Indicadores, auditorias, certificações: ferramentas de qualidade para gestão em saúde / Indicators, audits, certifications, quality tools for health management

A forma de gerir a qualidade nas organizações de saúde vem causando ao longo dos últimos anos uma inquietude nos gestores, dirigentes e nos profissionais da área de saúde. Tal momento reflete o descompasso existente entre as práticas de gestão, as exigências das organizações e as necessidades dos profissionais. Minimizar essa disritmia exige o conhecimento de conceitos sobre indicadores, auditorias e certificações, várias ferramentas de qualidade para ajudar a compreender e a complementar práticas renovadas na gestão das organizações de saúde enquanto prestadores de serviços à população. As organizações de saúde precisam mais do que nunca compreender a necessidade de mudar, avaliar, certificar e acreditar para assim responder às expectativas e necessidades dos clientes, encantando-os num processo contínuo. Os pesquisadores cujos textos compões este livro desenvolvem conceitos como eixo orientador, sobre os processos de avaliação e de gestão de qualidade. Trata-se agora de utilizá-los como avanço efetivo na teoria e prática das ações das organizações de saúde que prezam a modernização.

Quality of life in heart transplant candidates.

OBJECTIVE: To assess the quality of life of patients with refractory heart failure disease as candidates for heart transplant. METHODS: A transversal, descriptive and prospective study with 18 adult patients, with mean age of 52 years under pre-transplantation outpatient follow-up at educational and public hospital in São Paulo town. The quality of life was assessed by reference to 'The Medical Outcomes Study 36-item Short-Form Health Survey' (SF-36) generic questionnaire in order to assess the aspects in relation to the function, dysfunction, physical and emotional uneasiness. RESULTS: According to this group, 14 (77.8%) of these patients were male and four (22.2%) female; 14 (77.8%) of them were classified as functional class IV and four (22.2%) as functional class III (New York Heart Association); 17 (94.4%) of them were at stage D and one (5.6%) at stage C (American Heart Association/American College of Cardiology). The mean results obtained from the assessment of SF-36 scales were: functional capacity 38%, pain 49%, health general condition 49%, vitality 39%, social aspects 53%, emotional aspects 43% and mental health 54%. CONCLUSION: The quality of life of patients presenting terminal heart failure is considered to be very bad; it is likely to be worse than in many other more common morbid entities. Both mental and social aspects are least affected, on the other hand the vitality and functional capacity are the most affected.

Qualidade de vida dos candidatos a transplante de coração / Quality of life in heart transplant candidates

OBJETIVO: Aferir a qualidade de vida de pacientes com insuficiência cardíaca refratária, inscritos como candidatos a transplante de coração. MÉTODOS: Estudo prospectivo, descritivo, transversal de 18 pacientes, com média de idade de 52 anos, em acompanhamento ambulatorial pré-transplante, de um hospital público e vinculado ao ensino do Município de São Paulo. A qualidade de vida foi avaliada por meio do questionário genérico The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), com a finalidade de avaliar aspectos relativos a função, disfunção, desconforto físico e emocional. RESULTADOS: Dessa amostra, 14 (77,8 por cento) pacientes eram do sexo masculino e quatro (22,2 por cento), do sexo feminino; 14 (77,8 por cento) dos pacientes foram classificados segundo tipo funcional IV e quatro (22,2 por cento) em tipo funcional III (New York Heart Association); 17 (94,4 por cento) encontravam-se em estágio D e um (5,6 por cento) em estágio C (American Heart Association/ American College of Cardiology). As médias obtidas na avaliação das escalas do SF-36 foram: capacidade funcional 38 por cento, dor 49 por cento, estado geral de saúde 49 por cento, vitalidade 39 por cento, aspectos sociais 53 por cento, aspectos emocionais 43 por cento e saúde mental 54 por cento. CONCLUSÃO: A qualidade de vida dos pacientes com insuficiência cardíaca terminal é considerada muito ruim; provavelmente pior que em muitas outras entidades mórbidas mais comuns. Os aspectos, social e mental são os menos afetados, sendo os mais comprometidos, a vitalidade e a capacidade funcional.

OBJECTIVE: To assess the quality of life of patients with refractory heart failure disease as candidates for heart transplant. METHODS: A transversal, descriptive and prospective study with 18 adult patients, with mean age of 52 years under pre-transplantation outpatient follow-up at educational and public hospital in São Paulo town. The quality of life was assessed by reference to "The Medical Outcomes Study 36-item Short-Form Health Survey" (SF-36) generic questionnaire in order to assess the aspects in relation to the function, dysfunction, physical and emotional uneasiness. RESULTS: According to this group, 14 (77.8 percent) of these patients were male and four (22.2 percent) female; 14 (77.8 percent) of them were classified as functional class IV and four (22.2 percent) as functional class III (New York Heart Association); 17 (94.4 percent) of them were at stage D and one (5.6 percent) at stage C (American Heart Association/American College of Cardiology). The mean results obtained from the assessment of SF-36 scales were: functional capacity 38 percent, pain 49 percent, health general condition 49 percent, vitality 39 percent, social aspects 53 percent, emotional aspects 43 percent and mental health 54 percent. CONCLUSION: The quality of life of patients presenting terminal heart failure is considered to be very bad; it is likely to be worse than in many other more common morbid entities. Both mental and social aspects are least affected, on the other hand the vitality and functional capacity are the most affected.

Caracterização dos cuidadores de candidatos a transplante do coração na UNIFESP / Characterization of the patients' caregivers on the waiting list for heart transplant at UNIFESP

OBJETIVOS: Identificar e caracterizar o principal cuidador dos pacientes candidatos a transplante do coração; comparar as diferenças entre as informações coletadas com os pacientes e cuidadores; e classificar os cuidadores segundo a sua dedicação e eficiência na assistência ao paciente, correlacionando-os aos dados sociodemográficos. MÉTODOS: Estudo descritivo realizado de outubro de 2004 a março de 2005, no ambulatório da UNIFESP, por meio de entrevista estruturada, com amostragem de 21 pacientes e seus cuidadores. RESULTADOS: O principal cuidador era membro da família (95 por cento), na maioria das vezes, o cônjuge, sendo 13 (81 por cento) mulheres e três (19 por cento) homens, com idade variando de 24 a 65 anos (média de 44,3). Declararam-se 56 por cento casados; 43,8 por cento católicos; 29 por cento cursaram o ensino fundamental, 24 por cento completaram o ensino médio e 14 por cento tinham nível superior. Atividade profissional era exercida por 68,8 por cento e 81,4 por cento possuíam renda própria. Todos os cuidadores residiam na mesma casa que o paciente. Estabelecido um escore, classificaram-se os cuidadores em oito (50 por cento) "bons", sete (43,7 por cento) "regulares" e apenas um (6,3 por cento) foi considerado "ruim". Não encontramos correlação estatisticamente significante entre o escore e as variáveis escolaridade, atividade profissional e renda. CONCLUSÃO: É importante determinar os instrumentos para o reconhecimento e caracterização do cuidador. Neste estudo, identificou-se um familiar (cônjuge), do sexo feminino, com idade média de 44,3 anos, renda própria, classificados, na maioria, como "bons" ou "regulares", não havendo correlação com escolaridade, atividade profissional e renda. Novos estudos complementares, com casuística maior, deverão estabelecer a relação entre o papel do cuidador e os resultados do transplante cardíaco.

OBJECTIVES: To identify and describe the main caregiver of the patients on the heart transplant waiting list; to compare relevant information provided by patients and caregivers, and to classify the caregivers according to their dedication and efficiency in assisting the patient by correlating them to sociodemographic data. METHODS: Descriptive study performed from October 2004 to October 2005 at UNIFESP outpatient clinics. The study sample consisted of 21 patients and their caregivers. Data were collected through a structured interview. RESULTS: The main caregiver was a family member (95 percent), usually the spouse. There were 13 women (81 percent) and three men (19 percent). Patient age ranged from 24 to 65 years (mean 44.3). Patients were married (56 percent); catholic (43.8 percent); 29 percent have finished elementary school; 24 percent have finished high school; 14 percent have higher education; 68.8 percent have a regular job; and 81.4 percent had their own income. All caregivers lived in the same house as the patient. Once a score was established, the caregivers were classified as: "good" - 8 (50 percent); "regular" - 7 (43.7 percent); and "bad" 1 - (6.3 percent). The scores were correlated with education, professional activity, and income without any significant statistical correlation. CONCLUSION: It is important to determine the instruments to recognize and describe the caregivers. The caregiver is usually a family member (spouse), female, mean age of 44.3 years; has his/her own income and, most of the time, he/she is classified as "good" or "regular", and no correlation was found with education, professional activity and income. Further studies with a larger sample should establish the relationship between the caregiver's role and the heart transplant outcomes.

Characterization of the patients' caregivers on the waiting list for heart transplant at UNIFESP.

OBJECTIVES: To identify and describe the main caregiver of the patients on the heart transplant waiting list; to compare relevant information provided by patients and caregivers, and to classify the caregivers according to their dedication and efficiency in assisting the patient by correlating them to sociodemographic data. METHODS: Descriptive study performed from October 2004 to October 2005 at UNIFESP outpatient clinics. The study sample consisted of 21 patients and their caregivers. Data were collected through a structured interview. RESULTS: The main caregiver was a family member (95%), usually the spouse. There were 13 women (81%) and three men (19%). Patient age ranged from 24 to 65 years (mean 44.3). Patients were married (56%); catholic (43.8%); 29% have finished elementary school; 24% have finished high school; 14% have higher education; 68.8% have a regular job; and 81.4% had their own income. All caregivers lived in the same house as the patient. Once a score was established, the caregivers were classified as: "good" - 8 (50%); "regular" - 7 (43.7%); and "bad" 1 - (6.3%). The scores were correlated with education, professional activity, and income without any significant statistical correlation. CONCLUSION: It is important to determine the instruments to recognize and describe the caregivers. The caregiver is usually a family member (spouse), female, mean age of 44.3 years; has his/her own income and, most of the time, he/she is classified as "good" or "regular", and no correlation was found with education, professional activity and income. Further studies with a larger sample should establish the relationship between the caregiver's role and the heart transplant outcomes.