entre uma organização social de saúde (OSS) e prefeitura de uma cidade do interior paulista / Evaluation of the performance of a management contract between a health social organization and the mayor of a city in the interior of São Paulo

Introdução: A Organização Social de Saúde é uma entidade sem fins lucrativos que se encontra em estágio de expansão e há uma nítida divergência de opiniões quanto a sua efetividade e cumprimento das metas designadas pelo contrato de gestão proposto pelas instituições públicas. Objetivo: Analisar se há o cumprimento de metas estabelecidas pelo con-trato de gestão entre a Prefeitura Municipal de Catanduva/SP e o Hospital Psiquiátrico Espírita Mahatma Gandhi (OSS). Métodos: É um estudo descritivo e transversal. A coleta de dados foi realizada a partir do Relatório do Observatório de Saúde de Catanduva de 2019, estabelecendo uma relação comparativa com as metas propostas no Contrato de Gestão vigente. Foram analisadas as seguintes variáveis: número de consultas médicas, número de consultas de enfermagem e taxa de encaminhamento médico nas Unidades de Saúde da Família. Resultados: Em relação à taxa de encaminhamen-tos realizados durante o ano de 2019 em todas as USF, a média foi inferior ao valor de referência estabelecido no contra-to, sugerindo alta taxa de resolubilidade desses serviços. Além disso, produção médica e de enfermagem nas Unidades de Saúde da Família do município de Catanduva encontra-se, em sua maioria, acima do previsto no contrato de gestão, representando o cumprimento dos valores estabelecidos pela contratante. Conclusão: As metas atribuídas à OSS no contrato foram cumpridas pelas unidades de saúde conforme os valores pactuados pela Prefeitura Municipal (AU)

Introduction: The Social Health Organization is a non-profit entity that is in an expansion stage and there is a clear divergence of opinions regarding its effectiveness and compliance with the goals designated by the man-agement contract proposed by public institutions. Objective: To evaluate if the goals established by the manage-ment contract between the City of Catanduva / SP and the Psychiatric Hospital Spiritist Mahatma Gandhi (OSS) are met. Methods : It is an observational, descriptive and cross-sectional study. Data collection was carried out based on the 2019 Catanduva Health Observatory Report, establishing a comparative relationship with the goals proposed in the current Management Contract. The following variables were analyzed: number of medical consultations, number of nursing consultations and medical resolvability index in Family Health Units. Results: Regarding medical resolution, the average rate of referrals made during 2019 in all FHUs was lower than the reference value established in the contract, suggesting a high rate of resolution of these services. In addition, medical and nursing production in the Family Health Units in the municipality of Catanduva is mostly above that provided for in the management contract, representing compliance with the values established by the contractor. Conclusion: The targets assigned to the OSS in the contract were met by the health units in accordance with the values agreed by the City Hall (AU)

Outcomes of managing healthcare services using the Theory of Constraints: A systematic review.

Despite ever-increasing resources devoted to healthcare, lack of capacity and timeliness are still chronic problems worldwide. This systematic review aims to present an overview of the Theory of Constraints (TOC) implementations in healthcare services and their outcomes. We analysed 42 TOC implementations (15 full-text articles, 12 video proceedings, and 2 theses/disserations) from major scientific electronic databases and TOC International Certification Organization Conferences. All implementations reported positive outcomes, both tangible and intangible. The two main improvements reported by authors were in productivity (98%; n = 41) - more patients treated - and in the timeliness of care (83%; n = 35). Furthermore, the selected studies reported dramatic improvements: 50% mean reductions in patient waiting time; 38% reduction in patient length of stay; 43% mean increase in operating room productivity and 34% mean increase in throughput. TOC implementations attained positive results in all levels of the health and social care chain. Most TOC recommendations and changes showed almost immediate results and required little or no additional cost to implement. Evidence supports TOC as a promising solution for the chronic healthcare problem, improving quality and timeliness, both necessary conditions for providing effective healthcare.

Desafos à atuação dos trabalhadores de Vigilância Sanitária nos serviços de saúde / Challenges to the performance of health surveillance workers in health services

Introdução: A vigilância sanitária é uma função precípua do Estado para proteção da saúde individual e coletiva mediante ações de controle de riscos, atuais ou potenciais, presentes na produção de bens e serviços, e integra o Sistema Único de Saúde. A vigilância sanitária de serviços de saúde é parte do escopo de atuação da Vigilância Sanitária (Visa) para o controle dos riscos e iatrogenias nos serviços de saúde. Objetivo: Analisar desafios à atuação dos trabalhadores de Visa nos serviços de saúde. Método: O estudo, de abordagem qualitativa, integra uma pesquisa financiada pelo CNPQ para análise do controle sanitário realizado pelas Visa em serviços de saúde da atenção básica e especializada. Utilizou-se a técnica de Grupo Focal com trabalhadores da Visa de oito estados brasileiros. As falas foram transcritas e analisadas segundo a técnica de análise de conteúdo temática, sistematizadas em duas categorias: Gestão e Organização dos Serviços e Condições de Trabalho. Resultados: Identificou-se problemas e desafios, tais como: incipiente planejamento das ações; dificuldades na organização do trabalho decorrentes da rotatividade de gestores, da falta de recursos humanos e tecnológicos, da ausência de coordenação e da integração dos níveis do Sistema Nacional de Vigilância Sanitária. Emergiram insatisfações e desafios sobre condições de trabalho, precarizações dos vínculos, baixos salários, equipes incompletas e necessidade de concursos públicos e de valorização do trabalho. Conclusões: A atuação da Visa em serviços de saúde requer a superação de múltiplos desafios, que perpassam a integração das ações nos distintos níveis de gestão e questões de capacitação, incorporação de tecnologias e de readequação de processos de trabalho.

Introduction: Health surveillance (Visa) is a primary function of the State for the protection of individual and collective health through risk control actions, current or potential, present in the production of goods and services, and is part of SUS (Brazilian Universal Health System). Health surveillance of health services is part of Visa's scope of action for the control of risks and iatrogenic diseases in health services. Objective: To analyze challenges to the performance of Visa in health services. Method: The study, with a qualitative approach, integrates research funded by CNPq to analyze the sanitary control carried out by Visa in health services of primary and specialized care; the Focus Group technique was used with Visa workers from 8 Brazilian states. The speeches were transcribed and analyzed according to the thematic content analysis technique, systematized in two categories: Management and Organization of Services, and Working Conditions. Results: Problems and challenges were identifed, such as: incipient planning of actions; difculties in the organization of work, resulting from the turnover of managers, the lack of human and technological resources, and the lack of coordination and integration of the levels of the National Health Surveillance System. Dissatisfactions and challenges about working conditions, precarious employment conditions, low wages, incomplete teams and the need for public tenders and work valorization emerged. Conclusions: Visa's performance in health services requires overcoming multiple challenges, which permeate the integration of actions at different levels of management and training issues, incorporation of technologies and readjustment of work processes.

Preparedness in a public health emergency: determinants of willingness and readiness to respond in the onset of the COVID-19 pandemic.

OBJECTIVES: Healthcare professionals' high risk of infection and burnout in the first months of the COVID-19 pandemic probably hindered their much-needed preparedness to respond. We aimed to inform how individual and institutional factors contributed for the preparedness to respond during the first months of a public health emergency. STUDY DESIGN: Cross-sectional study. METHODS: We surveyed healthcare workers from a Local Health Unit in Portugal, which comprises primary health care centers and hospital services, including public health units and intensive care units, in the second and third months of the COVID-19 epidemic in Portugal. The 460 answers, completed by 252 participants (about 10% of the healthcare workers), were analyzed using descriptive statistics and multiple logistic regressions. We estimated adjusted odds ratios for the readiness and willingness to respond. RESULTS: Readiness to respond was associated with the perception of adequate infrastructures (aOR = 4.04, P < 0.005), lack of access to personal protective equipment (aOR = 0.26, P < 0.05) and organization (aOR = 0.31, P < 0.05). The willingness to act was associated with the perception of not being able to make a difference (aOR = 0.05, P < 0.005), risk of work-related burnout (aOR = 21.21, P < 0.01) and experiencing colleagues or patients' deaths due to COVID-19 (aOR = 0.24, P < 0.05). CONCLUSIONS: Adequate organization, infrastructures, and access to personal protective equipment may be crucial for workers' preparedness in a new public health emergency, as well workers' understanding of their roles and expected impact. These factors, together with the risk of work-related burnout, shall be taken into account in the planning of the response of healthcare institutions in future public health emergencies.

Application of Mixed Methods in Health Services Management Research: A Systematic Review.

Mixed methods research (MMR) is versatile, pragmatic, and adaptable to constraints and opportunities during a research process. Although MMR has gain popularity in health services management research, little is known about how the research approach has been used and the quality of research. We conducted a systematic review of 198 MMR articles published in selected U.S.-based and international health services management journals from 2000 through 2018 to examine the extent of MMR application and scientific rigor. Results showed limited, yet increasing, use of MMR and a high degree of correspondence between MMR designs and study purposes. However, most articles did not clearly justify using MMR designs and the reporting of method details and research integration were inadequate in a significant portion of publications. We propose a checklist to assist the preparation and review of MMR manuscripts. Additional implications and recommendations to improve transparency, rigor, and quality in MMR are discussed.

"Avançado" ou "precipitado"? Sobre o Modelo de Acesso Avançado/Aberto na Atenção Primária à Saúde / "Advanced" or "precipitate"? About the Advanced/Open Access Model in Primary Health Care / ¿"Avanzado" o "apresurado"? Sobre el Modelo de Acceso Avanzado/Abierto en Atención Primaria de Salud

Resumo O modelo de Acesso Avançado ou Aberto (Advanced/Open Access) vem sendo estimulado por gestores e valorizado pela medicina de família e comunidade brasileira como modelo de gestão da clínica na Equipe de Saúde da Família. Este artigo de revisão integrativa discute como essa tecnologia pode qualificar ou prejudicar a Atenção Primária à Saúde. Embora ajude a promover mudanças necessárias em agendas tradicionalmente voltadas para ações programáticas, o modelo tem um forte viés gerencialista. Ao desconsiderar premissas básicas, sua implantação pode resultar em sofrimento do profissional e em sua alienação perante o território e o cuidado integral em saúde, além de reforçar o modelo biomédico e a medicalização social. Apontamos caminhos para que 'avançado' não signifique 'precipitado', destacando que uma implantação com base no diálogo entre trabalhadores, gestores e usuários parece mais coerente com a própria literatura sobre Acesso Avançado e com a produção nacional sobre Acolhimento no Sistema Único de Saúde.

Abstract The Advanced/Open Access model has been encouraged by managers and valued by Brazilian family and community medicine as a model of clinical management in the Family Health Team. This integrative review article discusses how this technology can qualify or hinder Primary Health Care. Although it helps to promote necessary changes in agendas traditionally focused on programmatic actions, the model has a strong managerialist bias. By disregarding basic premises, its implementation may result in professional suffering and alienation from the territory and integral health care, besides reinforcing the biomedical model and social medicalization. We point out ways for 'advanced' not to mean 'precipitate', highlighting that an implementation based on dialogue among workers, managers, and users seems more coherent with the literature on Advanced Access and with the national production on Welcoming in the Unified Health System.

Resumen El modelo de Acceso Avanzado o Abierto (Advanced/Open Access) ha sido estimulado por los gestores y valorado por la medicina de familia y por la comunidad brasileña como modelo de gestión de la clínica en el Equipo de Salud de la Familia. Este artículo de revisión integradora analiza cómo esta tecnología puede calificar o perjudicar la Atención Primaria de Salud. Si bien ayuda a promover cambios necesarios en agendas tradicionalmente enfocadas en acciones programáticas, el modelo tiene un fuerte sesgo administrativista. Al desconocer premisas básicas, su implementación puede resultar en sufrimiento del profesional y en su alienación ante el territorio y del cuidado integral en salud, además de reforzar el modelo biomédico y la medicalización social. Señalamos caminos para que 'avanzado' no signifique 'apresurado', destacando que una implementación basada en el diálogo entre trabajadores, gestores y usuarios parece más coherente con la literatura sobre Acceso Avanzado y con la producción nacional sobre Acogida en el Sistema Único de Salud.

Hospital management by health services management graduates: the change paradigm in Iran.

BACKGROUND: The hospital management and its functions can be very important in improving the quality of hospital care, and their managers need several competencies to perform these functions efficiently and effectively. Today, more attention should be paid to the use of professional hospital managers, especially those educated in the field of Health Services Management. The present study aimed to study the change paradigm of hospital management by graduates of Health Services Management in a hospital in Iran as a developing country. MATERIALS AND METHODS: This study was a qualitative case study conducted in the Hazrate Ali Asghar Hospital in Shiraz, Iran in 2018 in order to determine the "why", "how" and "what" aspects of applying hospital managers educated in the field of Health Services Management instead of other traditional managers, as a change paradigm. The samples were selected purposefully and semi-structured in-depth interviews with 12 people were used to explain the experiences of management style by graduates of Health Services Management. Data were collected and analyzed simultaneously using the thematic analysis method and with the inductive approach. RESULTS: Results of the interviews led to the identification of 6 main themes and 26 sub-themes. The main themes were structural reforms, process reforms, organizational culture reforms, performance reforms, resource reforms, and consequences and results. CONCLUSION: According to the results, shifting from the use of traditional managers to the use of graduates of Health Services Management in the hospital proposed as a change paradigm in the hospital management is accompanied by some reforms in the hospital structures, processes, resources, culture, and performance. Such reforms may lead to some valuable final consequences and results such as increasing patient and staff satisfaction and effectiveness of actions and activities. This hypothesis is recommended to be tested in other similar settings.

Barriers and enablers to Aboriginal and Torres Strait Islander careers in health: A qualitative, multisector study in western New South Wales.

OBJECTIVE: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non-Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. DESIGN: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. SETTING: Western New South Wales. PARTICIPANTS: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non-Aboriginal; n = 28). MAIN OUTCOME MEASURES: Identified barriers and enablers and regional strategies for improving career pathways. RESULTS: Aboriginal people interested in pursuing a career in health face barriers in: pre-employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. CONCLUSION: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self-determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members.

Descripción de la implantación y grado de desarrollo de tecnología de comunicación e informática de los equipos de Atención Primaria en los servicios autonómicos de salud en España / Description of the implementation and degree of development of primary care telecommunication and information technology in regional health services in Spain

Objetivo: Describir la situación, percepciones y opiniones de los profesionales sanitarios de Atención Primaria (AP) respecto a los sistemas de telecomunicación y telemedicina de este ámbito, así como determinar su grado de satisfacción. Método: Estudio descriptivo observacional transversal realizado en profesionales sanitarios de Atención Primaria mediante un cuestionario autocumplimentado con variables sociodemográficas, características laborales, opiniones y percepciones sobre desarrollo informático, sistemas de información, accesibilidad telemática, seguridad para pacientes y el grado de satisfacción de los profesionales respecto al desarrollo informático. Resultados: Los resultados muestran que se puede acceder a informes de alta hospitalaria y urgencias en el 89,2% (intervalo de confianza [IC] 95%: 86,4-92,0) y 87,2% (IC 95%: 84,2-90,2) de casos, respectivamente. Existe opción de teleconsulta con hospitalaria según un 95,1% de encuestados. Un 38,9% indicó disponer de alertas de recepción de informes de hospital, y el 73,3%, tener accesibilidad telemática para sus pacientes. El 34,8% señaló que no había ninguna mejora en general en las vías de comunicación, y el 51,7% y tampoco veía mejoras en los recursos tecnológicos en general tras la pandemia. Un 13,0% manifestó estar muy insatisfecho y el 27,3% dijo estar insatisfecho con el nivel de desarrollo informático en sistemas de telemedicina y telecomunicación en la AP de su área sanitaria. Conclusiones: La mayoría de los equipos de Atención Primaria de los Servicios Autonómicos disponen de historia clínica compartida con el hospital, mientras que solo una parte cuenta con sistemas de alertas de recepción de informar del ámbito hospitalario. El obligado cambio de la asistencia sanitaria no ha mejorado sustancialmente los recursos tecnológicos tras la pandemia y existe un considerable grado de insatisfacción de los profesionales.(AU)

Objective: To report Primary Care healthcare professionals’ circumstances, insight and points of view in regard to telecommunication systems and telemedicine as well as determine their degree of satisfaction. Method: Descriptive, observational, transversal study performed on primary healthcare professionals by means of a self-completion questionnaire with socio-demographic variables, job characteristics, views and perceptions in regard to IT development, information systems, online accessibility, patient safety and the degree of satisfaction of healthcare professionals with IT development. Results: The results showed that it is possible to access discharge reports from hospitalized patients and from the accident and emergency department in 89.2% (95%CI: 86.4-92.0) and 87.2% (95%CI: 84.2-90.2) of cases, respectively. According to 95.1% of people polled, there is an option for remote consultation with hospital care. A total of 38.9% of survey respondents pointed out that they receive e-notifications of hospital reports and 73.3% claimed to have online access to their patients’ information. A total of 34.8% and 51.7% of clinicians stated that, in general, there was no improvement in communication channels or technological resources after the pandemic, respectively. A total of 13.0% of respondents expressed that they are very unsatisfied and 27.3% unsatisfied with IT development in primary healthcare telemedicine systems and telecommunication in their health area. Conclusion: Most Primary Care healthcare teams in regional health services have access to medical histories shared with hospitals. However, just some of them have electronic notification systems for hospital reports. The mandatory change in healthcare has not substantially improved technological resources after the pandemic and there is a considerable level of dissatisfaction among professionals.(AU)

El reto de la pandemia de la COVID-19 para la Atención Primaria / The challenge of the COVID-19 pandemic for Primary Care

La COVID-19 ha provocado muchos cambios en el sistema sanitario y, por supuesto, en Atención Primaria. La pandemia ha marcado un antes y un después, tanto a nivel organizativo en los centros de salud como en la manera de abordar las demandas y necesidades de los pacientes, y en el desempeño de la Medicina Familiar. En marzo de 2020 todos veíamos con preocupación cómo la Atención Primaria era invisible para las administraciones. La forma inicial de abordar la atención a la pandemia con un enfoque hospitalocentrista ha condicionado probablemente el diseño organizativo a lo largo de las diferentes oleadas. Al comienzo de la pandemia, la Atención Primaria no disponía de pruebas para el diagnóstico de la COVID-19, y fuimos testigos de cómo la inquietud y el miedo se apoderaba de los médicos y médicas de familia, muy especialmente en aquellas comunidades autónomas (CCAA) en las que el virus azotaba con fuerza a la población. La Atención Primaria, como siempre, se mantuvo cerca de la ciudadanía, priorizando la atención telefónica y dando respuesta a las demandas de los pacientes, muy especialmente al abordaje de la COVID-19. La Atención Primaria trabajó no solo como un eficaz muro de contención de la epidemia, sino también gestionando y resolviendo en el domicilio los casos leves o moderados que no necesitaban ingreso hospitalario. Sin embargo, para seguir haciendo frente a la pandemia y a la nueva situación se precisaban cambios organizativos y de gestión, más profesionales y nuevos roles. Es importante constatar que, para el buen desempeño de la Medicina Familiar del siglo XXI, para que la Atención Primaria salga reforzada de esta pandemia, las soluciones pasan por una adecuada financiación y una apuesta firme por mantener la longitudinalidad.(AU)

The COVID-19 pandemic has led to many changes in the healthcare system including of course in Primary Care. The pandemic has marked a before and after for primary care both on an organisational level in healthcare centres, how patient requests and requirements are tackled and how family medicine is conducted. In March 2020 we all worried at how primary care appeared to be invisible for administrations. How the pandemic was initially managed with a hospital-centric approach probably conditioned the organisational design over the different waves. At the onset of the pandemic, Primary Care did not have tests to diagnose COVID-19, and we witnessed how concern and fear took hold over family doctors, most especially in those autonomous communities in which the virus whipped the population hard. Primary Care as always, stayed close to citizens and priority was given to telephone attention and responding to patient requests, most especially when tackling COVID-19. Primary Care worked not only as an effective protective wall for the epidemic but also to manage and resolve mild or moderate cases at home that needed hospital admission. However, to continue managing the pandemic and the new situation organisational and management changes, more professionals and new roles were all required. It is important to observe that for family medicine to function correctly in the 21st century and so that Primary Care comes out of this pandemic stronger, solutions entail both correct financing and a firm commitment to upholding continuity.(AU)

Extramural gerontology management devising an integrating record for a geriatric care service, an experience report.

The Gerontological Care Plan is idealized through case management that includes in its aspect engaging the elderly, self-care and the acquisition and maintenance of health-promoting behaviors. OBJECTIVE: To evaluate the importance of a gerontological care plan, in a geriatric service of a referral hospital in the city of São Paulo. METHODS: Fifteen older adult patients were interviewed and the Gerontological Care Plan (PAGe) was applied. RESULTS: Most respondents were classified as independent for instrumental activities of daily living, 42% of whom lived alone. Data from 277 yellow sheets were analyzed, that is, referral forms, in which it was found that the most affected areas were: social work and psychology. For the social worker, the most recurring requests were: verification of the social support network, namely lack of companion and caregiver, with 53%; family problems, with 20%; lack of adherence to treatment, 12%, and problems related to medication, 10%. In the area of psychology, 82% of referrals were due to the need for psychological support, psychotherapy, and help with family problems, depression and grief. CONCLUSIONS: A gerontological management proposal was developed within the Geriatric Services of Hospital das Clínicas. The management plan was intended to integrate the actions carried out by the interprofessional team, through the creation of an Integrating Form that allowed the gerontologist to propose, execute and implement a plan of care, follow-up, and monitoring of cases, including the extra context-hospital.

O Plano de Atenção Gerontológica é idealizado por meio da gestão de casos que engloba em sua vertente, engajamento da pessoa idosa, autocuidado e aquisição e manutenção de comportamentos de promoção de saúde. OBJETIVO: Avaliar a importância de um plano de atenção gerontológica em um serviço de geriatria de um hospital de referência na cidade de São Paulo. MÉTODOS: Foram entrevistados 15 pacientes idosos, sendo aplicado o Plano de Atenção Gerontológica (PAGe). RESULTADOS: Em sua maioria, os entrevistados foram classificados como independentes para as atividades instrumentais de vida diária, sendo que 42% deles residem sozinhos. Dados de 277 folhas amarelas foram analisados, ou seja, Fichas de Encaminhamento, nos quais foi possível verificar que as áreas mais acionadas foram o serviço social e a psicologia. Para assistência social, as solicitações mais recorrentes foram a verificação da rede de suporte social, falta de acompanhante e de cuidador, com 53%, problemas familiares, com 20%, falta de adesão ao tratamento, 12%, e problemas relacionados a medicamentos, 10%. Na área da psicologia, 82% dos encaminhamentos foram feitos por necessidade de acompanhamento psicológico/psicoterapia, problemas com família, depressão e luto. CONCLUSÕES: Elaborou-se uma proposta de Gestão Gerontológica dentro dos Serviços de Geriatria do Hospital das Clínicas. O plano de gestão teve o intuito de integrar as ações realizadas pela equipe interprofissional, por meio da criação de uma Ficha Integradora que permitiu ao profissional gerontólogo propor, executar e implementar um plano de atenção, acompanhamento e monitoramento dos casos, incluindo o contexto extra-hospitalar.

Extramural gerontology management devising an integrating record for a geriatric care service, an experience report / Gestão gerontológica extramuros: a proposta de criação de um protocolo integrador para uma unidade de internação hospitalar

ABSTRACT. The Gerontological Care Plan is idealized through case management that includes in its aspect engaging the elderly, self-care and the acquisition and maintenance of health-promoting behaviors. Objective: To evaluate the importance of a gerontological care plan, in a geriatric service of a referral hospital in the city of São Paulo. Methods: Fifteen older adult patients were interviewed and the Gerontological Care Plan (PAGe) was applied. Results: Most respondents were classified as independent for instrumental activities of daily living, 42% of whom lived alone. Data from 277 yellow sheets were analyzed, that is, referral forms, in which it was found that the most affected areas were: social work and psychology. For the social worker, the most recurring requests were: verification of the social support network, namely lack of companion and caregiver, with 53%; family problems, with 20%; lack of adherence to treatment, 12%, and problems related to medication, 10%. In the area of psychology, 82% of referrals were due to the need for psychological support, psychotherapy, and help with family problems, depression and grief. Conclusions: A gerontological management proposal was developed within the Geriatric Services of Hospital das Clínicas. The management plan was intended to integrate the actions carried out by the interprofessional team, through the creation of an Integrating Form that allowed the gerontologist to propose, execute and implement a plan of care, follow-up, and monitoring of cases, including the extra context-hospital.

RESUMO. O Plano de Atenção Gerontológica é idealizado por meio da gestão de casos que engloba em sua vertente, engajamento da pessoa idosa, autocuidado e aquisição e manutenção de comportamentos de promoção de saúde. Objetivo: Avaliar a importância de um plano de atenção gerontológica em um serviço de geriatria de um hospital de referência na cidade de São Paulo. Métodos: Foram entrevistados 15 pacientes idosos, sendo aplicado o Plano de Atenção Gerontológica (PAGe). Resultados: Em sua maioria, os entrevistados foram classificados como independentes para as atividades instrumentais de vida diária, sendo que 42% deles residem sozinhos. Dados de 277 folhas amarelas foram analisados, ou seja, Fichas de Encaminhamento, nos quais foi possível verificar que as áreas mais acionadas foram o serviço social e a psicologia. Para assistência social, as solicitações mais recorrentes foram a verificação da rede de suporte social, falta de acompanhante e de cuidador, com 53%, problemas familiares, com 20%, falta de adesão ao tratamento, 12%, e problemas relacionados a medicamentos, 10%. Na área da psicologia, 82% dos encaminhamentos foram feitos por necessidade de acompanhamento psicológico/psicoterapia, problemas com família, depressão e luto. Conclusões: Elaborou-se uma proposta de Gestão Gerontológica dentro dos Serviços de Geriatria do Hospital das Clínicas. O plano de gestão teve o intuito de integrar as ações realizadas pela equipe interprofissional, por meio da criação de uma Ficha Integradora que permitiu ao profissional gerontólogo propor, executar e implementar um plano de atenção, acompanhamento e monitoramento dos casos, incluindo o contexto extra-hospitalar.

Reinventing Privatization: A Political Economic Analysis of the Social Health Organizations in Brazil.

The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations (Organizações Sociais de Saúde or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, from which we selected 49 for analysis. The main findings reveal that NPM is the central theme of most articles about OSS in Brazil (n = 26). There is evidence corroborating our hypothesis that transferring management of public health care services to private non-profit organizations is a softer version of privatization as, although financing is kept public, the rationale and ethos of OSS services institutionally and operationally mimic the private sector. The practical consequence is that attainment of health care in Brazil ends up being neither fully commodified (based on ability to pay) nor fulfilled as a citizen's right following its national constitution.

Efeitos da acreditação Joint Commission International no gerenciamento hospitalar: a visão dos gestores de um hospital privado / Effects of Joint Commission International accreditation on hospital management: the view of managers of a private hospital

As organizações de saúde públicas e privadas convivem com as incertezas econômicas, aumento dos custos e a grande exigência dos clientes por uma prestação de serviço com maior excelência. Por aturem em um mercado competitivo, as organizações devem criar alternativas de melhoria dos processos, pautadas na segurança do serviço prestado e na identificação de suas fragilidades para uma melhoria contínua, estabelecendo, dessa forma, oportunidades inovadoras para agirem no dia a dia. Diante disso, a acreditação hospitalar apresenta-se como uma estratégia para avaliar segurança assistencial, padronização das técnicas e conformidades nos processos de trabalho. Esta pesquisa tem como objetivo geral analisar os efeitos da mudança da acreditação ONA para JCI, na visão dos gestores de um hospital privado de grande porte de Belo Horizonte. Os objetivos específicos são descrever as principais diferenças entre o processo de Acreditação ONA e JCI; descrever as principais mudanças nos processos de trabalho, na estrutura e no gerenciamento das equipes com a mudança da acreditação ONA para JCI, e identificar os possíveis benefícios da JCI em relação à ONA para a gestão hospitalar. Utilizou-se a metodologia do estudo de caso de abordagem qualitativa. Os participantes da pesquisa foram gestores de um hospital privado de grande porte localizado em Belo Horizonte. A técnica empregada na coleta de dados foi a entrevista semiestruturada. Analisaram-se os dados coletados por meio da Análise do Conteúdo, seguindo a modalidade de Análise Categorial Temática e buscaram-se identificar pontos em comum e práticas estabelecidas que se destacam. Agruparam-se os resultados coletados em três categorias: Processo de Acreditação ONA e JCI: principais diferenças; mudanças advindas da JCI no processo de trabalho, gerenciamento das equipes, adequações na estrutura física; e benefícios da mudança da Acreditação ONA para a Acreditação JCI. Os resultados desta pesquisa evidenciaram que os gestores se preparam de formas diferentes para cada norma acreditadora. Para a ONA, os gestores relataram que houve uma definição dos processos e sua documentação e, para JCI, adequações na estrutura física e aperfeiçoamento dos protocolos. Um ponto em comum foi a definição de um programa de capacitação que auxiliou os gestores na condução do processo de acreditação de cada norma. A JCI trouxe mudança na gestão de pessoas, na estrutura física do hospital para atender os requisitos relacionados à segurança nas instalações e no aprimoramento dos processos internos. Com a mudança de norma acreditadora, os gestores pontuaram que a JCI aproximou a equipe dos gestores, houve atenção maior com a segurança dos pacientes e familiares e benefícios nas relações intersetoriais. Assim, a partir desses dados, estruturou-se uma proposta de incorporação dos elementos de mensuração estabelecidos pela Acreditação JCI, aplicáveis a cada setor, na cadeia cliente fornecedor interno com o objetivo de aprimorar a integração dos setores com os requisitos da Acreditação, a fim de promover melhorias e eficiência dos processos.

Public and private health organizations live with economic uncertainties, rising costs and the great demand from customers for a service with greater excellence. By acting in a competitive market, organizations must create alternatives to improve processes based on the safety of the service provided and identification of its weaknesses for continuous improvement, thus establishing innovative opportunities to act on a day-to-day basis. Therefore, hospital accreditation is presented as a strategy to assess care safety, standardization of techniques and compliance in work processes. This research aims to analyze the effects of changing from ONA to JCI accreditation, in the view of managers of a large private hospital in Belo Horizonte. The specific objectives are to describe the main differences between the ONA and JCI Accreditation process; describe the main changes in the work processes, structure and management of teams with the change from ONA to JCI accreditation; and identify the possible benefits of JCI in relation to ONA for hospital management. The methodology used was the case study with a qualitative approach. Research participants were managers of a large private hospital located in Belo Horizonte. The techniques used in data collection were the semistructured interview. The collected data were analyzed through Content Analysis, following the Thematic Categorical Analysis modality and sought to identify common points and established practices that stand out. The collected results were grouped into three categories: ONA and JCI Accreditation Process: main differences; Changes arising from JCI in the work process, team management, adjustments to the physical structure; and Benefits of moving from ONA Accreditation to JCI Accreditation. The results of this research showed that managers prepare in different ways for each accreditation standard. For the ONA, the managers reported that there was a definition of the processes and their documentation and, for JCI, adjustments in the physical structure and improvement of the protocols. A common point was the definition of a training program that helped managers in conducting the accreditation process for each standard. JCI brought changes in people management, in the hospital's physical structure to meet the requirements related to safety in the facilities and in the improvement of internal processes. With the change in the accreditation standard, managers pointed out that JCI brought the management team closer, there was greater attention to the safety of patients and families and benefits in intersectoral relationships. Thus, based on these data, a proposal was structured to incorporate the measurement elements established by the JCI Accreditation, applicable to each sector, in the internal customer-supplier chain. The objective is to improve the integration of sectors with Accreditation requirements in order to promote improvements and efficiency of processes.

A needs assessment for postgraduate training in selected public health disciplines: evidence from health services organisations in Lusaka, Zambia.

BACKGROUND: As most low and middle-income countries seek to achieve universal health coverage targets, there is an ever-increasing need to train human resources with the required core skills and competencies. This study reports on a needs assessment conducted among health services organisations (HSOs) to understand postgraduate training needs and service gaps for selected public health disciplines - Health Policy and Systems, Health Economics, and Healthcare Management and Planning - at the University of Zambia. METHODS: The study adopted a cross-sectional design, comprising qualitative and quantitative components. Data were collected using semi-structured questionnaires administered to 32 representatives of purposively sampled public and private health service organisations based in Lusaka Zambia. The health services organisations included regulatory authorities, research institutions, government ministries, insurance firms and other cooperating partners. RESULTS: Overall (n = 22), more than 68% of the stakeholders reported that they had no employees that were formally trained in the three disciplines. More than 90% of the stakeholders opined that training in these disciplines would be beneficial in providing competencies to strengthen service provision. The horizontal skills mismatch for health economics, and health services management and planning were found to be 93 and 100%, respectively. Among the critical public health training needs were: policy development and analysis, economic evaluation, and strategic management. CONCLUSIONS: This study confirms that introducing post-graduate training in the proposed public health disciplines will not only benefit Zambian health services organisations but also help strengthen the health systems in general. For other empirical contexts, the findings imply the need for the introduction of academic programmes which respond to ever-changing public health skills demanded. They should be matched with local priorities and service delivery.

Link of Patient Care Outcome to Occupational Differences in Response to Human Resource Management: A Cross-Sectional Comparative Study on Hospital Doctors and Nurses in China.

This study assessed the link of patient care outcome to occupational differences in response to human resource management. A cross-sectional survey was conducted in three large regional hospitals in China. A total of 700 questionnaires were distributed to doctors, nurses, allied health workers, and managers and 499 (71%) were completed. Data were analyzed using a final sample of 193 doctors and 180 nurses. Quality of patient care was rated by the participants using a modified version of the Victorian Patient Satisfaction Questionnaire. Human resource management was measured on seven aspects: job security, recruitment, training, transformational leadership, information sharing, job quality, and teams. The differences between doctors and nurses in response to the human resource management practices and their associations with quality of care were compared through independent samples t-tests, correlational analyses, and moderator regressions. Doctors gave a higher rating on quality of patient care than their nurse counterparts. 'Training', 'transformational leadership', and 'information sharing' were more likely to be associated with higher ratings on quality of patient care in nurses. By contrast, a greater association between 'teams' and quality of patient care was found in doctors. Although doctors and nurses in China are exposed to the same hospital management environment, professional differences may have led them to respond to management practices in different ways.