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RESUMEN Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud ABSTRACT Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article’s objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care RESUMO Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde

ABSTRACT Objectives: to assess the operationalization of Primary Health Care in the COVID-19 pandemic, according to Primary Care Assessment Tool: PCATool-Brasil attributes, from physicians’ and nurses’ perspective. Methods: a cross-sectional study, carried out with 99 physicians and nurses from Basic Health Units in a state in northeastern Brazil, with the aid of the adapted instrument PCATool-Brasil. Results: Essential Score was classified as high performance (6.6) and General Score as low performance (6.5). First Contact Access, Care Integration, and Community Guidance scores were 6.6). Conclusions: the attributes of Primary Health Care, in general, showed values above or close to the cut-off point in the assessment. These data can support strategies for local and national managers to strengthen Primary Health Care in the COVID-19 pandemic and future public health emergencies.

Information Systems play a relevant role for primary health care in policy orientation and attention of users needs; therefore, criteria and mechanisms are required to establish whether in a specific strategy implementation, they provide adequate support. In this paper, a characterization of Information Systems that support primary health care, based on the model of community-oriented primary care is presented. A set of essential characteristics that the Information Systems should offer to support the primary health care was identified, with which it is possible to establish the aspects that require intervention to improve their support for strategy implementation . On the basis of the obtained characterization, the development of a methodology which will allow a more formalized evaluation is under construction.

RESUMO Objetivou-se analisar a produção científica sobre a aplicação dos Estudos de Avaliabilidade na área da saúde. Trata-se de uma revisão integrativa da literatura realizada de setembro a outubro de 2017, com busca de pesquisas avaliativas com aplicação de um Estudo de Avaliabilidade, na Biblioteca Virtual em Saúde, Scopus e Web of Science. Analisaram-se 21 artigos, 57,1% publicados nos últimos cinco anos. Os resultados demonstram que há incorporação de aspectos importantes da teoria dos Estudos de Avaliabilidade nos estudos, tais como modelo teórico norteador, uso das etapas próprias de um Estudo de Avaliabilidade, realização da modelagem do programa e associação de fontes de evidências. Conclui-se que o uso do Estudo de Avaliabilidade vem aumentando na área da saúde, entretanto, há necessidade de melhorar sua qualidade, especialmente quanto ao objetivo e questão de pesquisa, descrição do envolvimento dos autores e autorização do local de pesquisa, envolvimento dos stakeholders, descrição dos procedimentos de análise dos dados, estratégias para garantir validade e confiabilidade dos dados, e contribuição para aumento do conhecimento acadêmico, explicitando as contribuições potenciais do Estudo de Avaliabilidade e da avaliação em saúde.

ABSTRACT Objective: to describe the stages of construction and content validation of an instrument to assess Primary Health Care Planning workshops. Methods: this methodological study focused on validating the instrument’s content. The instrument developed was assessed by a committee of experts using the Delphi Technique, in two rounds. For the degree of agreement, percentage agreement and Content Validity Index (CVI) were used. Results: in the first round, six experts participated, and the degree of agreement was 87% for clarity and 94% for representativeness. In the second round, five experts participated, the CVI was 0.95 for clarity, 0.97 for representativeness and 0.96 total CVI. The final instrument had 42 items divided into three chunks. Conclusion: the instrument has content validity to assess Primary Health Care Planning workshops, being a tool for the use of state and municipal administrations.

Objective: To evaluate the quality of nursing care in a population of patients with hemodialysis treatment in the city of Bogotá. Materials and Methods: A cross-sectional descriptive study was carried out, through the application of the Colombian adaptation of the Care-Q instrument that relates attitudes and nursing care activities that were evaluated by the patient through a Likert scale. The universe consisted of all the patients on hemodialysis who belong to a support group of chronic patients, reaching a limit of 100 patients summoned to whom the instrument was applied. Results: It was determined that between 60% and 85% of the population evaluated in a positive way the care provided by the nursing staff. Conclusions: A considerable percentage of satisfaction was found within the participating population, which is contrasted with what is evidenced in the literature where it is stated that the nurse is the most suitable professional for the care of this type of patients. It made evident the need to generate research aimed at the continuous evaluation of nursing care, because it facilitates the creation of actions for improvement in the management of care and allows working for the fulfi llment of quality in health care.

The evaluation of nutrition programs and policies has traditionally focused on analysing the impact and biological outcomes of their actions. Objective: To examine whether evaluations of nutrition programs include the following sociopolitical categories: (a) the right to food; (b) citizenship building; (c) civil participation in public policies; (d) women’s empowerment; and (e) territoriality in policy planning. Methodology: A comprehensive literature review of articles and documents that evaluate food and nutrition programs carried out in different Latin American countries and published during 2005-2013. Results: It was found that the evaluations carried out generally do not use these categories. In the cases where they are used, the conceptual development applied to the evaluation process is still incipient. Discussion: This study analyzed the sociopolitical categories of: the right to food; citizenship building; civil participation in public policies; women’s empowerment; and territoriality in policy planning, and found that although these categories are not prioritised when nutritional programs in Latin America are assessed, in most cases they form the basis of these programs. Conclusion: Social protection nutrition programs demand new objectives and actions. It is necessary to apply evaluation criteria that account for these new underpinnings in order to establish consistency between government institutions’ discourse, and the reality of their efforts.

OBJETIVO: Determinar la claridad, relevancia y pertinencia de una estrategia de evaluación de la atención primaria de la salud en distintos subsistemas de salud. MATERIAL Y MÉTODOS: La estrategia fue evaluada mediante talleres con tomadores de decisiones y responsables de la gestión de los servicios de tres organizaciones de salud, cada una de ellas de uno de los siguientes subtemas: subsistema pública, seguridad social y privado. El estudio fue realizado entre mayo de 2006 y mayo de 2007 en la Provincia de Santa Fe (Argentina). RESULTADOS: La estrategia fue considerada clara y relevante de manera unámine, aunque sólo altamente pertinente por la organización pública. El seguro social y la aseguradora privada cuestionaron la pertinencia de evaluar el desarrollo de las acciones intersectoriales, la participación comunitaria y de considerar como parte del marco de evaluación a los determinantes de la salud. Asimismo consideraron necesario restringir a sus contribuyentes el alcance de las nociones de acceso universal y equidad en salud. DISCUSIÓN: La valoración de la pertinencia de la estrategia fue explicada como resultado de las particularidades del contexto institucional, así como de las metas y estrategias de supervivencia desplegadas por cada organización.OBJECTIVE: To determinate the clarity, relevance and per tinence of a primary health care evaluation strategy for different Latin American health sub-systems. MATERIAL AND METHODS: This strategy was assessed using workshops held with decision makers and administrative managers from a public health organization, a social insurance and a private insurance health organization. The study took place in the province of Santa Fe (Argentina) between May 2006 and May 2007. RESULTS: The strategy was determined to be clear and relevant by all organizations, but highly applicable only in the public case. The social-insurance and private cases questioned the pertinence of objectives related to community participation, intersectoral actions and a focus on social determinants of health, in addition to considering it necessary to restrict the scope of ideas related to universal access and equity with regard to their client population. DISCUSSION: The evaluation of the pertinence of the strategy was explained by the particularities of the institutional context, as well as the goals and survival strategies used by each organization.

A presente revisão bibliográfica realiza um percurso por várias correntes do pensamento que se ocuparam do estudo das narrativas. Foram analisados estudos clássicos de estrutura narrativa oriundos da literatura, da história, da teoria da comunicação e da psicanálise a fim de explorar se suas categorias e conceitos seriam metodologicamente aplicáveis na pesquisa qualitativa em saúde. Nas conclusões, destaca-se a potencialidade de se utilizar narrativas para o estudo de situações nas quais interessem as mediações entre experiência e linguagem, estrutura e eventos, sujeitos e coletivos, memória e ação política - questões que tradicionalmente interessam à área de "Políticas, Planejamento e Gestão" da saúde coletiva brasileira.La revisión bibliográfica realiza un recorrido por varias corrientes del pensamiento que se ocuparon de estudiar las narrativas. Se analizaron estudios clásicos de estructura narrativa oriundos de la literatura, de la historia, de la teoría de la comunicación y del psicoanálisis para explorar si sus categorías y conceptos serian metodológicamente aplicables en la investigación cualitativa de la salud. En las conclusiones, se destaca la potencialidad de utilizarse narrativas para el estudio de situaciones en las cuales interesen las mediaciones entre experiencia y lenguaje, estructura y eventos, sujetos y colectivo, memoria y acción política- cuestiones que tradicionalmente interesan en el área de "Políticas, Planificación y Gestión" de la salud colectiva brasilera.The present bibliographic review followed a path through several chains of thought concerned with studying narratives. Some classical studies on narrative structure with origins within literature, history, communications theory and psychoanalysis were analyzed with the aim of exploring whether their categories and concepts would be methodologically applicable to qualitative health-related research. In the conclusions, the potential for using narratives to study situations in which there is interest in mediations between experience and language, between structure and events, between subjects and collective groups or between memory and political action are highlighted. These are questions that traditionally are of interest within Brazilian public health with regard to the field of "Policy, Planning and Management".

Background: there has not been a validated questionnaire available in Spanish to evaluate patient satisfaction with gastrointestinal endoscopy. Our aim was to evaluate the external validity and internal consistency of the Spanish version of a questionnaire on patient satisfaction with gastrointestinal endoscopy elaborated by the American Society for Gastrointestinal Endoscopy. Design: prospective questionnaire validation study. Patients and methods: a total of 485 consecutive patients referred to two different hospitals for endoscopy were interviewed by telephone. Internal consistency was studied using Cronbach's alfa test and corrected item-total correlations (CITC). External validity was determined using a mailed questionnaire completed by 185 patients -correlations between telephone and postal responses were calculated, as well as the correlation with the total score obtained. Results: Cronbach´s alfa was 0.82 and mean CITC was 0.59. Weighted kappa values for the same questionnaire items performed by telephone or mail varied between 0.51 and 0.81. Total score correlation was 0.78. Internal consistency and external validity were not affected by differences in the administration of the questionnaire (mail or by telephone), different interviewers, type of endoscopy, or source of patients. Conclusions: the Spanish version of the ASGE questionnaire on satisfaction with endoscopy is valid, reliable, and reproducible.Objetivos: no se dispone en castellano de un cuestionario validado para la valoración de la satisfacción del paciente en endoscopia digestiva. Evaluar la validez externa y la consistencia interna de la versión en castellano del cuestionario recomendado por la American Society for Gastrointestinal Endoscopy sobre satisfacción en endoscopia. Diseño experimental: estudio de validación de un cuestionario, recogida de datos prospectiva. Pacientes y métodos: cuatrocientos ochenta y cinco pacientes consecutivos remitidos para endoscopia a dos hospitales diferentes fueron entrevistados telefónicamente. La validez interna se estudió mediante alfa de Cronbach y correlación total inter-ítem media. Para estimar la validez externa se remitió un cuestionario anónimo a 185 pacientes y se calcularon las correlaciones entre las respuestas dadas telefónicamente y por correo, así como la correlación en la puntuación global obtenida mediante la suma de los valores para las siete cuestiones del cuerpo principal del cuestionario. Resultados: la alfa de Cronbach fue de 0,82 y la CTITM de 0,59. La kappa ponderada entre las mismas cuetiones en los cuestionarios administrados telefónica o anónimamente variaron entre 0,51 y 0,81. La correlación en la puntuación total fue de 0,78. La validez interna y externa no se vio afectada por diferencias en la administración del cuestionario (correo o telefónico), los diferentes entrevistadores, el tipo de endoscopia o la procedencia de los pacientes. Conclusiones: la versión en castellano del cuestionario recomendado por la ASGE sobre satisfacción en endoscopia es válida, fiable y reproducible.

Se describe la aplicación de una propuesta metodológica para evaluar un servicio estomatológico por el método trazador, tomándose la caries dental como enfermedad trazadora de la calidad de los mismos por criterio de experto. Se emplearon como indicadores para la evaluación la revisión de 102 historias clínicas de pacientes que fueron atendidos en el servicio por caries dental, los indicadores operacionales del Programa Nacional de Estomatología, y los resultados de las encuestas autoaplicadas de los 19 proveedores de servicio, así como de 40 pacientes entrevistados que asistieron a la clínica por caries dental en el período comprendido del 7 al 18 de agosto del 2000. A cada uno de estos aspectos se le otorgaron 25 puntos, para un total de 100 puntos. Se arribó a la conclusión de que la enfermedad seleccionada resultó útil para evaluar el servicio objeto de la investigación. La puntuación alcanzada fue de 73 puntos, para una categoría regular según la escala de Link. Se obtuvieron 20, 19, 18 y 16 puntos en los aspectos evaluados en el orden antes descrito.The application of a methodological proposal to evaluate a dental service by the tracer method, considering dental caries as a disease to measure the quality of these services by expert citerion is described. The review of 102 medical histories of patients that were attended at the service due to dental caries, the operational indicators of the National Stomatology Program and the results of the self-applied surveys of the 19 dental service providers, as well as of 40 patients that were interviewed when they went to the dental clinic for presenting dental caries on August 7 through 18, 2000. Each of these aspects was given 25 points, for a total of 100. It was concluded that the selected disease proved to be useful to evaluate the objective service of the investigation. The final score was 73 points, attaining a fair category according to Link's scale. 20, 19, 18 and 16 points were obtained in the aspects evaluated in the above-mentioned order.

OBJETIVO: Caracterizar o cuidado pré-natal em uma amostra representativa de mães, identificando o serviço de saúde onde estas realizaram o acompanhamento da gestação e os motivos que as levaram a escolher este local. MÉTODOS: Estudo transversal, realizado nos meses de março e abril de 1997, nas quatro principais maternidades de Pelotas, RS, através de entrevista a 401 mães no pós-parto imediato. RESULTADOS: Fizeram acompanhamento pré-natal, em um posto de saúde 51% das mães, sendo a proximidade geográfica o critério mais freqüentemente referido para tal escolha (46,8%). Para 85% das mães, o serviço de saúde mais próximo de casa era um posto de saúde. No entanto, 52,2% dessas não utilizaram esse local para as consultas pré-natais alegando a má qualidade do atendimento (37,4%). Conforme referido pelas mães, entre os procedimentos de rotina do pré-natal recomendados pelo programa de saúde da rede pública, incluindo a promoção do aleitamento materno, apenas a imunização anti-tetânica foi realizada mais freqüentemente nos postos do que nos demais locais. CONCLUSÕES: Tendo em vista a expressiva utilização da rede pública para o acompanhamento pré-natal, necessitam ser implementados investimentos em educação continuada dos profissionais, com ênfase no cumprimento de normas técnicas pré-estabelecidas.OBJECTIVE: To describe the prenatal care delivered to a representative sample of mothers, identifying the health care facility they attended and to explore the reasons that led them to choose that specific health facility. METHOD: A cross-sectional study was conducted at four maternity hospitals in Pelotas, in Southern Brazil, from March to April 1997. A total of 401 mothers were interviewed at the hospital, immediately after delivery. RESULTS: The majority of mothers (51%) were followed up at a primary health care facility (PHCF). The main reported reason for choosing a PHCF was its geographic accessibility (46.8%). For 85% of the mothers, the nearest health service was a PHCF. However, 52.2% of them did not attend the consultations at this setting mainly because of a supposed low quality care (37.4%). Except for immunization with tetanus toxoids, all other usual prenatal care procedures recommended by the local health ministry, including promotion of breastfeeding, were performed less frequently at the PHCF than in other health care settings. CONCLUSION: Given the high coverage of the public prenatal care program, efforts should be made to improve the quality of care delivered to pregnant women, mainly by encouraging health professionals, especially doctors, to follow the established guidelines.

Resumo Partindo do exame da legislação, jurisprudência e doutrina, analisa-se o trajeto usual dos pedidos de medicamentos no Sistema Único de Saúde, enfatizando-se solicitações fora da Relação Nacional de Medicamentos Essenciais. O roteiro usual pelo qual a única resposta às negativas é a propositura de ações judiciais onera o sistema, torna-o complexo e potencializa iniquidades. Nesse contexto, procura-se repensar essa sistemática partindo de mecanismos não judiciais de solução de conflitos. Com base na premissa de que judicialização não nasce no judiciário e nele não termina, consideram-se medidas para “desjudicializar” a saúde: adoção de câmaras de mediação além do protocolo do Sistema Único de Saúde e antes das demandas judiciais; reforço do diálogo interinstitucional entre entidades como Defensoria Pública, Ministério Público, Secretaria de Saúde e Núcleos de Apoio Técnico dos tribunais; ampliação das vias não judiciais, facilitando o acesso, reduzindo gastos não destinados ao tratamento e aprimorando a saúde pública.

Background: The care of patients with Alzheimer's disease and other dementias has become a priority for healthcare systems. This is evidenced by the increasing number of clinical practice guidelines (CPG) developed in our country aimed to help professionals in making health decisions. The aim of our study was to evaluate the quality of the Spanish CPG on Alzheimer's disease and other dementias using the AGREE II instrument., Methods: Nine GPC were selected according to the inclusion criteria: Full GPC available; aimed to healthcare professionals; and published between 2002-2013. Two reviewers independently assessed the quality of the guides through the AGREE II instrument, in order to assess the methodological rigor and transparency of the GPC., Results: 88.8% of the guides scored a very poor quality editorial independence. Respect to rigor in the development and clarity of presentation, 77.7% also scored very low quality. There is a guide that stands out for a score above 50% in all domains of the instrument., Conclusions: The worst scored domains were Editorial independence, Rigor in the development and Applicability, in this order. The highest rated domains were Scope and Objectives and Clarity of Presentation. The guideline of the Ministry of Health, Social Policy and Equality is the best, obtaining a score above 50% in all domains. Overall, the quality of the 9 guidelines evaluated is low or very low, only two of them score as good overall quality.