OBJETIVO: Analisar a satisfação de usuários em relação ao acesso, à infraestrutura e à qualidade dos serviços na Atenção Primária à Saúde (APS) no Brasil. MÉTODOS: Estudo transversal com dados de 114.615 usuários vinculados a 30.523 equipes de saúde, obtidos por meio do banco de dados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Foram estudadas variáveis independentes relacionadas ao acesso, à infraestrutura e à qualidade dos serviços na APS. O desfecho, satisfação dos usuários, foi mensurado através das variáveis: “se tivesse a opção, mudaria de equipe ou de serviço de saúde” e “recomendaria este serviço de saúde para um amigo ou familiar”. Para avaliar a satisfação de acordo com as variáveis independentes de exposição, foi utilizado o teste Qui-quadrado de Pearson, considerando nível de significância de 5%. Análises descritivas das variáveis foram realizadas através de frequências absoluta (n) e relativa (%). RESULTADOS: A satisfação dos usuários esteve associada às variáveis de acesso (p < 0,001), infraestrutura (p < 0,001) e qualidade dos serviços (p < 0,001) na APS. A proximidade do serviço, atenção à demanda espontânea, escuta e o respeito dos profissionais às singularidades do paciente, assim como a resolutividade dos serviços, sem necessidade de encaminhamentos para outros e a boa infraestrutura, estiveram relacionados com a satisfação dos usuários. CONCLUSÃO: Para a garantia da melhoria da qualidade dos serviços ofertados na APS do Brasil, os aspectos de satisfação dos usuários identificados no presente estudo devem ser considerados na organização e gestão dos serviços.
PurposeIn 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.Design/methodology/approachThis was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.FindingsThe four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.Originality/valueThis paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.
Introduction: To study the effect of myofascial techniques applied to the cranial regionon the behavior of autonomic nervous system (ANS), using the analyses of heart ratevariability. Method: This is a clinical trial study accomplished with 66 healthy subjects(33 male and 33 female). Myofascial techniques applied to the cranial area usingcraniosacral therapy were executed on the individuals. The Nerve-Express system, afully automated system, was used before and after the application of the techniques toquantitatively assess the autonomic function based on heart rate variability analysis. Toverify the existence of differences among the dependent variables the Wilcoxon SignedRanks Test was used and o Mann-Whitney Test was applied in order to compare theindependent variable. Results: It was observed a statistically significant increase, inthe values of parasympathetic nervous system (PSNS), after the application of thetechnique. The quantitative values of sympathetic nervous system (SNS) decreased ordid not modify in female group. This profile in female group was statistically significantalthough in the male group the miofascial mobilization did not modify the values ofSNS. The quantitative values of SNS and PSNS behaved equal relatively in both studiedgroups, not being significant statistically the difference between the male and femalegroups. Conclusion: These results suggest that the myofascial technical applied to thecranial area by craniossacral therapy is able to promote alterations in the behavior ofANS, generally, increasing PSNS and decreasing SNS.
O estudo das impressões plantares permite o diagnóstico de diferentes patologias que acometem a estrutura podal, facilitando, assim, o tratamento adequado. Esta pesquisa, quantitativa, descritiva, tem por objetivo analisar as impressões plantares emitidas por dois equipamentos: a plantigrafia e a baropodometria computadorizada. Fizeram parte do estudo 28 indivíduos voluntários (o que corresponde a 56 pés), de ambos os sexos, com idade entre 20 e 30 anos. Para coleta dos dados foram utilizados um baropodômetro e um plantígrafo, por meio dos quais se obtiveram as impressões plantares dos indivíduos, que foram analisadas e classificadas utilizando-se mesmo método. A concordância nos exames foi estimada pela medida estatística Kappa ponderado. Observou-se que os dois métodos apresentaram uma concordância moderada, porém sem significância estatística.
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