Acupuntura no Sistema Único de Saúde - uma análise nos diferentes instrumentos de gestão / Acupuncture in Brazil´s Unified Health System - an analysis based on different health management tools

Resumo A inserção de Práticas Integrativas e Complementares nos sistemas públicos de saúde tem sido muito discutida nacional e internacionalmente. No Brasil a Política Nacional de Práticas Integrativas e Complementares norteia a inclusão da acupuntura no Sistema Único de Saúde. Este artigo analisou a implantação da acupuntura no SUS de 26 municípios do Departamento Regional de Saúde XIII/São Paulo, entre 2001 e 2011, a partir dos Planos Municipais de Saúde, Relatórios Anuais de Gestão e Sistemas de Informação. Os registros referentes à acupuntura foram analisados nas categorias contexto, atores, conteúdo e processo de implantação da prática. Os resultados mostraram um contexto favorável no âmbito legislativo e desfavorável no financiamento; somente atores institucionais; o conteúdo continha incoerências na estrutura dos documentos e nos registros da acupuntura; o processo mostrou que a política auxiliou a descrever a organização para a oferta da acupuntura. Conclui-se que a acupuntura e os instrumentos de gestão e planejamento em saúde têm incorporação incipiente nos 26 municípios, o que obsta o monitoramento e mantém essas práticas na periferia do sistema.

Abstract The integration of Integrative and Complementary Practices into public health systems has been the subject of national and international debate. In Brazil, the National Policy on Integrative and Complementary Practices guides the integration of acupuncture into the Unified Health System (UHS). This article explored the availability and/or accessibility of acupuncture in the UHS in 26 municipalities in the XIII Health Region of the State of São Paulo between 2001 and 2011, based on the analysis of Municipal Health Plans, Annual Management Reports and complementary data obtained from Information Systems. The data was analyzed using a framework for policy analysis based on: context, process, content and actors. Results show that the legislative framework provides a favorable environment; however public funding for these activities is particularly limited. Only government actors participated in the decision-making processes; the plans and reports contained inconsistencies both in structure and in the references made to acupuncture; the process showed that the policy helped to describe the organization of the provision of acupuncture services. The study concludes that the integration of acupuncture and use of health management and planning tools is limited in the 26 municipalities and that this precludes monitoring and maintains these practices on the periphery of the system.

Costo-efectividad del tratamiento con acupuntura en la artrosis cervical / Cost-effectiveness of the acupuncture therapy in cervical osteoarthritis

Se realizó una evaluación económica de costo-efectividad del tratamiento acupuntural en 76 pacientes con artrosis cervical ya diagnosticada, pertenecientes al Consultorio Médico El Toro del Policlínico Docente Eduardo Mesa Llull", del municipio de II Frente, provincia de Santiago de Cuba, desde enero de 2008 hasta junio de 2009, para lo cual se utilizaron 2 técnicas: la acupuntural en el grupo A y la convencional medicamentosa en el grupo B, en ambos casos aplicadas en 38 integrantes, respectivamente. Entre los principales hallazgos figuraron: la terapia acupuntural resultó ser menos costosa que el tratamiento medicamentoso ($ 785,85 la primera y $ 1 568,63 el segundo) y la respuesta terapéutica se obtuvo en menor tiempo (8 días como promedio) con la técnica milenaria, en contraste con la farmacoterapia (21 días como promedio); finalmente sobresalió que la acupuntura fue efectiva en todos los pacientes y el uso de medicamentos solamente en 13 (34,2 por ciento).

A financial evaluation of acupuncture therapy cost-effectiveness was performed in 76 patients with already diagnosed cervical osteoarthritis belonging to El Toro physician's office from Eduardo Mesa LLull Teaching Polyclinic of II Frente municipality in Santiago de Cuba province, from January 2008 to June 2009, for which 2 techniques were used: acupuncture in group A and conventional medication in group B, both were applied in 38 patients respectively. Main findings revealed that acupuncture therapy was less expensive than drug therapy ($ 785, 85 and $ 1 568, 63 respectively) and therapy response was obtained in a shorter period (8 days average) with the thousand-year-old technique, in contrast to pharmacotherapy (21 days average). Finally, it was observed that acupuncture was effective in all patients and medications only in 13 (34,2 percent).