Avaliação do SISVAN na gestão de ações de alimentação e nutrição em Minas Gerais, Brasil
RESUMO O Núcleo de Apoio à Saúde da Família (Nasf) foi criado em 2008 visando aumentar a resolutividade e o escopo das ações da Atenção Básica (AB). Composto por uma equipe multiprofissional deve desenvolver atividades conjuntas com as equipes AB, seguindo a lógica do apoio matricial e das ações técnico-pedagógicas ou clínico-assistenciais, pretendendo a integralidade do cuidado. O objetivo deste estudo foi analisar o trabalho do Nasf no território brasileiro, considerando a integração entre as equipes Nasf e AB, a partir de dados provenientes da avaliação externa do Programa Nacional para Melhoria do Acesso e da Qualidade (PMAQ) segundo ciclo. Os resultados encontrados apontam adequação quanto à infraestrutura, às atividades de apoio matricial e às atividades integradas com as equipes AB. Contudo, o monitoramento e análise de indicadores, a formação inicial e a educação permanente carecem de maior desenvolvimento.
Objective To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease. Methods Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in the SUS between late February through June. Patients aged 18 years or older with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization. Results 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in the SUS were predominantly male (56.5%) with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (±6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The odds on in-hospital death were 16.8% higher among men than among women and increased with age. Black individuals had a higher likelihood of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states, such as Amazonas and Rio de Janeiro, had a higher risk of in-hospital death from COVID-19. The odds on in-hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants, though being hospitalized in the municipality of residence was a protective factor. Conclusion There was broad variation in COVID-19 in-hospital mortality in the SUS, associated with demographic and clinical factors, social inequality, and differences in the structure of services and quality of health care.
OBJECTIVE:To describe the implantation and the effects of directly-observed treatment short course (DOTS) in primary health care units. METHODS:Interviews were held with the staff of nine municipal health care units (MHU) that provided DOTS in Rio de Janeiro City, Southeastern Brazil, in 2004-2005. A dataset with records of all tuberculosis treatments beginning in 2004 in all municipal health care units was collected. Bivariate analyses and a multinomial model were applied to identify associations between treatment outcomes and demographic and treatment process variables, including being in DOTS or self-administered therapy (SAT). RESULTS:From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with DOTS and 3,480 (75.7%) with SAT. The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure. The odds of death were 52.0% higher among patients on DOTS as compared to SAT. DOTS modality including community health workers (CHWs) showed the highest treatment success rate. A reduction of 21.0% was observed in the odds of default (vs. cure) among patients on DOTS as compared to patients on SAT, and a reduction of 64.0% among patients on DOTS with CHWs as compared to those without CHWs. CONCLUSIONS:Patients with a "low compliance profi le" were more likely to be included in DOTS. This strategy improves the quality of care provided to tuberculosis patients, although the proposed goals were not achieved.
ObjectiveTo characterize the Brazilian philanthropic hospital network and its relation to the public and private sectors of the Sistema Unico de Saude (SUS) [Brazilian Unified Health System]. Methods This is a descriptive study that took into consideration the geographic distribution, number of beds, available biomedical equipment, health care complexity as well as the productive and consumer profiles of philanthropic hospitals. It is based on a sample of 175 hospitals, within a universe of 1,917, involving 102 distinct institutions. Among these, there were 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds randomly included in this study. Twenty-six of the twenty-seven SUS inpatient care providers with at least 599 beds, as well as ten institutions which do not provide their services to SUS, were also included. This is a cross-sectional study and the data was obtained in 2001. Data collection was conducted by trained researchers, who applied a questionnaire in interviews with the hospital's managers. ResultsWithin the random sample, 81.2% of the hospitals are located in cities outside of metropolitan areas, and 53.6% of these are the only hospitals within their municipalities. Basic clinical hospitals, without ICUs, predominate within the random sample (44.9%). Among the individual hospitals of the large philanthropic institutions and the special hospitals, the majority -53% and 60% respectively -are level II general hospitals, a category of greater complexity. It was verified that complexity of care was associated to hospital size, being that hospitals with the greatest complexity are situated predominantly in the capitals. Conclusions Given the importance of the philanthropic hospital sector within the SUS in Brazil, this paper identifies some ways of formulating appropriate health policies adjusted to the specificities of its different segments.
This study aimed to identify strategies to implement clinical guidelines for hypertension in IntroduçãoA área da assistência à saúde tem sido marcada, desde a década de 90, por uma crescente preocupação com o estímulo à utilização de práticas endossadas pelo conhecimento científico, tendo em vista principalmente a melhoria da qualidade da assistência, mas também, de forma progressiva, a alocação mais eficiente de recursos.Hoje é internacionalmente aceita a pressuposição de que o uso de diretrizes clínicas para a prevenção, o diagnóstico, o tratamento e a reabilitação de doenças, definidas a partir da evidência científica acerca da eficácia e efetividade de intervenções, produz melhores resultados 1 além de atender a interesses de sistemas de saúde, mais ou menos dependentes de recursos públicos.Diretrizes clínicas constituem-se em recomendações sistematicamente desenvolvidas para orientar médicos e pacientes acerca dos cuidados de saúde apropriados, em circunstâncias clínicas específicas 2 . Elas contemplam indicações e contra-indicações, bem como benefícios esperados e riscos do uso de tecnologias em saú-de (procedimentos, testes diagnósticos, medicamentos etc.) para grupos de pacientes definidos.Apesar do reconhecimento que a aplicação das recomendações contidas nas diretrizes clíni-cas possibilita alcançar melhores resultados assistenciais, seu uso ainda é incipiente. Em função disso, tem crescido o interesse em identificar características facilitadoras do uso e estratégias efe-ARTIGO ARTICLE
OBJECTIVE:To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. METHODS:The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. RESULTS:The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. CONCLUSIONS:The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.
This paper presents the management characteristics of charity hospitals in
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