Envolvimento dos usuários de sistemas de saúde na Avaliação de Tecnologias em Saúde (ATS): uma revisão narrativa de estratégias internacionais

Castro, Rosana; Elias, Flávia Tavares Silva

doi:10.1590/1807-57622016.0549

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…Mecanismos de participação social estão presentes em países cujo sistema de saúde e gestão de tecnologias são tomados como exemplos para o Brasil [22][23][24][25][26][27][28][29][30] . Os métodos utilizados são os mais diversos, prevalecendo a inclusão de representantes em conselhos e comitês 22,24,27,28 .…”

Section: Discussionunclassified

Participação social na gestão de tecnologias em saúde em âmbito federal no Brasil

2020

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OBJETIVO: Caracterizar e discutir os processos formais de participação social previstos e implementados pelas instituições Agência Nacional de Vigilância Sanitária (Anvisa), Comissão Nacional de Incorporação de Tecnologias no SUS (Conitec) e Agência Nacional de Saúde Suplementar (ANS). MÉTODOS: Estudo exploratório, descritivo, comparativo, conduzido por meio de análise de documentos publicados até 2018 no sítio eletrônico e da legislação específica de cada instituição. RESULTADOS: Os espaços de participação social identificados incluem a representação em colegiados e participação direta por meio de uma demanda inicial ou em consultas públicas, audiências públicas e ouvidorias. A Anvisa conduziu 187 consultas públicas entre 1999 e 2018, e contabilizou 10.699 contribuições. Em 76 (41%) consultas públicas não há informações sobre as contribuições recebidas. A Conitec conduziu 234 consultas públicas, e recebeu 53.174 contribuições entre 2011 e 2018. Identificou-se que 70 (23%) recomendações da Conitec foram emitidas sem consulta pública, e 26 (8%) recomendações preliminares foram alteradas após consulta pública. As alterações de recomendação aconteceram especialmente em casos com grande volume de contribuições. A ANS conduziu 8 consultas públicas sobre o rol de procedimentos e eventos em saúde entre 2000 e 2018, e recebeu pelo menos 31.498 contribuições. Em três consultas públicas não há informações sobre o número de contribuições recebidas. CONCLUSÕES: Observa-se recente avanço normativo e de desempenho institucional em favor da participação social em espaços decisórios notadamente técnicos, embora de forma bastante heterogênea entre as instituições analisadas. O poder deliberativo da participação social de influenciar as decisões em saúde ainda necessita de estudo aprofundado, incluindo a caracterização dos participantes e a legitimidade das decisões subsequentes.

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Section: Discussionunclassified

Participação social na gestão de tecnologias em saúde em âmbito federal no Brasil

2020

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“…Public engagement strategies should be devised in conjunction with society, allowing the public to choose their preferred form of engagement in HTA and bridging the gap between society and healthcare decision-making processes [2]. When developing healthcare guidelines in the United Kingdom, for example, the National Institute for Health and Care Excellence (NICE) stipulates that at least two ‘consumers’ of the guideline in question be involved in the process and provides information on the role of all participants [29].…”

Section: Discussionmentioning

confidence: 99%

Public engagement in health technology assessment in Brazil: the case of the Trastuzumab public consultation

Carvalho

Sousa

Barreto

et al. 2019

BMC Health Serv Res

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BackgroundPublic engagement in health technology assessment (HTA) is increasing worldwide. There are several forms of public engagement and it is not always possible to determine which stakeholders participate in the HTA process and how they contribute. Our objective was to investigate which types of social representatives contributed to the public consultation on the incorporation of Trastuzumab for early-stage breast cancer treatment within the public health system in Brazil, held in 2012 by the National Committee for Health Technology Incorporation (CONITEC).MethodsA mixed methods approach was used to analyze social representativeness and the composition of the corpus from the public consultation, which consisted of 127 contributions. Three types of analysis were performed using IRaMuTeQ software: classic lexical analysis, descending hierarchical classification and specificities analysis. The contributions were clustered according to the main categories of discourse observed, into four social representation categories: 1) patient representation/advocacy; 2) pharmaceutical industry/advocacy; 3) healthcare professionals; and 4) individual contributions.ResultsCategory 1 contained words related to increased survival due to use of the drug and a low score for words pertaining to studies on Trastuzumab. The word “safety” obtained a positive score only in category 2, which was also the only category that exhibited a negative score for the word “risk”. Category 3 displayed the lowest scores for “diagnosis” and “safety”. The word “efficacy” had a negative score only in category 4.ConclusionsEach category exhibited different results for words related to health systems and to key concepts linked to HTA. Our analysis enabled the identification of the most prominent contributions for each category. Despite the promising results obtained, further research is needed to validate this software for use in analyzing public contributions.

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“…According to the recommendation report made available after the public consultation [ 27 ], contributions were distributed as follows: 66 from women; 24 from family members, friends or caregivers; 233 from health professionals; 63 from stakeholders; and 10 from legal entities, including companies [ 2 ], educational institutions [ 1 ], medical societies [ 3 ], patient groups/associations/organizations [ 2 ] and others [ 2 ]. Based on CONITEC’s report [ 28 ], most contributions (84%) were from women and 79% of contributors considered the guidelines good or very good, 7% fair and 14% inadequate of highly inadequate.…”

Section: Methodsmentioning

confidence: 99%

“…There is a growing body of literature that recognizes the importance of public engagement in health technology assessment (HTA) [ 1 , 2 ], whereby communities are involved in decision-making as well as the planning, design, governance and delivery of services [ 3 ]. Public engagement, such as patient-citizens [ 4 ], for example, can improve accountability, transparency, and social inclusion in addition to providing a real-world understanding of the benefits and adverse effects of using technology to manage the process [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Public engagement in health technology assessment in Brazil: the case of the public consultation on National Clinical Guidelines for Care in Normal Birth

Carvalho¹,

Silva²,

Barreto

2021

BMC Public Health

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Background There is a growing body of literature that recognizes the importance of public engagement in health technology assessment. However, there is still uncertainty regarding how the results should be recorded, analyzed, and used by decision makers. Objective Synthesize the contributions of the Brazilian public (women, health professionals, managers, educational institutions, and companies) about the implementation of the National Clinical Guidelines for Care in Normal Birth from the public consultation carried out in Brazil. Method IRaMuTeQ software was used to organize and summarize the corpus based on three types of analysis: descriptive statistics; descending hierarchical classification; and specificities analysis. The public consultation was conducted in 2016 by the National Committee for Health Technology Incorporation (CONITEC) in the Brazilian public health system as part of the guideline development process. Results The corpus consisted of 303 texts, separated into 1233 text segments, 1081 of which were used, corresponding to retention of 87.67%. Five classes emerged from our analyses: mandatory presence of an obstetrician during labor and delivery in hospital settings; barriers and facilitators for guideline implementation; use of evidence—based practices by health professionals; progression of labor and delivery and women’s rights; and mobilization to promote the guideline For each class, the most frequent words and sentences with the highest chi-squared scores were presented. Barriers were associated with lack of financial resources, training and professional motivation, and facilitators with training to change the practices of health professionals. Obstetric nurses emerged as an alternative for supervising normal births as well as the mandatory presence of an obstetrician during childbirth in hospital settings. Conclusion Our findings summarize the contributions provided by the Brazilian public and shed some light on the barriers and facilitators of clinical guidelines for care in normal birth. These topics are not typically explored by quantitative studies. Including this information in the decision-making process would not only increase public engagement, but provide greater evidence for implementing the clinical guidelines nationwide.

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Envolvimento dos usuários de sistemas de saúde na Avaliação de Tecnologias em Saúde (ATS): uma revisão narrativa de estratégias internacionais

Cited by 7 publications

References 27 publications

Participação social na gestão de tecnologias em saúde em âmbito federal no Brasil

Participação social na gestão de tecnologias em saúde em âmbito federal no Brasil

Public engagement in health technology assessment in Brazil: the case of the Trastuzumab public consultation

Public engagement in health technology assessment in Brazil: the case of the public consultation on National Clinical Guidelines for Care in Normal Birth

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