244 results on '"Health Services Coverage"'
Search Results
102. ¿Qué muestran las Encuestas de Calidad de Vida sobre el sistema de salud en Colombia?
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Zambrano, Andrés, Ramírez, Manuel, Yepes, Francisco José, Guerra, José Alberto, and Rivera, David
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2008
- Full Text
- View/download PDF
103. Cobertura e fatores associados à realização do exame de detecção do câncer de colo de útero em área urbana no Sul do Brasil: estudo de base populacional.
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Gasperin, Simone Iara, Boing, Antonio Fernando, and Kupek, Emil
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2007
104. Controversia a la reforma de la Ley 100 de 1993, Ley 1122 de enero de 2007.
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Tafur, Luis Alberto
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MEDICAL laws , *INDEPENDENT regulatory commissions , *MEDICAL care costs , *MEDICAL economics , *MEDICAL care - Abstract
Introduction: This paper analyzes Law 1122 of 2007 and compares with present rules and possibilities of obtaining proposed goals. Direction: This Law creates the Comisión Reguladora de Salud (CRES) assigning to the Consejo Nacional de Seguridad Social (CNSSS) activities for advising and consultation turning it no operative. This decision gives full power to the executive branch because the President designs the Comissioners and does not take in account the social and institutional participation. A good point is the creation of the Defender of the Patient although does not consider the Superintendencia Nacional de Salud. Universal coverage and financing: With the goal of reaching the national coverage this Law increases the dues to the contributive system in 0.5% and the percentage of the General System of Contributions that different institutions must give to the affiliation to the Regimen Subsidiado, decreasing in proportion the amount giving by the national government. It is said that the national coverage will not be reached because none of different systems, neither population segment of 19 to 24 years old unemployed, students and singles, approximately 2 million people and the population no affiliated to the regimen contributivo, level III of Sisben. It is very positive the decrease to one year the period to be allowed to change EPS, and the decrease of the lack period to 26 months for surgical and high cost diseases. Medical services: The compulsory engagement of EPS from regimen subsidiado of 60% from UPC with ESE, discourage the search for quality as a competence goal. It is criticized that Ministerio de Protección Social has to regulate many sections furthermore. [ABSTRACT FROM AUTHOR]
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- 2007
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- View/download PDF
105. Socio-demographic characteristics, treatment coverage, and self-rated health of individuals who reported six chronic diseases in Brazil, 2003.
- Author
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Theme-Filha, Mariza Miranda, Szwarcwald, Célia Landmann, and De Souza-Júnior, Paulo Roberto Borges
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2005
- Full Text
- View/download PDF
106. Disparities in Access and Mortality of Patients With ST‐Segment–Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register
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Laís Costa Souza Oliveira, Jussiely Cunha Oliveira, Luís Flávio Andrade Prado, Thiago Augusto Nascimento, Antônio Carlos Sobral Sousa, Jeferson Cunha-Oliveira, Eduardo José Pereira Ferreira, Enilson Vieira Moraes, Rafael Vasconcelos Barreto, Marcos Antonio Almeida-Santos, Ikaro Daniel de Carvalho Barreto, Larissa Andreline Maia Arcelino, Fábio Serra Silveira, José Teles de Mendonça, Ticiane Clair Remacre Munareto Lima, and José Augusto Barreto-Filho
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Male ,medicine.medical_specialty ,Time Factors ,Myocardial Infarction ,acute myocardial infarction ,030204 cardiovascular system & hematology ,Health Services Accessibility ,Public healthcare ,Time-to-Treatment ,health services coverage ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Cardiovascular Disease ,Internal medicine ,Humans ,Medicine ,ST segment ,Hospital Mortality ,Prospective Studies ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Original Research ,health disparities ,Quality and Outcomes ,Myocardial reperfusion ,business.industry ,health policy and outcomes research ,Health Services ,Middle Aged ,Prognosis ,medicine.disease ,Health equity ,Survival Rate ,Elevation (emotion) ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Public Health ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Health Services and Outcomes Research ,Follow-Up Studies - Abstract
Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30‐day mortality for patients with ST ‐segment–elevation myocardial infarction are similar among patients using the Brazilian Public Health System ( SUS ) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST ‐segment–elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention ( PCI ) were investigated. The timeline, rates of use of PCI , and the 30‐day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P SUS patients was 11.9% and of private patients was 5.9% ( P =0.04). In the fully adjusted model, the odds ratio for 30‐day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI , 1.15–7.61; P =0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30‐day follow‐up.
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- 2019
107. Prenatal evaluation in primary care in Northeast Brazil: factors associated with its adequacy
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Silva, Esther Pereira da, Leite, Antônio Flaudiano Bem, Lima, Roberto Teixeira, and Osório, Mônica Maria
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Health Services Coverage ,Cobertura de Serviços de Saúde ,Cuidado Pré-Natal, organização & administração ,Health Status Disparities ,Prenatal Care, organization & administration ,Outcome and Process Assessment (Health Care) ,Avaliação de Processos e Resultados (Cuidados de Saúde) ,Disparidades nos Níveis de Saúde - Abstract
OBJECTIVE To characterize prenatal care and verify possible factors associated with its adequacy. METHODS This is a cross-sectional study based on interviews with health care professionals and consultations on official documents of women attending prenatal of the primary health care in the city of João Pessoa, capital of Paraíba, in the Northeast region of Brazil. Prenatal care was evaluated by an index with criteria referring to aspects of structure, process and outcome, denominated IPR/Prenatal. The multivariate logistic regression method revealed that demographic, socioeconomic, reproductive and maternal morbidity variables were possible determinants for prenatal adequacy. RESULTS The survey involved 130 services and 1,625 primary health care patients. Prenatal care was adequate in approximately 23% of the cases. Low prevalence of referral to maternity, educational strategies and examinations were observed. The analysis showed that non-adolescent women (OR = 1,390), with a longer period of schooling (OR = 1.750), higher per capita income (OR = 1,870) and primiparous women (OR = 1,230) were more likely to have an adequate prenatal. CONCLUSIONS Prenatal care, when evaluated by broader criteria, showed a low percentage of adequacy. Strategies should be developed to ensure the referral to the maternity where the birth will take place and health education activities and examinations to provide adequate prenatal care in the municipality under study. In addition, factors associated with adequacy must be considered by managers and health professionals. RESUMO OBJETIVO Caracterizar a assistência pré-natal e verificar possíveis fatores associados à sua adequação. MÉTODOS Este é um estudo transversal realizado a partir de entrevistas com os profissionais de serviços de saúde e de consultas em documentos oficiais de mulheres assistidas no pré-natal da atenção primária à saúde na cidade de João Pessoa, capital da Paraíba, na região Nordeste brasileira. O pré-natal foi avaliado por meio de um índice com critérios referentes aos aspectos de estrutura, processo e resultado, denominado IPR/Pré-Natal. Verificou-se pelo método de regressão logística multivariada se variáveis demográficas, socioeconômicas, reprodutivas e de morbidades maternas foram possíveis fatores determinantes para a adequação do pré-natal. RESULTADOS A pesquisa envolveu 130 serviços e 1.625 pacientes da atenção primária de saúde. O pré-natal se apresentou adequado em aproximadamente 23% dos casos. Foram observadas baixas prevalências de encaminhamento à maternidade, estratégias educativas e realização de exames. As análises mostraram que mulheres não adolescentes (OR = 1,390), com maior tempo de escolaridade (OR = 1,750), maior renda per capita (OR = 1,870) e primíparas (OR = 1,230) apresentaram maiores chances de ter um pré-natal adequado. CONCLUSÕES O pré-natal, ao ser avaliado por critérios mais amplos, mostrou baixo percentual de adequação. Devem ser elaboradas estratégias que garantam o encaminhamento para a maternidade onde será feito o parto e a realização de atividades de educação em saúde e dos exames para propiciar o pré-natal adequado no município estudado. Além disso, os fatores associados à adequação devem ser levados em conta por parte dos gestores e profissionais de saúde.
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- 2019
108. Assistência pré-natal no Sul do Brasil: cobertura, tendência e disparidades
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Saavedra,Janaina S, Cesar,Juraci A, and Linhares,Angélica O
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Health Evaluation ,Cuidado Pré-Natal, utilização ,Health Services Coverage ,lcsh:Public aspects of medicine ,Prenatal Care, utilization ,Coverage Equity ,Cobertura de Serviços de Saúde ,Equidade em Cobertura ,Avaliação em Saúde ,lcsh:RA1-1270 ,Health Status Disparities ,Disparidades nos Níveis de Saúde - Abstract
OBJECTIVE To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio Grande do Sul, in 2007, 2010, 2013 and 2016. METHODS This study included all recent mothers living in this municipality, between 1/1 and 12/31 of those years, who had a child weighing more than 500 grams or 20 weeks of gestational age in one of the only two local maternity hospitals. Trained interviewers applied, still in the hospital and up to 48 hours after delivery, a unique and standardized questionnaire, seeking to investigate maternal demographic and reproductive characteristics, the socioeconomic conditions of the family and the assistance received during pregnancy and childbirth. To assess the adequacy of prenatal care, the criteria proposed by Takeda were used, which considers only the number of prenatal appointments and gestational age at initiation, and by Silveira et al., who in addition to these two variables, considers the achievement of some laboratory tests. Chi-square tests were used to compare proportions and assess the linear trend. RESULTS The total of 10,669 recent mothers were included in this survey (96.8% of the total). Prenatal coverage substantially increased between 2007 and 2016. According to Takeda, it rose from 69% to 80%, while for Silveira et al., it increased from 21% to 55%. This improvement occurred for all income groups (p < 0.01). The disparity between the extreme categories of income reduced, according to Takeda, and increased according to Silveira et al. CONCLUSIONS The provision of prenatal care, considering only the number of appointments and the early start, occurred in greater proportion among the poorest. However, only the richest recent mothers were contemplated with more elaborate care, such as laboratory tests, which increased the disparities in the provision of prenatal care. RESUMO OBJETIVO Estimar a cobertura, examinar a tendência e avaliar se houve redução da disparidade em relação à renda familiar na realização de pré-natal adequado entre puérperas residentes em Rio Grande, RS, nos anos de 2007, 2010, 2013 e 2016. MÉTODOS Foram incluídas neste estudo todas as puérperas residentes nesse município que, entre 1/1 a 31/12 desses anos, tiveram filho com peso superior a 500 gramas ou 20 semanas de idade gestacional em alguma das duas únicas maternidades locais. Entrevistadoras treinadas aplicaram, ainda no hospital e em até 48 horas após o parto, questionário único e padronizado, buscando investigar as características demográficas e reprodutivas maternas, as condições socioeconômicas da família e a assistência recebida durante a gestação e parto. Para avaliação da adequação do pré-natal, foram utilizados os critérios propostos por Takeda, que considera apenas o número de consultas pré-natais e a idade gestacional de início, e de Silveira et al., que além dessas duas variáveis, leva em conta a realização de alguns testes laboratoriais. Foram utilizados os testes qui-quadrado para comparar proporções e avaliar tendência linear. RESULTADOS Foram incluídas neste inquérito 10.669 puérperas (96,8% do total). Verificou-se substancial aumento na cobertura de pré-natal adequado entre 2007 e 2016. Segundo Takeda, passou de 69% para 80%, enquanto para Silveira et al. aumentou de 21% para 55%. Essa melhora no período ocorreu para todos os grupos de renda (p < 0,01). Houve redução na disparidade entre as categorias extremas de renda segundo Takeda e aumento acentuado segundo Silveira et al. CONCLUSÕES A oferta de pré-natal, considerando apenas o número de consultas e o início precoce, ocorreu em maior proporção entre as mais pobres. No entanto, ao oferecer cuidados mais elaborados, como exames laboratoriais, estes alcançaram principalmente as puérperas mais ricas, aumentando assim as disparidades na oferta da assistência pré-natal.
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- 2019
109. Is there a fair distribution of the structure of dental services in the capitals of the Brazilian Federative Units?
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Erika Bárbara Abreu Fonseca Thomaz, Luiz Augusto Facchini, João Ricardo Nickenig Vissoci, Thiago Augusto Hernandes Rocha, Elisa Miranda Costa, Aline Sampieri Tonello, Catherine A. Staton, José Aquino Junior, Ana Carolina Mendes Pinheiro, Núbia Cristina da Silva, Ana Graziela Araujo Ribeiro, and Rejane Christine de Sousa Queiroz
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medicine.medical_specialty ,Health services coverage ,Population ,Dental Caries ,03 medical and health sciences ,Environmental health ,medicine ,Humans ,Cities ,Dental Care ,education ,Socioeconomic status ,Health policy ,Social policy ,education.field_of_study ,030505 public health ,Equity (economics) ,Geography ,Primary Health Care ,business.industry ,lcsh:Public aspects of medicine ,Research ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,Health services research ,Ecological study ,lcsh:RA1-1270 ,Equity ,Socioeconomic Factors ,Human resources in dentistry ,0305 other medical science ,business ,Brazil - Abstract
Background Brazilian Primary Care Facilities (PCF) provide primary care and must offer dental services for diagnosis, prevention, and treatment of diseases. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services. Objective To analyze the structure of dental caries services in the capitals of the Brazilian Federative Units and identify whether socioeconomic factors and caries (need) are predictors of the oral health services structure. Methods This is an ecological study with variables retrieved from different secondary databases, clustered for the level of the federative capitals. Descriptive thematic maps were prepared, and structural equations were analyzed to identify oral health service structure’s predictors (Alpha = 5%). Four models with different outcomes related to dental caries treatment were tested: 1) % of PCF with a fully equipped office; 2) % of PCF with sufficient instruments, and 3) % of PCF with sufficient supplies; 4) % of PCF with total structure. Results 21.6% of the PCF of the Brazilian capitals had a fully equipped office; 46.9% had sufficient instruments, and 30.0% had sufficient supplies for caries prevention and treatment. The four models evidenced proper fit indexes. A correlation between socioeconomic factors and the structure of oral health services was only noted in model 3. The worse the socioeconomic conditions, the lower the availability of dental supplies (standard factor loading: 0.92, P = 0.012). Estimates of total, direct and indirect effects showed that dental caries experience observed in the Brazilian population by SB-Brasil in 2010 did not affect the outcomes investigated. Conclusion Material resources are not equitably distributed according to the socioeconomic conditions and oral health needs of the population of the Brazilian capitals, thus contributing to persistent oral health inequities in the country.
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- 2019
110. Incorporação de medicamentos imunobiológicos para artrite reumatoide no setor suplementar de saúde do Brasil
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Borssatto, Adriane Gisele Fonseca, Escolas::EAESP, Schout, Denise, Felix, Evandro Penteado Villar, and Escrivão Junior, Álvaro
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Serviços de saúde - Brasil ,Arthritis, rheumatoid ,Health services coverage ,Regulação e fiscalização em saúde ,Technology assessment, biomedical ,Seguro-saúde ,Private health care coverage ,Artrite reumatoide ,Tecnologia - Avaliação ,Saúde suplementar ,Health care coordination and monitoring ,Administração de empresas ,Cobertura de serviços de saúde ,Produtos biológicos ,Biological products ,Supplemental health ,Avaliação da tecnologia biomédica ,Cobertura de serviços privados de saúde - Abstract
A artrite reumatoide (AR) é uma doença inflamatória autoimune de alta prevalência na população geral, caracterizada por ser progressiva e deixar sequelas graves e irreversíveis. Entre as inúmeras drogas para o tratamento da doença, existem as medicações modificadoras do curso da doença (MMCD), divididas em sintéticas e imunobiológicas (ou biológicas). Nos últimos anos, houve aumento significativo do número e classes das drogas biológicas de alto custo, entre elas: inibidores do fator de necrose tumoral (anti-TNF), depletor de linfócito B; bloqueador da co-estimulação do linfócito T, e bloqueador do receptor de interleucina-6. O objetivo deste trabalho foi avaliar o panorama da incorporação dessas drogas no Rol de Procedimentos e Eventos em saúde da Agência Nacional de Saúde Suplementar (ANS), sob a perspectiva de pacientes, médicos e gestores. Na fase inicial, foi realizada revisão de literatura para construção do cenário do sistema de saúde brasileiro em que o processo se insere. A segunda fase compreendeu a análise de entrevistas com representantes da Comissão de Incorporação de Tecnologias em Saúde (CONITEC), ANS, operadoras de saúde em suas diversas modalidades, médicos e pacientes. As diferentes visões do processo foram confrontadas entre si e com as informações encontradas na pesquisa bibliográfica. As percepções das partes envolvidas na análise mostraram-se bastante heterogêneas, demonstrando a complexidade do processo e as dificuldades em se atender as diversas demandas. O processo de incorporação das medicações evidenciou: a duplicidade de coberturas no subsetor público e suplementar, a necessidade de avaliação criteriosa e baseada em evidências das novas tecnologias para a sustentabilidade do sistema de saúde e a importância da adesão dos médicos aos protocolos clínicos e diretrizes. Rheumatoid arthritis (RA) is an autoimmune inflammatory disease of high prevalence in the general population, characterized by a progressive course and with serious and irreversible sequelae. Among the numerous drugs for the treatment, there are the disease modifying antirheumatic drugs (DMARDS), divided into synthetic and immunobiological (or biological). In recent years, there has been significant increase in the number and types of high-cost biological drugs: tumor necrosis factor inhibitors, B-lymphocyte depletor; T-cell costimulation blocker; and interleukin-6 receptor inhibitors. The objective of this work was to evaluate the panorama of the incorporation of these drugs in the Role of Procedures and Events in health of the National Agency of Supplementary Health (ANS), from the perspective of the main ones involved in the process of inclusion of these new technologies. Firstly, a literature review was carried out to construct the scenario of the Brazilian health system in which the process is inserted. The second phase includes the analysis of interviews with the representatives of the Commission for the Mobilization of Technologies in Health (CONITEC), ANS, and health operators in its various modalities, doctors and patients. The different views of the process were confronted with each other and with the information found in the bibliographic research. The perceptions of the parties involved in the analysis were quite heterogeneous, demonstrating the complexity of the process and the difficulties in meeting the diverse demands. The process of incorporating the medications showed the duplication of coverage in the public and supplementary subsector, the need for a careful and evidence-based evaluation of the new technologies for the sustainability of the health system and the importance of adherence to clinical protocols and guidelines.
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- 2019
111. Prenatal evaluation in primary care in Northeast Brazil: factors associated with its adequacy
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Esther Pereira da, Silva, Antônio Flaudiano Bem, Leite, Roberto Teixeira, Lima, and Mônica Maria, Osório
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Adult ,Adolescent ,Prenatal Care, organization & administration ,Young Adult ,Pregnancy ,Surveys and Questionnaires ,Cobertura de Serviços de Saúde ,Cuidado Pré-Natal, organização & administração ,Humans ,Primary Health Care ,Health Services Coverage ,lcsh:Public aspects of medicine ,Prenatal Care ,lcsh:RA1-1270 ,Health Status Disparities ,Reference Standards ,Outcome and Process Assessment (Health Care) ,Avaliação de Processos e Resultados (Cuidados de Saúde) ,Cross-Sectional Studies ,Logistic Models ,Outcome and Process Assessment, Health Care ,Socioeconomic Factors ,Female ,Original Article ,Brazil ,Disparidades nos Níveis de Saúde - Abstract
OBJECTIVE To characterize prenatal care and verify possible factors associated with its adequacy. METHODS This is a cross-sectional study based on interviews with health care professionals and consultations on official documents of women attending prenatal of the primary health care in the city of João Pessoa, capital of Paraíba, in the Northeast region of Brazil. Prenatal care was evaluated by an index with criteria referring to aspects of structure, process and outcome, denominated IPR/Prenatal. The multivariate logistic regression method revealed that demographic, socioeconomic, reproductive and maternal morbidity variables were possible determinants for prenatal adequacy. RESULTS The survey involved 130 services and 1,625 primary health care patients. Prenatal care was adequate in approximately 23% of the cases. Low prevalence of referral to maternity, educational strategies and examinations were observed. The analysis showed that non-adolescent women (OR = 1,390), with a longer period of schooling (OR = 1.750), higher per capita income (OR = 1,870) and primiparous women (OR = 1,230) were more likely to have an adequate prenatal. CONCLUSIONS Prenatal care, when evaluated by broader criteria, showed a low percentage of adequacy. Strategies should be developed to ensure the referral to the maternity where the birth will take place and health education activities and examinations to provide adequate prenatal care in the municipality under study. In addition, factors associated with adequacy must be considered by managers and health professionals.
- Published
- 2019
112. Measures by a Regional Inter-managerial Commission to regulate specialized services in Brazil's National Health System
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Jamille Amorim Carvalho, Roberto Moreira Silveira Filho, Patty Fidelis de Almeida, and Adriano Maia dos Santos
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H1-99 ,cobertura de serviços de saúde ,030505 public health ,Health (social science) ,acesso aos serviços de saúde ,administração de serviços de saúde ,regional health planning ,Health Policy ,Public Health, Environmental and Occupational Health ,atenção secundária à saúde ,Social sciences (General) ,health services coverage ,03 medical and health sciences ,0302 clinical medicine ,secondary health ,health services administration ,health services accessibility ,030212 general & internal medicine ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,regionalização - Abstract
Resumo A fragmentação da assistência e a dificuldade para ofertar cuidado integral à saúde expõem a necessidade de constituir um território sanitário regional coeso e com cooperação entre municípios. A Comissão Intergestores Regional (CIR), como lócus de governança regional, configura o espaço de pactuação, cooperação e fortalecimento da região de saúde. O artigo objetivou identificar como a regulação da oferta de serviços especializados é abordada nos debates da CIR e quais os principais encaminhamentos. Foi realizado estudo de abordagem qualitativa com base em pesquisa documental a partir da análise das atas e de observações mensais das reuniões da CIR, constituída por 19 municípios, no período de 2013-2015. Os resultados indicaram que, mesmo com pautas diversificadas, houve foco na atenção especializada/hospitalar. Processos regulatórios restringiram-se à criação de fluxos regionais para atenção hospitalar. Percebeu-se preocupação em relação à permanente revisão do teto financeiro da Programação Pactuada e Integrada (PPI) e dos indicadores do Sistema de Pactuação de Diretrizes, Objetivos, Metas e Indicadores de Saúde (SISPACTO). No caso estudado, a CIR representou um espaço potente para governança regional. As reuniões revelaram as dificuldades comuns e as estratégias dos gestores para superação dos problemas na oferta e acesso de serviços especializados entre os municípios. Abstract Fragmentation of care and the difficulty of offering comprehensive care pose the need to establish a cohesive regional health territory with cooperation among municipalities. As a locus of regional governance, the health authorities' Regional Inter-managerial Commission (Comissão Intergestores Regional, CIR) is a space for concertation and cooperation to strengthen the health region. This paper aims to identify how regulation of specialized health services is addressed in CIR discussions and what the chief recommendations are. A qualitative study was conducted from 2013 to 2015, on the basis of a documentary review, by analysis of the minutes and monthly observation of CIR meetings, which involved 19 municipalities. The results indicated that, despite diversified agendas, the focus was hospital care. Regulatory processes considered were restricted to creating regional flows to hospital care. A concern was observed with the permanent review of the funding ceiling for the agreed integrated programme (Programação Pactuada e Integrada, PPI) and with the indicators of the system for agreeing health guidelines, goals, targets and indicators (Sistema de Pactuação de Diretrizes, Objetivos, Metas e Indicadores de Saúde, SISPACTO). In the case studied, the CIR was a powerful space for regional governance. The meetings highlighted the common difficulties and the managers' strategies for surmounting problems in supply and access to specialized services among municipalities.
- Published
- 2016
113. Information technologies intended to solve contingencies in the Peruvian subsidized health system affiliation: 'ReSUelve tu afiliación'
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Villegas-Ortega, José, Loyola-Martínez, César, Santisteban-Romero, Javier, Manchego-Lombardi, Mónica, and Lozada-Urbano, Michelle
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Male ,perú ,lcsh:R5-920 ,Insurance, Health ,Health Policy ,lcsh:R ,seguro de salud ,lcsh:Medicine ,accesibilidad a los servicios de salud ,Seguro de Salud ,Accesibilidad a los servicios de salud ,Sistemas de información ,Cobertura de los servicios de salud ,Perú ,Insurance, health ,Health services accessibility ,Information systems ,Health services coverage ,Peru ,Government Programs ,sistemas de información ,cobertura de los servicios de salud ,Humans ,Female ,Information Technology ,lcsh:Medicine (General) - Abstract
The National Health Authority (SUSALUD) has developed an online platform, “ReSUelve tu afiliación”, with the intent to solve the problems with health service access experienced by Peruvian citizens who hold health insurance policies through institutions that manage health insurance funds (IAFAS). This platform virtually articulates the main IAFAS in Peru, which receives requests from any user requiring an update on his/her affiliation status to be resolved within 24 hours. Nearly 8 months after the implementation of this platform, more than 55 thousand applications have been resolved, thus ensuring timely access to health services under the corresponding user coverage form. As a result, this platform has helped to guarantee citizens’ rights to health service access in the face of infringement caused by delays in affiliation processing among the different IAFAS in Peru. La Superintendencia Nacional de Salud (SUSALUD) ha desarrollado la plataforma en línea: “ReSUelve tu afiliación” con el propósito de solucionar problemas de acceso a los servicios de salud de los ciudadanos peruanos que cuentan con un seguro de salud en las instituciones administradoras de fondos de aseguramiento en salud (IAFAS). Esta plataforma articula virtualmente a las principales IAFAS en Perú, las cuales reciben solicitudes de cualquier usuario que requiera actualización del estado de su filiación, para resolverlas en menos de 24 h. En casi ocho meses de implementación se han resuelto más de 55 mil solicitudes, con lo cual se ha logrado que los usuarios accedan de forma oportuna a los servicios de salud bajo la cobertura correspondiente. De esta manera, se contribuye a garantizar el derecho al acceso a los servicios de salud, derecho que se veía vulnerado por los retrasos en los trámites de afiliación entre las diferentes IAFAS del país.
- Published
- 2016
114. Un modelo de atencion en salud al pueblo wayuu en la frontera colombo-venezolana.
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Gomez, Maria Beatriz Duarte, Alegria, Martha Liliana Ortega, Rios, Luis Hernando Mora, and Fernandez, Noly Coromoto
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INTERNATIONAL relations , *TRANSCULTURAL medical care , *MEDICAL care of indigenous peoples - Abstract
At meetings and workshops with Wayúu communities and government officials from Colombia and Venezuela, after validating the analysis of the health situation and its determinants, the components of a binational health care model for the Wayúu people living on the border between the two countries were identified. Although both countries have made progress in intercultural health care, some aspects of their legislation and service organization still need to be strengthened to make the guaranteed right to health a reality. The allocation of new national resources--or the redistribution of current resources--should be ensured, as well as the management of international resources for conducting a short-term pilot project and implementing the model in the medium term. [ABSTRACT FROM AUTHOR]
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- 2011
115. Time trend of Family Health Strategy coverage in Brazil, its Regions and Federative Units, 2006-2016
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Neves, Rosália Garcia, Flores, Thaynã Ramos, Duro, Suele Manjourany Silva, Nunes, Bruno Pereira, and Tomasi, Elaine
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Family Health ,Saúde da Família ,Primary Health Care ,Health Services Coverage ,Estudos de Séries Temporais ,Cobertura de Serviços de Saúde ,Atención Primaria de Salud ,Salud de la Familia ,Time Series Studies ,Atenção Primária à Saúde ,Estudios de Series Temporales ,Cobertura de los Servicios de Salud - Abstract
Resumo Objetivo: analisar a tendência temporal da cobertura da Estratégia Saúde da Família (ESF) no Brasil, suas regiões e Unidades da Federação (UFs), em 2006-2016. Métodos: estudo ecológico de séries temporais com dados do Departamento de Atenção Básica do Ministério da Saúde; utilizou-se regressão de Prais-Winsten. Resultados: no Brasil, as coberturas da ESF em 2006 e 2016 foram de 45,3% e 64,0%, respectivamente, com tendência crescente (variação anual = 8,4%: IC95% 7,4;9,3); as cinco regiões nacionais mostraram tendência crescente na cobertura, assim como a maioria das UFs, exceto Roraima, Amapá, Piauí, Rio Grande do Norte e Paraíba, que apresentaram estabilidade; em 2016, 14 UFs apresentaram coberturas entre 75 e 100%, e 11 entre 50 e 74,9%; São Paulo e o Distrito Federal mostraram coberturas menores que 50%. Conclusão: embora, em geral, a cobertura da ESF tenha aumentado, em 2016, 13 UFs apresentaram coberturas inferiores a 75%; necessitam-se mais esforços pela universalização da ESF. Resumen Objetivo: analizar la tendencia temporal de cobertura de Estrategia de Salud de la Familia (ESF) en Brasil, las unidades de la federación (UFs) y regiones, entre 2006-2016. Métodos: estudio ecológico con análisis de series temporales, mediante regresión de Prais-Winsten; los datos de cobertura de la ESF se obtuvieron de la página del Departamento de Atención Primaria del Ministerio de Salud. Resultados: en Brasil, las coberturas entre 2006 y 2016 fueron de 45,3% y 64,0%, respectivamente, con tendencia creciente de cobertura (variación anual=8,4%: IC95% 7,4;9,3); las cinco regiones han mostrado una tendencia creciente de aumento de cobertura; la mayoría de las UFs mostraron tendencia creciente, a excepción de Roraima, Amapá, Piauí, Rio Grande do Norte y Paraíba, que presentaron estabilidad; en 2016, 14 UFs presentaron coberturas entre 75 y 100%, y 11 entre 50 y 74,9%; São Paulo y el Distrito Federal presentaron coberturas menores que 50%. Conclusión: aun cuando la cobertura de la ESF aumentó, en 2016, 13 UFs todavía tenían una cobertura inferior al 75%; por lo tanto, son necesarios más esfuerzos para la universalización de la cobertura. Abstract Objective: to analyze the Family Health Strategy (FHS) coverage time trend in Brazil, its Regions and Federative Units (FUs) in 2006-2016. Methods: this was an ecological study with time series analysis of Ministry of Health Primary Care Department data; Prais-Winsten regression was used. Results: FHS coverage in Brazil in 2006 and 2016 was 45.3% and 64.0%, respectively, with an increasing trend of coverage (annual variation = 8.4%: 95%CI 7.4;9.3); all five regions showed an increasing trend in coverage, as did the majority of FUs, with the exception of Roraima, Amapá, Piauí, Rio Grande do Norte and Paraíba, which showed stability; in 2016, 14 FUs had coverage of between 75 and 100%, and 11 had coverage of between 50 and 74,9%; coverage in São Paulo and Federal District was below 50%. Conclusion: although, overall, FHS coverage increased, 13 FUs presented coverages below 75% in 2016; therefore, more efforts are needed to universalize coverage.
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- 2018
116. Lógicas de transformación de los sistemas de salud en América Latina y resultados en acceso y cobertura de salud
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Ernesto Báscolo, Natalia Houghton, and Amalia del Riego
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lcsh:Arctic medicine. Tropical medicine ,030505 public health ,cobertura de serviços de saúde ,lcsh:RC955-962 ,Reforma de la atención de salud ,Health care reform ,acesso aos serviços de saúde ,lcsh:Public aspects of medicine ,lcsh:R ,Public Health, Environmental and Occupational Health ,lcsh:Medicine ,lcsh:RA1-1270 ,accesibilidad a los servicios de salud ,Reforma dos serviços de saúde ,primary health care ,03 medical and health sciences ,health services coverage ,0302 clinical medicine ,cobertura de los servicios de salud ,atención primaria de salud ,health services accessibility ,030212 general & internal medicine ,Investigación Original ,0305 other medical science ,atenção primária à saúde - Abstract
Characterize health system reform processes implemented in eight Latin American countries and evaluate their results in terms of health access and coverage conditions.Data from nationally representative household surveys were used to characterize health system reform processes in Chile, Colombia, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay and to assess resulting conditions governing health care access and coverage.Five countries introduced changes to expand financial coverage, with a perspective on primary health care limited to the expansion of health service packages, while three countries prioritized changes in health service organization based on a more comprehensive approach to primary health care. Countries in the first group increased insurance coverage but saw no improvement in access to health services. In the second group of countries, important barriers to access continue to exist despite improvements.Health system reforms can be described in terms of the type of transformations promoted. Reforms that focus on expanding insurance coverage improve financial protection but do not result in positive changes in access. Reforms that prioritize transformations in the organization of health services lead to improved access, yet a large proportion of the population continues to report barriers to access in the countries studied. The socioeconomic conditions of the population and unstable policies stand in the way of achieving more significant progress.Caracterizar os processos de reforma do sistema de saúde implementados em oito países da América Latina e avaliar os resultados obtidos quanto ao acesso e cobertura de saúde.Foi realizada uma caracterização combinada dos processos de transformação dos sistemas de saúde do Chile, Colômbia, El Salvador, Guatemala, México, Paraguai, Peru e Uruguai com a avaliação da situação de acesso e cobertura de saúde a partir de dados obtidos em pesquisas nacionais de domicílios representativas dos países estudados.Cinco países empreenderam mudanças para ampliar a cobertura financeira, com uma perspectiva de atenção primária limitada à ampliação dos pacotes de serviços de saúde, e três países priorizaram mudanças na organização dos serviços de saúde, com uma perspectiva mais abrangente à atenção primária à saúde. Nos países do primeiro grupo, ocorreu a ampliação da cobertura do seguro de saúde, porém sem melhoria do acesso aos serviços. Nos países do segundo grupo, houve melhorias, mas continuam existindo grandes barreiras de acesso.As reformas do sistema de saúde podem ser caracterizadas pelo tipo de transformação ocorrida. Reformas direcionadas a ampliar a cobertura do seguro de saúde aumentam a cobertura financeira, porém não resultam em mudanças favorecendo o acesso. As reformas que priorizam mudanças na organização dos serviços de saúde resultam em melhorias de acesso, porém persistem as barreiras de acesso a uma grande parcela da população nesses países. A condição socioeconômica da população e a instabilidade das políticas impedem alcançar um progresso mais significativo.
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- 2018
117. Prenatal care in Southern Brazil: coverage, trend and disparities
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Janaina S, Saavedra, Juraci A, Cesar, and Angélica O, Linhares
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Adult ,Time Factors ,Adolescent ,Health Evaluation ,Cuidado Pré-Natal, utilização ,Young Adult ,Pregnancy ,Reference Values ,Surveys and Questionnaires ,Prenatal Care, utilization ,Coverage Equity ,Cobertura de Serviços de Saúde ,Humans ,Avaliação em Saúde ,Healthcare Disparities ,Child ,Family Characteristics ,Health Services Coverage ,Prenatal Care ,Health Status Disparities ,Socioeconomic Factors ,Equidade em Cobertura ,Female ,Original Article ,Brazil ,Maternal Age ,Disparidades nos Níveis de Saúde - Abstract
OBJECTIVE To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio Grande do Sul, in 2007, 2010, 2013 and 2016. METHODS This study included all recent mothers living in this municipality, between 1/1 and 12/31 of those years, who had a child weighing more than 500 grams or 20 weeks of gestational age in one of the only two local maternity hospitals. Trained interviewers applied, still in the hospital and up to 48 hours after delivery, a unique and standardized questionnaire, seeking to investigate maternal demographic and reproductive characteristics, the socioeconomic conditions of the family and the assistance received during pregnancy and childbirth. To assess the adequacy of prenatal care, the criteria proposed by Takeda were used, which considers only the number of prenatal appointments and gestational age at initiation, and by Silveira et al., who in addition to these two variables, considers the achievement of some laboratory tests. Chi-square tests were used to compare proportions and assess the linear trend. RESULTS The total of 10,669 recent mothers were included in this survey (96.8% of the total). Prenatal coverage substantially increased between 2007 and 2016. According to Takeda, it rose from 69% to 80%, while for Silveira et al., it increased from 21% to 55%. This improvement occurred for all income groups (p < 0.01). The disparity between the extreme categories of income reduced, according to Takeda, and increased according to Silveira et al. CONCLUSIONS The provision of prenatal care, considering only the number of appointments and the early start, occurred in greater proportion among the poorest. However, only the richest recent mothers were contemplated with more elaborate care, such as laboratory tests, which increased the disparities in the provision of prenatal care.
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- 2018
118. Variación espacial de la cobertura del tratamiento de hipertensión arterial, en el municipio de Santiago de Chile
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Rebolledo, Elizabeth Salinas, Chiaravalloti Neto, Francisco, Meza, María Teresa Escobar, and Giatti, Leandro Luiz
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Primary Health Care ,Health Services Coverage ,Atención Primaria de Salud ,Sistemas de Información Geográfica ,Hipertensión ,Hypertension ,Geographic Information Systems ,Chile ,Regresión Espacial ,Cobertura de los Servicios de Salud ,Spatial Regression - Abstract
RESUMEN Una de las tareas de la atención primaria de la salud es alcanzar una cobertura adecuada para el tratamiento de pacientes con hipertensión arterial. El objetivo de este estudio es analizar la variación espacial de la cobertura del tratamiento de hipertensión arterial en el municipio de Santiago de Chile, en el año de 2014, evaluando su relación con la distancia hacia los establecimientos de atención primaria y con factores socioeconómicos del lugar, utilizando técnicas de georreferenciamiento, modelos de regresión de Poisson global y geográficamente ponderada. Los resultados mostraron que la cobertura del tratamiento de hipertensión arterial presentaba dependencia espacial, dado que su relación con la presencia de adultos mayores, la proporción de inscritos, el nivel socioeconómico y la distancia hacia los establecimientos de salud varía en el espacio. Se concluye que para mejorar la cobertura de hipertensión arterial es necesario contemplar las diferentes realidades locales, lo que puede ser facilitado mediante la aplicación de técnicas de análisis espacial. ABSTRACT One of the tasks of primary health care is to achieve adequate treatment coverage for patients with arterial hypertension. The aim of this study was to analyze the spatial variation of hypertension treatment coverage in the municipality of Santiago de Chile in 2014, evaluating its relationship with the distance to primary health care establishments and socioeconomic factors using georeferencing techniques and global and geographically weighted Poisson regression models. According to the results, arterial hypertension treatment coverage shows spatial dependence, given that its relationship with the presence of older adults, the proportion of population enrolled, socioeconomic status and the distance to primary health care establishments varied spatially. It is concluded that in order to improve hypertension coverage it is necessary to consider different local realities, a process that can be facilitated by the application of spatial analysis techniques.
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- 2018
119. Assessing HIV, TB, Malaria and Childhood Immunization Supply-Side Readiness in Indonesia
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World Bank Group
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HIV TREATMENT ,MALARIA ,MEN WHO HAVE SEX WITH MEN ,ANTI-RETROVIRAL THERAPY ,HIV AIDS ,HEALTH SERVICES COVERAGE ,HIV COUNSELING ,TUBERCULOSIS ,IMMUNIZATION - Abstract
The Indonesian health sector is currently experiencing a financing transition that will have a profound impact on the country's efforts to achieve universal health coverage (UHC) and national health goals. The transition is marked, on the one hand, by increasing per capita expenditure on health and, on the other, by declining of out-of-pocket payments (OOP) and a significant reduction of external funding for health as a source of health financing. Assuming steady economic growth, Indonesia is soon projected to greatly reduce or transition from its reliance on external financing for the national AIDS, Tuberculosis (TB), Malaria, and Childhood Immunization (ATMI) programs. While varying somewhat from program to program, the extent of financial transition required will be substantial for all four programs. Complicating the transition process is the fact that all four programs are currently engaged in making significant changes in program strategies and implementation processes in response to both underperformance and Indonesia's commitment to reaching global targets.
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- 2018
120. Vacunación contra Hepatitis B: un estudio de revisión
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Araújo, Telma Maria Evangelista de, Sousa, Karinna Alves Amorim de, Dias, Samya Raquel Soares, Oliveira, Vanessa Cavalcante, Marques, Evellyn Stefanne Bastos, Araújo, Telma Maria Evangelista de, Sousa, Karinna Alves Amorim de, Dias, Samya Raquel Soares, Oliveira, Vanessa Cavalcante, and Marques, Evellyn Stefanne Bastos
- Abstract
O conhecimento preciso da cobertura vacinal contra hepatite B é um dos elementos essenciais para a vigilância epidemiológica e interrupção da cadeia de transmissão da infecção. O objetivo desse estudo é analisar a adesão e a situação vacinal contra hepatite B na população geral. Trata-se de revisão integrativa da literatura. Buscaram-se artigos nas bases de dados da Biblioteca Virtual de Saúde (BVS) - Enfermagem e Scientific Electronic Library Online (SCIELO). Foram incluídos os artigos publicados em português, disponíveis online em texto completo e publicados entre 2005 à 2013. Ao final foram selecionados 17 artigos para a revisão. Foi encontrada uma baixa cobertura vacinal que variou de 14% a 99% entre os grupos estudados. Os principais fatores relacionados a não adesão à vacinação foram: não gostar de agulha, estar em tratamento para HIV, baixa renda, falta de conhecimento quanto às vacinas, dentre outros. Conclui-se que a cobertura vacinal contra hepatite B está aquém da preconizada pelo Ministério da Saúde. Neste sentido, sugere-se maior atuação da Estratégia Saúde da Família, junto a população alvo da vacina, especialmente escolares, além de incremento na educação permanente dos profissionais de saúde., El conocimiento preciso de la cobertura vacunal contra Hepatitis B es uno de los elementos esenciales para la supervisión epidemiológica e interrupción de la cadena de transmisión de la infección. El objetivo de ese estudio es analizar la adhesión y la situación vacunal contra Hepatitis B en la población en general. Se trata de revisión integrativa de la literatura. Se buscaron artículos en las bases de datos de la Biblioteca Virtual de Salud (BVS) – Enfermería y Scientific Eletronic Library Online (SCIELO). Fueron agregados los artículos publicados en portugués, disponibles online en texto completo y publicados entre 2005 al 2013. Al final fueron seleccionados 17 artículos para la revisión. Se identificó una baja cobertura vacunal que varió de 14% a 99% entre los grupos estudiados. Los principales factores relacionados a la no adhesión a la vacunación fueron: miedos a las agujas, estar en tratamiento para VIH, bajos ingresos, falta de conocimiento acerca de las vacunas, entre otros. Se concluye que la cobertura vacunal contra Hepatitis B está a quien de la preconizada por el Ministerio de la Salud. En este sentido, se sugiere una mayor actuación de la Estrategia Salud de la Familia, con la población objetivo de la vacuna, especialmente la escuela, así como un aumento de la formación constante de los profesionales de la salud., The precise knowledge of the hepatitis B vaccination coverage is a key element for the epidemiological surveillance and interruption of the infection transmission chain. The objective of that study is to analyze the accession and the vaccination status against hepatitis B in the general population. It is an integrative literature review. They sought for articles in databases of the Virtual Health Library (VHL) - Nursing and Scientific Electronic Library Online (SciELO). Articles published in Portuguese, available online in full text and published from 2005 to 2013. At the end, 17 of the selected articles to review were included. A low vaccination coverage ranging from 14% to 99% between the groups was found. The main factors related to non- accession to vaccination were: not to like needle, to be treated for HIV, low income, lack of knowledge about the vaccines, among others. We conclude that the immunization coverage for hepatitis B is below of the recommended by the Brazilian Department of Health. In this sense, it is suggested greater role of the Family Health Strategy, in the target population of the vaccine, especially schoolchildren, and increase in permanent education health professionals.
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- 2017
121. Examining changes in maternal and child health inequalities in Ethiopia
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Elizabeth Mary Foster, Anne Bakilana, Qaiser M. Khan, Huihui Wang, Colin Andrews, and Alemayehu A. Ambel
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Male ,Maternal and child health ,Maternal Health ,Race and health ,CHILD HEALTH ,0302 clinical medicine ,Pregnancy ,Global health ,030212 general & internal medicine ,Socioeconomics ,Health inequalities ,030503 health policy & services ,Health Policy ,Child Health ,Health services research ,Middle Aged ,Health equity ,Child, Preschool ,HEALTH OUTCOMES ,VACCINATION ,NUTRITION ,PRENATAL CARE ,Female ,Health education ,0305 other medical science ,Adult ,medicine.medical_specialty ,Adolescent ,HEALTH SERVICES COVERAGE ,Health care utilization ,HEALTH INEQUALITY ,STUNTING ,Young Adult ,03 medical and health sciences ,Environmental health ,medicine ,Humans ,Social determinants of health ,Health policy ,Demography ,business.industry ,MORTALITY ,Research ,Public health ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,Health Status Disparities ,Patient Acceptance of Health Care ,MATERNAL HEALTH ,HEALTH CARE UTILIZATION ,Socioeconomic Factors ,Ethiopia ,business ,SURVEYS - Abstract
Background Ethiopia has made considerable progress in maternal, newborn, and child health in terms of health outcomes and health services coverage. This study examined how different groups have fared in the process. It also looked at possible factors behind the inequalities. Methods The study examined 11 maternal and child health outcomes and services: stunting, underweight, wasting, neonatal mortality, infant mortality, under-5 mortality, measles vaccination, full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. It explored trends in inequalities by household wealth status based on Demographic and Health Surveys conducted in 2000, 2005, 2011, and 2014. The study also investigated the dynamics of inequality, using concentration curves for different years. Decomposition analysis was used to identify the role of proximate determinants. Results The study found substantial improvements in health outcomes and health services: Although there is still a considerable gap between the rich and the poor, inequalities in health services have been reduced. However, child nutrition outcomes have mainly improved for the rich. The changes observed in wealth-related inequality tend to reflect the changing direct effect of household wealth on child health and health service use. Conclusions The country’s efforts to improve access to health services have shown some positive results, but attention should now turn to service quality and to identifying multisectoral interventions that can change outcomes for the poorest. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0648-1) contains supplementary material, which is available to authorized users.
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- 2017
122. Oferta da Fonoaudiologia na rede pública municipal de saúde nas capitais do Nordeste do Brasil
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Santos, Jéssica Andrade Pinheiro dos, Arce, Vladimir Andrei Rodrigues, Magno, Liz Duque, and Ferrite, Silvia
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Health services coverage ,Acesso aos serviços de saúde ,Health services accessibility ,Cobertura de serviços de saúde ,Unified Health System ,Fonoaudiologia ,Sistema Único de Saúde ,Speech, language and hearing sciences ,Desigualdades em saúde ,Health inequalities - Abstract
RESUMO Introdução No Brasil, o Estado é responsável pelo acesso universal e igualitário à saúde, porém, é comum a escassez na oferta de serviços. Objetivo Descrever e comparar a oferta do profissional de Fonoaudiologia na rede pública municipal de saúde, administração direta, nas capitais da região Nordeste do Brasil. Métodos Os dados foram coletados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Instituto Brasileiro de Geografia e Estatística (IBGE), para 2007 e 2014. As variáveis foram o número de fonoaudiólogos da administração direta da rede pública municipal de saúde, o nível de atenção de lotação do profissional e o número de unidades de saúde da gestão municipal. Na análise, foram estimadas a oferta do profissional, de acordo com a população residente e por nível de atenção das unidades de saúde, a evolução 2007-2014 e o deficit atual do profissional. Resultados Houve crescimento na oferta do profissional no conjunto das capitais do Nordeste do país (2007-2014), porém, com média de apenas 1,5 fonoaudiólogo para cada 100.000 habitantes, em 2014. As maiores ofertas foram verificadas em João Pessoa e Aracaju e, as menores, em Natal e Salvador. Considerando-se a razão fonoaudiólogos/unidades de saúde por nível de atenção, as maiores ofertas foram observadas na Atenção Hospitalar e, as menores, na Atenção Básica. O deficit estimado de fonoaudiólogos foi expressivo, com diferenças intrarregionais. Conclusão A oferta de fonoaudiólogos na rede pública municipal de saúde, via administração direta, nas capitais do Nordeste do país, é insuficiente e desigual, restringindo o acesso da população aos serviços de Fonoaudiologia. ABSTRACT Introduction In Brazil, the State is responsible for universal and equal access to healthcare, although a scarcity in services is common. Purpose To describe and compare the supply of Speech, Language and Hearing (SLH) professionals under direct government management in the municipal public healthcare networks in the state capitals of the Brazilian Northeast. Methods Data for 2007 and 2014 was collected from the National Register of Health Facilities and the Brazilian Institute of Geography and Statistics. The variables were the number of SLH professionals under direct government management in the municipal public healthcare network, the operational level of healthcare, and the number of health units under municipal management. Our analysis estimated: the supply of professionals, by resident population and level of healthcare unit, the evolution between 2007 and 2014 and the current professional deficit. Results Between 2007 and 2014, the supply of professionals in Northeastern state capitals rose; however, the 2014 average was only 1.5 professionals per 100,000 inhabitants. The greatest supply was found in João Pessoa and Aracaju, while the least was in Natal and Salvador. In terms of the ratio of professionals/health units per level of healthcare, the greatest supply of professionals was found in hospital care and the least in primary care. The estimated professional deficit was substantial and presented intra-regional differences. Conclusion The supply of professionals under direct government management in the state capitals of the country’s Northeast region is insufficient and unequal, restricting access to SLH services.
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- 2017
123. Audiology - Communication Research (ACR)
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Jéssica Andrade Pinheiro dos Santos, Vladimir Andrei Rodrigues Arce, Liz Duque Magno, and Silvia Ferrite
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Health services coverage ,General Computer Science ,Acesso aos serviços de saúde ,Health services accessibility ,Unified Health System ,Fonoaudiologia ,lcsh:Otorhinolaryngology ,lcsh:RF1-547 ,030507 speech-language pathology & audiology ,03 medical and health sciences ,0302 clinical medicine ,Cobertura de serviços de saúde ,Sistema Único de Saúde ,Desigualdades em saúde ,Speech, language and hearing sciences ,030223 otorhinolaryngology ,0305 other medical science ,Health inequalities - Abstract
Submitted by Vladimir Andrei Rodrigues Arce (vladimir.arce@hotmail.com) on 2018-06-10T15:12:51Z No. of bitstreams: 1 Oferta da Fonoaudiologia na rede pública municipal de saúde nas capitais do Nordeste do Brasil.pdf: 180667 bytes, checksum: 3f23a5d42585ab3e6c6c3314f54974e2 (MD5) Approved for entry into archive by Delba Rosa (delba@ufba.br) on 2018-06-18T13:19:43Z (GMT) No. of bitstreams: 1 Oferta da Fonoaudiologia na rede pública municipal de saúde nas capitais do Nordeste do Brasil.pdf: 180667 bytes, checksum: 3f23a5d42585ab3e6c6c3314f54974e2 (MD5) Made available in DSpace on 2018-06-18T13:19:44Z (GMT). No. of bitstreams: 1 Oferta da Fonoaudiologia na rede pública municipal de saúde nas capitais do Nordeste do Brasil.pdf: 180667 bytes, checksum: 3f23a5d42585ab3e6c6c3314f54974e2 (MD5) Previous issue date: 2017-05-18 Introdução No Brasil, o Estado é responsável pelo acesso universal e igualitário à saúde, porém, é comum a escassez na oferta de serviços. Objetivo Descrever e comparar a oferta do profissional de Fonoaudiologia na rede pública municipal de saúde, administração direta, nas capitais da região Nordeste do Brasil. Métodos Os dados foram coletados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Instituto Brasileiro de Geografia e Estatística (IBGE), para 2007 e 2014. As variáveis foram o número de fonoaudiólogos da administração direta da rede pública municipal de saúde, o nível de atenção de lotação do profissional e o número de unidades de saúde da gestão municipal. Na análise, foram estimadas a oferta do profissional, de acordo com a população residente e por nível de atenção das unidades de saúde, a evolução 2007-2014 e o deficit atual do profissional. Resultados Houve crescimento na oferta do profissional no conjunto das capitais do Nordeste do país (2007-2014), porém, com média de apenas 1,5 fonoaudiólogo para cada 100.000 habitantes, em 2014. As maiores ofertas foram verificadas em João Pessoa e Aracaju e, as menores, em Natal e Salvador. Considerando-se a razão fonoaudiólogos/unidades de saúde por nível de atenção, as maiores ofertas foram observadas na Atenção Hospitalar e, as menores, na Atenção Básica. O deficit estimado de fonoaudiólogos foi expressivo, com diferenças intrarregionais. Conclusão A oferta de fonoaudiólogos na rede pública municipal de saúde, via administração direta, nas capitais do Nordeste do país, é insuficiente e desigual, restringindo o acesso da população aos serviços de Fonoaudiologia. São Paulo
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- 2017
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124. Vacunación contra Hepatitis B: un estudio de revisión
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Karinna Alves Amorim de Sousa, Evellyn Stefanne Bastos Marques, Samya Raquel Soares Dias, Telma Maria Evangelista de Araújo, and Vanessa Cavalcante Oliveira
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Cultural Studies ,Low income ,SciELO ,History ,medicine.medical_specialty ,Nursing (miscellaneous) ,Population ,Alternative medicine ,Target population ,Cobertura de los Servicios de Salud ,medicine ,education ,education.field_of_study ,Health Services Coverage ,business.industry ,Vaccination ,Vacunación ,Hepatitis B ,medicine.disease ,language.human_language ,Anthropology ,Family medicine ,language ,Enfermería ,Portuguese ,business ,Cartography - Abstract
O conhecimento preciso da cobertura vacinal contra hepatite B é um dos elementos essenciais para a vigilância epidemiológica e interrupção da cadeia de transmissão da infecção. O objetivo desse estudo é analisar a adesão e a situação vacinal contra hepatite B na população geral. Trata-se de revisão integrativa da literatura. Buscaram-se artigos nas bases de dados da Biblioteca Virtual de Saúde (BVS) - Enfermagem e Scientific Electronic Library Online (SCIELO). Foram incluídos os artigos publicados em português, disponíveis online em texto completo e publicados entre 2005 à 2013. Ao final foram selecionados 17 artigos para a revisão. Foi encontrada uma baixa cobertura vacinal que variou de 14% a 99% entre os grupos estudados. Os principais fatores relacionados a não adesão à vacinação foram: não gostar de agulha, estar em tratamento para HIV, baixa renda, falta de conhecimento quanto às vacinas, dentre outros. Conclui-se que a cobertura vacinal contra hepatite B está aquém da preconizada pelo Ministério da Saúde. Neste sentido, sugere-se maior atuação da Estratégia Saúde da Família, junto a população alvo da vacina, especialmente escolares, além de incremento na educação permanente dos profissionais de saúde. El conocimiento preciso de la cobertura vacunal contra Hepatitis B es uno de los elementos esenciales para la supervisión epidemiológica e interrupción de la cadena de transmisión de la infección. El objetivo de ese estudio es analizar la adhesión y la situación vacunal contra Hepatitis B en la población en general. Se trata de revisión integrativa de la literatura. Se buscaron artículos en las bases de datos de la Biblioteca Virtual de Salud (BVS) – Enfermería y Scientific Eletronic Library Online (SCIELO). Fueron agregados los artículos publicados en portugués, disponibles online en texto completo y publicados entre 2005 al 2013. Al final fueron seleccionados 17 artículos para la revisión. Se identificó una baja cobertura vacunal que varió de 14% a 99% entre los grupos estudiados. Los principales factores relacionados a la no adhesión a la vacunación fueron: miedos a las agujas, estar en tratamiento para VIH, bajos ingresos, falta de conocimiento acerca de las vacunas, entre otros. Se concluye que la cobertura vacunal contra Hepatitis B está a quien de la preconizada por el Ministerio de la Salud. En este sentido, se sugiere una mayor actuación de la Estrategia Salud de la Familia, con la población objetivo de la vacuna, especialmente la escuela, así como un aumento de la formación constante de los profesionales de la salud. The precise knowledge of the hepatitis B vaccination coverage is a key element for the epidemiological surveillance and interruption of the infection transmission chain. The objective of that study is to analyze the accession and the vaccination status against hepatitis B in the general population. It is an integrative literature review. They sought for articles in databases of the Virtual Health Library (VHL) - Nursing and Scientific Electronic Library Online (SciELO). Articles published in Portuguese, available online in full text and published from 2005 to 2013. At the end, 17 of the selected articles to review were included. A low vaccination coverage ranging from 14% to 99% between the groups was found. The main factors related to non- accession to vaccination were: not to like needle, to be treated for HIV, low income, lack of knowledge about the vaccines, among others. We conclude that the immunization coverage for hepatitis B is below of the recommended by the Brazilian Department of Health. In this sense, it is suggested greater role of the Family Health Strategy, in the target population of the vaccine, especially schoolchildren, and increase in permanent education health professionals.
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- 2017
125. Governança regional: estratégias e disputas para gestão em saúde
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Ligia Giovanella and Adriano Maia dos Santos
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Health Management ,National Health Programs ,Public administration ,Regional Health Planning ,Regional policy ,Regionalização ,Health care rationing ,Participação Comunitária ,Cobertura de Serviços de Saúde ,Health care ,Humans ,Medicine ,Health Manager ,Gestor de Saúde ,Health Services Administration ,Health policy ,Health Care Rationing ,Local Government ,Health management system ,Health Services Coverage ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Corporate governance ,Unified Health System ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Original Articles ,Administração de Serviços de Saúde ,Focus group ,Gestão em Saúde ,Local government ,Consumer Participation ,Public Health Practice ,Alocação de Recursos para a Atenção à Saúde ,Sistema Único de Saúde ,business ,Delivery of Health Care ,Brazil - Abstract
OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes.METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics.RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System.CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee’s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making. OBJETIVO Analisar o sistema de governança regional em saúde quanto a estratégias e disputas de gestão.PROCEDIMENTOS METODOLÓGICOS Pesquisa qualitativa com gestores de saúde de 19 municípios que integram a região de saúde no estado da Bahia. Foram realizadas 17 entrevistas semiestruturadas com gestores/gerentes (estadual, regional e municipal), grupo focal, observações na Comissão Intergestores Regional e documentos institucionais, em 2012. Foram analisados os componentes político-institucional e organizacional e interpretados pela hermenêutica-dialética.RESULTADOS A comissão intergestores regional foi a principal estratégia da governança regional, sendo ferramenta fundamental para fortalecimento da governança por reunir diferentes sujeitos responsáveis pela tomada de decisão nos territórios sanitários e pela negociação da alocação de recursos e distribuição dos estabelecimentos de uso comum na região. A rotatividade de secretários de saúde, baixa autonomia nas decisões executivas, a qualificação técnica insuficiente para exercício da função e o atravessamento das políticas partidárias na tomada de decisão são fatores que obstruem a comissão intergestores regional às demandas sociais. Recursos financeiros insuficientes não viabilizam o cumprimento da programação pactuada integrada nem o aumento da oferta pública na rede e impunham ao gestor a compra de serviços no mercado privado por valores acima da Tabela do Sistema Único de Saúde. Foram relatados atravessadores contratados para agilizar o acesso aos serviços especializados (diagnóstico, terapêutico e/ou cirúrgico) em outros municípios mediante pagamento direto a médicos por procedimentos já custeados pelo Sistema Único de Saúde.CONCLUSÕES A rede regionalizada de saúde apresenta padrão de governança conflitante e com institucionalidade intermediária.A comissão intergestores regional necessita incorporar, à rotina de gestão, dispositivos mais democráticos que logrem articulação com instituições de ensino, permeáveis às demandas sociais, para definição das políticas regionais.
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- 2014
126. Primary Health Care: care coordinator in regionalized networks?
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Almeida, Patty Fidelis de and Santos, Adriano Maia dos
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Systems Integration ,Regionalização ,Atenção Primária à Saúde, organização & administração ,Primary Health Care, organization & administration ,Health Services Coverage ,Cobertura de Serviços de Saúde ,Health Services, supply & distribution ,Serviços de Saúde, provisão & distribuição ,Regional Health Planning ,Integração de Sistemas - Abstract
RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. RESUMO OBJETIVO Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde. MÉTODOS Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia. RESULTADOS A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de serviços ambulatoriais hospitalares e de pronto-atendimento, desarticulados da rede. Problemas de acesso e oferta de atenção especializada eram agravados pela dependência do setor privado nas regiões, ainda que tenham sido observados avanços na institucionalização de fluxos desde a Atenção Primária à Saúde. A contrarreferência era deficiente e a comunicação interprofissional escassa, principalmente quando o usuário era atendido na rede contratada ou conveniada. CONCLUSÕES A capacidade de coordenação mostra-se afetada tanto pela fragmentação da rede regional, quanto por problemas intrínsecos à Atenção Primária à Saúde, pouco fortalecida em seus atributos essenciais. Apesar de as regiões de saúde apresentarem problemas em comum, a Atenção Primária à Saúde continua sendo um tema circunscrito aos limites municipais.
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- 2016
127. [COVID-19 deaths: Distribution by age and universal medical coverage in 22 countriesMortes por COVID-19: distribuição por idade e universalidade da cobertura médica em 22 países].
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Fantin R, Brenes-Camacho G, and Barboza-Solís C
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Objective: Relate standardized age distribution of COVID-19 deaths in 22 countries in the Americas and Europe to different indicators of population characteristics and health systems., Methods: Distributions of COVID-19 deaths by age group in 22 countries of the Americas and Europe were standardized based on the age pyramid of the world's population. Correlations were calculated between the standardized proportion of people aged <60 years among the deceased and each of six indicators., Results: Standardization based on the world age pyramid revealed considerable differences in age distribution among countries; the proportion of people aged <60 years was higher in Latin America and the United States than in Canada or Western Europe. The standardized proportion of people aged <60 years among persons who died of COVID-19 is strongly correlated to the existence of universal quality medical coverage (r=-0.92, p<0.01). This relationship remained significant after being adjusted for the other indicators., Conclusion: We propose that weaknesses in medical coverage of the population may have created higher case-fatality in populations aged <60 years in Latin America and the United States.
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- 2021
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128. Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002-2017.
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Freire AR, Freire DEWG, Araújo ECF, de Lucena EHG, and Cavalcanti YW
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- Brazil epidemiology, Cities, Humans, Public Health, Health Services Accessibility, Hospitalization statistics & numerical data, Mouth Neoplasms mortality, Oral Medicine, Socioeconomic Factors
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Background : Oral cancer is a frequent neoplasm worldwide, and socioeconomic factors and access to health services may be associated with its risk. Aim: To analyze effect of socioeconomic variables and the influence of public oral health services availability on the frequency of new hospitalized cases and mortality of oral cancer in Brazil. Materials and Methods : This observational study analyzed all Brazilian cities with at least one hospitalized case of oral cancer in the National Cancer Institute database (2002-2017). For each city were collected: population size, Municipal Human Development Index (MHDI), Gini Coefficient, oral health coverage in primary care, number of Dental Specialized Centers (DSC) and absolute frequency of deaths after one year of the first treatment. The risk ratio was determined by COX regression, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Poisson regression was used to determine factors associated with higher mortality frequency. Results : Cities above 50,000 inhabitants, with high or very high MHDI, more unequal (Gini > 0.4), with less oral health coverage in primary care (<50%) and without DSC had a greater accumulated risk of having 1 or more cases ( p < 0.001). Higher frequency of deaths was also associated with higher population size, higher MHDI, higher Gini and lower oral health coverage in primary care ( p < 0.001). Conclusions : The number hospitalization and deaths due to oral cancer in Brazil was influenced by the cities' population size, the population's socioeconomic status and the availability of public dental services.
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- 2020
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129. FRECUENCIA DE MAMOGRAFÍA Y EXAMEN CLÍNICO DE MAMA EN MUJERES DEL RÉGIMEN SUBSIDIADO - MANIZALES (CALDAS) FREQUENCIA DE MAMOGRAFÍA E EXAME CLÍNICO DE MAMA EM MUHERES DO RÉGIME SUBSIDIADO - MANIZALES (CALDAS) MAMMOGRAM FREQUENCY AND CLINICAL BREAST EXAM IN WOMEN UNDER THE SUBSIDIZED HEALTH REGIME- MANIZALES (CALDAS)
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Walter Antonio Arboleda Ruiz, Diana Paola Betancurth Loaiza, and Luz Ángela Correa Ramírez
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examen físico ,tamizaje ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,Cribado ,cobertura dos serviços de saúde ,tamisação ,physical exam ,exame físico ,health services coverage ,cobertura de los servicios de salud ,mammogram ,Screening ,mamografía ,Crivado ,mamografia - Abstract
Objetivo: Determinar la cobertura del examen clínico y mamografía de tamización para cáncer de mama en un grupo de mujeres del régimen subsidiado en el municipio de Manizales. Materiales y Métodos: Estudio observacional de tipo transversal. Se efectuó una encuesta telefónica a 352 mujeres con edades comprendidas entre 50 y 69 años, residentes en el área urbana y rural del municipio de Manizales durante el cuarto trimestre de 2010. La cobertura de tamización se valoró como la proporción de mujeres con antecedente de mamografía y examen clínico de la mama, fueron excluidas las mujeres con antecedente personal de cáncer de mama. Se estimó frecuencia de vida, frecuencia en los últimos dos años y en el último año. Se analizaron factores asociados a la práctica de tamización mediante el cálculo de OR ajustados. Resultados: La frecuencia de vida de uso de examen clínico fue de 56% y de mamografía 42,3%, de los cuales el 3 y el 7% fueron diagnósticos respectivamente (mujeres sintomáticas), el resto lo hizo con fines de cribado. Por tamización 53,1% tenían examen clínico en el último año y 24,7% mamografías en los últimos dos años. No se halló relación de las diferentes variables con la no realización de la mamografía. Conclusiones: Existe una baja cobertura de la mamografía y el examen clínico de mama por tamización en las mujeres del régimen subsidiado, a pesar de las recomendaciones generadas por el Ministerio de la Protección Social y el Instituto Nacional de Cancerología.Objetivo: Determinar a cobertura do exame clínico e mamografia de tamisação para câncer de mama num grupo de mulheres do regime subsidiado no município de Manizales. Materiais e Métodos: Estudo observacional de tipo transversal. Efeito se uma enquete telefônica a 352 mulheres com idades compreendidas entre 50 e 69 anos, residentes na aérea urbana e rural do município de Manizales durante o quarto trimestre de 2010. A cobertura de tamisação se valorou como a proporção de mulheres com antecedente de mamografia e exame clínico da mama, foram excluídas as mulheres com antecedente pessoal de câncer de mama. Estimou se frequência nos últimos dois anos e no ultimo ano. Analisaram se fatores associados a pratica de tamisação mediante o calculo de OR ajustados. Resultados: A frequência de vida de uso de exame clinica foi de 56% e de mamografia 42,3%, dos quais o 3 e o 7% foram diagnósticos respectivamente (mulheres sintomáticas), o resto o fez com fins de crivado. Por tamisação 53,1% tinham exame clinico no ultimo ano e 24,7% mamografias nos últimos dois anos. Não se encontrou relação das diferentes variáveis com a não realização da mamografia. Conclusões: Existe uma baixa cobertura da mamografia e o exame clínico de mama por tamisação nas mulheres do regime subsidiado, a pesar das recomendações geradas pelo Ministério da Proteção Social e o Instituto Nacional de Cancerologia.Objective: To determine the scope of breast clinical exam and screening for cancer mammogram in a group of women under the subsidized health regime in the municipality of Manizales. Materials and Methods: Observational, transversal type study. Telephone interviews were carried out with 352 women in ages between 50 and 69 years old, resident in the urban and rural areas of the municipality of Manizales during the fourth trimester in 2010. The scope of screening was assessed as the proportion of women with mammogram and clinical breast exam history and women with personal record of breast cancer were excluded. Life frequency, frequency in the last two years and in the previous year was estimated. Factors associated with the screening practice were analyzed using the adjusted OR calculation. Results: Frequency of useful life of the clinical exam was 56% and mammogram was 42.3% from which 3 and 7% were diagnoses respectively (asymptomatic women); the rest were done for screening purposes. Through screening, 53.1% had had clinical exam during the previous year and 24.7% had had mammograms during the last two years. Relationship of the different variables with the carrying out of mammograms was not found. Conclusions: There is low coverage of mammogram and clinical breast exam through screening in women under the subsidized health regime in spite of the recommendations generated by Social Protection Ministry and the National Study of Cancer Institute.
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- 2012
130. Assistência pré-natal nos serviços públicos e privados de saúde: estudo transversal de base populacional em Rio Grande, Rio Grande do Sul, Brasil
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Gabriela Breitembach dos Santos, Juraci Almeida Cesar, Carolina Fischer Cunha, Raúl Andrés Mendoza-Sassi, and Andréa T. Sutil
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Gerontology ,Response rate (survey) ,Program evaluation ,Avaliação de Serviços de Saúde ,education.field_of_study ,medicine.medical_specialty ,Health Services Coverage ,business.industry ,Public sector ,Population ,Public Health, Environmental and Occupational Health ,Developing country ,Prenatal Care ,Prenatal care ,Health Services Evaluation ,Private sector ,Cuidado Pré-Natal ,Family medicine ,Cobertura de Serviços de Saúde ,medicine ,Outpatient clinic ,business ,education - Abstract
Este estudo teve por objetivo avaliar a assistência recebida durante o pré-natal nos setores público e privado em Rio Grande, Rio Grande do Sul, Brasil. Aplicou-se questionário padronizado a todas as mães residentes nesse município, cujos filhos nasceram nas duas únicas maternidades locais entre 1º de janeiro e 31 de dezembro de 2010. Os locais de consultas avaliados no setor público foram as unidades básicas de saúde (UBS) com e sem Estratégia Saúde da Família (ESF) e os ambulatórios; no setor privado foram as clínicas de convênio e os consultórios particulares. Utilizou-se o teste qui-quadrado para comparar proporções. A taxa de respondentes foi de 97,2% (2.395 em 2.464). Dentre as 23 variáveis e indicadores avaliados nesses locais, sete mostraram nítida vantagem para mães que consultaram na ESF e seis para mães atendidas em clínica de convênio e consultório particular. Quatro variáveis mostraram cobertura praticamente universal nos cinco locais estudados. A assistência pré-natal mostrou melhor cobertura para gestantes atendidas no setor privado. Gestantes atendidas na ESF apresentaram cobertura semelhante àquela observada no setor privado. This study aimed to evaluate public and private prenatal care for women in Rio Grande, Rio Grande do Sul State, Brazil. Women who gave birth at the two local maternity hospitals from January 1 to December 31, 2010, answered a standardized questionnaire. The interview sites in the public sector were primary health care units with and without the Family Health Strategy (FHS) and outpatient clinics; the private sector included clinics operated by health plans and private physicians' offices. The chi-square test was used to compare proportions. The response rate was 97.2% (2,395 out of 2,464). Among the 23 target variables and indicators, seven showed a clear advantage for mothers who had received prenatal care under the FHS and six for health plan clinics and private offices. Four variables showed virtually universal coverage at all five study sites. Prenatal care showed better coverage for pregnant women treated in the private sector. Pregnant women treated under the FHS showed similar coverage to that in the private sector.
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- 2012
131. [Payment mechanisms and financial resources management for consolidation of Ecuador's health system]
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Tatiana, Villacrés and Ana Cristina, Mena
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Informe Especial ,capitation fee ,health services coverage ,Financing, Government ,financiamiento público ,capitación ,cobertura de los servicios de salud ,Health care reform ,government ,Healthcare Financing ,Ecuador ,Reforma sanitaria ,financing - Abstract
RESUMEN Objetivos. El objetivo de este artículo es analizar la propuesta planteada por el Ministerio de Salud Pública para la reforma del modelo de financiamiento público en Ecuador referente a mancomunación de fondos y mecanismos de pago. Método. Se realizó una revisión documental sobre el modelo de financiamiento, el marco legal vigente y las bases presupuestarias por medio de Pubmed, Scielo, LILACS Ecuador y LILACS regional utilizando como palabras clave financiamiento de la salud, sistemas de financiamiento en salud, capitación, mancomunación de fondos, reforma de salud Ecuador, sistema de salud Ecuador y mecanismos de pago en salud. Se incluyeron, además, libros y otros documentos referidos por expertos en sistemas de salud. Resultados. La revisión del modelo de financiamiento permitió identificar la segmentación histórica del sistema de salud ecuatoriano, a partir de la cual nace la propuesta del Ministerio de Salud Pública para reformar el modelo de financiamiento. El Ministerio ha planteado como soluciones la mancomunación de fondos y el pago de servicios en el primer nivel de atención mediante una cápita ajustada por riesgos socioeconómicos y demográficos. Los avances en la reforma del modelo de financiamiento incluyen el diseño de los planteamientos, sus mecanismos de implementación y el debate con los actores. Conclusiones. La implementación de estas modificaciones puede generar mejoras para el sistema de salud en la eficiencia, dispersión de riesgos, incentivos para el cumplimiento de objetivos sanitarios, así como contribuir a su sostenibilidad y avanzar hacia la cobertura universal de salud. No obstante, existen limitaciones legales, políticas y operativas que dificultan su implantación.
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- 2016
132. Disparities between the public and private services in the use of reperfusion therapies for patients with STEMI : VICTIM data
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Oliveira, Laís Costa Souza and Barreto-Filho, José Augusto
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Myocardial reperfusion ,Myocardial infarction ,Hospitais privados ,Health services coverage ,CIENCIAS DA SAUDE ,Infarto do miocárdio ,Cobertura de serviços de saúde ,Unified Health System ,Sistema Único de Saúde ,Private hospitals ,Reperfusão miocárdica ,Ciências da saúde - Abstract
Fundação de Apoio a Pesquisa e à Inovação Tecnológica do Estado de Sergipe - FAPITEC/SE Introduction: The use of reperfusion therapy in the treatment of patients with STEMI, in the shortest time possible, is essential to reduce morbidity and mortality. Previous studies suggest the existence of disparities in the care of patients attended by public and private health services. However, major gaps still exist when this service is focused on patients with STEMI, especially in Brazil. Objective: To estimate disparities in the use of reperfusion therapy for patients diagnosed with STEMI treated in hospitals capable of performing primary angioplasty of public and private in Sergipe. Methods: This is a cross-sectional study with a quantitative approach which used records Study VICTIM. Data were collected in only four hospitals capable of performing primary angioplasty in Sergipe, being one public and three private. We evaluated 301 patients diagnosed with STEMI, 249 of which were treated at public hospitals and 52 in private hospitals from December 2014 until October 2015. Results: On the way to the hospital capable of performing primary angioplasty, 3.2 % of patients treated in public hospitals made use of fibrinolytic, and 1.9% of patients treated in private institutions (p = 1.0). Amongst those patients treated in hospitals with ability to perform primary angioplasty, only 45.3% of treated at the public hospital arrived in ideal time (≤ 12 hours starting from the onset of symptoms), compared with 80.5% of patients treated in private hospitals (p
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- 2016
133. A Cobertura da Estratégia de Saúde da Família (ESF) no Brasil, segundo a Pesquisa Nacional de Saúde, 2013
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Maria Aline Siqueira Santos, Deborah Carvalho Malta, Ademar Arthur Chioro dos Reis, Sheila Rizzato Stopa, Eduardo Alves Melo, and José Eudes Barroso Vieira
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Gerontology ,Health services coverage ,Health surveys ,Primary health care ,Estratégia Saúde da Família ,03 medical and health sciences ,0302 clinical medicine ,Family Health Strategy ,Inquéritos epidemiológicos ,Cobertura de serviços de saúde ,Medicine ,030212 general & internal medicine ,National health ,Family health ,030505 public health ,Primary Health Care ,business.industry ,Health Policy ,lcsh:Public aspects of medicine ,Unified Health System ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Atenção Primária à Saúde ,Sistema Único de Saúde ,0305 other medical science ,business ,Humanities - Abstract
Resumo O objetivo deste artigo é apresentar a cobertura da Estratégia Saúde da Família (ESF) estimada pela Pesquisa Nacional de Saúde (PNS), comparando com dados administrativos e coberturas anteriores da Pesquisa Nacional de Amostras de Domicílios (PNAD), além de descrever frequências de visitas domiciliares das equipes. Foram comparados dados de inquéritos populacionais em 2008 (PNAD), em 2013 (PNS) e dados administrativos do Departamento de Atenção Básica, sobre a proporção de pessoas moradoras em domicílios cadastrados em unidade de saúde da família, para Brasil, Grandes Regiões e Unidades da Federação, além de indicadores com visitas domiciliares por escolaridade. Observou-se aumento na cobertura da população pelo Saúde da Família no Brasil, passando de 50,9%, segundo a PNAD 2008, para 53,4% em 2013, segundo a PNS. O crescimento ocorreu no Brasil, Grandes Regiões, urbano e rural. Os dados da PNS em 2013 foram semelhantes aos administrativos do DAB em 2013, cerca de 56% de domicílios cadastrados. Populações com menor escolaridade receberam mais visitas domicíliares mensalmente. A ESF é um importante promotor de equidade em saúde e o aumento de sua cobertura e abrangência é exitoso no país. Abstract Objective to present Family Health Strategy (ESF) coverage according to the National Health Survey (PNS), comparing to administrative data and previous coverage of the National Household Sample Survey (PNAD 2008), and describe the frequencies of home visiting teams. Methods it was compared data from 2013 according to PNS and data from the Ministry of Health and the National Household Sample Survey (PNAD 2008). Home visiting indicators of PNS were stratified by education and Major Regions. Results the proportion of households registered in Family Health Teams in Brazil was 53.4% (95%CI: 52.1-54.6), being higher in rural areas and in the Northeast. The proportion of residents in registered households was 56.2%, similar to the Ministry of Health (56.4%) and showed growth compared to PNAD 2008 (50.9%). There was variation between regions, UF and capitals. People with lower education level have received more home visiting monthly. Discussion the ESF is an important promoter of health equity and its coverage and scope increase is successful in the country.
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- 2016
134. Primary Health Care: care coordinator in regionalized networks?
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Patty Fidelis de Almeida and Adriano Maia dos Santos
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Primary Health Care, organization & administration ,medicine.medical_specialty ,National Health Programs ,Cross-sectional study ,MEDLINE ,Regional Health Planning ,Health administration ,Regionalização ,03 medical and health sciences ,0302 clinical medicine ,Atenção Primária à Saúde, organização & administração ,Nursing ,Surveys and Questionnaires ,Cobertura de Serviços de Saúde ,Health care ,medicine ,Health Services, supply & distribution ,Humans ,030212 general & internal medicine ,Serviços de Saúde, provisão & distribuição ,Health policy ,Family Health ,HRHIS ,030505 public health ,Primary Health Care ,Health Services Coverage ,business.industry ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Original Articles ,Health Services ,Private sector ,Integração de Sistemas ,Systems Integration ,Cross-Sectional Studies ,Family medicine ,Health law ,0305 other medical science ,business ,Brazil - Abstract
To analyze the breadth of care coordination by Primary Health Care in three health regions.This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia.Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network.Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries.Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde.Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia.A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de serviços ambulatoriais hospitalares e de pronto-atendimento, desarticulados da rede. Problemas de acesso e oferta de atenção especializada eram agravados pela dependência do setor privado nas regiões, ainda que tenham sido observados avanços na institucionalização de fluxos desde a Atenção Primária à Saúde. A contrarreferência era deficiente e a comunicação interprofissional escassa, principalmente quando o usuário era atendido na rede contratada ou conveniada.A capacidade de coordenação mostra-se afetada tanto pela fragmentação da rede regional, quanto por problemas intrínsecos à Atenção Primária à Saúde, pouco fortalecida em seus atributos essenciais. Apesar de as regiões de saúde apresentarem problemas em comum, a Atenção Primária à Saúde continua sendo um tema circunscrito aos limites municipais.
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- 2016
135. Derecho a la salud: (in)congruencia entre la estructura jurídica y el sistema de salud
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Juvenal Bazilashe Balegamire, Fernando Mitano, Carla Aparecida Arena Ventura, Pedro Fredemir Palha, and Mônica Cristina Ribeiro Alexandre d'Auria de Lima
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Sistemas de Salud ,Sistemas de Saúde ,Human Rights ,National Health Programs ,Direito à Saúde ,Coberturas de los Servicios de Salud ,Accesibilidad a los Servicios de Saud ,Derecho a la Salud ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Right to Health ,Universal Health Insurance ,Cobertura de Serviços de Saúde ,Humans ,030212 general & internal medicine ,General Nursing ,Mozambique ,lcsh:RT1-120 ,030505 public health ,lcsh:Nursing ,Acesso aos Serviços de Saúde ,Health Services Coverage ,Original Articles ,Health Systems ,0305 other medical science - Abstract
Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage. Objetivo discutir o direito à saúde, incorporação nos instrumentos jurídicos e o desdobramento na prática no Sistema Nacional de Saúde, em Moçambique. Método trata-se de uma análise documental, de cunho qualitativo, que após leitura exaustiva e interpretativa dos instrumentos jurídicos e de obras que versam sobre o direito à saúde, acesso e cobertura universal, resultaram na construção de três categorias empíricas: instrumentos dos direitos humanos e sua inter-relação com a construção do direito à saúde; sistema nacional de saúde em Moçambique; lacunas entre teoria e prática na consolidação do direito à saúde no país. Resultados Moçambique ratificou vários instrumentos jurídicos internacionais e regionais (da África) que tratam sobre o direito à saúde e assegurou em sua Constituição. No entanto, sua incorporação pelo Sistema Nacional de Saúde tem sido limitada, pois não consegue oferecer acesso e cobertura universal aos serviços de saúde de forma equânime em toda sua extensão territorial e nos distintos níveis de atenção. Conclusões a efetivação do direito à saúde é complexa e exigirá do Estado uma mobilização de ações conjuntas de políticas financeiras, educacionais, tecnológicas, habitacionais, saneamento e gestão, assim como, a garantia do acesso e cobertura universal à saúde. Objetivo discutir el derecho a la salud, su incorporación en los instrumentos jurídicos y las consecuencias en la práctica en el Sistema Nacional de Salud, en Mozambique. Método se trata de un análisis documental, de orden cualitativo, que después de lectura exhaustiva e interpretativa de los instrumentos jurídicos y de obras que versan sobre el derecho a la salud, acceso y cobertura universal, resultaron en la construcción de tres categorías empíricas: instrumentos de los derechos humanos y su interrelación con la construcción del derecho a la salud; sistema nacional de salud en Mozambique; y vacíos entre teoría y práctica en la consolidación del derecho a la salud en el país. Resultados Mozambique ratificó varios instrumentos jurídicos internacionales y regionales (de África) que tratan sobre el derecho a la salud y los aseguró en su Constitución. Sin embargo, su incorporación por el Sistema Nacional de Salud ha sido limitada, ya que no consigue ofrecer acceso y cobertura universal a los servicios de salud de forma ecuánime en toda su extensión territorial y en los distintos niveles de atención. Conclusiones la efectuación del derecho a la salud es compleja y exigirá del Estado una movilización de acciones conjuntas de políticas financieras, educacionales, tecnológicas, habitacionales, saneamiento y administración, así como, la garantía del acceso y cobertura universal a la salud.
- Published
- 2016
136. VIGILÂNCIA EM SAÚDE E A COBERTURA DE EXAME CITOPATOLÓGICO DO COLO DO ÚTERO: REVISÃO INTEGRATIVA
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Selma Regina de Andrade and Janara Caroline Ribeiro
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medicine.medical_specialty ,Uterine cervical neoplasms ,Health services coverage ,Prueba de Papanicolaou ,Scopus ,MEDLINE ,CINAHL ,Nursing ,Cobertura de los servicios de salud ,Neoplasias do colo do útero ,03 medical and health sciences ,0302 clinical medicine ,Cobertura de serviços de saúde ,medicine ,Vigilancia en salud pública ,Neoplasias del cuello uterino ,Public health surveillance ,030212 general & internal medicine ,Cervix neoplasm ,Pap test ,General Nursing ,Cervical cancer ,030505 public health ,medicine.diagnostic_test ,business.industry ,Enfermagem ,Papanicolaou Test ,medicine.disease ,Papanicolaou test ,Vigilância em saúde pública ,Health promotion ,Family medicine ,Enfermería ,Teste de Papanicolaou ,0305 other medical science ,business - Abstract
This integrative review aimed to evidence in the literature health surveillance activities that contribute to the increased coverage of the cervical Pap smear. The search was undertaken between April and May 2014 in the databases LILACS, CINAHL, MEDLINE and Scopus, using the keywords health surveillance, cervix neoplasm prevention, and Papanicolaou test, in Portuguese, English and Spanish. We selected 341 articles, of which 33 met the inclusion criteria. In studies, the actions have been identified and grouped according to two main control practices of cervical cancer adopted in Brazil: primary prevention and secondary prevention, with emphasis on health promotion and prevention actions that contributed to the increased coverage of the cervical Pap smear. RESUMEN Revisión integrativa dirigida a la evidencia en la literatura en las actividades de vigilancia de salud que contribuyen al aumento de la cobertura de la citología del cuello uterino. Se llevó a cabo la búsqueda entre abril y mayo de 2014 en las bases de datos LILACS, CINAHL, MEDLINE y Scopus utilizando los descriptores: vigilancia de salud, cáncer cervical, prueba de Papanicolaou, en Portugués, Inglés y Español. Se seleccionaron 341 artículos, de los cuales 33 cumplieron los criterios de inclusión. En los estudios, las acciones han sido identificadas y agrupadas de acuerdo con dos prácticas principales de control de cáncer cervical adoptados en Brasil: la prevención primaria y prevención secundaria, con énfasis en la promoción y prevención de los factores de salud que contribuyen al aumento de la cobertura de la prueba de citopatológico del cuello uterino. RESUMO Revisão integrativa com o objetivo de evidenciar na literatura as ações de vigilância em saúde que contribuem para o aumento da cobertura do exame citopatológico do colo do útero. Foi realizada a busca entre abril e maio de 2014, nas bases de dados LILACS, CINAHL, MEDLINE e Scopus utilizando os descritores vigilância em saúde, câncer do colo do útero, exame de Papanicolau, em português, inglês e espanhol. Foram selecionados 341 artigos, dos quais 33 atenderam aos critérios de inclusão. Nos estudos, as ações foram identificadas e agrupadas conforme duas principais práticas de controle do câncer do colo do útero adotadas no Brasil: prevenção primária e prevenção secundária, destacando-se ações de promoção e prevenção à saúde que contribuem para o aumento da cobertura do exame citopatológico do colo do útero.
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- 2016
137. Un modelo de atención en salud al pueblo Wayúu en la frontera colombo-venezolana A health care model for the Wayúu people on the colombian-venezuelan border
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María Beatriz Duarte Gómez, Martha Liliana Ortega Alegría, Luis Hernando Mora Ríos, and Noly Coromoto Fernández
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lcsh:Arctic medicine. Tropical medicine ,Salud indígena ,lcsh:RC955-962 ,lcsh:Public aspects of medicine ,sistemas de salud ,indigenous health ,lcsh:R ,salud fronteriza ,lcsh:Medicine ,lcsh:RA1-1270 ,Colombia ,Venezuela ,border health ,health services coverage ,vulnerable groups ,cobertura de los servicios de salud ,health systems ,comunidades vulnerables - Abstract
En reuniones y talleres con comunidades wayúu y funcionarios de gobierno de Colombia y Venezuela, tras validar el diagnóstico de salud y sus determinantes, se identificaron componentes para un modelo de atención binacional en salud destinado al pueblo wayúu que habita la frontera entre ambos países. Si bien ha habido avances en la atención sanitaria intercultural en ambos países, todavía hace falta fortalecer algunos aspectos de la legislación y la organización de los servicios para hacer posible la garantía del derecho a la salud. Se debe asegurar la asignación de nuevos recursos nacionales - o la redistribución de los actuales- y la gestión de recursos internacionales para ejecutar un proyecto piloto en el corto plazo e implementar el modelo en el mediano plazo.At meetings and workshops with Wayúu communities and government officials from Colombia and Venezuela, after validating the analysis of the health situation and its determinants, the components of a binational health care model for the Wayúu people living on the border between the two countries were identified. Although both countries have made progress in intercultural health care, some aspects of their legislation and service organization still need to be strengthened to make the guaranteed right to health a reality. The allocation of new national resources-or the redistribution of current resources-should be ensured, as well as the management of international resources for conducting a short-term pilot project and implementing the model in the medium term.
- Published
- 2011
138. Epidemiological description of burns trauma in a childrend hospital. Manizales (Colombia) 2004-2005
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Cardona B, Federico, Echeverri L, Andrés, Forero, Juan F, García R, Carlos A, Gómez L, Claudia M, Gómez O, Claudia P, Mahecha G, Daniel D, Martínez M, Edgar E, Quintero C, Gladys E, Castaño C, José Jaime, and González, Sandra P
- Subjects
índices de severidad de la enfermedad ,lcsh:R5-920 ,lcsh:R ,lcsh:Medicine ,quemaduras ,unidad de quemados ,índices de gravedad del trauma ,burns ,health services coverage ,burn units ,severity of illness index ,epidemiology ,trauma severity indices ,epidemiologia ,lcsh:Medicine (General) ,cobertura de servicios de salud - Abstract
Antecedentes. Las lesiones por quemaduras se han convertido en un problema de salud pública, especialmente en países en desarrollo. Objetivo. Identificar la epidemiología del trauma por quemaduras en la población que consultó al servicio de urgencias del Hospital Infantil “Rafael Henao Toro” de la ciudad de Manizales en el período comprendido entre el año 2004 y 2005. Material y métodos. Se realizó un estudio descriptivo retrospectivo con base en la revisión de 439 historias clínicas, evaluando las variables de edad, género, seguridad social, procedencia, área geográfica, causa, profundidad, gravedad, extensión en porcentaje, área corporal comprometida, estancia hospitalaria y compañía. Resultados. Se encontró que la mayoría de las quemaduras ocurrieron en pacientes de un año de edad (21,6%), predominó el género masculino (59%). La mayoría no tenía seguridad social (52,2%). El 44,9 por ciento de los pacientes residía en la ciudad de Manizales. La principal etiología fueron los alimentos en 194 pacientes (44,2%) predominando el grado I de quemadura en un 78,1 por ciento, con gravedad moderada en 314 pacientes (71,5%). La media de estancia hospitalaria fue 11,99 días. Conclusiones. Se determinó una mayor frecuencia de quemaduras en niños, menores de cinco años, causadas por alimentos, en miembro superior y de gravedad moderada. Background. Burns have become an increasing problem of public health, in developping countries.. Objetive. To identify the epidemiology of burns trauma in the population that consults to the emergency room in children hospital “Rafael Henao Toro” of Manizales the city between 2004 and 2005 years. Materials and methods. A retrospective descriptive study was made based in the revision of 439 clinical histories, evaluating the of age, sex, social security, origin, geographic area, cause, depth, seriousness, percentage, and corporal area concerned. Results. Burns happened in patients of one year old (21,6%), masculine genre (59%) predominated. Most of the patients did not have social security, corresponding to 52,2%. 44,9% of patients living in the city. The main etiology were hot foods in 194 patients (44,2%). Burn of first degree in 78.1% was the most frequent, with moderate seriousness in 314 patients (71,5%). The most frequent corporal burned extension was of 2% in 15,3% of the total of the studied population, while the corporal region of greater commitment was the superior member in 111 patients (25,3%). The average of hospitalization was 11,99 days. Conclusions. Burns trauma was of greater frequency in children under, five years old, caused by hot foods, in superior member, and of moderate seriousness.
- Published
- 2007
139. Utilização de serviços de saúde em áreas cobertas pelo programa saúde da família (Qualis) no Município de São Paulo
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Moisés Goldbaum, Chester Luiz Galvão Cesar, Hillegonda Maria Dutilh Novaes, and Reinaldo José Gianini
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Health services coverage ,Pesquisa sobre serviços de saúde ,Serviços de saúde ,Family health ,lcsh:Public aspects of medicine ,Inquérito populacional ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Equity ,Population survey ,Coleta de dados ,Saúde da família ,Prestação de cuidados de saúde ,Health services ,Serviços de saúde/utilização ,Morbidade ,Data collection ,Cobertura de serviços de saúde ,Delivery of health care ,Health services research ,Morbidity ,Eqüidade - Abstract
OBJETIVO: O Programa de Saúde da Família se constitui em estratégia de reorganização do sistema de atenção à saúde para o Sistema Único de Saúde. O objetivo do estudo foi verificar mudanças no perfil de utilização de serviços de saúde após implantação do Programa, identificando fatores associados às mudanças observadas. MÉTODOS: Foram analisados dados de utilização de serviços e procura por assistência em duas amostras definidas por conglomerados e representativas da população coberta (n=1.865) e não coberta pelo Programa de Saúde da Família (n=2.036) de dois distritos do Município de São Paulo. Os dados fazem parte de inquérito populacional realizado em 2001. Foi empregada a análise estatística própria para conglomerados. RESULTADOS: Na utilização de serviços, nas áreas cobertas pelo Programa de Saúde da Família, não foram observadas razões de prevalência significantemente diferentes segundo escolaridade e renda, e nas áreas não cobertas as razões de prevalência foram mais elevadas para maior escolaridade e renda. Na procura por assistência em pessoas com episódios de morbidade, nas áreas cobertas pelo Programa a razão de prevalência foi maior em pessoas com grau de limitação intenso, e nas áreas não cobertas a razão de prevalência foi mais elevada para maior escolaridade e menor para os inativos. CONCLUSÕES: Nas áreas estudadas, na população coberta pelo Programa de Saúde da Família a renda e escolaridade não se constituem em fatores que diferenciam de forma significativa o perfil de utilização de serviços de saúde e de procura por assistência, indicando que o programa pode estar contribuindo para maior equidade nessas condições. OBJECTIVE: The Family Health Program (FHP) is a strategy for reorganizing the healthcare attendance system within the Brazilian National Health System. The objective of the study was to assess whether there had been changes in the utilization profile of the healthcare services following implementation of the program, and to identify factors associated with any changes observed. METHODS: Data on service utilization and demand for attendance were analyzed by means of two cluster-based population samples, representing areas covered (n=1865) and not covered (n=2036) by the FHP, in two districts of the municipality of São Paulo. The data formed part of a population survey carried out in 2001. Statistical methods for cluster analysis were used. RESULTS: In the area covered by the FHP, no statistically different prevalence ratios (PR) according to schooling and income levels were observed for service utilization. In the area not covered by the FHP, service utilization was positively associated with greater schooling and income. Among individuals with illnesses, the demand for attendance in the area covered by the FHP was higher (higher PR) among those with severe physical limitations. In the area not covered, the PR was higher among those with greater schooling and lower among those who were inactive (unemployed or retired). CONCLUSIONS: In the areas studied, for the population covered by the FHP, income and schooling levels did not constitute factors that significantly differentiated the utilization profile of the healthcare services and the demand for attendance. This indicates that the program may be contributing towards greater equity under these conditions.
- Published
- 2005
140. Planos privados de assistência à saúde: cobertura populacional no Brasil Private health plans: populational coverage in Brazil
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Luiz Felipe Pinto and Daniel Ricardo Soranz
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Demographic conditions ,PNAD/1998 ,Health services coverage ,Planos privados de saúde ,lcsh:Public aspects of medicine ,Fatores demográficos ,Cobertura de serviços de saúde ,PNAD/ 1998 ,lcsh:RA1-1270 ,Private health plans - Abstract
Foram utilizados o Cadastro de Beneficiários da Agência Nacional de Saúde Suplementar (ANS) e a Pesquisa Nacional por Amostra de Domicílios (PNAD/IBGE) para descrever o perfil da cobertura dos serviços por planos privados de saúde. Apesar da regulação pela ANS, não se deve perder de vista que o acesso, a utilização e a cobertura populacional em planos de saúde precisam ser periodicamente monitorados, principalmente na região Sudeste, que concentra 70% da população coberta por planos de saúde. Também são necessários estudos mais detalhados sobre as capitais brasileiras, que constituem grandes centros de concentração de clientela; e investigações para os subgrupos etários que mais utilizam os serviços de saúde: crianças menores de 5 anos, mulheres em idade fértil e idosos. Os resultados do estudo indicam que, no Sistema de Saúde Brasileiro, os planos privados de assistência à saúde se configuram como mais um fator de geração de desigualdades sociais no acesso e na utilização de serviços de saúde, pois cobrem apenas uma parcela específica da população brasileira: pessoas de maior renda familiar, de cor branca, com maior nível de escolaridade, inseridas em determinados ramos de atividade do mercado de trabalho, moradores das capitais/regiões metropolitanas.The Beneficiaries' Frame from ANS and the data of the PNAD/IBGE have been used to describe the profile of the private health plans' coverage. Although the regulation functions of ANS, one should not forget that private health insurance access, use and coverage should be monitored continuously, specially the private market of Southeast Region, which concentrate 70% of coverage people in Brazil. Others studies are also necessary for Brazilian capitals, which constitute great urban cities of insurance people. Besides this, more detailed investigation must be developed for age groups with higher utilization of health services: children up to 5 years, women between 15-49 years, and elderly people. The results of this study indicate that private health plans on Brazilian Health System constitute another factor of social inequalities on access and utilization of health services, because they cover only a specific slice of Brazilian population: the ones with higher family income, white people, people with higher education level, workers in some labor market activities, people who live in capital or urban areas.
- Published
- 2004
141. Evaluation of the Family Health Strategy implementation in Santa Catarina in 2004 and 2008
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Costa, Filipe Ferreira and Calvo, Maria Cristina Marino
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Health services coverage ,Health evaluation ,Serviços de saúde ,Family Health Program ,Programa Saúde da Família ,Cobertura de serviços de saúde ,Atenção básica ,Evaluation ,Avaliação em saúde ,Health services ,Primary health care ,Avaliação - Abstract
This study aimed to evaluate the implementation of the Family Health Program in municipalities of the State of Santa Catarina, Brazil at two different periods (2004 and 2008). Two hundred forty-four (83%) municipalities with complete health information data comprised the sample. Indicators of coverage, evidence of change in the healthcare model, and impact were calculated based on health system database. Official documents and observed distribution of measures at the country level were used in order to classify municipalities within each indicator. A high coverage level increased from 73 to 83% of the cities between 2004 and 2008. Most of them showed poor evidence of change in the healthcare model at both time points. Increased proportion of cities showed low levels of morbidity by diseases sensible to the primary health care from 2004 to 2008. Despite the fact that was improvement in coverage and impact indicators over four years, most of the cities studied showed poor evidence of change in the healthcare model, warning to the review of the health care practices and organization by health professionals and managers. O presente estudo trata de uma avaliação da Estratégia de Saúde da Família no Estado de Santa Catarina em dois períodos distintos: 2004 e 2008. Ao todo, 244 (83%) municípios apresentaram informações completas e foram incluídos nas análises. Foram calculados indicadores de cobertura potencial, indício de mudança no modelo assistencial e de impacto sobre internações, com informações obtidas nos sistemas de informação em saúde. Os parâmetros de classificação dos indicadores foram definidos por meio de documentos oficiais ou calculados a partir da distribuição observada no Brasil. A alta cobertura potencial aumentou de 73 para 83% dos municípios entre os anos de 2004 e 2008. A maioria dos municípios foi classificada na categoria de "fraco" indício de mudança de modelo assistencial, não havendo mudanças importantes neste indicador entre os dois períodos analisados, mas houve aumento de municípios com taxas reduzidas de internação por doenças sensíveis à atenção básica. Os resultados indicaram ampliação da rede assistencial na atenção básica no estado de Santa Catarina, mas sem indícios de efetiva mudança do modelo assistencial, o que estabelece a necessidade de aperfeiçoamentos no trabalho das equipes.
- Published
- 2014
142. Evaluation of the Family Health Strategy implementation in Santa Catarina in 2004 and 2008
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Maria Cristina Marino Calvo and Filipe Ferreira da Costa
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Time Factors ,Health services coverage ,Epidemiology ,Distribution (economics) ,Sample (statistics) ,Avaliação ,Country level ,Environmental health ,Health care ,Cobertura de serviços de saúde ,Humans ,Medicine ,Cities ,Evaluation ,Primary health care ,Family Health ,Family health ,Health professionals ,business.industry ,Serviços de saúde ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Family Health Program ,Atenção básica ,lcsh:RA1-1270 ,General Medicine ,Health services ,Strategy implementation ,Health evaluation ,Programa Saúde da Família ,Health information ,business ,Avaliação em saúde ,Brazil ,Program Evaluation - Abstract
This study aimed to evaluate the implementation of the Family Health Program in municipalities of the State of Santa Catarina, Brazil at two different periods (2004 and 2008). Two hundred forty-four (83%) municipalities with complete health information data comprised the sample. Indicators of coverage, evidence of change in the healthcare model, and impact were calculated based on health system database. Official documents and observed distribution of measures at the country level were used in order to classify municipalities within each indicator. A high coverage level increased from 73 to 83% of the cities between 2004 and 2008. Most of them showed poor evidence of change in the healthcare model at both time points. Increased proportion of cities showed low levels of morbidity by diseases sensible to the primary health care from 2004 to 2008. Despite the fact that was improvement in coverage and impact indicators over four years, most of the cities studied showed poor evidence of change in the healthcare model, warning to the review of the health care practices and organization by health professionals and managers.
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- 2014
143. Uso de los establecimientos de salud del Ministerio de Salud del Perú, 2009-2011
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Curioso, Walter H., Pardo, Karim, and Valeriano, Luis
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Sistemas de salud ,Centros de salud ,Estadísticas de servicios de salud ,Seguro de salud ,Cobertura de los servicios de salud ,Health systems ,Health centers ,Health services statistics ,Insurance, health ,Health services coverage - Abstract
Objective. To describe the use of health services and associated factors in health care centers of the Ministry of Health of Peru (MINSA). Materials and methods. An ecological study was conducted with information from outpatients placed in all health centers from all Regions at the national level from 2009-2011. The use of health services was defined by the proportion of outpatient and the total population. This variable was compared by gender, age group, geographic area, and calendar year. Chi-square test was performed to compare proportions between the different layers. In addition, linear regression was performed to determine factors associated. Results. In this period of time there was an increased number of health care centers and health insurance coverage, but the use of health services decreased from 43.3% (2009) to 40.3% (2011). An increased use by female residents, age group of 0-29 years old and residents from the southern region was found. A multivariate analysis was conducted and factors associated with use of health systems were geographic area, and calendar year. Conclusions. Use of health services is not associated to the increased number of health centers nor the access to health insurance, but it is associated to individual factors or health system-related factors that should be evaluated in future studies. Objetivo. Describir el uso de los servicios de salud y los factores asociados a este en los establecimientos de salud del Ministerio de Salud del Perú (MINSA). Materiales y método. Se realizó un estudio ecológico con información de los atendidos en los centros de salud a nivel nacional, durante años 2009 a 2011, empleando el sistema de información de salud HIS del MINSA. El uso de los servicios de salud fue definido por la proporción de atendidos y el total de la población. Esta variable se comparó por sexo, grupo de edad, zona geográfica y año calendario. Se realizó la prueba de chi cuadrado para comparar proporciones entre los diferentes estratos y regresión lineal para determinar los factores asociados. Resultados. Entre los años 2009-2011 hubo un incremento en el número de centros de salud y cobertura de seguros de salud, pero el uso de los servicios de salud disminuyó de 43,3% (2009) a 40,3% (2011). Se encontró un mayor uso por pobladores del sexo femenino, en el grupo de edades de 0 a 29 años y los residentes en la zona sur del país. En el análisis multivariado los factores asociados con uso de los sistemas de salud fueron zona geográfica y año calendario. Conclusiones. El uso de los servicios de salud no está asociada con el incremento en el número de centros de salud ni al acceso a los seguros de salud, sino a factores individuales o del sistema de salud que deben ser evaluados en estudios posteriores.
- Published
- 2014
144. Avaliação dos serviços de saúde do Município de Cáceres, MT (Brasil): contribuições à programação local An evaluation of the health services of Cáceres, Mato Grosso State, Brazil: contributions to the local program
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Márcia Lotufo and Elisabeth Carmem Duarte
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Serviços de saúde ,Cobertura de serviços de saúde ,Morbidade ,Recursos de saúde ,Health services ,Health services coverage ,Morbidity ,Health resources ,Public aspects of medicine ,RA1-1270 - Abstract
São analisadas informações sobre a oferta dos serviços de saúde do Município de Cáceres, MT (Brasil), que permitirá fomentar discussões com os órgãos gerenciadores do setor, tendo em vista a reformulação dos planos e programas de saúde. Com a utilização do instrumento da técnica CENDES/OPS, foram coletados dados referentes à estrutura nosológica da demanda atendida, distribuição e utilização dos recursos humanos e capacidade física dos serviços de saúde do Município, no período de 1981 a 1984. Verificou-se que o perfil da morbidade registrado manteve-se constante, com predomínio das Demais Doenas Infecciosas e Parasitárias e Doenças Agudas do Aparelho Respiratório. Constatou-se melhora quantitativa quanto à capacidade física e recursos humanos para o setor saúde, especialmente na rede pública. Acredita-se que estas não foram acompanhadas por alterações significativas na qualidade dos serviços oferecidos.It was analysed information relating to the health services offered in Cáceres county, Mato Grosso, Brazil, with a view to stimulating discussion with the organs which administer the system, with the intention of reformullating health plans and programs. By means of CENDES/OPS, data have been collected concerning the nosologic structure of the demandmet, distribution and utilization of human resources and the physical capacity of the municipal health services in the period from 1981 to 1984. It was observed that the profile of morbidity registered remained constant with a predominance of the "Other Infections and Parasitic Diseases" and "Acute Diseases of the Respiratory System" as causes of death. A quantitative improvement was observed with reference to the physical capacity and human resources of health care offered, especially in the public sector. The opinion was that these were not accompanied by significant improvements in the quality of the services offered.
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- 1987
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145. Estudo das condições de saúde das crianças do Município de São Paulo (Brasil), 1984/1985: IX - Cobertura e qualidade da assistência materno-infantil A study of children's health in S. Paulo city (Brazil), 1984/1985: IX - Coverage and quality of maternal and child care
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Carlos Augusto Monteiro, Maria Célia Guerra Medina, Maria Helena D'Aquino Benicio, and Maurício Meyer
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Saúde da criança ,Inquéritos epidemiológicos ,Saúde materno-infantil ,Cobertura de serviços de saúde ,Qualidade de cuidados de saúde ,Child health ,Health surveys ,Maternal and child health ,Health services coverage ,Quality of health care ,Public aspects of medicine ,RA1-1270 - Abstract
Como parte de investigação epidemiológica sobre condições de saúde na infância, foram estudadas a cobertura e a qualidade da assistência materno-infantil prestada à população do Município de São Paulo. Todas as estimativas do estudo baseiam-se em dados obtidos através de inquérito recordatório aplicado a uma amostra representativa de crianças menores de cinco anos residentes no Município (n = 1.016). A cobertura da assistência pré-natal foi estimada em 92,9%, sendo que em cerca de 70% dos casos a assistência foi iniciada no primeiro trimestre de gestação e o número de consultas realizadas foi de seis ou mais. A cobertura da assistência hospitalar ao parto foi estimada em 99,0%, observando-se que 47,1% das crianças nasceram através de cesareanas. A cobertura da assistência de puericultura foi estimada em 98,0%, sendo que em dois terços das vezes a assistência foi iniciada nos primeiros dois meses de vida. Ainda com relação à puericultura, pôde-se observar: grande concentração de consultas no primeiro ano de vida (em média 7,7 consultas), percentagem relativamente alta de crianças vacinadas (Sabin = 86,7%, Tríplice = 85,1%, BCG = 89,0%, Anti-sarampo = 85,9%), decréscimo expressivo de consultas após a idade de doze meses e pequena proporção de crianças com assistência odontológica (19,5%). A estratificação social da população revelou diferenciais sócio-econômicos mínimos quanto à cobertura geral da assistência materno-infantil, observando-se, entretanto, diferenças expressivas quanto a aspectos qualitativos da assistência. Comparando-se o presente inquérito com outros realizados no país, observa-se que a situação de São Paulo apresenta-se mais favorável do que a observada no conjunto das áreas urbanas brasileiras. Verifica-se também que tem sido positiva a evolução recente da assistência materno-infantil no Município. As principais deficiências ainda encontradas dizem respeito a características relacionadas à qualidade da assistência, sendo imprescindível, sobretudo nos estratos populacionais de pior nível sócio-econômico, elevar a cobertura da assistência pré-natal precoce e a cobertura de puericultura após o primeiro ano de vida. Um item especialmente preocupante relacionado à assistência ao parto foi a alta incidência de cesareanas, uma das maiores já registrada em uma população.A survey of 1,016 randomly selected children under five years of age was carried out in S. Paulo city, Brazil, with a view to studying the epidemiology of health conditions. The quality and the coverage of maternal and child care were observed. Both characteristics were estimated by means of domiciliary interviews. The prenatal care coverage was 92.9%. In 70% of the cases prenatal care started in the first quarter of pregnancy and the number of visits was 6 or more. Ninety-nine percent of the children were born in hospitals and in 47.1% of the cases caesarean section was mentioned. Ninety-eight percent of the children went, at least once, to well-baby clinics, about two thirds of them during the first two months of life. With regard to the activities provided by those clinics, a great concentration of visits in the first year of life (averaging 7.7 visits per child) was observed as well as a high percentage of immunized children (Sabin 86.7%, DPT 85.1%, BCG 89.0%, Measles 85.9%), a striking decrease of visits after 12 months of age and a very small proportion of children attended by an odontology specialist (19.5%). Considering the global coverage of maternal and infant care, minimal differences were observed between socioeconomic strata. Nevertheless the differences were impressive when qualitative aspects of the care were taken into account. Compared with other surveys made in Brazil, the present one shows that the situation of S. Paulo city is better than that of other urban areas of the country. It was also observed that there has been an increase in maternal and child care coverage over the last decade. The main problems still found in the city seem to be related to the qualitative aspects of the assistance. Early attraction of women for prenatal care and an increase in the coverage of well-baby clinics after the first year of life are definitely necessary, particularly for the poorest segments of the population. One important aspect which is a reason for concern is the enormous incidence of caesarean sections one of the highest ever registered in a population.
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- 1988
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146. Disparities in Access and Mortality of Patients With ST-Segment-Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register.
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Oliveira JC, Almeida-Santos MA, Cunha-Oliveira J, Oliveira LCS, de Carvalho Barreto ID, Clair RemacreMunareto Lima T, Andreline Maia Arcelino L, Andrade Prado LF, Serra Silveira F, Augusto da Silva Nascimento T, Pereira Ferreira EJ, Vasconcelos Barreto R, Vieira Moraes E, Teles de Mendonça J, Sousa ACS, and Barreto-Filho JA
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- Brazil epidemiology, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Male, Middle Aged, Percutaneous Coronary Intervention methods, Prognosis, Prospective Studies, Risk Factors, ST Elevation Myocardial Infarction surgery, Survival Rate trends, Time Factors, Time-to-Treatment, Health Services Accessibility statistics & numerical data, Public Health statistics & numerical data, Registries, ST Elevation Myocardial Infarction mortality
- Abstract
Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30-day mortality for patients with ST-segment-elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST-segment-elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30-day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P <0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P <0.001). The 30-day mortality rate of SUS patients was 11.9% and of private patients was 5.9% ( P =0.04). In the fully adjusted model, the odds ratio for 30-day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15-7.61; P =0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30-day follow-up.
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- 2019
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147. O mix público-privado e os arranjos de financiamento hospitalar no Brasil
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Juliana Pires Machado, Mônica Martins, and Iuri da Costa Leite
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Health services coverage ,Health systems ,Hospital administration ,Equity in Health ,Hospitalization ,Public aspects of medicine ,RA1-1270 - Abstract
Com o objetivo de caracterizar a rede hospitalar brasileira quanto ao grau de compartilhamento SUS e planos de saúde, o artigo aborda a diversificação de fontes de financiamento, discutindo o tema no contexto do sistema de saúde caracterizado pelo mix público-privado desde a prestação de serviços até o pagamento e a gestão. Observou-se que a maioria dos hospitais era privado e atendia SUS e planos, com menor disponibilidade de leitos de alta complexidade no SUS. Não se identificou proporcionalidade entre oferta de leitos e cobertura da população por planos nem complementariedade SUS e planos. Os achados ajudam a delinear a oferta e os riscos à equidade no acesso, uso e qualidade do cuidado.
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148. Fatores associados à inadequação do uso da assistência pré-natal
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Liberata C Coimbra, Antônio A M Silva, Elba G Mochel, Maria T S S B Alves, Valdinar S Ribeiro, Vânia M F Aragão, and Heloisa Bettiol
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prenatal care ,maternal health services ,health services coverage ,quality of health care ,socioeconomic factors ,risk factors ,cross-sectional studies ,equity ,Public aspects of medicine ,RA1-1270 - Abstract
OBJETIVO: Identificar fatores associados à inadequação do uso da assistência pré-natal em comunidade urbana. MÉTODOS: Foi realizado estudo transversal em amostra sistemática, estratificada por maternidades, de todos os nascimentos hospitalares do município de São Luís, MA, no período de março de 1997 a fevereiro de 1998. Foram avaliados indicadores socioeconômicos e demográficos, de saúde reprodutiva, morbidade na gravidez e utilização de serviços pré-natais. Utilizou-se questionário padronizado respondido pelas puérperas antes da alta hospitalar. A adequação do uso da assistência pré-natal foi analisada pelo índice "Adequacy of Prenatal Care Utilization" (APNCU) e por um novo índice proposto, baseado nas recomendações do Ministério da Saúde, Brasil. RESULTADOS: Foram entrevistadas 2.831 puérperas, atendidas em dez unidades de saúde pública e privada. A inadequação do uso da assistência pré-natal foi de 49,2% pelo índice APNCU, e de 24,5% pelo novo índice proposto. Mulheres atendidas em serviços públicos de saúde, de baixa escolaridade e baixa renda familiar, sem companheiro ou com doença durante a gravidez, tiveram maiores percentuais de inadequação do uso do atendimento pré-natal, pelos dois índices analisados. Pelo novo índice proposto, maiores percentuais de inadequação foram associados à alta paridade e idade materna, enquanto baixa idade materna (
149. Uso de los establecimientos de salud del Ministerio de Salud del Perú, 2009 - 2011
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Walter H Curioso, Karim Pardo, and Luis Valeriano
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health systems ,health centers ,health services statistics ,insurance ,health ,health services coverage ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objetivo. Describir el uso de los servicios de salud y los factores asociados a este en los establecimientos de salud del Ministerio de Salud del Perú (MINSA). Materiales y método. Se realizó un estudio ecológico con información de los atendidos en los centros de salud a nivel nacional, durante años 2009 a 2011, empleando el sistema de información de salud HIS del MINSA. El uso de los servicios de salud fue definido por la proporción de atendidos y el total de la población. Esta variable se comparó por sexo, grupo de edad, zona geográfica y año calendario. Se realizó la prueba de chi cuadrado para comparar proporciones entre los diferentes estratos y regresión lineal para determinar los factores asociados. Resultados. Entre los años 2009-2011 hubo un incremento en el número de centros de salud y cobertura de seguros de salud, pero el uso de los servicios de salud disminuyó de 43,3% (2009) a 40,3% (2011). Se encontró un mayor uso por pobladores del sexo femenino, en el grupo de edades de 0 a 29 años y los residentes en la zona sur del país. En el análisis multivariado los factores asociados con uso de los sistemas de salud fueron zona geográfica y año calendario. Conclusiones. El uso de los servicios de salud no está asociada con el incremento en el número de centros de salud ni al acceso a los seguros de salud, sino a factores individuales o del sistema de salud que deben ser evaluados en estudios posteriores.
150. Uso de los establecimientos de salud del Ministerio de Salud del Perú, 2009 - 2011
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Walter H Curioso, Karim Pardo, and Luis Valeriano
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health systems ,health centers ,health services statistics ,insurance ,health ,health services coverage ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objetivo. Describir el uso de los servicios de salud y los factores asociados a este en los establecimientos de salud del Ministerio de Salud del Perú (MINSA). Materiales y método. Se realizó un estudio ecológico con información de los atendidos en los centros de salud a nivel nacional, durante años 2009 a 2011, empleando el sistema de información de salud HIS del MINSA. El uso de los servicios de salud fue definido por la proporción de atendidos y el total de la población. Esta variable se comparó por sexo, grupo de edad, zona geográfica y año calendario. Se realizó la prueba de chi cuadrado para comparar proporciones entre los diferentes estratos y regresión lineal para determinar los factores asociados. Resultados. Entre los años 2009-2011 hubo un incremento en el número de centros de salud y cobertura de seguros de salud, pero el uso de los servicios de salud disminuyó de 43,3% (2009) a 40,3% (2011). Se encontró un mayor uso por pobladores del sexo femenino, en el grupo de edades de 0 a 29 años y los residentes en la zona sur del país. En el análisis multivariado los factores asociados con uso de los sistemas de salud fueron zona geográfica y año calendario. Conclusiones. El uso de los servicios de salud no está asociada con el incremento en el número de centros de salud ni al acceso a los seguros de salud, sino a factores individuales o del sistema de salud que deben ser evaluados en estudios posteriores.
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