Intervenções estimuladoras de mudança em cenários de educação na saúde / Change-inducing interventions in health education settings

Resumo O artigo objetiva analisar a percepção de participantes sobre o efeito de intervenções desenvolvidas no âmbito de um projeto que integra o Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS). Adotou-se o desenho metodológico de avaliação normativa, na perspectiva da abordagem de pesquisa qualitativa. Na pesquisa, foram envolvidos 21 profissionais de saúde de cinco projetos de intervenção, representando as cinco regiões brasileiras. As mudanças percebidas e tangibilizadas foram constatadas como resultado das intervenções. Dentre as conclusões, destaca-se que houve convergência entre percepções e intencionalidades do projeto avaliado.

Abstract The article aims to analyze the participants' perception of the effect of interventions developed within a project nested in the Support Program for Institutional Development of the Unified Health System (PROADI-SUS). We adopted normative assessment from the perspective of a qualitative research approach. Twenty-one health professionals from five intervention projects representing the five Brazilian regions were involved in the research. The changes perceived and made tangible were identified as a result of the interventions. Among the conclusions, we underscore a convergence between perceptions and intentions of the evaluated project.

The design of a comprehensive intervention project for children ’ s health in Nujiang Prefec-ture,Yunnan / 中国卫生政策研究

The Theory of Change holds that the change in a project ’ s effectiveness can be derived from the changing process in the certain context .Only after analyzing changes caused by a project and the possible changing path or hypothesis can we determine the real cause of an effect .In 2012, the maternal, child and community health department of the former Ministry of Health began a comprehensive intervention project for children ’ s health in Nu-jiang Prefecture .The project was designed to explore modes and mechanisms for improving children ’ s health in the west, poverty and ethnic minority areas through cooperation at the national , provincial, and prefecture levels.Based on the Theory of Change , this article describes the logical framework of the comprehensive intervention project .In or-der to lay the foundation for improving the project design , ensuring the implementation of the project and conducting the follow-up monitoring and evaluation , we also expound the goals , implementation strategies , and intervention measures, project activities and output , implementation routes .

Hacia un cambio de paradigma en la medicina transfusional: propuesta de acción en un Hospital Público / Towards a change in the paradigm of transfusion medicine: proposal of action in a Public Hospital

Una de las características del modelo médico imperante hoy en cuanto a algunas acciones del trabajo clínico-quirúrgico diario y cotidiano, lo constituye ciertas prácticas basadas en los "usos y costumbres" conducente al "automatismo terapéutico", alejándose así de una práctica reflexiva con base firme en la adecuada evidencia científica en la valoración de su indicación. El uso y las indicaciones de la transfusión de sangre, en muchos casos, entra de lleno en ése marco y constituye un buen ejemplo de la práctica médica rutinaria que no siempre parte de un posicionamiento científico sólido. Presentamos aquí un “Proyecto de Inversión o Intervención” en un Hospital Público del país como plan de acción de un programa de 2 años de duración sobre adecuado uso e indicación de la transfusión de sangre, con el objetivo de impacto de ir transitando por el camino del modelo de la Medicina Basada en la Evidencia. Con ello pretendemos una rentabilidad social concreta en cuanto a evitar al paciente una práctica innecesaria y potencialmente peligrosa y, además, contribuir a la implementación de un modelo de acción médica más sustentado en la evidencia mundial que en la experiencia individual. Creemos que así el desarrollo de la indicación médica será más correcto conduciendo a una Medicina más beneficiosa y barata.

We present in this work an Intervention Project, as a social project, in a attempt to solve a common problem to many hospitals, in this particular case one hospital of the city of San Juan, Argentina, which is the daily medicine practice based on "uses and habits" and "automatic therapeutic indication" instead of Evidence Based Medicine (EBM). Transfusion Medicine is a good example of that way of behavior and, despite a marked revision process during the last two decades, medical doctors continue to indicate blood and derivates without a solid scientific base. Patients are placed under the situation of a no necessary and potential harmful and dangerous practice and the costs of medical attention increases without benefits. It can also produce moral and juridical conflicts in the daily medicine practice (Jehovah Witness). We propose a 2 years program based on a "Properly Use of Blood" plan using the "logical frame approach" (LFA) as a specific management tool and looking at the EBM as the guide paradigm. We hope to reach, in achieving our aims, a more correct, harmless and cheaper diary medical action.