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REME rev. min. enferm ; 24: e-1283, fev.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1053383


Objetivo: refletir sobre o estabelecimento de metas no planejamento da aposentadoria à luz da teoria de Imogene King, que se caracteriza por ser interacionista, pautada no cuidado de Enfermagem que não se restringe ao âmbito individual, mas pode ser prestado a um grupo social com o qual o profissional estabelece contato. Método: estudo reflexivo realizado por meio de aporte teórico relacionado à teoria do alcance de metas de Imogene King e análise reflexiva do tema planejamento da aposentadoria. Resultados: o estabelecimento de metas ocorre a partir da interação entre enfermeiro e trabalhador, em que cada indivíduo reage de forma particular à aposentadoria, influenciado por suas experiências e percepções. Compete ao enfermeiro valorizar os conhecimentos do trabalhador, a fim de estimular sua adesão ao planejamento da aposentadoria. O trabalhador possui necessidades básicas de informação sobre a aposentadoria, que devem ser fornecidas em momento oportuno pelo profissional. Conclusão: o estabelecimento de metas contribui para que o trabalhador note concretamente seus avanços até o desligamento do trabalho. A teoria de Imogene King direciona o enfermeiro do trabalho no estabelecimento de metas com trabalhadores em pré-aposentadoria.(AU)

Objective: to reflect on the establishment of goals in retirement planning in the light of Imogene King's theory, which is characterized by being interactionist, based on Nursing care that is not restricted to the individual scope, but can be provided to a social group with the which the professional establishes contact. Method: reflective study carried out through theoretical support related to the theory of goal attainment by Imogene King and reflective analysis of the theme of retirement planning. Results: the establishment of goals occurs from the interaction between nurse and employee, in which each individual reacts in a particular way to retirement, influenced by their experiences and perceptions. It is up to the nurse to value the employee's knowledge, in order to encourage their adherence to retirement planning. The employee has basic information needs about retirement, which must be provided by the professional in a timely manner. Conclusion: the establishment of goals contributes to the employee concretely noting his advances until he leaves work. Imogene King's theory directs the occupational health nurse in setting goals with preretirement employees.(AU)

Objetivo: reflexionar sobre la planificación de la jubilación y el establecimiento de metas a la luz de la teoría de Imogene King, que se caracteriza por ser interaccionista,basada en la atención de enfermería no limitada al alcance individual sino que incluye a todo el grupo social con el cual el profesional establece contacto. Método: estudio reflexivo basado en la teoría de metas de Imogene King y análisis reflexivo de la planificación de la jubilación. Resultados: el establecimiento de metas ocurre a partir de la interacción entre el enfermero y el trabajador, en el que cada individuo reacciona de modo diferente a la jubilación, influenciado por sus experiencias y percepciones. Le corresponde al enfermero valorar el conocimiento del trabajador para fomentar su adhesión a la planificación de la jubilación. El profesional debe proporcionar de manera oportuna información básica sobre la jubilación. Conclusión: el establecimiento de metas contribuye a que el trabajador note concretamente sus avances hasta que se desvincule de su trabajo. La teoría de Imogene King orienta al enfermero de trabajo en el establecimiento de metas con los trabajadores que se preparan para la jubilación. (AU)

Humanos , Aposentadoria , Teoria de Enfermagem , Saúde do Trabalhador , Enfermagem do Trabalho , Apoio ao Planejamento em Saúde
Prev Chronic Dis ; 16: E87, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31274409


INTRODUCTION: Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people's health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees. METHODS: We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods. RESULTS: Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively. CONCLUSION: Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.

Doenças Cardiovasculares/prevenção & controle , Serviços de Saúde Comunitária , Planejamento Ambiental , Apoio ao Planejamento em Saúde , Promoção da Saúde , Simulação por Computador , Análise Custo-Benefício , Humanos , Modelos Biológicos , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde
Prev Chronic Dis ; 16: E89, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31298211


PURPOSE AND OBJECTIVES: Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California. INTERVENTION APPROACH: HSC works in both clinical systems and communities to reduce CVD risk. The initiative grew out of a longer-term county-wide collaborative effort known as Health Action. The clinical component involves activating primary care providers around management of CVD risk factors; community activities include community health workers conducting blood pressure screenings and a local heart disease prevention campaign. EVALUATION METHODS: The impact of the clinical improvement efforts was tracked using blood pressure data from the 4 health systems participating in HSC. Descriptive information on the community-engagement efforts was obtained from program records. Lessons learned in developing and maintaining the collaborative were gathered through document review and interviews with key informants. RESULTS: Favorable trends were seen in blood pressure control among patients with hypertension in the participating health systems: patients with controlled blood pressure increased from 58% in 2014 to 67% in 2016 (P < .001). Between 2017 and 2019, the community engagement effort conducted 99 outreach events, reaching 1,751 individuals, and conducted 1,729 blood pressure screenings, with 441 individuals referred to clinical providers for follow-up care. HSC scored highly on 6 essential elements of an effective coalition and achieved a degree of sustainability that has eluded many other collaboratives. IMPLICATIONS FOR PUBLIC HEALTH: Factors contributing to the success of HSC include 1) starting small and focused to build trust among participants and demonstrate value, 2) working within the framework of a larger effort, and 3) providing long-term, open-ended backbone support.

Doenças Cardiovasculares/prevenção & controle , Serviços de Saúde Comunitária , Promoção da Saúde , California , Doenças Cardiovasculares/epidemiologia , Agentes Comunitários de Saúde , Assistência à Saúde , Apoio ao Planejamento em Saúde , Humanos , Hipertensão , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde
Clin Obes ; 9(3): e12307, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30957415


To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.

Promoção da Saúde/economia , Obesidade/fisiopatologia , Programas de Redução de Peso/economia , Adulto , Índice de Massa Corporal , Análise Custo-Benefício , Feminino , Apoio ao Planejamento em Saúde , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Estudos Retrospectivos , Perda de Peso , Programas de Redução de Peso/métodos , Programas de Redução de Peso/organização & administração
Sex Health ; 16(1): 63-69, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30620884


Background Pre-exposure prophylaxis (PrEP) became publicly funded in New Zealand (NZ) on 1 March 2018. PrEP could have a substantial population-level effect on HIV transmission if scaled up rapidly. An accurate estimate of the size of the PrEP-eligible population would guide implementation. METHODS: We drew on nine sources to estimate the PrEP-eligible population, namely Statistics NZ data, Pharmaceutical Management Agency (PHARMAC) data on adults receiving funded antiretroviral treatment (ART), expert advice, estimates of the HIV care cascade, surveillance of undiagnosed HIV in a community sample of gay and bisexual men (GBM), surveillance of HIV diagnoses, NZ Health Survey data on sexual orientation among males, behavioural surveillance among GBM and behavioural data among people living with HIV (PLWH) from the HIV Futures NZ study. From these sources we derived three estimates relating to GBM, non-GBM and total eligible population. Sensitivity analyses examined different assumptions (GBM denominators, proportion PLWH diagnosed, proportion of diagnosed PLWH treated). RESULTS: We estimated that 17.9% of sexually active HIV-negative GBM would be eligible for PrEP, equating to 5816 individuals. We estimated that 31 non-GBM individuals would be eligible for PrEP. Thus, in total, 5847 individuals would be eligible for PrEP, comprising 99.5% GBM and 0.5% non-GBM. Sensitivity analyses ranged from 3062 to 6718 individuals. CONCLUSIONS: Policy makers can use enumeration to monitor the speed and scale in coverage as implementation of publicly funded PrEP proceeds. Sexual health and primary care services can use enumeration to forecast PrEP demand and plan accordingly. Better quality data, especially on transgender adults in NZ, would improve the accuracy of estimates.

Definição da Elegibilidade/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Adolescente , Adulto , Idoso , Coleta de Dados , Feminino , Financiamento Governamental , Previsões , Apoio ao Planejamento em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
Surgery ; 165(2): 273-280, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30316576


BACKGROUND: The Bill and Melinda Gates Foundation has made unparalleled contributions to global health and human development by bringing together generous funding, strategic partnerships, and innovative leadership. For the last twenty years, the Gates Foundation has supported the expansion of programs that directly address the fundamental barriers to the advancement of marginalized communities around the globe, with a transformative focus on innovations to combat communicable diseases and to ensure maternal and child health. Despite the wide spectrum of programs, the Gates Foundation has not, as of yet, explicitly supported the development of surgical care. METHODS: This article explores the pivotal role that the Gates Foundation could play in advancing the emerging global surgery agenda. First, we demonstrate the importance of the Gates Foundation's contributions by reviewing its history, growth, and evolution as a pioneering supporter of global health and human development. Recognizing the Foundation's use of metrics and data in strategic planning and action, we align the priorities of the Foundation with the growing recognition of surgical care as a critical component of efforts to ensure universal health care. RESULTS: To promote healthy lives and well-being for all, development of quality and affordable capacity for surgery, obstetrics and anesthesia is more important than ever. We present the unique opportunity for the Gates Foundation to bring its transformative vision and programing to the effort to ensure equitable, timely, and quality surgical care around the world.

Fundações , Saúde Global/economia , Procedimentos Cirúrgicos Operatórios/economia , Países em Desenvolvimento/economia , Apoio ao Planejamento em Saúde , Política de Saúde , Humanos
J Cataract Refract Surg ; 44(8): 1012-1017, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30037700


PURPOSE: To establish a refractive surgery unit at Tilganga Institute of Ophthalmology through support from international donations and provide knowledge transfer for doctors and management to make the unit self-sustaining, nonprofit laser refractive surgery, and financial support for other eyecare projects at Tilganga. SETTING: Tilganga Institute of Ophthalmology, Kathmandu, Nepal. DESIGN: Retrospective study. METHODS: A foundation was created to establish a refractive surgery unit using a cost-recovery model; that is, patients are charged according to their financial status to cover running costs, patients without funds to pay for surgery, and other eyecare projects for the underprivileged population of Kathmandu, Nepal. Donations were obtained to fund refurbishment within Tilganga Hospital and purchase equipment and technology. A Nepalese surgeon was selected from Tilganga and completed an 8-month fellowship and proctorship of the first series of surgeries. The refractive surgery unit was opened in January 2012, and the cost-recovery model was evaluated up to December 2016. RESULTS: During the period evaluated, 74.8% of patients were treated at full cost, 17.2% at subsidized cost, and 8.6% free of charge. The refractive surgery unit generated a profit representing 28% of the running cost in this period, which was used to reduce the deficit of the main hospital. Surgical outcomes achieved were comparable to those reported by groups in the developed world. CONCLUSION: A self-sustaining nonprofit laser refractive surgery clinic, operating with high quality, was successfully implemented supported by international donations for initial setup costs and a cost-recovery model thereafter.

Organizações sem Fins Lucrativos/economia , Procedimentos Cirúrgicos Refrativos/métodos , Socorro em Desastres/organização & administração , Adulto , Idoso , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Feminino , Apoio ao Planejamento em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Nepal , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Procedimentos Cirúrgicos Refrativos/economia , Socorro em Desastres/economia , Estudos Retrospectivos
Pediatrics ; 141(Suppl 2): S180-S187, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29437051


Congenital Zika virus infection has obvious implications for infants, and considerable research has addressed the nature and consequences of congenital Zika syndrome (CZS). Children with classic CZS meet the criteria for "children with medical complexity," and ongoing research is required to understand the range of needs and optimal treatment options. Far less attention has been given to the consequences of CZS for families, which are both immediate and lifelong. Although families of children with CZS have much in common with families of other children with disabilities, at least 4 features of CZS have special family implications: (1) the severity of the impact on children with obvious abnormalities at birth, coupled with the anticipation of a lifetime of caregiving and economic burdens; (2) uncertainty about the unfolding consequences, both for obviously affected children and for exposed children with no symptoms at birth; (3) a lack of specialized professional knowledge about the course of the disease or treatment options; and (4) social isolation, a lack of social or community supports, and potential stigma. Supporting families will require a family-centered approach to services, extensive care coordination, access to evolving new information, ongoing surveillance, formal and informal supports, and individualized child and family services.

Serviços de Saúde Comunitária/métodos , Saúde da Família , Complicações Infecciosas na Gravidez/epidemiologia , Apoio Social , Infecção por Zika virus/epidemiologia , Zika virus , Serviços de Saúde Comunitária/tendências , Saúde da Família/tendências , Feminino , Apoio ao Planejamento em Saúde/tendências , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/terapia
Pediatr Infect Dis J ; 37(5): 407-412, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29278610


BACKGROUND: Despite the increase in Health System Strengthening (HSS) grants, there is no consensus among global health actors about how to maximize the efficiency and sustainability of HSS programs and their resulting gains. To formally analyze and compare the efficiency and sustainability of Gavi's HSS grants, we investigated the factors, events and root causes that increased the time and effort needed to implement HSS grants, decreased expected outcomes and threatened the continuity of activities and the sustainability of the results gained through these grants in Cameron and Chad. METHODS: We conducted 2 retrospective independent evaluations of Gavi's HSS support in Cameroon and Chad using a mixed methodology. We investigated the chain of events and situations that increased the effort and time required to implement the HSS programs, decreased the value of the funds spent and hindered the sustainability of the implemented activities and gains achieved. RESULTS: Root causes affecting the efficiency and sustainability of HSS grants were common to Cameroon and Chad. Weaknesses in health workforce and leadership/governance of the health system in both countries led to interrupting the HSS grants, reprogramming them, almost doubling their implementation period, shifting their focus during implementation toward procurements and service provision, leaving both countries without solid exit plans to maintain the results gained. CONCLUSIONS: To increase the efficiency and sustainability of Gavi's HSS grants, recipient countries need to consider health workforce and leadership/governance prior, or in parallel to strengthening other building blocks of their health systems.

Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Apoio ao Planejamento em Saúde/estatística & dados numéricos , Camarões , Chade , Assistência à Saúde , Saúde Global , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/organização & administração , Apoio ao Planejamento em Saúde/economia , Apoio ao Planejamento em Saúde/legislação & jurisprudência , Apoio ao Planejamento em Saúde/organização & administração , Humanos , Cooperação Internacional , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
Am J Health Promot ; 32(1): 170-176, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29277125


PURPOSE: To test the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally available weight management program. DESIGN: A randomized trial tested the impact of employer subsidy: 100%; 80%, 50%, and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. TRIAL REGISTRATION: NCT01756066. SETTING AND PARTICIPANTS: Twenty three thousand twenty-three employees of 2 US companies. MEASURES: The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation. Analysis and Results: Enrollment differed significantly by subsidy level ( P < .0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs 80% subsidy: 6.2%, P = .002; vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Among enrollees, there were no differences among the 4 groups in attendance or weight loss. CONCLUSION: This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost-effectiveness of such subsidies or alternative designs.

Custo Compartilhado de Seguro , Emprego/economia , Apoio ao Planejamento em Saúde/economia , Promoção da Saúde/economia , Promoção da Saúde/métodos , Programas de Redução de Peso/economia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
Porto Alegre; s.n; 2018. 13 p.
Tese em Português | Coleciona SUS | ID: biblio-943756


O artigo aborda o apoio matricial e as suas nuances traduzidas em potencialidades e dificuldades, no contexto da atenção básica, executado por um Núcleo de Apoio à Saúde da Família em contato com oito Equipes de Saúde da Família. O objetivo é cartografar e narrar as vivências e os fenômenos que se produzem nos encontros de apoio matricial, bem como as ferramentas utilizadas nesse processo. Trata-sede uma pesquisa qualitativa, de cunho exploratório, que tem como procedimento, um estudo de caso com narrativas produzidas pela pesquisadora. A idéia de construção do trabalho perpassa o entendimento da importância do matriciamento na Atenção Primária à Saúde, para o desenvolvimento da saúde integral dos usuários do serviço. Nesse sentido, identificar o apoio matricial como possibilitador de novas formas de fazer em saúde, suscita perceber a importância da saúde na vida das pessoas. Entende-se o matriciamento como um instrumento que viabiliza ações de cuidado compartilhado e continuado em saúde, na atenção básica, levando em conta os cuidados com a atenção integral aos sujeitos atendidos. Este trabalho compartilhado visa ampliar o escopo de ações e qualificar o trabalho, já que um suporte técnico de núcleos diferenciados é ofertado a uma equipe multidisciplinar (SILVA; LIMA; ROBERTO; BARFKNECHT; VARGAS; KRANEN; NOVELLI, 2010). O percurso metodológico será de pesquisa qualitativa e o registro dos dados será feito na forma de diário de campo, escritos pela própria pesquisadora que participa das reuniões de matriciamento juntamente às equipes referenciadas.

Brasil , Apoio ao Planejamento em Saúde , Saúde Pública , Sistema Único de Saúde
Rev. APS ; 20(4): 501-518, 20/10/2017.
Artigo em Português | LILACS | ID: biblio-916606


Este estudo teve como objetivo avaliar a implantação do Núcleo de Apoio à Saúde da Família (NASF) em três municípios da Zona da Mata Norte de Pernambuco, determinando o grau de implantação do NASF nesses municípios, a partir das dimensões estrutura e processo e analisando a influência do contexto político e estrutural na variação do grau de implantação. Trata-se de uma pesquisa avaliativa do tipo análise de implantação 1-b, desenvolvida no período de março a agosto de 2015, com os profissionais do NASF, coordenadores da AB e secretários de saúde. Os NASF dos municípios A, B e C obtiveram um grau de implantação de 72% (parcialmente implantado), 81% (implantado) e 68% (parcialmente implantado), respectivamente. Na análise do contexto, houve uma coerência nos resultados, pois o único município onde o NASF foi considerado implantado foi o mesmo que apresentou um contexto mais favorável. Da mesma forma, o município com o grau de implantação mais baixo foi o que obteve um contexto mais desfavorável. Observou-se que uma gestão que proporciona condições adequadas para realização das atividades pelos profissionais, sejam elas relacionadas à estrutura ou ao processo, influencia positivamente a implantação da intervenção.

This study aimed to evaluate the implementation of the Family Health Support Center (FHSC) in three municipalities in the Northern Zona da Mata of Pernambuco, determining the degree of FHSC implementation in these municipalities from the structure and process dimensions, and analyzing the influence of the political and structural context in the variation of the degree of implementation. This is an evaluative study, type 1b implementation analysis, developed in the period from March to August 2015 with FHSC professionals, coordinators from AB, and secretaries of health. The FHSC from the A, B, and C municipalities obtained a degree of implementation of 72% (partially implemented), 81% (implemented), and 68% (partially implemented), respectively. In the context analysis there was a consistency in the results, because the only region where the FHSC was considered implemented was the same one that presented a more favorable context. In similar fashion, the region with the lowest degree of implementation was the one that had a more unfavorable context. It was observed that management that provides suitable conditions for carrying out activities by professionals, whether related to the structure or the process, positively influences the implementation of the intervention.

Atenção Primária à Saúde , Avaliação em Saúde , Centros de Saúde , Saúde da Família , Estratégia Saúde da Família , Apoio ao Planejamento em Saúde
Rev. APS ; 20(4): 551-564, 20/10/2017.
Artigo em Português | LILACS | ID: biblio-946527


Este estudo de caso teve como objetivo caracterizar Núcleos de Apoio à Saúde da Família (NASF) com foco no grau de integração às equipes vinculadas. Um formulário semiestruturado foi respondido por 31 NASF e as respostas foram convertidas para escores de 0 a 2, com valoração previamente definida, a partir de revisão de literatura e normativas. Em seguida, os NASF foram estratificados segundo modalidade. Para a caracterização do grau de integração, foram definidos pesos para as dimensões do formulário, com exceção do perfil da equipe, analisado de maneira descritiva. A somatória dos pontos obtidos pelos NASF definiu o grau de integração às equipes apoiadas, que foi considerado incipiente, especialmente entre os NASF Modalidade II. Foi verificado maior percentual de NASF com grau de integração satisfatório na Modalidade I. A definição de estratégias, que promovam mudanças estruturais e de processo na implantação dos NASF, incluindo ajustes no trabalho de ambas as equipes e direcionamento e apoio institucional, é necessária para que a integração e a colaboração esperadas possam ser consolidadas.

This case study aimed to characterize Family Health Support Centers (FHSCs) focused on the degree of integration into related teams. A semi-structured form was completed by 31 FHSCs and the answers were converted to scores from 0 to 2, with pre-defined valuation based on literature and regulatory review. Then the FHSCs were stratified by type. To characterize the degree of integration, weights were set for the dimensions on the form, except for team profile, which was analyzed descriptively. The sum of points obtained by the FHSCs defined the degree of integration of the supported teams, which was considered incipient, especially among the Type II FHSCs. A higher percentage of FHSCs with a satisfactory degree of integration was found in Type I. The definition of strategies to promote structural and process changes in the implementation of FHSCs, including adjustments to the work of the teams and that of guidance and institutional support, is needed so that the expected integration and collaboration can be consolidated.

Estratégia Saúde da Família , Políticas Públicas de Saúde , Atenção Primária à Saúde , Avaliação em Saúde , Centros de Saúde , Colaboração Intersetorial , Apoio ao Planejamento em Saúde
Rev. baiana saúde pública ; 40(2 (2016)):, Set. 2017.
Artigo em Português | LILACS | ID: biblio-859793


O apoio institucional, no âmbito da Atenção Básica, propõe ampliar as atribuições da gestão, com vistas a envolver as equipes nos processos decisórios que incidam diretamente na promoção da saúde, prevenção de riscos e minimização das doenças e agravos à saúde da população. Este trabalho tem como objetivo descrever as atividades desenvolvidas pela equipe gestora da Atenção Básica do município de Santo Antônio de Jesus, Bahia, por meio do apoio institucional. Trata-se de estudo descritivo do tipo relato de experiência, que aborda a vivência de gestores da Atenção Básica no gerenciamento dos serviços. Os principais resultados deste trabalho apontaram que, em Santo Antônio de Jesus, o apoio institucional vem colaborando para tornar a gestão mais democrática, no sentido de fomentar a cogestão. Concluiu-se que o apoio institucional contribuiu para a implantação de novos processos no Sistema Único de Saúde, como o Acolhimento com Classificação de Risco, o matriciamento feito pelo Núcleo de Apoio à Saúde da Família e o estímulo à cogestão, constituindo-se numa aposta para fomentar práticas mais condizentes com a Política Nacional de Atenção Básica.

Institutional support, within the scope of Primary Care, proposes to broaden the attributions of management, in order to involve the teams in the decision-making processes that directly affect health promotion, risk prevention and disease and health problems minimization for the population. This work aims to describe the activities developed by the management team of Primary Care of the municipality of Santo Antônio de Jesus, Bahia, through institutional support. It is a descriptive study, an experience report, which addresses the experience of managers of Basic Attention on managing services. The main results of this study indicate that, in Santo Antônio de Jesus, institutional support has been collaborating to make management more democratic, to enhance co-management. In conclusion, the institutional support contributed to the implantation of new processes to the Unified Health System, such as the Reception with Risk Classification, the matricial practice by the Family Health Support Nucleus and the incentive to co-management, constituting a bet on promoting practices that are more consistent with the National Primary Care Policy

El apoyo institucional, en el ámbito de la Atención Básica, propone ampliar las atribuciones de la gestión, con la intención de integrar los equipos en los procesos decisorios que incidan directamente en la promoción de la salud, prevención de riesgos y minimización de las enfermedades y agravios a la salud de la población. Este trabajo tiene como objetivo describir las actividades desarrolladas por el equipo gestor de la Atención Básica del municipio de Santo Antônio de Jesus, Bahia, a través del apoyo institucional. Se trata de un estudio descriptivo de tipo relato de experiencia, que aborda la vivencia de gestores de la Atención Básica en la gestión de los servicios. Los principales resultados de este trabajo apuntaron que, en Santo Antônio de Jesus, el apoyo institucional viene colaborando para hacer la gestión más democrática, en el sentido de fomentar la cogestión. Se concluyó que el apoyo institucional contribuyó para la implantación de nuevos procesos en el Sistema Único de Salud, como el Acogimiento con Clasificación de Riesgo, el matriciado hecho por el Núcleo de Apoyo a la Salud de la Familia y el estímulo a la cogestión, constituyéndose en una apuesta para fomentar prácticas más acordes con la Política Nacional de Atención Básica.

Atenção Primária à Saúde , Apoio ao Planejamento em Saúde , Política de Saúde
J Public Health Manag Pract ; 23(6): 684-689, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28628582


OBJECTIVE: The aim of this study was to assess the impact of a revolving loan fund (RLF) on timing of device insertion and long-acting reversible contraception (LARC) access among a high-risk urban population at 3 Boston community health centers. DESIGN: Three health centers were identified to implement a RLF. Each clinic received $5000 from the RLF to purchase LARC devices. Data collected through medical record review retrospectively 1 year prior to start of the RLF and prospectively for 1 year thereafter included patient demographics, type of LARC selected, patient's date of documented interest in a LARC device, and date of insertion. The effect of a RLF on delay to LARC insertion was tested using negative binomial regression, controlling for site and potential confounding variables between the pre- and post-RLF periods. SETTING: Three urban community health centers. PARTICIPANTS: Reproductive-aged women who received family planning services at the 3 participating health centers. MAIN OUTCOME MEASURES: Increasing access to LARC and decreasing wait times to LARC insertion after implementation of the RLF. RESULTS: Data on 133 patients in the pre-RLF group and 205 in the post-RLF group were collected. There were no statistically significant differences in demographic or clinical characteristics between the 2 time periods. LARC uptake increased significantly from the pre- to post-RLF period, specifically among implant users. There was a statistically significant decrease in the mean number of days in delay from interest to insertion from the pre- to post-RLF period (pre-RLF: 31.3 ± 50.6 days; post-RLF: 13.6 ± 16.7 days, adjusted P < .001). The reasons for the delay did not differ significantly between the 2 time periods. CONCLUSION: The RLF decreased wait time for the devices and increased overall insertion rates. This may serve as a promising solution to improve LARC access in community health centers. This project could be expanded to include more health centers, creating a city wide RLF. This expansion could allow for further data analysis, including unintended pregnancy rates with LARC delay, LARC continuation rates, and sustainability of a RLF.

Centros Comunitários de Saúde/economia , Acesso aos Serviços de Saúde/normas , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Adulto , Boston , Centros Comunitários de Saúde/tendências , Serviços de Planejamento Familiar/economia , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/organização & administração , Feminino , Apoio ao Planejamento em Saúde/tendências , Humanos , Contracepção Reversível de Longo Prazo/economia , Contracepção Reversível de Longo Prazo/métodos , Estudos Prospectivos , Estudos Retrospectivos , População Urbana/estatística & dados numéricos
Acad Med ; 92(10): 1416-1420, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28353501


PROBLEM: The Affordable Care Act charged the Agency for Healthcare Research and Quality to create the Primary Care Extension Program, but did not fund this effort. The idea to work through health extension agents to support health care delivery systems was based on the nationally known Cooperative Extension System (CES). Instead of creating new infrastructure in health care, the CES is an ideal vehicle for increasing health-related research and primary care delivery. APPROACH: The CES, a long-standing component of the land-grant university system, features a sustained infrastructure for providing education to communities. The Michigan State University (MSU) Model of Health Extension offers another means of developing a National Primary Care Extension Program that is replicable in part because of the presence of the CES throughout the United States. A partnership between the MSU College of Human Medicine and MSU Extension formed in 2014, emphasizing the promotion and support of human health research. The MSU Model of Health Extension includes the following strategies: building partnerships, preparing MSU Extension educators for participation in research, increasing primary care patient referrals and enrollment in health programs, and exploring innovative funding. OUTCOMES: Since the formation of the MSU Model of Health Extension, researchers and extension professionals have made 200+ connections, and grants have afforded savings in salary costs. NEXT STEPS: The MSU College of Human Medicine and MSU Extension partnership can serve as a model to promote health partnerships nationwide between CES services within land-grant universities and academic health centers or community-based medical schools.

Relações Comunidade-Instituição , Comportamento Cooperativo , Assistência à Saúde/organização & administração , Apoio ao Planejamento em Saúde , Atenção Primária à Saúde/organização & administração , Assistência à Saúde/economia , Assistência à Saúde/métodos , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Humanos , Michigan , Patient Protection and Affordable Care Act , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/métodos , Estados Unidos , Universidades