Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas / Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.

Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

Sistemas de notificación de eventos adversos como estrategia para la cultura de calidad y seguridad del paciente / Adverse event reporting systems as a strategy for a culture of quality and patient safety

Introducción: el objetivo de los Sistemas de Notificación de Eventos Adversos, Eventos Centinela y Cuasifallas, es conocer la frecuencia con la que se presentan y generar las estrategias para su disminución y la no repetición de dichos eventos. Se debe informar al personal de salud involucrado en los procesos de atención, principalmente a quienes tienen contacto directo con los pacientes. Desarrollo: se realizó una revisión bibliográfica conceptual y de investigación sobre los sistemas de notificación de eventos adversos. La búsqueda y selección de artículos publicados de 2016 a 2021, fue en la base de datos PubMed y el índice de revistas de acceso abierto Medigraphic, mediante los siguientes criterios de búsqueda en español e inglés: sistemas de notificación, evento adverso, evento centinela, sistema VENCER, Instituto Mexicano del Seguro Social, Secretaría de Salud; así como el uso del operador booleano AND: Notificatión AND adverse event, notification system AND sentinel event, adverse event AND quality plan. Se obtuvo un aproximado de 194 resultados, de los cuales se seleccionaron los artículos que se apegaban al objetivo de esta revisión. Conclusiones: con la presente revisión bibliográfica se muestra que la notificación de los eventos adversos por parte del personal de la salud involucrados en los procesos de atención, adquiere especial relevancia cuando ésta es proporcional a la adquisición de luna cultura de calidad y seguridad en la atención de los pacientes... (AU)

Abstract Introduction: The objective of the Notification Systems for Adverse Events, Sentinel Events and Near Failures is to know the frequency with which they occur and to generate strategies for their reduction and non-repetition of said events. Health personnel involved in the care processes should be informed, mainly those who have direct contact with patients. Development: A conceptual and research literature review on adverse event reporting systems was carried out. The search and selection of articles published from 2016 to 2021 was in the PubMed database and the Medigraphic open access journal index, using the following search criteria in Spanish and English: notification systems, adverse event, sentinel event, VENCER system, Mexican Institute of Social Security, Ministry of Health, as well as the use of the boolean operator AND: Notification AND adverse event, notification system AND sentinel event, adverse event AND quality plan. An approximate of 194 results were obtained, from which the articles that met the objective of this review were selected. Conclusions: This bibliographic review shows that the notification of adverse events by health personnel involved in care processes acquires special relevance when it is proportional to the acquisition of a culture of quality and safety in care. from the patients.

Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil

Abstract Objective: To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. Methods: A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. Results: The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. Conclusions: The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.

Asociación entre la calidad de atención de enfermería percibida y nivel de satisfacción por pacientes hospitalizados / Association between perceived quality of nursing care and level of satisfaction by hospitalized patients

OBJETIVO: El objetivo de este estudio fue determinar la asociación entre la calidad de la atención percibida y el nivel de satisfacción por pacientes hospitalizados en una institución de salud en México. MÉTODO: Se trata de un estudio cuantitativo, descriptivo-correlacional, de corte transversal. La muestra (n=37) se conformó por pacientes hospitalizados en una institución se segundo nivel de atención en Guanajuato. Las variables, calidad percibida de la atención de Enfermería y satisfacción global se midieron utilizando el instrumento de SERVQHOS-E de 17 ítems y dos subescalas (tangibles e intangibles). Los datos se analizaron mediante estadística descriptiva y la prueba Chi-cuadrada de Pearson. El programa SPSS auxilió en el procesamiento de datos. RESULTADOS: El 51% de los participantes se identifican como hombres con una edad promedio de 42.97 años. La Calidad Intangible la calificaron como regular (57%), mientras que la Calidad Tangible como buena (65%). El nivel de satisfacción fue evaluado como Satisfecho (49%) y Muy Satisfecho (51%). Se encontró una asociación entre los factores intangibles con el nivel de satisfacción (p = .015); sin embargo, en los factores tangibles no se encontró asociación (p = .248). CONCLUSIONES: Estos resultados podrían reflejar la formación rigurosa y de calidad de los enfermeros que laboran en esta institución. Sin embargo, también podrían indicar las carencias de la institución en cuanto a equipo tecnológico para brindar mejores servicios de salud.

OBJECTIVE: The aim of this study was to determine the association between the perceived quality of care received and the level of satisfaction of hospitalized patients in Guanajuato, Mexico. METHODS: This is a quantitative, descriptive-correlational, cross-sectional study. The sample (n=37) was made up of patients hospitalized in a second level care institution in Guanajuato, Mexico. The variables, perceived quality of nursing care and overall satisfaction were measured using the SERVQHOS-E instrument with 17 items and two subscales (tangible and intangible). Data were analyzed using descriptive statistics and Pearson's Chi-square test. The SPSS program helped in data processing. RESULTS: 51% of the participants identified themselves as men with an average age of 42.97 years. The Intangible Quality was rated as regular (57%), while the Tangible Quality was good (65%). The level of satisfaction was evaluated as Satisfied (49%) and Very Satisfied (51%). An association was found between the intangible factors with the level of satisfaction (p = 0.015); however, no association was found for tangible factors (p = 0.248). CONCLUSIONS: These results could reflect the rigorous and quality training of the nurses who work in this institution. However, they could also indicate the institution's shortcomings in terms of technological equipment to provide better health services.

Determinants of Health-Related Quality of Life among Post-Partum Women Residing in a Resettlement Colony of East Delhi.

Abstract: The postpartum period marks a transition phase in the life of the mother as well as the whole family. Health Related Quality of Life (HRQoL) is an important aspect for not only mother’s physical and psychological health. The study was conducted in a resettlement colony, Kalyanpuri located in Delhi, India with a sample size of 330 post-partum women and the data was collected in the 6th week of post-partum period using the MOS SF-36 (Medical Outcomes Study Short Form 36 Health Survey) for health related quality of life. Among the study subjects, 34.2% had the birth order two and they showed the best mean HRQoL score. The mean score was low for the study subjects with complications in the antepartum, intrapartum and postpartum period (52.9 ± 18.4) as well as in foetal complications where the intrapartum period complications had the worst mean HRQoL score. Healthcare workers of the study area visited 91.5% of the subjects during the post-partum period and had better HRQoL mean score. Also, 22.4% subjects had history of mistreatment and abuse with decline in the mean HRQoL scores. Across the study subjects, 54.4% had financial hardships faced by their family members which had poor HRQoL mean scores. This study uncovered various horizons of health related quality of life for assessment of women in the post-partum period which emphasised the modifications and considerations to include quality as one of the determinant and indicator of health.

(Ine)quality in Healthcare: a perspective from the accreditation of clinical laboratories in Costa Rica / (Ine)quidades en la calidad de la atención sanitaria: perspectiva de la acreditación de laboratorios clínicos en Costa Rica

Abstract Introduction: Given the relevance of quality-assured laboratory services for health system strengthening and improvement, this study had the objective of exploring the distribution of ISO 15189-accredited and non-accredited laboratories in Costa Rica, in order to identify possible gaps in the fulfillment of its commitment to provide quality healthcare for all.Methods: Our research was conducted with a descriptive scope and following a quantitative approach. Costa Ricas Accreditation Body and College of Microbiologists databases were searched to collect data regarding clinical laboratory registration and ISO 15189 accreditation status. Laboratory availability indicators by geographical division were computed with this data.Results: Out of 480 clinical laboratories allowed to operate in Costa Rica as of January 2021, only 5 (about 1%) have been accredited in compliance with ISO 15189, all of which are private and located in the province of San José. Also, laboratory density (in terms of facilities per 100 km2 and per 100 000 population) is heterogeneous among provinces. Clinical laboratory services are more easily available in central provinces of the country (e.g. San José and Heredia), where ratios for laboratory density are higher. On the contrary, coastal provinces such as Limón and Puntarenas exhibit low laboratory density ratios, reflecting geographical disparities in access to healthcare.Conclusions: Geographic disparities in the access to clinical laboratory services were observed. This should raise awareness among public health authorities and private healthcare providers regarding the countrys progress in attaining its quality healthcare for all commitment.

Resumen Introducción: Dada la relevancia de asegurar la calidad en los servicios de laboratorio para el fortalecimiento de los sistemas de salud, este estudio tuvo como objetivo explorar la distribución de laboratorios acreditados con ISO 15189 en Costa Rica, buscando identificar posibles brechas en el cumplimiento del compromiso país de brindar atención sanitaria de calidad para todos. Metodología: Se realizó una investigación con alcance descriptivo, siguiendo un enfoque cuantitativo. Se exploraron las bases de datos del Ente Costarricense de Acreditación y del Colegio de Microbiólogos de Costa Rica para recopilar datos sobre el registro y estado de acreditación de laboratorios clínicos. Con estos datos, se calcularon indicadores de densidad de laboratorios por división geográfica. Resultados: De los 480 laboratorios clínicos autorizados para operar en Costa Rica a enero 2021, solo 5 (aproximadamente un 1%) están acreditados por ISO 15189; todos ellos son privados y se ubican en la provincia de San José. Además, hay heterogeneidad entre provincias en cuanto a la densidad de laboratorios (establecimientos por 100 km2 y por 100 000 habitantes). Los servicios de laboratorio clínico están más fácilmente disponibles en provincias "centrales" del país (como San José y Heredia). Por el contrario, provincias costeras como Limón y Puntarenas exhiben bajas densidades de laboratorios, lo que refleja desigualdades en el acceso a la atención en salud. Conclusiones: Se observaron disparidades geográficas en el acceso a los servicios de laboratorio clínico. Esto debería crear conciencia entre los proveedores de salud públicos y privados sobre el progreso del país en el cumplimiento de su compromiso de "atención sanitaria de calidad para todos".

Indicadores de evaluación de los registros clínicos de enfermería: Implementación de una herramienta tecnológica / Evaluation indicators of nursing clinical records: Implementation of a technological tool

Resumen Objetivo: Implementar una herramienta tecnológica que facilite la evaluación de los registros clínicos de enfermería con indicadores aplicados a cada fase del proceso de atención, comparado con estándares establecidos en seis áreas de atención en un hospital público del estado de Tabasco. Materiales y Métodos: La investigación es cuantitativa, diseño no experimental, tipo descriptivo y transversal, la población de 145,022 registros clínicos de enfermería y la muestra de 384 pacientes de seis áreas de hospitalización y urgencias del Hospital Regional de Alta Especialidad "Dr. Gustavo A. Rovirosa Pérez", la recolección de datos se llevó a cabo de enero-diciembre de 2018, por medio de un instrumento integrado por seis indicadores, para analizar la calidad aplicada a cada una de las fases del proceso enfermero, identificación, valoración, diagnósticos NANDA, intervenciones NIC, evaluación de resultados NOC, y la integridad de la información; los datos fueron procesados por medio de una herramienta tecnológica previamente diseñada. Resultados: La muestra total de registros clínicos presentó un cumplimiento de 81.2% que corresponde a un estándar de regular calidad y de forma específica: los servicios de pediatría 86.5%, medicina interna 85.9%, ginecología y obstetricia 82.8%, traumatología 80.6% y cirugía general 80.3% que corresponde a regular calidad. En el servicio de urgencias los registros son deficientes 70.9%. Los indicadores que presentan menor calidad fueron: el registro de la etiqueta diagnóstica 67% y las intervenciones de enfermería 66%. La principal falla fue la omisión de datos al momento de documentar. Conclusiones: Los registros clínicos presentaron regular calidad, se evidencia que no se cumple de forma completa con las anotaciones del quehacer profesional sustentado en el proceso enfermero, la seguridad del paciente, y la importancia de la evaluación de la calidad con un instrumento tecnológico para la mejora continua.

Abstract Objective: Implement a technological tool that facilitates the evaluation of clinical nursing records with indicators applied to each phase of the care process, compared with standards established in six areas of care in a public hospital in the state of Tabasco. Materials and Methods: The quantitative research, non-experimental design, descriptive and cross-sectional type, the population of 145,022 nursing clinical records and the sample of 384 patients from six hospitalization and emergency areas of the Hospital Regional de Alta Especialidad "Dr. Gustavo A. Rovirosa Pérez ", the data collection was carried out from January-December 2018, by means of an instrument composed of six indicators to analyze the quality applied to each of the phases of the nursing process, identification, assessment, NANDA diagnostics, NIC interventions, evaluation of NOC results, and the integrity of the information, the data were processed by means of a previously designed technological tool. Results: The total sample of nursing clinical records presented a compliance of 81.2% that corresponds to a standard of regular quality and specifically the services of pediatrics 86.5%, internal medicine 85.9%, gynecology and obstetrics 82.8%, traumatology 80.6% and general surgery 80.3% corresponding to regular quality. In the emergency service, the records are deficient 70.9%. The indicators with the lowest quality were the registration of the diagnostic label 67% and the nursing interventions 66%. The main flaw was the omission of data at the time of documenting. Conclusions: The clinical records presented regular quality, it is evident that the annotations of the professional work supported by the nursing process, patient safety, and the importance of quality evaluation with a technological instrument for the continuous improvement.

Implementación de un diseño curricular basado en competencias sobre seguridad y calidad asistencial / Implementation of Curricular Design Based on Healthcare Safety and Quality Competences

Introducción: La formación en seguridad asistencial es esencial para incrementar la calidad de la atención en enfermería. Objetivo: Evaluar el grado de cumplimiento en la implementación de un diseño curricular basado competencias en seguridad y calidad asistencial en la Escuela de Enfermería Universidad Finis Terrae. Métodos: Estudio mixto de tipo secuencial exploratorio realizado el año 2016. Se efectuó un análisis de contenido cualitativo de los perfiles de egreso de 38 Escuelas de Enfermería en Chile y 35 programas de estudio de la Escuela de Enfermería Universidad Finis Terrae. Posteriormente, se realizó un estudio descriptivo cuantitativo en 29 docentes y tres coordinadoras de asignatura seleccionados de forma intencional. Se utilizaron métodos estadísticos descriptivos, análisis cualitativos y dos niveles de triangulación de datos. Resultados: Seis escuelas de enfermería chilenas declararon conceptos relacionados a la seguridad y calidad asistencial. Referente a los programas de la institución estudiada, todos tienen incorporadas competencias asociadas a seguridad asistencial. En consideración a los resultados sobre la enseñanza de seguridad asistencial, el promedio obtenido fue alto (58,793; DS=9,217). La subvariable con mayor ponderación fue la conducta ética (9,1) y la de menor ponderación fue trabajo seguro (6,7). En las entrevistas semiestructuradas, la mayoría de coordinadoras consideraron la calidad asistencial como lo más importante. Conclusiones: El grado de cumplimiento de la implementación del diseño curricular orientado hacia el desarrollo de competencias en seguridad y calidad asistencial es alto. Sin embargo, el grado de importancia otorgado a los temas sobre seguridad y calidad asistencial fue diferente entre docentes y coordinadores(AU)

Introduction: Healthcare safety training is essential to increase the quality of nursing care. Objective: To assess the degree of compliance in the implementation of a curricular design based on safety and quality of care competences at the School of Nursing of Finis Terrae University. Methods: Mixed study of exploratory and sequential type carried out in 2016. A qualitative content analysis was carried out of the graduation profiles of 38 nursing schools in Chile and 35 study programs of the School of Nursing of Finis Terrae University. Subsequently, a quantitative descriptive study was carried out with 29 professors and three intentionally selected subject coordinators. Descriptive statistical methods, qualitative analysis and two levels of data triangulation were used. Results: Six Chilean nursing schools declared concepts related to safety and quality of care. Regarding the programs of the institution studied, all include competences associated with healthcare safety. Concerning the results about teaching of healthcare safety, the average obtained was high (58.793; SD=9,217). The subvariable with the highest weighting was ethical conduct (9.1) and the one with the lowest weighting was safe work (6.7). In the semistructured interviews, the majority of the coordinators considered quality of care as the most important element. Conclusions: The degree of compliance with the implementation of the curricular design oriented towards the development safety and quality of care competences is high. However, the degree of importance given to safety and quality of care issues was different between teachers and coordinators(AU)

Gestión por procesos y la referenciación competitiva para la mejora de la calidad de la atención / Process Management and Benchmarking for Improving Quality of Care

Introducción: La calidad es un elemento estratégico que incide en la transformación y mejora de los sistemas sanitarios. Dado su carácter continuo es necesario visualizar y asumir enfoques efectivos para su mejora, como son la gestión por procesos y la referenciación competitiva. Objetivo: Identificar las tendencias de aplicación de la gestión por procesos y la referenciación competitiva en la mejora de la calidad de la atención. Métodos: Metarevisión de artículos de segunda generación del conocimiento, de los años 2014-2020. Se utilizaron las palabras clave "gestión por procesos", "referenciación competitiva", "benchmarking", "benchmarking AND gestión por procesos" y "referenciación competitiva AND gestión por procesos". Los criterios de inclusión para la selección de los artículos fueron: artículos originales publicados a textos completos en inglés, portugués y español, disponible en sitios especializados en áreas de gerencia, revistas electrónicas administración y gestión sanitaria y revistas científicas de calidad en salud. Conclusiones: La revisión realizada mostró escasa literatura que integre la gestión por procesos y la referenciación competitiva para la mejora de la calidad, sin embargo, se identificaron ejemplos de su aplicación de forma independiente. La aplicación de estas tecnologías por los profesionales de enfermería evidenció algunas reservas de mejora que permiten futuras aplicaciones en diversas áreas de práctica de estos profesionales(AU)

Introduction: Quality is a strategic element with an incidence in the transformation and improvement of health systems. Given its continuous nature, it is necessary to visualize and assume effective approaches for its improvement, such as process management and benchmarking. Objective: Identify the application trends of process management and benchmarking in improving quality of care. Methods: Metareview of articles from the second generation of knowledge and published from 2014 to 2020. The following keywords were used: gestión de procesos [process management], referenciación competitiva [benchmarking], benchmarking, benchmarking AND gestión de procesos [benchmarking and process management] and referenciación competitiva AND gestión de procesos [benchmarking AND process management]. The following inclusion criteria were considered for the selection of the articles: original articles published in full texts in English, Portuguese and Spanish; as well as available on sites specialized in management areas, electronic journals on health administration and management, and journals on health quality. Conclusions: The review carried out showed little literature integrating process management and benchmarking for quality improvement; however, examples of their application were identified independently. The application of these technologies by nursing professionals showed some involvement for improvement that allow future applications in several areas of performance by these professionals(AU)

Characterize the main adverse events with harm reported in a Teaching Hospital in Minas Gerais

Background and Objectives: adverse events are a major public health problem. The purpose of the study was to characterize the main adverse events with harm reported in a teaching hospital in Minas Gerais. Methods: this is a retrospective cross-sectional descriptive study with quantitative approach, which assessed the reports on adverse events, carried out between January 2015 and December 2018. Pearson's chi-square test was applied in order to verify the association between categorical variables. Cramer's measure V was calculated to assess the degree of association between the respective variables. In the observation of statistically significant results, the Z test was applied to compare proportions with adjustments by the Bonferroni method. Results: a total of 445 adverse events were reported, being the highest number in 2018 (61.8%) involving "Abrasion and friction" process (44.7%), which correspond to grades 3 and 4 pressure injuries. Most adverse events were reported by the Emergency Unit (29.2%), and serious harm (7.6%) and deaths (1.3%) were more prevalent in this place. There was a statistically significant association between types of harm and types of incidents (p<0.001), types of harm (p<0.001) and years of occurrence, and also between the harm and the hospital sectors (p=0.003). Conclusion: adverse event reports back institutional risk management by strengthening the patient safety culture.(AU)

Factores predictores de satisfacción de pacientes en consulta externa pediátrica del Hospital El Cruce Néstor Kirchner / Predictive variables of patient satisfaction in the pediatric outpatient clinic of El Cruce-Néstor Kirchner Hospital

INTRODUCCIÓN: El papel de los pacientes en los sistemas sanitarios es cada vez más relevante. Su satisfacción aparece como uno de los principales indicadores al evaluar la gestión sanitaria y la calidad asistencial. El objetivo del estudio fue determinar variables predictoras de satisfacción con la atención médica en la consulta externa pediátrica del Hospital El Cruce-Néstor Kirchner. MÉTODOS: Se realizó un estudio de corte transversal. Se incluyó a pacientes en edad pediátrica que concurrieron al Hospital a partir de junio de 2018. Se completaron encuestas CAHPS (Consumer Assessment of Healthcare Providers and Systems) después de la visita. Se utilizó test de Kruskal-Wallis para comparar distribución de cada variable predictora; para variables independientes categóricas, se realizó tabla n x p buscando significancia por test de chi cuadrado ajustada por número de comparaciones y chi cuadrado de tendencia lineal buscando asociación entre categorías predictoras ordenadas y variable respuesta. RESULTADOS: Un total de 423 personas respondieron el cuestionario; 368 eran mujeres, 390/415 eran padre o madre. La mayoría estaba conforme; sólo 3 asignaron puntajes menores a 7 (mínimo 0, máximo 10). Ninguna de las variables predictoras analizadas se asoció significativamente con peor evaluación del profesional y satisfacción con la atención. DISCUSIÓN: Hay un alto grado de satisfacción con la atención. Los motivos podrían ser abordados en profundidad mediante estudios cualitativos.

Predictive variables of patient satisfaction in the pediatric üutpatíent clinic of El Cruce-Néstor Kirchner Hospital / Factores predictores de satisfacción de pacientes en consulta externa pediátrica del hospital el cruce-nestor kirchner

RESUMEN INTRODUCCIÓN : El papel de los pacientes en los sistemas sanitarios es cada vez más relevante. Su satisfacción aparece como uno de los principales indicadores al evaluar la gestión sanitaria y la calidad asistencial. El objetivo del estudio fue determinar variables predictoras de satisfacción con la atención médica en la consulta externa pediátrica del Hospital El Cruce-Néstor Kirchner. MÉTODOS : Se realizó un estudio de corte transversal. Se incluyó a pacientes en edad pediátrica que concurrieron al Hospital a partir de junio de 2018. Se completaron encuestas CAHPS (Consumer Assessment of Healthcare Providers and Systems) después de la visita. Se utilizó test de Kruskal-Wallis para comparar distribución de cada variable predictora; para variables independientes categóricas, se realizó tabla n x p buscando significancia por test de chi cuadrado ajustada por número de comparaciones y chi cuadrado de tendencia lineal buscando asociación entre categorías predictoras ordenadas y variable respuesta. RESULTADOS : Un total de 423 personas respondieron el cuestionario; 368 eran mujeres, 390/415 eran padre o madre. La mayoría estaba conforme; sólo 3 asignaron puntajes menores a 7 (mínimo 0, máximo 10). Ninguna de las variables predictoras analizadas se asoció significativamente con peor evaluación del profesional y satisfacción con la atención. DISCUSIÓN : Hay un alto grado de satisfacción con la atención. Los motivos podrían ser abordados en profundidad mediante estudios cualitativos.

ABSTRACT INTRODUCTION : The role of patients in health systems is increasingly relevant. Their satisfaction appears as one of the main indicators to evaluate health management and quality of care. The objective of the study was to determine predictive variables of satisfaction with medical care in the pediatric outpatient clinic of El Cruce Néstor Kirchner Hospital. METHODS : A cross-sectional study was conducted. It included pediatric patients who attended the Hospital since June 2018. Post-visit CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys were completed. Kruskal-Wallis test was used to compare the distribution of each predictor variable; for categorical independent variables, n x p table was performed looking for significance by chi-square test adjusted for number of comparisons and chisquare of linear trend looking for association between ordered predictor categories and response variable. RESULTS : A total of 423 people answered the questionnaire; 368 were female, 390/415 were father or mother. Most respondents reported being satisfied; only 3 of them assigned scores lower than 7 (minimum 0, maximum 10). None of the predictive variables analyzed were significantly associated with worse evaluation of professionals and satisfaction with care. DISCUSSION : There is a high level of satisfaction with the attention. Qualitative studies would help to thoroughly explain the reasons.

Categorización de la atención fonoaudiológica: una propuesta para adultos en contexto hospitalario / Categorizing speech-language pathology attention: a proposal for adults inpatient

Existe la necesidad de desarrollar herramientas que demuestren el impacto de la intervención fonoaudiológica en el ámbito hospitalario, lo que exige implementar modelos asistenciales y de gestión, que favorezcan la demanda clínica y la eficiencia de los procesos y de los equipos. Diversas profesiones del área sanitaria han empleado modelos de categorización de la atención que, junto con satisfacer las demandas de los pacientes, traducen las actividades de su disciplina en términos de gestión. Actualmente, en el ámbito fonoaudiológico no se cuenta con herramientas de este tipo que permitan determinar la cantidad de atenciones necesarias para una persona en contexto hospitalario. Debido a lo anterior, en el artículo se presenta la creación, desarrollo y aplicación de una matriz cuali-cuantitativa. El objetivo de la matriz es valorar y estandarizar la carga de trabajo fonoaudiológico requerido para cada paciente adulto hospitalizado, considerando su contexto clínico global. Esta matriz de categorización considera cinco variables clínicas evaluadas durante la rehabilitación del paciente y cuatro calificadores en relación con el orden de severidad. Se establecen y proponen diferentes categorías de atención que entregan una carga terapéutica recomendada (desde 1 a 2 atenciones semanales en casos leves hasta 2 atenciones diarias en casos complejos). Finalmente, se discute su uso y los beneficios de su implementación como una herramienta que permite optimizar procesos de gestión, determinar brechas y justificar la inclusión de nuevos fonoaudiólogos en el contexto hospitalario.

There is a need to develop tools that demonstrate the impact of speech therapy intervention in the hospital setting, which requires the implementation of care and management models that favor clinical demand and efficiency of processes and equipment. Various professions in the health area have used categorization models that, along with satisfying the demands of patients, translate the activities of their discipline into management terms. Currently, in the speech therapy field, there are no tools of this kind available that allow determining the amount of care necessary for a person in a hospital context. Due to the above circumstances, this article presents the creation, development and application of a qualitative-quantitative matrix. The objective of the matrix is to assess and standardize the speech therapy workload required for each hospitalized adult patient, considering their global clinical context. This categorization matrix considers five clinical variables evaluated during the patient's rehabilitation and four qualifiers in relation to the order of severity. Different categories of care that deliver a recommended therapeutic load (from 1 to 2 weekly visits in mild cases to 2 daily visits in complex cases) are established and proposed. Finally, their use and the benefits of their implementation are discussed as a tool that allows optimizing management processes, determining gaps and justifying the inclusion of new speech therapists in the hospital context.

Análisis de parámetros de calidad y de costos, de uso del catéter venoso central de inserción periférica frente al catéter de inserción central, en población pediátrica del Hospital Universitario del Valle, Cali, Colombia. 2011-2014 / Analysis of quality parameters and costs of using the central venous catheter of peripheral insertion versus the central insertion catheter in pediatric patients at Hospital Univeristario Del Valle, Cali Colombia 2011-2014

Objetivo: estimar parámetros de calidad y de costos en el procedimiento de inserción de Catéter Venoso Central y el Catéter Venoso Central de inserción periférica. Metodología: Se evaluaron las historias de niños (edad 31 días -15 años ), que ingresaron al Hospital Universitario del Valle, entre enero de 2011 y diciembre de 2014, que requirieron canalización de una vena central. Se evaluaron variables demográficas, de calidad y se estimaron costos de ambos procedimientos. Resultados: Se evaluaron 100 procedimientos de inserción Central y 100 de inserción periférica, los últimos tuvieron menor tiempo de espera, se realizaron en la habitación, no requirieron ayuno, ni traslado al quirófano, a un menor costo, lo cual impactó la oportunidad de administración de tratamiento farmacológico, la evolución y la estancia hospitalaria. Conclusiones: Se recomienda que el procedimiento de inserción periférica sea la primera elección en niños que requieran tratamientos endovenosos mayores a cinco días, para esto es necesario conformar un grupo que supervise el funcionamiento de los catéteres y brinde educación continua al personal de salud de los servicios de hospitalización y a familiares, contar con una sala de procedimiento para la inserción del PICC que brinde seguridad y adecuado manejo del dolor.

Aim: to estimate quality and cost parameters of central venous catheter insertion peripheral and central venous catheter procedures. Methods: we reviewed records of 200 children (31 days - years old), hospitalised at a University Hospital between January 2011 and December 2014 who required central vein access. We assessed demographic, quality variables and cost of both procedures. Results: we reviewed records of 100 central insertion and 100 peripheral insertion procedures. Peripheral insertions had less waiting time, were conducted next to the child's bed, without need for fasting or transfering to the operating room, at a lower cost, all of these ensured timely administration of medicaments and nutrition, which resulted in lower stance time. The peripheral insertion also freed surgeon and operating room time to perform other interventions. Conclusions: We recommend that peripheral insertion procedure should be the first choice in children requiring intravenous treatments longer than five days. In order to establish a periferal insertion procedure in a hospital, a team is required to follow-up the patients and provide continuing education to health personnel in services and to family members, there is also a need for an appropiate space for insertion procedures and pain management.

La condición indígena en los servicios de salud: comparación de la calidad en la atención 2012-2018 para la población en pobreza / Indigenous condition in health services: comparison of quality of care 2012-2018 for poor population

Resumen: Objetivo: Comparar la percepción de la calidad de atención ambulatoria de servicios de salud en 2012 y 2018, por condición indígena y no indígena. Material y métodos. Con información de dos encuestas poblacionales (Encuesta Nacional de Salud y Nutrición [Ensanut] 2012 y Ensanut 100k) se analizó la calidad de atención con indicadores de estructura, proceso, resultado en salud y satisfacción. Resultados: Entre 2012 y 2018 aumentó la utilización de servicios privados, disminuyó la buena opinión sobre las condiciones del lugar y la percepción de tiempo de espera corto para utilizadores no indígenas. Para servicios públicos se mantuvo alto el surtimiento de medicamentos, disminuyó la realización de estudios de laboratorio y gabinete en la unidad de atención y la explicación del tratamiento farmacológico principalmente en no indígenas. La percepción de mejoría y la satisfacción fue buena. Conclusión: Es prioritario un modelo de atención ambulatoria acorde con las necesidades y expectativas de la población más vulnerable y, principalmente, indígena.

Abstract: Objective: To compare the perception of the quality of ambulatory care in users of health services in 2012 and 2018, by indigenous and non-indigenous condition. Materials and methods: With information from two population surveys (Encuesta Nacional de Salud y Nutrición [Ensanut] 2012 and Ensanut 100k) the quality of care was analyzed based on indicators of structure, process, health outcome and care satisfaction. Results: Between 2012 and 2018, the use of private health services increased; favorable opinion about the conditions of the site, and perception of short waiting times decreased among non-indigenous people. In public health services, the supply of medicines remained high, the laboratory and Rx tests in the same care unit and pharmacology treatment explanation decreased, particularly among non-indigenous patients. Perception of health improvement and satisfaction of care was adequate. Conclusion: An ambulatory care model aimed to response needs and expectations of the most vulnerable population, mainly the indigenous population, is a priority.

Factores asociados a la calidad de la atención prenatal en Perú / Factors associated with the quality of prenatal care in Peru

RESUMEN Objetivo. Estimar la proporción de mujeres peruanas que recibieron un control prenatal (CPN) de calidad para el último parto de los últimos cinco años y determinar sus factores asociados. Materiales y métodos. Estudio transversal analítico de la Encuesta Demográfica y de Salud Familiar 2017. Se calculó la proporción de CPN de calidad según número de CPN. Se estimaron razones de prevalencia crudas y ajustadas (RPa) de presentar un CPN de calidad. Resultados. Se analizaron datos de 18 156 mujeres, el 56,1% recibió un CPN de calidad. Recibir más CPN incrementó la probabilidad de recibir un CPN de calidad (49,6% y 59,9% para seis y ocho controles, respectivamente). Ser de la sierra (RPa=0,85; IC 95%: 0,80-0,91), vivir en la zona rural (RPa=0,94; IC 95%: 0,89-0,99) y pertenecer a una etnia nativa (RPa=0,72; IC 95%: 0,66-0,79) se asoció con un menor probabilidad de recibir un CPN de calidad. Tener educación secundaria (RPa=1,16; IC 95%: 1,10-1,22) y superior (RPa=1,15; IC 95%: 1,07-1,23), ser del quintil de riqueza 2 (RPa=1,15; IC 95%: 1,08-1,22), quintil 3 (RPa=1,18; IC 95%: 1,09-1,27), quintil 4 (RPa=1,16; IC 95%: 1,07-1,26) y quintil 5 (RPa=1,16; IC 95%: 1,05-1,28), ser del resto de la Costa (RPa=1,06; IC 95%: 1,00-1,12) y Selva (RPa=1,31; IC 95%: 1,24-1,39), tener una afiliación a un seguro de salud (RPa=1,24; IC 95%: 1,18-1,30), orden de nacimiento 2 a 3 (RPa=1,10; IC 95%:1,06-1,15) o ≥4 (RPa = 1,20; IC 95%:1,14-1,27) y haber recibido un CPN en el primer trimestre (RPa=1,20; IC 95%: 1,14-1,26) se relacionaba a una mayor probabilidad de recibir un CPN de calidad. Conclusiones. Cuatro de cada diez mujeres no recibieron un CPN de calidad. Ser mujer de etnia nativa o de la sierra o zona rural estuvo asociado a una mala calidad del CPN, requiriéndose priorización de estos grupos en las estrategias de salud materna.

ABSTRACT Objective . To estimate the proportion of Peruvian women who received quality prenatal care (PNC) for their last childbirth in the last five years and to determine its associated factors. Materials and Methods. Analytical cross-sectional study of the 2017 Demographic and Family Health Survey. The proportion of quality PNC was calculated based on the number of PNC control visits. Bivariate and adjusted prevalence ratios (PRa) of quality PNC were estimated. Results. Data from 18,156 women were analyzed; 56.1% received quality PNC. Receiving more PNC visits increased the likelihood of receiving quality PNC (49.6% and 59.9% for six and eight control visits, respectively). Being from the highlands (PRa=0.85; 95% CI: 0.80-0.91), living in rural areas (PRa=0.94; 95% CI: 0.89-0.99), and belonging to a native ethnic group (PRa=0.72; 95% CI: 0.66-0.79) was associated with a lower likelihood of receiving quality PNC. Having completed high-school (PRa=1.16; 95% CI: 1.10-1.22) and higher education (PRa=1.15; 95% CI: 1.07-1.23), being from the 2nd wealth quintile (PRa=1.15; 95% CI: 1.08-1.22), 3rd quintile (PRa=1.18; 95% CI: 1.09-1.27), 4th quintile (PRa=1.16; 95% CI: 1.07-1.26), and 5th quintile (PRa=1.16; 95% CI: 1.05-1.28); being from the rest of the Coast (PRa=1.06; 95% CI: 1.00-1.12) and Jungle (PRa=1.31; 95% CI: 1.24-1.39); being enrolled in health insurance (PRa=1.24; 95% CI: 1.18-1.30); birth order 2-3 (PRa=1.10; 95% CI: 1.06-1.15) or ≥4 (PRa=1.20; 95% CI: 1.14-1.27), and having received PNC in the first trimester (PRa=1.20, 95% CI: 1.14-1.26) was related to an increased likelihood of receiving quality PNC. Conclusions . Four out of ten women did not receive quality PNC, especially in women of native ethnicity or residents of the highlands or rural areas, groups that would require prioritization in maternal health strategies.

A percepção da gestante sobre a qualidade do atendimento pré-natal em UBS, Campo Grande, MS / Pregnant women perception of the quality of prenatal care at UBS, Campo Grande, MS / La Percepción de la mujer embarazada acerca de la calidad de la atención prenatal en UBS, Campo Grande, MS

A assistência pré-natal tem o intuito de identificar aquelas pacientes com mais probabilidade de apresentar evolução desfavorável e acolher a mulher desde o princípio de sua gestação. O objetivo foi contribuir para a melhoria da qualidade do atendimento pré-natal nas unidades básicas de saúde (UBSs) do município de Campo Grande, MS, construindo saberes segundo a percepção da gestante. Tratou-se de um estudo descritivo exploratório de natureza qualitativa. A coleta de dados foi realizada por meio de entrevista estruturada aberta. Para analisar os resultados, o estudo foi dividido em cinco categorias temáticas, as quais demonstraram o entendimento, a opinião e os sentimentos das gestantes. Por fim, percebeu-se que para a assistência pré-natal ser de qualidade, é necessário que os profissionais e as gestantes caminhem juntos. Os profissionais precisam criar meios para que as gestantes não deixem de realizar consultas e elas podem esclarecer suas dúvidas, não existindo barreiras que atrapalhem essa comunicação.

Prenatal care assistance aims to identify those patients with a greater likelihood of unfavorable developments, and to welcome the woman from the beginning of her pregnancy. The goal was to contribute to the improvement of the quality of prenatal care in the Units of Basic Health (UBS) in the municipality of Campo Grande, MS, building knowledge from the perception of pregnant women. This is a descriptive exploratory qualitative study. Data collection was conducted through open structured interviews. The study was divided into five thematic categories, which demonstrate the understanding, opinions and feelings of pregnant women. Finally, we realized that the quality of prenatal care requires that professionals and the pregnant women to work together. Professionals need to engage the commitment of these pregnant women to their appointments, and pregnant women need the chance to have their questions answered without communication barriers.

La atención prenatal tiene la intención de identificar a aquellas pacientes con mayor probabilidad de presentar una evolución desfavorable, y de acoger a las mujeres desde el comienzo de su gestación. El objetivo fue contribuir a mejorar la calidad de la atención prenatal en las Unidades de Salud Básicas (UBS) del municipio de Campo Grande, MS, construyendo el conocimiento a partir de la percepción de la mujer embarazada. Estudio descriptivo exploratorio de naturaleza cualitativa. La recolección de datos se realizó mediante entrevistas de estructura abierta. Para analizar los resultados el estudio se dividió en cinco categorías temáticas, que mostraron la comprensión, opinión y sentimientos de las mujeres embarazadas. Por último, se señala que para que la atención prenatal sea de calidad es necesario que los profesionales y las mujeres embarazadas caminen juntos. Los profesionales necesitan crear medios para que estas mujeres embarazadas no dejen de realizar consultas y puedan clarificar sus dudas, sin barreras que obstaculicen esta comunicación.

Special Health Care Needs – Dentist Perception in Hyderabad, Telangana State

In the practice of dentistry we come across patients who need to be attended with special care as they disabled. Treating such patients require knowledge and expertise to manage them with utmost care. Aim: The study aimed to explore dentists’ perception and level of satisfaction with their dental education in preparing them to provide care to patients with special health care needs. Methods: This was a cross-sectional study. Study participants were dentists working in clinics in Hyderabad city, Telangana state. Results: Dentists reported good amount of confidence in caring for patients with special health care needs. A relationship existed between the quality of dental education and the dentists’ perception of their patient care. A great proportion of respondents were willing to attain educational activities to enhance their knowledge and skills. Conclusion: There is a need to organize extensive programs on management of patients who need special health care services. However the level of perception and the confidence to treat such patients among the dentists belonging to Hyderabad city is satisfactory.

Qualidade do cuidado à saúde das pessoas com diabetes mellitus tipo 2 assistidas na Estratégia Saúde da Família do município do Rio de Janeiro / Quality of health care for people with type 2 diabetes mellitus assisted by the Family Health Strategy in the city of Rio de Janeiro

Esta tese procurou analisar a qualidade do cuidado à saúde prestado às pessoas com diabetes mellitus tipo 2 pelas equipes da estratégia de saúde da família no município do Rio de Janeiro. Teve como objetivos descrever a ocorrência de internação por diabetes mellitus entre os anos de 2010 a 2015 segundo bairros de residência dos pacientes por meio de estudo ecológico e avaliar na perspectiva das pessoas com diabetes mellitus tipo 2 a qualidade do cuidado prestado pelos profissionais. Para investigar a relação entre internações por diabetes e condições de vida da população, calcularam-se indicadores demográficos, socioeconômicos e ambientais a partir do local de residência. A taxa média de internação por diabetes mellitus no período foi de 20,5 internações por 10 mil habitantes, sendo mais elevada entre pacientes do sexo masculino (23,0 por 10 mil) em comparação ao feminino (18,4 por 10 mil). A região Centro apresentou mais situações de vulnerabilidades sociais e ambientais e maior taxa de internação comparada às demais regiões. A análise de variância mostrou diferenças no que se refere às características sociodemográficas e ambientais que afetam as condições de vida e saúde em todas as regiões. Para alcance do segundo objetivo realizou-se inquérito com 451 pessoas com diagnóstico de Diabetes Mellitus 2, assistidas por equipes de Saúde da Família da área programática 2.1. Utilizou-se o Patient Assessment of Chronic Illness para investigar sobre o atendimento recebido e um formulário com variáveis socioeconômicas, condições clínicas, medidas antropométricas e exames laboratoriais para complementação de informações sobre a saúde dos participantes. Os resultados mostraram que 64% da amostra possuíam 60 anos ou mais, 52,1% se autodeclararam pardos, 62,6% possuíam ensino fundamental, 53,4% informaram ser casados/em união, 50,7% eram naturais do Rio de Janeiro. A ausência de informação de medidas antropométricas foi identificada em 50,8% dos prontuários e ausência de resultados de Urina I foi em 46,3%. A qualidade do cuidado prestado pelas equipes obteve a média de 2,5 (± 1,2 DP) e mediana de 2,3, resultado abaixo do ponto de corte 3,0, estabelecido para determinar cuidados à saúde consistentes e direcionados melhores práticas na gestão das condições crônicas. As dimensões do PACIC que apresentaram os piores resultados foram "Ativação do paciente" e "Coordenação do cuidado", com 2,0 e 1,9, respectivamente. Concluiu-se que o manejo das pessoas com diabetes mellitus tipo 2 realizado pelos profissionais das equipes, não está centrado em suas necessidades. É importante que as práticas profissionais sejam revistas, com oportunidade de ouvir as pessoas, espaço para que expressem suas necessidades e que se construam planos de cuidado mais adequados às condições de vida, tirando-as da dependência por consultas que não impactam em seu quadro clínico. É importante destacar que para o êxito de um bom plano terapêutico, a disponibilidade em ouvir, em receber, em orientar e pactuar com a pessoa os detalhes de suas ações de cuidado pode favorecer a autonomia, o vínculo e a melhora da capacidade de gerenciar cuidados individuais e coletivos com efetivos ganhos em saúde, controle glicêmico e diminuição das complicações.

This thesis aims to analyze the quality of health care provided to people with type 2 diabetes mellitus by the teams of the family health strategy in the city of Rio de Janeiro. It objectives to describe the incidence of hospitalization for diabetes mellitus between the years 2010 to 2015 according to neighborhoods of residence of patients through ecological study and to evaluate the quality of care provided by professionals from the perspective of people with type 2 diabetes mellitus. To investigate the relationship between hospitalizations for diabetes and the population's living conditions, demographic, socioeconomic and environmental indicators were calculated from the place of residence. The average rate of hospitalization for diabetes mellitus in the period was 20.5 hospitalizations per 10,000 inhabitants, being higher among male patients (23.0 per 10,000) compared to female patients (18.4 per 10,000). The Center region presented more situations of social and environmental vulnerabilities and a higher rate of hospitalization compared to the other regions. The analysis of variance showed differences with regard to sociodemographic and environmental characteristics that affect living and health conditions in all regions. To reach the second objective, a survey was carried out with 451 people diagnosed with diabetes mellitus 2, assisted by Family Health teams from Catchment Area 2.1. The Patient Assessment of Chronic Illness Care (PACIC) was used to investigate the care received and a form with socioeconomic variables, clinical conditions, anthropometric measurements and laboratory tests to complement information on the health of the participants. The results showed that 64% of the sample were 60 years old or older, 52.1% declared themselves to be brown, 62.6% had elementary school, 53.4% reported being married / in union, 50.7% were born in Rio de Janeiro. The absence of anthropometric information was identified in 50.8% of the medical records and the absence of Urine I results was in 46.3%. The quality of the care provided by the teams obtained an average of 2.5 (± 1.2 SD) and a median of 2.3, a result below the cutoff point 3.0, established to determine consistent health care directed at best practices in the management of chronic conditions. The dimensions of PACIC that presented the worst results were "Active Participation of the in Treatment" and "Care Coordination'', with 2.0 and 1.9, respectively. It was concluded that the management of people with type 2 diabetes mellitus performed by the professionals of the teams is not centered around their needs. It is crucial that professional practices are reviewed, with the opportunity to listen to the patient, give them a space to express their needs and to build health care plans that are more appropriate with their life conditions, taking them out of dependence for consultations that do not impact their clinical condition. It is important to emphasize that, in order to obtain a good therapeutic plan, it is important to listen, welcome, guide and decide in accordance with the patient the details of their care that can improvise autonomy, bonding and the management capacity of individuals and groups with effective gains in health, glycemic control and reduction of complications.

Esta tesis busca analizar la calidad de la atención médica brindada a las personas con diabetes mellitus tipo 2 por los equipos de la estrategia de salud familiar en la ciudad de Río de Janeiro. Sus objetivos son describir la ocurrencia de hospitalización por diabetes mellitus entre los años 2010 a 2015 según los barrios de residencia de los pacientes a través de un estudio ecológico y evaluar la calidad de la atención brindada por profesionales desde la perspectiva de las personas con diabetes mellitus tipo 2. Para investigar la relación entre las hospitalizaciones por diabetes y las condiciones de vida de la población, se calcularon indicadores demográficos, socioeconómicos y ambientales a partir del lugar de residencia. La tasa promedio de hospitalización por diabetes mellitus en el período fue de 20.5 hospitalizaciones por 10,000 habitantes, siendo mayor entre los pacientes masculinos (23.0 por 10,000) en comparación con las pacientes femeninas (18.4 por 10,000). La región Centro presentó más situaciones de vulnerabilidad social y ambiental y una tasa más alta de hospitalización en comparación con las otras regiones. El análisis de varianza mostró diferencias con respecto a las características sociodemográficas y ambientales que afectan las condiciones de vida y salud en todas las regiones. Para alcanzar el segundo objetivo, se realizó una encuesta con 451 personas diagnosticadas con diabetes mellitus 2, con la asistencia de equipos de Salud Familiar del Áreas de Influencia 2.1. La evaluación del Paciente de Atención a Enfermedades Crónicas (PACIC) se utilizó para investigar la atención recibida y un formulario con variables socioeconómicas, condiciones clínicas, mediciones antropométricas y pruebas de laboratorio, para complementar la información sobre la salud de los participantes. Los resultados mostraron que el 64% de la muestra tenía 60 años o más, el 52,1% se declaró marrón, el 62,6% tenía educación primaria, el 53,4% informó estar casado / en unión, el 50,7% nació en Río de Janeiro. La ausencia de información sobre mediciones antropométricas se identificó en el 50,8% de los registros médicos y la ausencia de resultados de la Orina I en el 46,3%. La calidad de la atención brindada por los equipos obtuvo un promedio de 2.5 (± 1.2 SD) y una mediana de 2.3, un resultado por debajo del punto de corte 3.0, establecido para determinar una atención médica consistente y dirigida a las mejores prácticas en el manejo de condiciones crónicas. Las dimensiones de PACIC que presentaron los peores resultados fueron " Participación activa del paciente en el tratamiento " y "Coordinación de la atención", con 2.0 y 1.9, respectivamente. Se concluyó que el manejo de personas con diabetes mellitus tipo 2 realizado por los profesionales de los equipos no se centra en sus necesidades. Es crucial que se revisen las prácticas profesionales, con la oportunidad de escuchar a las personas, tener un espacio para que expresen sus necesidades y a que se construyan planes de atención que sean más apropiados para las condiciones de vida, sacándolos de la dependencia de consultas que no afecten su cuadro clínico. Es importante resaltar que el éxito de un buen plan terapéutico, la disponibilidad para escuchar, recibir, guiar y acordar con la persona los detalles de sus acciones de atención puede favorecer la autonomía, el vínculo y la mejora de la capacidad de administrar la atención individual y colectiva con ganancias efectivas de salud, control glucémico y reducción de complicaciones.

How job stress influences job performance among Chinese healthcare workers: a cross-sectional study

OBJECTIVES@#Public service motivation refers to the idea of commitment to the public service, pursuit of the public interest, and the desire to perform work that is worthwhile to society. This study investigates how challenge stress and hindrance stress influence job performance among healthcare workers in Chinese public hospitals. It has also examined the mediating effect of public service motivation.@*METHODS@#Data of 1594 healthcare workers were obtained from typical public hospitals in eastern, central, and western China. To test our hypotheses, we used descriptive statistical analysis, correlation analysis, structural equation modeling, and subgroup analysis to investigate the sample.@*RESULTS@#Challenge stress and hindrance stress were strongly correlated among healthcare workers in Chinese public hospitals (β = 0.59; p < 0.001). Challenge stress was significantly positively associated with public service motivation (β = 0.14; p < 0.001) and job performance (β = 0.13; p < 0.001). Hindrance stress was significantly negatively associated with public service motivation (β = - 0.27; p < 0.001) and job performance (β = - 0.08; p < 0.05). Public service motivation was directly positively associated with job performance (β = 0.58; p < 0.001), and it indirectly mediated the association between job stress and job performance.@*CONCLUSIONS@#This study provides important empirical evidence on the effects of job stress and public service motivation on job performance among healthcare workers in Chinese public hospitals. Job performance may be raised by limiting hindrance stress, which provides moderate challenge stress and increases public service motivation.