Estudo avaliativo do processo de trabalho das Equipes de Atenção Básica a partir do PMAQ-AB

Medrado, Josiane Ribeiro Silva; Casanova, Angela Oliveira; Oliveira, Catia Cristina Martins de

doi:10.1590/0103-110420161070360

Cited by 18 publications

(25 citation statements)

References 3 publications

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“…That happens when the assessment of these actions is seen as a part of the work process instead of an imposition merely aimed at reaching targets. (7) The assessment process should be broad and provoke changes, (8) a daring and innovative proposal that demands time to mature and incorporate it into the work culture of the Primary Health Care services.…”

Section: Discussionmentioning

confidence: 99%

“…This fragmentation is related to the managers and teams' limitation to understand the planning, monitoring and assessment as parts of an ongoing work process for improvements. (7) This discontinuity emerged in the interviewees' reports about external assessment.…”

Section: Discussionmentioning

confidence: 99%

“…(4,7) To support the transformation of reality, the results should be disseminated and discussed (9) among the manager, team and evaluators, a gap the study subjects appointed. Result-based financial incentives have been more effective to produce short-term changes instead of promoting great transformations, (10) by supporting decision processes, improving the organization of Primary Health Care, communication, management transparency and the education of the subjects involved.…”

Section: Discussionmentioning

confidence: 99%

“…Result-based financial incentives have been more effective to produce short-term changes instead of promoting great transformations, (10) by supporting decision processes, improving the organization of Primary Health Care, communication, management transparency and the education of the subjects involved. (7) According to the interviewees, the managers and teams hardly work with standards and indicators. Their use disseminates the quality culture and favors the modulation of the professional profile, (6,11) which can contribute to overcome the fragmentation of the work processes in PHC.…”

Section: Discussionmentioning

confidence: 99%

“…The managers often treat the assessment as supervision and punishment, as they charge the achievement of targets and the improvement of indicators without qualifying and encouraging the professionals in parallel. (7) In addition, the services' shortages are observed, which the management should improve through continuing education and improvements in the structures and work relations. (12) The interviewees treated continuing education and institutional support as synonyms.…”

Section: Discussionmentioning

confidence: 99%

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Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

et al. 2017

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Objective: To analyze the implementation of the National Improved Access and Quality Program according to Primary Health Care managers. Methods: The thematic oral history was used, through semistructured interviews with five managers from Primary Health Care Services who participated actively in the two cycles of the Program in an administrative district of São Paulo City. The subjects answered the question "How do you assess the implementation process of the National Improved Access and Quality Program at this Primary Health Care Service?", among others. The analysis of the testimonies revealed the categories "The managers' perception of the implementation of the National Improved Access and Quality Program" and "Changes in the work processes since the implementation of the National Improved Access and Quality Program". Results: The managers acknowledged the Program as a well-structured proposal, which permits a broader management view on the health services. The interviewees evidenced the use of the quality indicators, which was hardly addressed and understood in the managers and teams' daily reality though. The interviewees demonstrated that they do not understand the concepts of continuing education and institutional support. The external evaluation phase was considered subjective and without standardization, producing data that did not contribute to the assessment of the changes the teams made. Conclusion: The systematic incorporation process of the assessment culture to support the continuing quality improvement in Primary Health Care is incipient. Despite the continuing distance between the proposals of Primary Health Care and the practice at the Primary Health Care services studied, the Program favored the organization of the work processes and contributed to the managers' focus on the teams' practice and their own activities. ResumoObjetivo: Analisar a implementação do Programa Nacional de Melhoria do Acesso e da Qualidade segundo gerentes de Unidades Básicas de Saúde. Métodos: Utilizou-se a história oral temática, por meio de entrevistas semiestruturadas com cinco gerentes de Unidades Básicas de Saúde que participaram ativamente dos dois ciclos do Programa em um distrito administrativo do município de São Paulo. Os sujeitos responderam, dentre outras, à questão "Como você avalia o processo de implementação do Programa Nacional de Melhoria do Acesso e da Qualidade nesta Unidade Básica de Saúde?" e da análise dos depoimentos emergiram as categorias "Percepção dos gestores quanto à implementação do Programa Nacional de Melhoria do Acesso e da Qualidade" e "Mudanças nos processos de trabalho a partir da implementação do Programa Nacional de Melhoria do Acesso e da Qualidade". Resultados: Os gerentes reconheceram o Programa como uma proposta bem estruturada, que permite ampliar a visão gerencial nos serviços de saúde. O uso dos indicadores de qualidade foi evidenciado pelos entrevistados, mas pouco trabalhado e compreendido no cotidiano dos gestores e equipes. Os entrevistados demonstraram não compr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

et al. 2017

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Pay for performance in Brazilian primary health care: quality of work processes, actions and services

Anjos

Scherer

Cantalino

et al. 2023

IJPSM

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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.

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Dental care for early childhood in Brazil

et al. 2019

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OBJECTIVE: To evaluate whether characteristics of health services, oral health team and dental surgeon are associated with provision of dental care for children up to five years old in Brazilian Primary Health Care. METHODS: A cross-sectional study was conducted with data from 18,114 oral health teams in Brazil, evaluated in 2014 by the National Program for Access and Quality Improvement in Primary Care. The study outcome was the proven performance of dental procedures on children up to five years old. Statistical analysis was performed by Poisson regression based on a hierarchical model, where the first level was composed of service organization variables, the intermediate level composed of unit planning characteristics, and the proximal level composed of variables related to dental surgeon characteristics. RESULTS: Prevalence of dental care performed by oral health teams was 80.9% (n = 14,239). Scheduled appointments and activities of education in health were positively associated with the outcome, as well as planning and programming activities for the population and monitoring and analysis of oral health indicators. Complementary training in public health, continuing education activities and career plan were variables related to dental surgeons associated with the service provision. CONCLUSIONS: One fifth of health units in Brazil do not provide dental care for children in early childhood. Health units’ well-structured organization and planning protocols are associated with the provision of this service, as well as better employment relationship and graduate activities for dental surgeons.

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Estudo avaliativo do processo de trabalho das Equipes de Atenção Básica a partir do PMAQ-AB

Cited by 18 publications

References 3 publications

Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

Implementação do Programa de Melhoria do Acesso e Qualidade segundo gestores da Atenção Básica de São Paulo

Pay for performance in Brazilian primary health care: quality of work processes, actions and services

Dental care for early childhood in Brazil

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