Why are there defaulters in eye health projects?

PURPOSE: To identify barriers to attendance for eye examination of schoolchildren. METHODS: Cross-sectional study. Students in grades 1-4 in elementary school in Guarulhos (Brazil) were screened and referred for ophthalmic examination in 2006. Facilities offered in this project were: examination arranged during weekends, free transportation, spectacle donation and two different opportunities for exam. A questionnaire was applied, by interview, to a sample consisted of students' parents attended in a community project who missed the first call and attended the recall, to identify the reasons for non-attendance. RESULTS: The sample consisted of 767 parents or guardians, corresponding to an equal number of schoolchildren. Personal characteristics of the students: 49.2 percent male and 50.8 percent female, 60.2 percent of them had never received previous ophthalmologic evaluation. Reported reasons for no-show to the project: parents had not received appropriate orientation (35.6 percent), loss of working day (20.6 percent), illness (12.4 percent), had another appointment (10.0 percent). The need for eyeglasses was higher in the recall. CONCLUSIONS: A significant number of parents did not take their children for ophthalmological exams, even when a second opportunity was offered in projects with transportation facilities, free exams performed during weekends and spectacle donation. The main causes of absenteeism were lack of awareness and work. For 87.1 percent of the absenteeism cases, the difficulties could be overcome via improved structuring of the first call. A recall increases attendance coverage of target population by only 15.2 percent (59.3 to 74.5 percent). Notably, the eye exam campaign was the first exam for most of the absent students.

Prontuário incompleto no pronto-socorro: uma barreira para a qualidade em saúde / Incomplete medical record in emergency service: a barrier for the quality in health

Objetivo: Avaliar o preenchimento dos prontuários médicos em unidade de pronto-socorro de Oftalmologia, fornecendo subsídios para avaliação da qualidade do serviço. Materiais e métodos: Analisou-se o preenchimento de prontuários (fichas administrativas) pelos plantonistas do Pronto-Socorro de Oftalmologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo durante semana típica de atendimento. Resultados: A amostra se compôs de 584 prontuários. Em 57 (9,8%) não constavam os destinos dos pacientes em 16 (2,7%) não tinham o nome do médico que realizou o atendimento em 15 (2,6%) não constavam o registro do médico atendente no Conselho Regional de Medicina. Em relação ao diagnóstico, para 6,0% a letra do médico estava ilegível e para 6,3% só constava o Código Internacional de Doenças. Para 33,4%, a anamnese não constava no prontuário (incluindo-se casos de trauma ocular). Conclusão: Encontrou-se falhas no preenchimento de prontuários em unidade de urgência oftalmológica de serviço universitário, que podem causar problemas para o hospital e para o próprio médico, por falta de ressarcimento do serviço prestado, por diminuição do padrão de qualidade de atendimento, pela impossibilidade de defesa em casos de litígio de mau prática e por deficiências no ensino e pesquisa.