Tendência temporal da avaliação do manejo adequado para diagnóstico e tratamento da tuberculose na atenção primária à saúde no Brasil entre 2012-2018 / Temporal trend in the evaluation of adequate management for diagnosis and treatment of tuberculosis in primary health care in Brazil (2012-2018) / Tendencia temporal de la evaluación del manejo adecuado para el diagnóstico y tratamiento de la tuberculosis en la atención primaria de salud en Brasil entre los años 2012 y 2018

Resumo: O objetivo do estudo foi analisar a presença de infraestrutura e processo de trabalho adequados na atenção primária à saúde (APS) para o diagnóstico, o monitoramento e o tratamento da tuberculose (TB) no Brasil de 2012 a 2018. Estudo de tendência temporal realizado com dados das unidades básicas de saúde (UBS) avaliadas nos ciclos I (2012), II (2014) e III (2018) do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Foi empregada a regressão de mínimos quadrados ponderada por variância para estimar as mudanças anuais, em pontos percentuais da infraestrutura e processo de trabalho adequado da TB em relação à macrorregião, ao porte do município e ao Índice Municipal de Desenvolvimento Humano e cobertura da Estratégia Saúde da Família. A amostra foi composta por 13.842 UBS e 17.202 equipes de saúde no ciclo I, 24.055 UBS e 29.778 equipes no II e 28.939 UBS e 37.350 equipes no III. Observou-se melhora gradual na proporção de infraestrutura e processo de trabalho ao atendimento da TB ao longo dos três ciclos do PMAQ-AB; contudo, nenhum local está integralmente adequado. A maior tendência de infraestrutura adequada foi verificada na Região Sul e no ano de 2018, em que 76,5% das UBS tinham todos os instrumentos para o cuidado à TB. A maior tendência de processo de trabalho adequado foi na Região Norte e no ano de 2018, em que 50,8% das equipes tinham a totalidade de itens para o cuidado à TB. O Programa Nacional de Controle da Tuberculose e o PMAQ-AB contribuíram para tais avanços, mas ainda é necessário o fomento de políticas públicas que garantam a melhoria contínua da assistência à TB na APS e a eficácia das medidas de controle e prevenção da doença.

Abstract: This study aimed to analyze the presence of infrastructure and adequate work processes in primary health care (PHC) for the diagnosis, monitoring, and treatment of tuberculosis (TB) in Brazil from 2012 to 2018. This is a temporal trend study carried out with data from basic health units (BHU) evaluated in the cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). Variance-weighted least-squares regression was used to estimate annual changes, in percentage points, of the infrastructure and adequate work process of TB in relation to the macroregion, municipality size, Municipal Human Development Index, and Family Health Strategy coverage. The sample consisted of 13,842 BHU and 17,202 health teams in cycle I; 24,055 BHU and 29,778 teams in cycle II; and 28,939 BHU and 37,350 teams in cycle III. There was a gradual improvement in the proportion of infrastructure and work process for TB care over the three cycles of the PMAQ-AB, but none of the sites is fully adequate. The greatest trend of adequate infrastructure was observed in the South Region, and in 2018, 76.5% of the UBS had all the instruments for TB care. The greatest trend of adequate work process was in the North Region, and in 2018, 50.8% of the teams had all the items for TB care. The Brazilian National Program for Tuberculosis Control and the PMAQ-AB have contributed to these advances, but there is still a need to promote public policies that ensure the continuous improvement of TB care in PHC, the effectiveness of TB control and prevention measures.

Resumen: El objetivo de este estudio fue analizar la presencia de infraestructura y proceso de trabajo adecuado en la atención primaria de salud (APS) para el diagnóstico, monitoreo y tratamiento de la tuberculosis (TB) en Brasil entre los años 2012 y 2018. Estudio de tendencia temporal realizado con datos de las unidades básicas de salud (UBS), evaluadas en los ciclos I (2012), II (2014) y III (2018) del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB). Se utilizó la regresión de mínimos cuadrados ponderada por varianza para estimar los cambios anuales, en puntos porcentuales de la infraestructura y el proceso de trabajo adecuado de la TB en relación con la macrorregión, el tamaño del municipio, el Índice Municipal de Desarrollo Humano y la cobertura de la Estrategia de Salud de la Familia. La muestra se compuso de 13.842 UBS y 17.202 equipos de salud en el ciclo I, 24.055 UBS y 29.778 equipos en el ciclo II y 28.939 UBS y 37.350 equipos en el ciclo III. Se observó una mejoría gradual en la proporción de infraestructura y proceso de trabajo en la atención de la TB a lo largo de los tres ciclos del PMAQ-AB, sin embargo, ningún local está completamente adecuado. Se verificó la mayor tendencia de infraestructura adecuada en la Región Sur y, en 2018, el 76,5% de las UBS tenían todas las herramientas para el cuidado de la TB. La Región Norte tuvo la mayor tendencia de proceso de trabajo adecuado y, en 2018, el 50,8% de los equipos tenían todo lo necesario para el cuidado de la TB. El Programa Nacional de Control de la Tuberculosis y el PMQA-AB contribuyeron para estos avances, pero aún es necesario promover políticas públicas que aseguren la mejoría continua de la asistencia de la TB en la APS y la eficacia de las medidas de control y prevención de la enfermedad.

Expansão da telessaúde na Atenção Primária à Saúde e as desigualdades regionais no Brasil / Expansion of telehealth in Primary Health Care and the regional inequalities in Brazil / Expansión de la telesalud en la Atención Primaria de Salud y desigualdades regionales en Brasil

O objetivo do estudo foi analisar a expansão da telessaúde na Atenção Primária à Saúde (APS) no Brasil e comparar as regiões geográficas. Estudo de série histórica com dados secundários da Avaliação Externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) obtidos a partir dos módulos I e II do 1º (2012), do 2º (2014) e do 3º (2018) ciclos. Os equipamentos de Tecnologia da Informação e o uso da telessaúde foram associados aos ciclos e às regiões geográficas pelo teste qui-quadrado ajustados pelo teste z de Bonferroni, e a comparação entre a média de equipamentos foi realizada pelo teste Kruskal-Wallis (p<0,05). Houve expansão no uso da telessaúde pelas Equipes de Atenção Básica (eAB) entre 2012 (12,7%), 2014 (27,7%) e 2018 (54,6%) (p<0,001). Houve aumento da média de todos equipamentos disponíveis para as eAB (p<0,001). Apesar do aumento na disponibilidade de equipamentos e do uso da telessaúde entre os ciclos e as regiões geográficas, as disparidades regionais se mantiveram, com as piores proporções no Norte e no Nordeste

The objective of the study was to analyze the expansion of telehealth in Primary Health Care in Brazil and make a comparison between Brazilian geographic regions. The historical series study with secondary data from the External Evaluation of the Access and Quality Improvement National Program of Primary Care obtained from modules I and II of the 1st (2012), 2nd (2014) and 3rd (2018) cycles. Information Technology equipment and the use of telehealth were associated with cycles and geographic regions by the chi-square test adjusted by Bonferroni's z test and comparison between the mean of equipment, by the Kruskal-Wallis test (p<0.05). The proportion of use of telehealth by the Primary Care Teams (eAB) increased between 2012 (12.7%), 2014 (27.7%) and 2018 (54.6%). There was expansion in the average of all equipment available for eAB (p<0.001). Despite the increase in the availability of equipment and use of telehealth between cycles and geographic regions, regional disparities remained, with worse proportions in North and Northeast regions

El objetivo del estudio fue analizar la expansión de la telesalud en la Atención Primaria de Salud en Brasil y comparar regiones geográficas. Estudio de serie histórica con datos secundarios de la Evaluación Externa del Programa Nacional de Mejora del Acceso y Calidad de la Atención Primaria obtenidos de los módulos I y II del 1° (2012), 2° (2014) y 3° (2018) ciclos. El uso de equipos de Tecnologías de la Información y telesalud se asoció con ciclos y regiones geográficas por la prueba de chi-cuadrado ajustada por la prueba z de Bonferroni y la comparación entre el promedio de equipos por la prueba de Kruskal-Wallis (p<0,05). Hubo expansión en el uso de telesalud por parte de los Equipos de Atención Primaria (eAB) entre 2012 (12,7%), 2014 (27,7%) y 2018 (54,6%) (p<0,001). Hubo un aumento en el promedio de todos los equipos disponibles para los eAB (p<0,001). A pesar del aumento en la disponibilidad de equipos y uso de telesalud entre ciclos y regiones geográficas, las disparidades regionales se mantuvieron, con peores proporciones en el Norte y Nordeste

Patients satisfaction with dental service, school of dentistry, University of Costa Rica / Satisfacción de los usuarios del Servicio de Odontología, Universidad de Costa Rica

The objective of this research was to use the Dental Satisfaction Questionnaire to determine the level of patient's satisfaction who come to the School of Dentistry of the University of Costa Rica. The research was conducted with the entire population of patients who received dental care in the Undergraduate Student Clinics of the School of Dentistry between April and September 2021. A digital survey was generated with the questions of the DSQ and sociodemographic variables, which was sent by email. Descriptive statistics were performed to establish the absolute and relative frequency, as well as measures of central tendency and variability, according to the nature of the variables. The Kolmogorov-Smirnov test was used in the conformity assessment of the data for the normal distribution. The relationships between the scores obtained from the Dental Satisfaction Questionnaire and the sociodemographic variables were analyzed using the Mann-Whitney U Test and the Kruskal-Wallis Test. A response rate of 36% was obtained. 98.5% of the subjects were satisfied with the services received. There was a statistically significant difference between the frequency of visits and the dental satisfaction scale (p=0.001). The scoring by type of clinic with regards to access, pain management, cost and availability were statistically significant (p=0.001, p=0.014, p=0.001, p=0.001, respectively). The differences in the relationship between the age groups and access was significant (p=0.014); in addition to that between education level and cost (p=0.001). A large majority of patients who come to the services of the School of Dentistry UCR are satisfied with the service received.

El objetivo de esta investigación fue utilizar el cuestionario DSQ para determinar el nivel de satisfacción de los pacientes que acuden a la Facultad de Odontología de la UCR. La investigación se realizó con toda la población de pacientes que recibieron atención dental en las Clínicas de pregrado y grado de la Facultad de Odontología UCR entre abril y setiembre del 2021. Se generó una encuesta digital con las preguntas del cuestionario DSQ y variables sociodemográficas, la cual se envió por medio del correo electrónico. Se realizó estadística descriptiva estableciendo la frecuencia absoluta y relativa, así como medidas de tendencia central y variabilidad, según la naturaleza de las variables. La prueba de Kolmogorov-Smirnov fue utilizada en la evaluación de la conformidad de los datos para la distribución normal. Las relaciones entre las puntuaciones obtenidas del Cuestionario de Satisfacción Dental y las variables sociodemográficas se analizaron mediante las pruebas de Prueba U de Mann-Whitney y la Prueba de Kruskal-Wallis. Se obtuvo un índice de respuesta del 36%. El 98,5% de los sujetos estuvo satisfecho con los servicios recibidos. Hubo diferencia estadísticamente significativa entre la frecuencia de visitas y la escala de satisfacción dental (p=0,001). También hubo diferencia estadísticamente significativa entre las diferentes clínicas y el acceso, manejo del dolor, costo y disponibilidad (p=0,001, p=0,014, p=0,001, p=0,001, respectivamente). De igual forma, hubo diferencia significativa en los grupos de edad y el acceso (p=0,014) y entre el nivel educativo y el costo (p=0,001). Una gran mayoría de los pacientes que acuden a los servicios de la Facultad de Odontología UCR están satisfechos con el servicio recibido.

¿Es sustentable la aplicación de las guías de práctica clínica en la práctica clínica del mundo real? / Is the application of clinical practice guidelines sustainable in real-world clinical practice?

Las guías de práctica clínica han contribuido a resolver un problema al sintetizar la evidencia y ponerla al alcance del profesional sanitario, pero su desarrollo e implementación creciente en los últimos años ha dado lugar a nuevos inconvenientes que aún no han sido resueltos. En este artículo editorial, la autora repasa cuestiones no tenidas en cuenta por las guías de práctica clínica, incluso aquellas consideradas de buena calidad de acuerdo a los estándares actuales, y reflexiona en especial sobre el uso del tiempo de los médicos en la consulta, aspecto desatendido que atenta contra la sustentabilidad del modelo actual de cuidado propuesto por estas recomendaciones. (AU)

Clinical practice guidelines have contributed to solving a problem by synthesizing the evidence and making it available to healthcare professionals, but their development and increasing implementation in recent years has given rise to new problems that have not yet been resolved. In this editorial article, the author reviews issues not taken into account by clinical practice guidelines, even those considered to be of good quality according to current standards, and reflects inparticular on the use of physicians' time in the consultation, a neglected aspect that undermines the sustainability of the current care model proposed by these recommendations. (AU)

Percepción de la calidad de la atención otorgada a los pacientes en el servicio de urgencia / Perception of the quality of care provided to patients in the emergency department

INTRODUCCIÓN. La atención de urgencia reviste características particulares, conjugándose múltiples factores que impactan en la calidad del servicio prestado, siendo su evaluación crucial para mejorar la satisfacción de los usuarios. No obstante, la utilización de encuestas no siempre logra profundizar la experiencia del paciente y del personal que presta el servicio. OBJETIVO. Conocer la calidad percibida por los usuarios de un servicio de urgencia de una clínica privada de Chile. METODOLOGÍA. Investigación cualitativa, descriptiva en la que participaron 20 pacientes, cinco familiares y diez integrantes del equipo de salud. Para la recolección de datos se realizaron entrevistas semiestructuradas y observación no participante. Se utilizó un enfoque inductivo para analizar los datos, realizando codificación selectiva y axial en base a siete categorías predefinidas basadas en las dimensiones de calidad. RESULTADOS. Del análisis de los discursos se obtuvieron seis categorías y 16 subcategorías de calidad de atención, siendo las más relevantes la oportunidad, la calidez, el confort y calidad técnica y capacidad resolutiva. En el caso del personal de salud, emergió la violencia por parte de pacientes o familiares como un factor relevante que impacta negativamente en la calidad. CONCLUSIÓN. Existió coincidencia en la percepción del personal de salud, pacientes y familiares. Se identificaron como fortalezas la amabilidad del personal, así como la accesibilidad y oportunidad de la información al paciente respecto de los procesos de atención. Se detectaron oportunidades de mejora relacionadas a los tiempos de espera, la presencia de especialistas y a la privacidad que ofrecen los boxes de atención.

INTRODUCTION: Emergency care involves multiple factors that impact the quality of the service provided, and its evaluation is crucial to enhance user satisfaction. However, the use of surveys does not always succeed in revealing the patient's experience and the experiences of staff who provide the service. OBJECTIVE: To ascertain the perceived quality of care by users of an emergency department in a private clinic in Chile. METHODOLOGY: Qualitative, descriptive research involving 15 patients, five relatives and ten healthcare team members. Data were collected through semi-structured interviews and non-participant observation. An inductive approach was used to analyze the data, implementing selective and axial coding based on seven pre-defined categories grounded on quality dimensions. RESULTS: From the analysis of the data, six categories and 16 subcategories of care quality were obtained, with the most relevant being timeliness, warmth, comfort, technical quality, and problem-solving capacity. In the case of health personnel, violence by patients or family members emerged as a relevant factor that negatively impacts quality. CONCLUSION: There was agreement in the perception of healthcare personnel, patients, and relatives. The friendliness of the staff, as well as the accessibility and timeliness of information provided to the patient regarding care processes, were identified as strengths. Opportunities for improvement were detected related to waiting times, the presence of specialists, and the privacy offered in the care setting.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil / Para além do acesso ao medicamento: papel do SUS e perfil da assistência em HIV no Brasil

ABSTRACT OBJECTIVE To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

RESUMO OBJETIVO Estimar a composição público-privada da assistência em HIV no Brasil e o perfil organizacional da extensa rede de serviços públicos. MÉTODOS Foram utilizados dados da Coorte Qualiaids-BR, que reúne dados dos sistemas nacionais de informações clínicas e laboratoriais de pessoas com 15 anos ou mais com primeira dispensação de terapia antirretroviral, entre 2015-2018, e informações dos serviços do SUS de acompanhamento clínico-laboratorial do HIV, produzidas pelo inquérito Qualiaids. O sistema de acompanhamento foi definido pelo número de exames de carga viral solicitados por algum serviço do SUS: acompanhamento no sistema privado - nenhum registro; acompanhamento no SUS - dois ou mais registros; acompanhamento indefinido - um registro. Os serviços do SUS foram caracterizados como ambulatórios, atenção básica e sistema prisional, segundo autoclassificação dos respondentes ao inquérito Qualiaids (72,9%); para os não respondentes (27,1%) a classificação baseou-se nos termos presentes nos nomes dos serviços. RESULTADOS No período, 238.599 pessoas com 15 anos ou mais iniciaram a terapia antirretroviral no Brasil, das quais, 69% receberam acompanhamento no SUS, 21,7% no sistema privado e 9,3% tiveram o sistema indefinido. Entre os acompanhados no SUS, 93,4% foram atendidos em serviços do tipo ambulatório, 5% em serviços de atenção básica e 1% no sistema prisional. CONCLUSÃO No Brasil o tratamento antirretroviral é fornecido exclusivamente pelo SUS, que também é responsável pelo acompanhamento clínico-laboratorial da terapia da maior parte das pessoas em serviços ambulatoriais. O estudo só foi possível porque o SUS mantêm registros e informações públicas acerca do acompanhamento em HIV. Não há nenhum dado disponível para o sistema privado.

Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

Access to childbirth care services in the interior of Pernambuco, Northeast region of Brazil / Acesso aos serviços de atenção ao parto no interior de Pernambuco, Nordeste do Brasil

ABSTRACT OBJECTIVE To analyze the access of women to the public health system network to childbirth care, highlighting the barriers related to the "availability and accommodation" dimension in a health macroregion of Pernambuco. METHODS Ecological study, conducted based on hospital birth records from the Hospital Information System of the Brazilian Unified Health System (SUS), and information from the state's Hospital Beds Regulation Center, about women residing in health macroregion II, in 2018. Displacements were reviewed considering the geographic distance between the municipality of residence and that of the childbirth; estimated time of displacement of pregnant women; ratio of shifts blocked for admission of pregnant women for delivery; and the reason for unavailability. RESULTS In 2018, health macroregion II performed 84% of usual risk childbirths, and 46.9% of high-risk childbirths. The remaining high-risk childbirths (51.1%) occurred in macroregion I, especially in Recife. The reference maternity for high-risk childbirths in that macroregion had 30.4% of the days of day shifts and 38.9% of the night shifts blocked for admission of childbirths; the main reason was the difficulty in maintaining the full team in service. CONCLUSIONS Women residing in the health macroregion II of Pernambuco face great barriers of access in search of hospital care for childbirth, traveling great distances even when pregnant women of usual risk, leading to pilgrimage in search of this care. There is difficulty regarding availability and accommodation in high-risk services and obstetric emergencies, with shortage of physical and human resources. The obstetric care network in macroregion II of Pernambuco is not structured to ensure equitable access to care for pregnant women at the time of childbirth. This highlights the need for restructuring this healthcare services pursuant to what is recommended by the Cegonha Network.

RESUMO OBJETIVO Analisar o acesso de mulheres atendidas na rede pública aos serviços de atenção ao parto, destacando-se as barreiras relacionadas à dimensão "disponibilidade e acomodação" em uma macrorregião de saúde de Pernambuco. MÉTODOS Estudo ecológico, realizado a partir dos registros de partos hospitalares do Sistema de Informação Hospitalar e de informações da Central de Regulação de Leitos do estado sobre mulheres residentes na macrorregião de saúde II, em 2018. Analisou-se os deslocamentos, considerando a distância geográfica entre o município de residência e o de ocorrência do parto, o tempo estimado do deslocamento das gestantes, a proporção de plantões bloqueados para admissão das gestantes para o parto e o motivo da indisponibilidade. RESULTADOS Em 2018, a macrorregião de saúde II realizou 84% dos partos de risco habitual e 46,9% de alto risco. Os demais partos de alto risco (51,1%) ocorreram na macrorregião I, sobretudo no Recife. A maternidade de referência para partos de alto risco dessa macrorregião teve 30,4% dos dias de plantões diurnos bloqueados para admissão de partos e 38,9% dos noturnos; o principal motivo foi a dificuldade em manter a equipe completa no serviço. CONCLUSÕES Mulheres residentes na macrorregião de saúde II de Pernambuco enfrentam grandes barreiras de acesso em busca de atendimento hospitalar para o parto, percorrendo grandes distâncias, mesmo quando gestantes de risco habitual, levando à peregrinação em busca dessa assistência. Há dificuldade de disponibilidade e acomodação nos serviços de alto risco e de emergências obstétricas, com insuficiente capacidade física e de recursos humanos. A rede de atenção obstétrica na macrorregião II de Pernambuco não está estruturada para garantir um acesso equânime à assistência das gestantes no momento do parto, o que evidencia a necessidade de sua reestruturação em aproximação ao preconizado pela Rede Cegonha.

Assessment of websites on cleft lip and palate in Brazilian Portuguese

ABSTRACT Purpose: this study aimed at assessing the legibility, reliability, usability and coverage of websites on cleft lip and/or palate (CL/P) in Brazilian Portuguese and providing a global comparison. Methods: in order to evaluate the obtained data, four protocols were used, i.e., the Website Coverage Protocol, the legibility (by means of the COH METRIX PORT), the reliability (Discern Protocol), and the usability (by means of the System Usability Scale). Results: 98 websites were included with average legibility scoring of 31.6±11.7, rated as a hard readability level. Coverage average scoring was 19.9±3.79 from a total of 35 points. As for reliability, average scoring was 43.2±6.51 points, rated as acceptable. The usability scoring was 24.8±2.18 points, rated as the worst imaginable one. Conclusion: therefore, the assessed Brazilian websites on CL/P were rated difficult for legibility, requiring high-school level of education, restricted coverage and acceptable reliability, in addition to the low usability. The results were similar to those of websites from other countries, except for the legibility aspect, which was lower for Brazilian websites.

Evaluación de la gestión de calidad de los servicios de Enfermería en un Centro de Restauración Neurológica / Evaluation of quality management of Nursing services at the International Center for Neurological Restoration

Introducción: La evaluación de la gestión de calidad de los servicios de Enfermería se perfila como una herramienta útil para trazar estrategias de mejora de los procesos organizacionales y satisfacer las necesidades del cliente. Objetivo: Evaluar la gestión de calidad de los servicios de Enfermería. Métodos: Estudio cuantitativo, descriptivo, de corte transversal, en el Centro Internacional de Restauración Neurológica, La Habana, en el año 2022. Participaron 60 enfermeras con 5 o más años de servicio, pertenecientes a los servicios lesiones estáticas, restauración biológica cerebral, atención a cubanos, lesiones raquimedulares, trastornos del movimiento y neurocirugía. Se aplicó una encuesta adaptada al contexto hospitalario basada en el Modelo Europeo de excelencia European Foundation for Quality Management. Se utilizó la media como medida de resumen. Se consideró la evaluación punto fuerte (aceptable) cuando el valor real alcanzado fue igual o superior al deseado y área de mejora (no aceptable) cuando el valor real no alcanzó el deseado. Resultados: La puntuación global fue de 977,88 de 1000 puntos que exige el Modelo. Se detectaron dos áreas de mejora a expensas de los criterios 3 (implicar los grupos de interés) y 5 (gestionar el funcionamiento y la transformación). Se evidenciaron puntos fuertes con énfasis en una cultura de calidad y elevada capacitación en los profesionales. Conclusión: La evaluación de gestión de la calidad en los servicios de Enfermería se considera aceptable. Los hallazgos obtenidos permiten plantearse acciones de mejora para fortalecer la calidad de la atención que se brinda a los clientes. La evaluación de la gestión de calidad en los servicios de enfermería es una estrategia metodológica útil para identificar errores y ayudar a identificar el camino hacia la excelencia(AU)

Introduction: The evaluation of quality management of Nursing services is emerging as a useful tool to outline strategies to improve organizational processes and meet customer needs, Objective: To evaluate the quality management of nursing services. Methods: Quantitative, descriptive, cross-sectional, cross-sectional study at the International Center for Neurological Restoration, Havana, Cuba, in the year 2022. Sixty nurses with 5 or more years of service, belonging to the services Static Injuries, Biological Brain Restoration, Care for Cubans, Rachimedullary Injuries, Movement Disorders and Neurosurgery participated. A survey was applied, adapted to the hospital context based on the European Model of Excellence EFQM. The mean was used as a summary measure. The evaluation was considered a strong point (acceptable) when the actual value achieved was equal to or higher than the desired value, and an area for improvement (not acceptable) when the actual value did not reach the desired value. Results: The overall score was 977.88 out of 1000 points required by the Model. Two areas for improvement were detected at the expense of criteria 3 (involve stakeholders) and 5 (manage operation and transformation). Strengths were evidenced with emphasis on a culture of quality and high qualification of professionals. Conclusion: The evaluation of quality management in nursing services is considered acceptable(AU)

Evaluación de la gestión de calidad de los servicios de Enfermería en un Centro de Restauración Neurológica / Evaluation of quality management of Nursing services at the International Center for Neurological Restoration

Introducción: La evaluación de la gestión de calidad de los servicios de Enfermería se perfila como una herramienta útil para trazar estrategias de mejora de los procesos organizacionales y satisfacer las necesidades del cliente. Objetivo: Evaluar la gestión de calidad de los servicios de Enfermería. Métodos: Estudio cuantitativo, descriptivo, de corte transversal, en el Centro Internacional de Restauración Neurológica, La Habana, en el año 2022. Participaron 60 enfermeras con 5 o más años de servicio, pertenecientes a los servicios lesiones estáticas, restauración biológica cerebral, atención a cubanos, lesiones raquimedulares, trastornos del movimiento y neurocirugía. Se aplicó una encuesta adaptada al contexto hospitalario basada en el Modelo Europeo de excelencia European Foundation for Quality Management. Se utilizó la media como medida de resumen. Se consideró la evaluación punto fuerte (aceptable) cuando el valor real alcanzado fue igual o superior al deseado y área de mejora (no aceptable) cuando el valor real no alcanzó el deseado. Resultados: La puntuación global fue de 977,88 de 1000 puntos que exige el Modelo. Se detectaron dos áreas de mejora a expensas de los criterios 3 (implicar los grupos de interés) y 5 (gestionar el funcionamiento y la transformación). Se evidenciaron puntos fuertes con énfasis en una cultura de calidad y elevada capacitación en los profesionales. Conclusión: La evaluación de gestión de la calidad en los servicios de Enfermería se considera aceptable. Los hallazgos obtenidos permiten plantearse acciones de mejora para fortalecer la calidad de la atención que se brinda a los clientes. La evaluación de la gestión de calidad en los servicios de enfermería es una estrategia metodológica útil para identificar errores y ayudar a identificar el camino hacia la excelencia.

Introduction: The evaluation of quality management of Nursing services is emerging as a useful tool to outline strategies to improve organizational processes and meet customer needs, Objective: To evaluate the quality management of nursing services. Methods: Quantitative, descriptive, cross-sectional, cross-sectional study at the International Center for Neurological Restoration, Havana, Cuba, in the year 2022. Sixty nurses with 5 or more years of service, belonging to the services Static Injuries, Biological Brain Restoration, Care for Cubans, Rachimedullary Injuries, Movement Disorders and Neurosurgery participated. A survey was applied, adapted to the hospital context based on the European Model of Excellence EFQM. The mean was used as a summary measure. The evaluation was considered a strong point (acceptable) when the actual value achieved was equal to or higher than the desired value, and an area for improvement (not acceptable) when the actual value did not reach the desired value. Results: The overall score was 977.88 out of 1000 points required by the Model. Two areas for improvement were detected at the expense of criteria 3 (involve stakeholders) and 5 (manage operation and transformation). Strengths were evidenced with emphasis on a culture of quality and high qualification of professionals. Conclusion: The evaluation of quality management in nursing services is considered acceptable.

Trend in hospitalizations due to ambulatory care-sensitive conditions in the Federal District / Tendencia de las internaciones por condiciones sensibles a la atención primaria de salud en Distrito Federal / Tendência das internações por condições sensíveis à atenção primária à saúde no Distrito Federal

ABSTRACT Objectives: to analyze the trend, according to sex, of Ambulatory Care-Sensitive Conditions in the Primary Health Care of the Federal District, from 2009 to 2019. Methods: ecological trend study using ACSC hospitalization data available in the Hospitalization System of the Single Health System. The Prais-Winsten method was used to calculate the annual rate variation, expressed in percentages. The dependent variable was the logarithm of the rates, and the independent one, the years in the time series. Results: the Federal District registered 2,103,951 general hospitalizations, 16.4% of which were due to Ambulatory Care-Sensitive Conditions. Males had a higher rate of hospitalization in the period, and both sexes showed a stationary trend. Conclusions: the time trend of Ambulatory Care- Sensitive Conditions was stationary, but further studies are necessary regarding primary health care coverage.

RESUMEN Objetivos: analizar tendencia de Internaciones por Condiciones Sensibles a la Atención Primaria por sexo en Distrito Federal desde 2009 a 2019. Métodos: estudio ecológico de tendencia con datos de ICSAP disponibles en el Sistema de Internaciones Hospitalarias del Sistema Único de Salud. Utilizado método de Prais-Winsten para el cálculo de la variación porcentual anual de las tasas. La variable dependiente fue el logaritmo de las tasas, y la independiente, los años de la serie temporal. Resultados: Distrito Federal registró 2.103.951 internaciones generales, siendo 16,4% Internaciones por Condiciones Sensibles a la Atención Primaria. El sexo masculino obtuvo la mayor tasa de internación en todo el periodo y hubo tendencia estacionaria tanto para el sexo masculino mientras el femenino. Conclusiones: las tendencias temporales de las Internaciones por Condiciones Sensibles a la Atención Ambulatoria mostradas estacionarias, pero resaltada la necesidad de estudios de correlación con la cobertura de la atención primaria de salud.

RESUMO Objetivos: analisar a tendência das Internações por Condições Sensíveis à Atenção Primária por sexo no Distrito Federal, no período de 2009 a 2019. Métodos: estudo ecológico de tendência com dados de ICSAP disponíveis no Sistema de Internações Hospitalares do Sistema Único de Saúde. Utilizou-se o método de Prais-Winsten para o cálculo da variação percentual anual das taxas. A variável dependente foi o logaritmo das taxas; e a variável independente, os anos da série temporal. Resultados: o Distrito Federal registrou 2.103.951 internações gerais, sendo 16,4% Internações por Condições Sensíveis à Atenção Primária. O sexo masculino obteve a maior taxa de internação em todo o período, e houve tendência estacionária tanto para o sexo masculino quanto para o sexo feminino. Conclusões: as tendências temporais das Internações por Condições Sensíveis à Atenção Primária mostraram-se estacionárias, porém ressalta-se a necessidade de estudos de correlação com a cobertura da Atenção Primária à Saúde.

Follow-up of children diagnosed with deafness in a neonatal hearing screening program in Manaus / Seguimento de crianças com diagnóstico de surdez em programa de triagem auditiva neonatal em Manaus

ABSTRACT OBJECTIVE To evaluate the follow-up of children diagnosed with deafness in neonatal hearing screening and risk factors for hearing loss. METHODS Quantitative, cross-sectional, and retrospective study to evaluate factors associated with hearing loss and the follow-up of cases of children diagnosed with audiological dysfunction, by analyzing electronic medical records of 5,305 children referred to a Specialized Center in Type I Rehabilitation, from January/2016 to February/2020, in the city of Manaus, Amazonas. The statistical study used Pearson's chi-square test and binary logistic regression in which odds ratio scans were obtained with reliability intervals of 95%. RESULTS Of the 5,305 children referred for the otoacoustic emission retest, 366 (6.9%) failed the retest. Children diagnosed with sensorineural hearing loss continued in the study, totaling 265 (72.4%). Only 58 (21.9%) children continued in the study to its end, of these 39 had received hearing aids at that point; and 16 (41%) had surgical indication for cochlear implants, of which only 3 (18.7%) had undergone surgery. Among the risk factors for hearing loss, we found 2.6 times more chance of failure in the otoacoustic emissions retest in those children who had a family history of hearing loss and ICU stay. CONCLUSION Although the screening flow reaches a large part of live births, the dropout rates during the process are high, therefore, the socioeconomic and geographic characteristics of regions such as the Amazon should be considered as relevant factors to the evasion of rehabilitation programs of these children. Hospitalization in the neonatal ICU and family history of hearing loss in the investigations could be identified as the main and most important factors for alteration of the otoacoustic emissions retests.

RESUMO OBJETIVO Avaliar o seguimento das crianças com diagnóstico de surdez na triagem auditiva neonatal e fatores de risco para deficiência auditiva. MÉTODOS Estudo quantitativo, transversal e retrospectivo para avaliação de fatores associados à perda auditiva e o seguimento dos casos de crianças diagnosticadas com disfunção audiológica, por meio da análise de prontuários eletrônicos de 5.305 crianças encaminhadas a um Centro Especializado em Reabilitação Tipo I, no período de janeiro/2016 a fevereiro/2020, na cidade de Manaus, Amazonas. O estudo estatístico utilizou o teste qui-quadrado de Pearson e por regressão logística binária nos quais foram obtidos odds ratio com intervalos de confiabilidade de 95%. RESULTADOS Das 5.305 crianças encaminhadas para realização do reteste da orelhinha, 366 (6,9%) falharam no reteste. Prosseguiram no estudo as crianças com diagnóstico de perda auditiva neurossensorial, totalizando 265 (72,4%). Permanecendo, no final da pesquisa, apenas 58 (21,9%) crianças, destas 39 receberam aparelho auditivo até o presente estudo; e 16 (41%) já tinham indicação cirúrgica para implante coclear, sendo que apenas três (18,7%) haviam realizado a cirurgia. Dentre os fatores de risco para deficiência auditiva encontramos 2,6 vezes mais chance de falha no reteste da orelhinha naquelas crianças que tinham história familiar de perda auditiva e internação em UTI. CONCLUSÕES Embora o fluxo de triagem alcance boa parte dos nascidos vivos, as taxas de evasão durante o processo são altas, portanto, as características socioeconômicas e geográficas de regiões como a Amazônia devem ser consideradas como fatores relevantes à evasão dos programas de reabilitação dessas crianças. Foi possível identificar que a internação em UTI neonatal e o histórico familiar de perda auditiva presentes nas investigações compõem os principais e mais importantes fatores para alteração dos retestes da orelhinha.

Utilização de serviços odontológicos no Brasil / Use of dental services in Brazil

O objetivo do presente estudo foi analisar a utilização de serviços odontológicos no Brasil. Trata-se de um estudo quantitativo, observacional, transversal, analítico. Os dados individuais foram obtidos das Pesquisas Nacionais de Saúde desenvolvidas nos anos de 2013 e 2019. Os dados foram analisados considerando os pesos amostrais decorrentes de amostras complexas. Para cada estudo, foram desenvolvidas técnicas de análise múltipla que contemplaram os objetivos do estudo. Os resultados foram discutidos em três artigos científicos aceitos para publicação em periódicos e um artigo em fase de finalização. Os resultados encontrados indicam que a população negra, residente na região Norte e Nordeste, de menor classe social e escolaridade apresentam maior chance de ter ido ao dentista há mais de dois anos e de nunca ter ido ao dentista, bem como maior chance de realizar procedimentos odontológicos cirúrgicos ou de urgência na última consulta odontológica. Observou-se em relação às características do domicílio, que morar em área rural, maior aglomeração e menor renda familiar reduziram as chances de ter utilizado serviços odontológicos no último ano. Por outro lado, pessoas que residiam em domicílios cadastrados na Estratégia de Saúde da Família tiveram menor chance de não ter realizado uma consulta odontológica ao longo da vida, ou de terem ido ao dentista há mais de um ano. Ao analisar especificamente a utilização de serviços públicos odontológicos, após ajuste para idade e sexo, a escolaridade, a cor da pele ou raça e a renda familiar demonstraram efeito predisponente na utilização de serviços públicos odontológicos. Os fatores facilitadores foram residir em domicílios cadastrados em equipes de atenção primária ou localizados em áreas rurais. Os fatores de necessidade associados à utilização de serviço odontológico público foram autopercepção de saúde bucal ruim ou péssima e não ter realizado tratamento restaurador no último atendimento odontológico. Em relação aos fatores contextuais, a utilização de serviço público odontológico esteve associada à maior cobertura populacional por equipes de saúde bucal na atenção primária. De forma geral, observamos um acesso desigual aos serviços odontológicos no Brasil. Esse cenário ocorre quando fatores sociais e facilitadores determinam quem utiliza os serviços, em detrimento da necessidade de utilização. Apesar disso, observamos um efeito importante, decorrente da oferta de serviços odontológicos na atenção primária como um fator mitigador de tais desigualdades, o que demonstra um efeito positivo das estratégias adotadas na Política Nacional de Saúde Bucal (AU).

The present study aimed to analyze dental services utilization in Brazil. This is a quantitative, observational, cross-sectional, analytical study. Individual data from the National Health Surveys developed in 2013 and 2019. Data were analyzed by adjusting the sample weights resulting from complex samples. For each study, multivariate analysis techniques addressed the study's objectives. The results will be discussed in three scientific papers accepted for publication in journals and one article in the process of being finalized. It was noticed that the population subgroups comprising Blacks and those residing in the North or Northeast, with lower social class and education, had a greater chance of having a last dental appointment more than two years and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. The outcome never had a dental appointment was significantly associated with illiterate, males, without private dental insurance, self-rated oral health as bad or very bad, household not enrolled in primary care teams, household in a rural area, high household crowding, and low household income per capita. The highest prevalence of public dental service utilization on an individual level was observed among unable to read or write people, indigenous, black or brown, with lower per capita household income, living in the rural area, and who self-rated oral health as regular or very bad/bad. On the contextual level, highest public dental service utilization was observed among those living in federal units with increased oral health coverage in primary health care. In general, we observe inequalities in dental services utilization in Brazil. This scenario occurs when social characteristics and facilitating aspects determine who uses the services, to the detriment of the need to use them. Despite this, we observed an important effect resulting from the provision of dental services in primary care as a mitigating factor for such inequalities, demonstrating a positive effect of the strategies adopted in the National Oral Health Policy (AU).

Surgical capacity assessment in the state of Amazonas using the surgical assessment tool. Cross-sectional study / Avaliação da capacidade cirúrgica do estado do Amazonas utilizando uma ferramenta de avaliação cirúrgica. Estudo transversal

ABSTRACT Objective: Brazil is a country with universal health coverage, yet access to surgery among remote rural populations remains understudied. This study assesses surgical care capacity among hospitals providing care for the rural populations in the Amazonas state of Brazil through in-depth facility assessments. Methods: a stratified randomized cross-sectional evaluation of hospitals that self-report providing surgical care in Amazonas was conducted from July 2016 to March 2017. The Surgical Assessment Tool (SAT) developed by the World Health Organization and the Program in Global Surgery and Social Change at Harvard Medical School was administered at remote hospitals, including a retrospective review of medical records and operative logbooks. Results: 18 hospitals were surveyed. Three hospitals (16.6%) had no operating rooms and 12 (66%) had 1-2 operating rooms. 14 hospitals (77.8%) reported monitoring by pulse oximetry was always present and six hospitals (33%) never have a professional anesthesiologist available. Inhaled general anesthesia was available in 12 hospitals (66.7%), but 77.8% did not have any mechanical ventilation device. An average of 257 procedures per 100,000 were performed. 10 hospitals (55.6%) do not have a specific post-anesthesia care unit. For the regions covered by the 18 hospitals, with a population of 497,492 inhabitants, the average surgeon, anesthetist, obstetric workforce density was 6.4. Conclusion: populations living in rural areas in Brazil face significant disparities in access to surgical care, despite the presence of universal health coverage. Development of a state plan for the implementation of surgery is necessary to ensure access to surgical care for rural populations.

RESUMO Objetivo: o Brasil é um país com cobertura universal de saúde, mas o acesso à cirurgia entre populações remotas permanece pouco estudado. Este estudo avalia a capacidade cirúrgica em hospitais que servem populações rurais no estado do Amazonas, Brasil, por meio de avaliações aprofundadas das instalações. Métodos: foi realizada avaliação estratificada randomizada transversal de hospitais que relataram prestar assistência cirúrgica de julho de 2016 a março de 2017. A Ferramenta de Avaliação Cirúrgica desenvolvida pela Organização Mundial da Saúde e o Programa de Cirurgia Global e Mudança Social da Harvard Medical School foi administrada em hospitais remotos, incluindo uma revisão retrospectiva de registros médicos e livros cirúrgicos. Resultados: 18 hospitais foram pesquisados. Três hospitais (16,6%) não tinham salas cirúrgicas e 12 (66%) tinham 1-2. 14 hospitais (77,8%) relataram que a oximetria de pulso estava "sempre presente" e seis hospitais (33%) nunca têm um anestesiologista disponível. A anestesia inalatória estava disponível em 12 hospitais (66,7%), 77,8% não possuíam dispositivo de ventilação mecânica. Em média, 257 procedimentos por 100.000 foram realizados. 10 hospitais (55,6%) não possuem unidade de recuperação anestésica. Para as regiões de abrangência dos 18 hospitais, com população de 497.492 habitantes, a densidade média de força de trabalho cirúrgica, anestesista e obstétrica foi de 6,4. Conclusão: as populações que vivem em áreas rurais no Brasil enfrentam disparidades significativas no acesso à assistência cirúrgica, apesar da presença de cobertura universal de saúde. O desenvolvimento de um plano estadual de cirurgia é necessário para garantir acesso à assistência cirúrgica às populações rurais.

Time to diagnosis and treatment for breast cancer in public and private health services / Tiempo de diagnóstico y tratamiento del cáncer de mama en asistencia pública y privada / Tempo para diagnóstico e tratamento do câncer de mama na assistência pública e privada

ABSTRACT Objective: To analyze the time to diagnosis and treatment for breast cancer and the associated factors, according to the type of care (public vs. private). Methodology: Retrospective cohort study with 477 women diagnosed with breast cancer between 2014 and 2016. Data were collected in an oncology service in a municipality in Minas Gerais, in the 2018-2019 period. Analyzes were performed using the Kaplan-Meier method and Cox's proportional regression model. Results: The median time to diagnosis was 70 days, being shorter for women who discovered the disease through screening tests and who were diagnosed in early stages of the disease. The median time for treatment was 32 days, which was shorter for women assisted by private health service, with a high level of education and who were diagnosed in early stages. Conclusions: Private care and facilitators of access to breast cancer care were associated with shorter waiting times.

RESUMEN Objetivo: Analizar el tiempo de diagnóstico y tratamiento del cáncer de mama y los factores asociados, según el tipo de assistência (pública vs. privada). Metodología: Cohorte retrospectiva con 477 mujeres diagnosticadas de cáncer de mama entre 2014-2016. Los datos fueron recolectados en un servicio de oncología de Minas Gerais, en el período 2018-2019. Los análisis se realizaron mediante el método de Kaplan-Meier y el modelo de regresión de Cox. Resultados: Mediana de tiempo para el diagnóstico fue de 70 días - menor para las que descubrieron la enfermedad mediante pruebas de detección y que fueron diagnosticadas en etapas tempranas. Mediana de tiempo para tratamiento fue de 32 días - menor para las atendidas por la red privada, con alto nivel educativo y diagnosticadas en etapas tempranas. Conclusiones: Asistencia en la red privada y facilitadores de acceso a la atención del cáncer de mama asociados a tiempos de espera más cortos.

RESUMO Objetivo: Analisar o tempo para o diagnóstico e tratamento do câncer de mama e os fatores associados, segundo o tipo de assistência (pública vs. privada). Métodos: Coorte retrospectiva com 477 mulheres diagnosticadas com câncer de mama entre 2014-2016. Os dados foram coletados em um serviço de oncologia de um município de Minas Gerais, entre 2018-2019. As análises foram realizadas pelo método de Kaplan-Meier e pelo modelo de regressão de Cox. Resultados: O tempo mediano para diagnóstico foi de 70 dias, sendo menor para aquelas que descobriram a doença por exames de rastreamento e diagnosticadas em estádios iniciais. O tempo mediano para o tratamento foi de 32 dias, sendo menor para as mulheres assistidas pela rede privada, com alta escolaridade e diagnosticadas em estádios iniciais. Conclusões: Assistência na rede privada e facilitadores do acesso ao cuidado do câncer de mama associaram-se a menores tempos de espera.

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.

Facilidades e entraves da referência em unidade de pronto atendimento / Facilidades y barreras de referencia en una unidad de atención de emergencia / Eases and hindrances of reference in an emergency care unit

Resumo Objetivo descrever, na perspectiva de enfermeiros e médicos, as facilidades e os entraves da referência em uma Unidade de Pronto Atendimento. Método estudo descritivo, qualitativo, realizado em uma Unidade de Pronto Atendimento de um município de Santa Catarina, Brasil. Participaram sete enfermeiros e 23 médicos. Os dados foram coletados por meio de entrevista individual semiestruturada e analisados mediante a técnica do Discurso do Sujeito Coletivo. Resultados as facilidades envolveram: ter serviços de referência especializados; gravidade do paciente; atendimento em "vaga zero"; boa relação entre os profissionais dos serviços de urgência e a empatia. Dentre os entraves, estavam: contato difícil por telefone com os hospitais e a superlotação destes; dificuldade para conseguir transporte, sobretudo, para paciente com situação clínica estável e a falta de ambulância do município. Conclusão e implicações para a prática as facilidades da referência potencializam o atendimento às urgências, porém, os entraves, referentes à vaga hospitalar e ao transporte, podem comprometer a integralidade e a continuidade do cuidado, necessitando de melhorias na atenção à saúde em rede.

Resumen Objetivo describir, desde la perspectiva de enfermeros y médicos, las facilidades y barreras de referencia en una Unidad de Urgencias. Método estudio descriptivo, cualitativo, realizado en una Unidad de Urgencias de una ciudad de Santa Catarina, Brasil. Participaron siete enfermeros y 23 médicos. Los datos fueron recolectados a través de entrevistas individuales semiestructuradas y analizados usando la técnica del Discurso Colectivo del Sujeto. Resultados las facilidades involucradas: contar con servicios de referencia especializados; gravedad del paciente; servicio en "vacante cero"; buena relación entre los profesionales de los servicios de urgencias y la empatía. Entre los obstáculos estaban: el difícil contacto telefónico con los hospitales y su hacinamiento; dificultad para conseguir transporte, especialmente para pacientes con situación clínica estable y falta de ambulancia en la ciudad. Conclusión e implicaciones para la práctica las facilidades de referencia mejoran la atención de emergencia, sin embargo, las barreras, relacionadas a la vacante hospitalaria y el transporte, pueden comprometer la integridad y continuidad de la atención, requiriendo mejoras en la atención en red.

Abstract Objective to describe, from the perspective of nurses and physicians, the eases and hindrances of referrals in an Emergency Care Unit. Method a descriptive, qualitative study, carried out in an Emergency Care Unit in a city of Santa Catarina, Brazil. Seven nurses and 23 physicians participated. Data was collected through individual semi-structured interviews and analyzed using the Discourse of the Collective Subject technique. Results the eases involved: having specialized reference services; patient severity; care in "zero vacancy"; good relationship among professionals of the emergency services and empathy. Among the hindrances were: difficult contact by telephone with hospitals and their overcrowding; difficulty in getting transport, especially for patients with stable clinical situation and the lack of ambulance from the municipality. Conclusion and implications for the practice the referral facilities potentiate the attendance to urgencies, however, the hindrances, referring to hospital vacancy and transport, can compromise the integrality and continuity of care, requiring improvements in network health care.

Número de equipes assistenciais e internações por condições sensíveis à atenção primária / Number of health care teams and hospitalizations due to primary care sensitive conditions

Resumo Objetivou-se analisar a correlação entre o número de equipes de saúde da Estratégia Saúde da Família (ESF) e o número de internações de causas sensíveis à atenção primária (ICSAP), considerando ainda taxas, custos e diárias hospitalares em um município de grande porte em Minas Gerais entre 2010 e 2019. Trata-se de um estudo ecológico de correlação de série temporal sobre as ICSAP de pacientes internados no sistema público de saúde. Os dados são do Sistema de Informação Hospitalar do Departamento de Informática do Sistema Único de Saúde (DATASUS) e do Sistema de Informação e Gestão da Atenção Básica. A análise de correlação foi realizada a partir de número, taxas brutas e padronizadas, percentuais, custos e diárias das ICSAP e cobertura assistencial (número médio de equipes), utilizando-se o coeficiente de correlação de Spearman, assumindo-se nível de significância de 5% (p < 0,05). Para todo o período, não se registrou correlação satisfatória para o aumento do número de equipes sobre as ICSAP (exceto para taxa padronizada de internações). Quando se avalia exclusivamente o período em que o município apresenta cobertura populacional superior a 70% para ESF, todas as correlações são inversamente proporcionais e estatisticamente significantes.

Abstract This study aimed to analyze the correlation between the number of health care teams of the Family Health Strategy (FHS) and the number of hospitalizations due to primary care sensitive conditions (HPCSC) taking into account rates, costs and hospital days in a large municipality of the state of Minas Gerais, Brazil, between 2010 and 2019. We performed an ecological time series correlation study on HPCSC of patients hospitalized by the public health system. Data were obtained from the Hospital Information System of the IT Department of the Public Health System (DATASUS) and from the Primary Care Information and Management System. The correlation analysis was performed based on the number, gross and standardized rates, percentages, costs and hospital days of HPCSC and health care coverage (average number of teams) using Spearman's correlation coefficient at a significance level of 5% (p < 0.05). No satisfactory correlation was found in the entire period between the increase in the number of health care teams and HPCSC (except for the standardized hospitalization rate). However, during the period in which the FHS coverage of the population was greater than 70%, all correlations were inversely proportional and statistically significant.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

ABSTRACT Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.