Consultório na Rua: experiências e sentimentos vivenciados pelos profissionais na assistência em saúde / Street Office: experiences and feelings experienced by health care professionals

2021.176470Introdução: o Consultório na Rua é uma estratégia da Atenção Básica no Sistema Único de Saúde (SUS), que tem como finalidade promover o cuidado às pessoas em situação de rua, sendo o serviço de referência sanitária para esta população. Através de ações que permitam a construção do vínculo de confiança, os profissionais promovem cuidado e assistência de saúde às demandas dos usuários. Objetivo: descrever as experiências, histórias e sentimentos vivenciados pelos profissionais do Consultório na Rua de Maceió-AL. Métodos: trata-se de estudo descritivo-exploratório, com abordagem qualitativa, realizado com 13 profissionais do Consultório na Rua de Maceió, cuja produção de dados ocorreu no período de outubro a dezembro de 2018, através da técnica da entrevista semiestruturada e dos registros em diário de campo. Os dados foram analisados pela técnica da Análise de Conteúdo, na modalidade temática, e discutidos à luz da literatura sobre a temática do Consultório na Rua. Resultados: a partir das entrevistas com os profissionais emergiram as seguintes temáticas: 1) experiências únicas; 2) histórias que marcam; e 3) sentimentos que transformam. Conclusão: pode-se concluir que o Consultório na Rua se mostra como um trabalho que gera ricas experiências e sentimentos para os profissionais, e que permite que os profissionais conheçam as histórias de vida dessa população ao mesmo tempo em que são afetados nesse processo. (AU)

Introduction: The Street Office is a Primary Care strategy in the Unified Health System (SUS), which aims to promote care for homeless people, being the health reference service for this population. Through actions that allow the construction of the bond of trust, professionals promote health care and care to the users' demands. Objective: Describing the experiences, stories and feelings experienced by the professionals of the Street Office of Maceió-AL. Methods: This is a descriptive-exploratory study with a qualitative approach, conducted with 13 professionals from the Street Office of Maceió, whose data production occurred from October to December 2018, through the semi-structured interview technique and records in a field diary. The data were analyzed by the content analysis technique, in the thematic modality, and discussed in the light of the literature on the theme of the Street Office. Results: From the interviews with the professionals emerged the following themes: 1) unique experiences; 2) stories that mark; and 3) feelings that transform. Conclusion: It can be concluded that the Street Office is shown as a work that generates rich experiences and feelings for professionals, allowing professionals to know the life histories of this population while they are affected in this process. (AU)

Satisfacción laboral en médicos de familia de un policlínico del municipio Placetas / Occupational Satisfaction in Family Doctors from a Polyclinic in Placetas Municipalities

Introducción: La satisfacción es mucho más que una aspiración humana, es un instrumento y una función para lograr la excelencia de la calidad en la atención en salud. Objetivo: Determinar el nivel de satisfacción laboral de médicos de la familia. Métodos: Se realizó un estudio descriptivo de corte transversal en el Policlínico Docente Norte de Placetas en el año 2019. El universo estuvo constituido por los 18 médicos de la familia del policlínico y con un muestreo no probabilístico, deliberado con carácter casuístico a partir de no haber contactado a algunos por difícil acceso quedó conformada la muestra por 15, teniendo como criterio de inclusión la voluntariedad de participar. Resultados: Predominaron como condiciones estructurales no adecuadas los servicios sanitarios (93,3 por ciento) y la privacidad de la consulta (73,3 por ciento); de las condiciones de trabajo propiamente dichas no adecuadas, los muebles de la consulta y sala de espera (86,6 por ciento); de los elementos relacionados con el diagnóstico y tratamiento, todos fueron no adecuados; de los factores subjetivos, el más referido fue el estrés (93,3 por ciento) y como grado de satisfacción, el poco satisfecho (80 por ciento). Conclusiones: Existe poca satisfacción laboral de los médicos del Policlínico Docente Norte de Placetas, determinado esto por un conjunto de factores interrelacionados entre sí(AU)

Introduction: Satisfaction is much more than a human aspiration; it is an instrument and a function to achieve excellence in quality of health care. Objective: To determine the level of occupational satisfaction of family doctors. Methods: A descriptive and cross-sectional study was carried out at Norte [North] Teaching Polyclinic of Placetas Municipality in 2019. The study population was made up of the 18 family doctors of the polyclinic, by nonprobabilistic sampling, casuistically deliberate based on the fact that there is no contact due to difficult access, the sample was made up of 15, with the willingness to participate as inclusion criterion. Results: Health services (93.3 percent) and privacy of the consultation (73.3 percent) predominated as unsuitable structural conditions; together with the office furniture and the waiting room (86.6 percent) as the so-called unsuitable occupational conditions; of the elements related to diagnosis and treatment, all were not adequate; of the subjective factors, the most referred to was stress (93.3 percent); and regarding degree of satisfaction, the category least satisfied (80 percent) predominated. Conclusions: There is little occupational satisfaction of the doctors of the Norte [North] Teaching Polyclinic of Placetas Municipality, determined by a set of interrelated factors(AU)

Satisfacción de los prestadores que laboran en los consultorios médicos. Colón. 2015-2016 / Satisfaction of the medical staff working at medical houses 2015-2016

RESUMEN Introducción: la necesidad de lograr una mayor satisfacción de los servicios de salud, y, así proporcionar un estado de bienestar en todos los que los reciben; obliga a contar con métodos transformadores que permitan identificar todo lo que influye, de forma positiva o negativa, sobre el rendimiento de las personas que trabajan en el sector de la salud pública. Objetivo: identificar el nivel de satisfacción de los prestadores que laboran en consultorios médicos en el municipio Colón, en el período 2015 - 2016. Materiales y métodos: se realizó un estudio de tipo descriptivo, de corte transversal. Universo y muestra estuvo constituido por los 123 médicos y enfermeras que se encontraban trabajando en los 62 consultorios médicos. Se estudiaron las siguientes variables: condiciones de los locales de atención, recursos necesarios para el trabajo, atención al capital humano y trato de la población. Resultados: el 92,6 y el 90,2 % de los prestadores estuvieron satisfechos con la preocupación, la superación y la limpieza de los consultorios. Predominaron los trabajadores no satisfechos (52,0 %) por los recursos que poseen para los exámenes clínicos. Conclusiones: Los prestadores que laboran en los consultorios médicos se encuentran insatisfechos. Las dimensiones estudiadas fueron evaluadas como no aceptables, solo las variables preocupación por la superación y existencia de agua para lavado de manos estuvieron por encima del estándar establecido (AU).

ABSTRACT Introduction: the necessity of reaching a higher satisfaction from the health services and, with that, providing welfare to everybody who receives them, makes it necessary to have transforming methods that allow to identify everything that having positive or negative influence on the performance of the people working in the public health field. Objective: to identify the satisfaction level of people working in the medical houses of the municipality of Colon, in the period 2015-2016. Materials and methods: a descriptive, cross sectional study was carried out, in a universe and sample composed by the 123 physician and nurses who were working at the 62 medical houses. The following variables were studied: conditions of the health care places, resources that are necessary for work, care to human capital and population handling. Results: 92,6 % and 90,2 % of the medical staff were satisfied with the concern, upgrading and cleaning of the consulting rooms. Predominated workers unsatisfied (52,0 %) with the resources they have for the clinical examination. Conclusions: the medical staff working at the medical houses is unsatisfied. The studied dimensions were evaluated as non-acceptable; only the variables concern for upgrading and existence of water for hand washing were above the established standard (AU).

Health Disparities: Challenges, Opportunities, and What You Can Do About It / Desigualdades na saúde: desafios, oportunidades e o que você pode fazer sobre isso

Racial disparities in health outcomes, access to health care, insurance coverage, and quality of care in the United States have existed for many years. The Development and implementation of effective strategies to reduce or eliminate health disparities are hindered by our inability to accurately assess the extent and types of health disparities due to the limited availability of race/ethnicity-specific information, the limited reliability of existing data and information, and the increasing diversity of the American population. Variations in racial and ethnic classification used to collect data hinders the ability to obtain reliable and accurate health-indicator rates and in some instances cause bias in estimating the race/ethnicity-specific health measures. In 1978, The Office of Management and Budget (OMB) issued "Directive 15" titled "Race and Ethnic Standards for Federal Statistics and Administrative Reporting" and provided a set of clear guidelines for classifying people by race and ethnicity. Access to health care, behavioral and psychosocial factors as well as cultural differences contribute to the racial and ethnic variations that exist in a person's health. To help eliminate health disparities, we must ensure equal access to health care services as well as quality of care. Health care providers must become culturally competent and understand the differences that exist among the people they serve in order to eliminate disparities. Enhancement of data collection systems is essential for developing and implementing interventions targeted to deal with population-specific problems. Developing comprehensive and multi-level programs to eliminate healthcare disparities requires coordination and collaboration between the public (Local, state and federal health departments), private (Health Insurance companies, private health care providers), and professional (Physicians, nurses, pharmacists, laboratories, etc) sectors.

Disparidades raciais nos resultados de saúde, acesso a cuidados de saúde, cobertura de seguro e qualidade de atendimento nos Estados Unidos existem há muitos anos. O desenvolvimento e a implementação de estratégias efetivas para reduzir ou eliminar as disparidades de saúde são dificultadas pela nossa incapacidade de avaliar com precisão a extensão e os tipos de disparidades de saúde devido à disponibilidade limitada de informações específicas de raça / etnia, confiabilidade limitada dos dados e informações existentes. e a crescente diversidade da população americana. Variações na classificação racial e étnica usadas para coletar dados dificultam a obtenção de índices confiáveis e precisos de indicadores de saúde e, em alguns casos, causam viés na estimativa de medidas de saúde específicas de raça / etnia. Em 1978, o Escritório de Administração e Orçamento (OMB) publicou a "Diretriz 15" intitulada "Normas Raciais e Étnicas para Estatísticas Federais e Relatórios Administrativos" e forneceu um conjunto de diretrizes claras para classificar as pessoas por raça e etnia. O acesso a cuidados de saúde, factores comportamentais e psicossociais, bem como diferenças culturais, contribuem para as variações raciais e étnicas que existem na saúde de uma pessoa. Para ajudar a eliminar as disparidades de saúde, devemos garantir a igualdade de acesso aos serviços de saúde, bem como a qualidade do atendimento. Os prestadores de cuidados de saúde devem tornar-se culturalmente competentes e compreender as diferenças existentes entre as pessoas que servem para eliminar as disparidades. O aprimoramento dos sistemas de coleta de dados é essencial para desenvolver e implementar intervenções direcionadas para lidar com problemas específicos da população. O desenvolvimento de programas abrangentes e multiníveis para eliminar as disparidades na atenção à saúde exige coordenação e colaboração entre os setores público, privado e profissional (departamentos de saúde locais, estaduais e federais), privados (empresas de seguro-saúde, provedores privados de saúde) e profissionais (médicos e enfermeiros), farmacêuticos, laboratórios, etc).

Diseño de un curso sobre diabetes mellitus dirigido a profesionales del nivel primario de atención / Design of a course on diabetes mellitus directed to primary health care professionals

Introducción: la experiencia demuestra que es indispensable mantener actualizado de forma permanente el conocimiento en los avances de la medicina a los profesionales de la salud para optimizar la calidad de la atención médica. Objetivo: diseñar un curso de posgrado dirigido a proveedores de salud que aporte los conocimientos más actualizados sobre diabetes mellitus en el nivel primario de atención. Métodos: se realizó una investigación descriptiva y se emplearon métodos del nivel teórico y del nivel empírico. La población de profesionales de la salud estuvo constituida por la totalidad de 84 profesionales del Policlínico "Hermanos Cruz", cuya distribución es la siguiente: médicos (N1= 29), enfermeras (N2= 30), podólogos (N3= 8), psicólogas (N4= 2), nutricionista (N5= 1), especialista en Educación y Promoción para la Salud (N6= 1) y profesores de Cultura Física (N7= 13). Estos últimos no forman parte de la plantilla del policlínico, pero por convenio de trabajo Minsap-INDER, prestan servicios en el nivel primario de atención. Resultados: fue necesario diseñar un curso a prestadores de salud, basado en la educación sobre temas de diabetes mellitus (DM), que incluye contenidos de promoción y EpS. La identificación de necesidades de aprendizaje en proveedores seleccionados arrojó déficit de conocimiento en esas temáticas. Conclusiones: se elaboró y propuso un programa de superación profesional teniendo en cuenta los resultados de la investigación. Se ofrecieron herramientas teóricas prácticas para la educación al diabético tipo 2 adulto mayor(AU)

Introduction: experience proves that medical advances knowledge strongly needs to be permanently updated for health professionals in order to optimize health care quality. Objective: to design a postgraduate course for health care providers, in order for them to apply, in the primary health care level, the most updated knowledge on diabetes mellitus.Methods: descriptive research using methods of the theoretical and empirical levels, carried out at Hermanos Cruz University Outpatient Polyclinic of Pinar del Río. The health professional population consisted of the totality (84 professionals from the Polyclinic) and is distributed as it follows: physicians (N1=29), nurses (N2=30), chiropodists (N3=8), psychologists (N4=2), nutritionist (N5=1), health promotions and education specialist (N6=1), and physical education professors (N7=13). The latter ones do not belong to the Polyclinic's staff, but under a work agreement between the Health Ministry and the National Institute of Sports they pay services in the primary health care level. Results: health providers were necessarily designed a course based on diabetes mellitus education, including contents of health promotion and education, because the identification of the learning needs in the selected providers showed knowledge deficit regarding these topics. Conclusions: a professional self-improvement plan was elaborated and proposed considering the research outcomes, and theoretical-practical tools were offered for education of type 2 diabetic senior adults(AU)

Efectividad de una estrategia educativa dirigida a adultos mayores diabéticos tipo 2 y proveedores de salud / Effectiveness of an educational strategy aimed at older adults suffering from type 2 diabetes and at health providers

Objetivo: Evaluar la efectividad de la estrategia educativa dirigida a adultos mayores diabéticos tipo 2 y proveedores de salud. Métodos: Investigación cuasi experimental que evaluó un antes-después con grupo control. El universo de estudio estuvo constituido por adultos mayores diabéticos dispensarizados en los policlínicos Hermanos Cruz (U= 1 369) y Pedro Borrás (U= 1 528), del primero se seleccionó el grupo experimental y en el segundo el grupo control, ambos del municipio y provincia Pinar del Río. Para determinar la muestra se utilizó un Muestreo por Conglomerados Bietápico con probabilidades proporcionales al tamaño de las Unidades de Primera Etapa quedando conformada para ambos grupos por 123 adultos mayores diabéticos tipo 2. Se trabajó con el universo de prestadores del GBT uno (U= 84) del policlínico Hermanos Cruz. La estrategia fue aplicada en el grupo experimental, y evaluada de forma inmediata, a los seis meses y al año. Resultados: Las comparaciones de los grupos en los momentos relacionados con la aplicación de la estrategia estuvieron dentro de lo esperado, generalmente se produjeron cambios significativos en los adultos mayores diabéticos tipo 2 en cuanto a los resultados globales y en cada una de las preguntas examinadas a favor del grupo experimental e igualmente en los proveedores de salud. Conclusiones: La mejoría detectada en los resultados de las variables de respuesta principal y secundarias, en el grupo experimental, dan una medida de la efectividad de la estrategia. Al mismo tiempo su estabilidad a los seis meses y al año considerado como horizonte temporal de evaluación, avalan su sostenibilidad(AU)

Objective: To evaluate the effectiveness of the educational strategy aimed at type 2 diabetic older adults and at health providers. Method: A quasi experimental research study to evaluate the situation before and after the application of this strategy in a control group. The study population consisted of diabetic old patients recruited at Hermanos Cruz (U= 1 369) and Pedro Borrás Astorga (U= 1 528) polyclinics. The experimental group was chosen from the first group and the control group from the second one, both in Pinar del Río municipality in Pinar del Rio province. A two-staged cluster was used with proportional probabilities according to the size of the first stage units and the final sample was 123 type 2 diabetic older adults for both groups. All the basic working team health providers from Hermanos Cruz polyclinics were involved in the study. The strategy was applied in the experimental group and immediately evaluated after six months and after a year. Results: The comparisons of the groups made at the time of the implementation of the strategy were within the expectations; there were significant changes in type 2 diabetics in terms of overall outcomes and each of the analyzed questions, which favored the experimental group along with the health providers. Conclusions: The improvement observed in the results of the answer variables of the experimental group shows the strategy effectiveness. At the same time, the stability of results after six months and a year endorses the strategy sustainability(AU))

Evaluación de la satisfacción de los usuarios y prestadores de servicios en la Clínica Estomatológica "Fe Dora Beris" / Evaluación de la satisfacción de los usuarios y prestadores de servicios en la Clínica Estomatológica "Fe Dora Beris"

Se hizo un estudio descriptivo y transversal de 8 estomatólogos y 120 pacientes atendidos en la Clínica Estomatológica "Fe Dora Beris" de Santiago de Cuba, desde julio hasta diciembre del 2014, a fin de evaluar el nivel de satisfacción de usuarios y prestadores de servicios estomatológicos, para lo cual se utilizó una encuesta. Se reestablecieron criterios, indicadores y estándares. Entre los principales resultados sobresalieron: solo 2 criterios relacionados con la investigación en los proveedores fueron inadecuados, y con respecto al nivel de satisfacción de los usuarios, el total de los integrantes de la serie manifestaron estar satisfechos con la atención recibida.

A descriptive and cross-sectional study of 8 dentists and 120 patients assisted at "Fe Dora Beris" Stomatological Clinic was carried out in Santiago de Cuba from July to December, 2014, in order to evaluate the satisfaction level of patients and providers about stomatological services by means of a survey. Criteria, indicators and standards were re-established. Among the main results there were: that just 2 criteria related to the investigation of the providers were inadequate, and regarding the satisfaction level of patients, all the members of the series were satisfied with the care provided.

Satisfacción de los usuarios y prestadores de un servicio de rehabilitación integral / Users and service workers' satisfaction from a service of comprehensive rehabilitation

Se realizó una investigación en sistemas y servicios de salud para evaluar el grado de satisfacción de 350 usuarios y 12 prestadores en el Servicio de Rehabilitación Integral de base comunitaria, perteneciente al Policlínico Docente "Armando García Aspurú" de Santiago de Cuba durante diciembre del 2011, para lo cual se confeccionaron 25 criterios, indicadores y estándares y se aplicaron encuestas, validadas mediante el coeficiente Alpha de Cronbach. Al finalizar la evaluación, entre los criterios que se tuvieron en cuenta para valorar la satisfacción de los usuarios y prestadores resultaron adecuados 8 de los primeros y 10 de los segundos (72,7 y 71,4 %, respectivamente), de manera que se cumplió con el estándar establecido. Se concluyó que tanto los usuarios como los prestadores del servicio están satisfechos con la atención que allí se brinda.

An investigation in health systems and services was carried out to evaluate the satisfaction degree of 350 users and 12 service workers in the Community Service of Comprehensive Rehabilitation with community base, belonging to "Armando García Aspurú" Teaching Polyclinic in Santiago de Cuba during December, 2011, for which 25 approaches, indicators and standards were established and surveys were applied, validated by means of the coefficient Alpha of Cronbach. When concluding the evaluation, among the criteria that were kept in mind to evaluate the satisfaction of the users and service workers, 8 of the first ones and 10 of the second ones (72.7 and 71.4%, respectively) were appropriate, so that the established standard was fulfilled. It was concluded that both, users and service workers are satisfied with the care received there.

Representación social de los prestadores de servicios de salud en la discapacidad visual / Social representation of the health service providers in visual disability

Introducción: el conocimiento de la representación social de los prestadores de servicios de salud resulta de suma importancia para la salud pública, debido a su influencia en la calidad de su relación con los pacientes. Objetivo: caracterizar la representación social de los prestadores de servicios de salud acerca de la discapacidad visual. Métodos: estudio de caso realizado en el policlínico Hermanos Ruíz Aboy en San Miguel del Padrón en el período de enero a junio de 2012. Participaron 33 informantes clave escogidos por muestreo intencional. Las técnicas de indagación empleadas fueron la asociación libre de palabras y las entrevistas en profundidad. Resultados: el estudio reveló la existencia en los prestadores de una representación angustiosa-conmiserativa-dependiente que configura elementos provenientes de referentes experienciales, componentes afectivos e insumos informacionales relacionados con las personas en situación de discapacidad visual. Conclusiones: los prestadores de servicios de salud investigados tiene en el núcleo de sus representaciones experiencias y conocimientos relacionados con el daño anatómico que condiciona limitación e incapacidad para la participación en la vida social de las personas con discapacidad visual, pero las asociaciones relativas a las necesidades de atención, definen un deficiente reconocimiento de elementos que garantizarían la compensación e integración psicosocial en estas personas...

Introduction: knowing the social representation of the health service providers is very important for the public health, due to their influence on the quality of relationship with the patients. Objective: to characterize the social representation of the health service providers on visual disability. Methods: case study performed in Hermanos Ruiz Aboy in San Miguel del Padron municipality in the period of January through June, 2012. Thirty three key informants selected by intentional sampling participated. The research techniques were free association of words and in-depth interviews. Results: this study disclosed the existence in health providers of an anguishing-commisserative-dependent representation that shapes elements from experience referents, affective components and informational inputs related to the persons facing visual disability. Conclusions: the health service providers under research have, in the core of their representation, experiences and knowledge linked to the anatomical damage that causes limitation and disability to be involved in the people with visual disability; however, the relative associations with the care requirements define a poor recognition of those elements that would assure compensation and psychosocial integration of these people...

Representación social de los prestadores de servicios de salud sobre la discapacidad motriz / Social representation of health care providers on motor disability

Introducción: el conocimiento de las representaciones sociales de los prestadores de servicios de salud constituye un insumo básico para la comprensión de la relación que éstos establecen con sus pacientes.Objetivo: caracterizar la representación social de los prestadores de servicios de salud sobre los individuos en situación de discapacidad motriz.Métodos: se realizó un estudio de caso en el que participaron 33 informantes clave del policlínico Hermanos Ruíz Aboy, del municipio Sal Miguel del Padrón, en el período de enero a junio de 2012, escogidos por muestreo intencional. Se emplearon como técnicas de indagación la asociación libre de palabras y la entrevista a profundidad.Resultados: la representación de los prestadores de servicio sobre la discapacidad motriz estuvo influenciada por sus conocimientos generales, su estado afectivo, su formación profesional, sus vivencias personales y su entorno inmediato.Conclusiones: el estudio reveló la existencia en los prestadores de servicios de salud de una representación esperanzadora que emerge de la configuración de elementos provenientes de referentes experienciales, componentes afectivos e insumos informacionales relacionados con las personas en situación de discapacidad motriz

Background: the knowledge by social representations about the service that health care providers give in different health services constitutes a basic aid for the comprehension of the relation that they establish with their patients.Objective: to characterize the social representation of health care providers on individuals presenting motor disability.Methods: a case study with the participation of 33 key informants of Hermanos Ruíz Aboy Polyclinic in San Miguel del Padrón Municipality was performed during the time period from January to June 2012. The informants were selected by intentional sampling. The research techniques applied were the free word association and the deep interview.Results: the representation of health care providers about motor disability was influenced by their general knowledge, their affective state, the professional formation, their personal experiences and the immediate environment.Conclusions: the study revealed the existence of a promising representation in the health care providers which emerges from the shaping of elements coming from experiences as referents, affective components and informational aids in relation to people presenting motor disabilities

Percepción sobre la prestación de servicios de atención a la infertilidad desde una mirada antropológica / Perception on the rendering of service to care for infertility from an anthropological viewpoint

Introducción: algunas investigaciones han dado cuenta de una especie de «frialdad médica¼ vista en la atención a la infertilidad por parte de los prestadores de salud y percibida por parte de los usuarios de estos servicios. Objetivo: conocer la percepción de usuarios y prestadores de salud, sobre la gestión y prestación de atención a la infertilidad en tres servicios en La Habana. Métodos: estudio descriptivo realizado entre abril de 2007 y marzo de 2010. Se empleó un abordaje de tipo cualitativo que responde al diseño de Teoría Fundamentada. La población objeto de estudio se estructuró en dos grupos: las parejas infértiles atendidas en servicios seleccionados y sus prestadores de salud. Resultados: se describieron cuatro categorías inductivas: la atención a la infertilidad por el sistema de salud; la organización, funcionamiento y satisfacción con los servicios de atención; la relación usuarios(as) prestadores, y el tránsito de los usuarios/as por los servicios de atención a la infertilidad. Se corroboraron debilidades para la atención a la infertilidad: insuficiente capacidad resolutiva y necesidad de establecer funciones, normas y algoritmos en cada nivel de atención, para la mejora de sus procesos e insuficiente pensamiento médico-social, que parte de la ideología médico-hegemónica. Conclusiones: existen limitaciones en recursos materiales y profesionales, es insuficiente la organización e integración de los servicios, lo que provoca fallas en la gestión y continuidad de la atención; se produce descentralización ejecutiva de la normativa y resulta insuficiente el tratamiento a las personas y a las parejas desde sus condicionamientos socioculturales.

Introduction: some research works have reported a sort of "medical coldness" observed in the care for infertility by health care providers and perceived by medical service users. Objective: to find out the perception of users and of health care providers on the management and provision of care for infertility in three medical services of Havana. Methods: descriptive study conducted from April 2007 to March 2010. A qualitative-type approach was used to respond to the design of founded theory. The target population was divided into two groups: fertile couples assisted in selected services and their health care providers. Results: four inductive categories were described: care for infertility by the health care system; the organization and functioning of and satisfaction with the infertility care services, relationships of users and service providers, and the transit of users through the services of care for infertility. Some weaknesses in infertility care services were confirmed such as the poor resolution capacity and the need of establishing functions, standards and algorithms in each level of care in order to improve their processes, and lack of adequate social and medical thinking resulting from the hegemonic medical ideology. Conclusions: there are some constraints in material and professional resources; the organization and integration of services are poor leading to failures in management and continuity of care; executive decentralization of standards and the treatment given to persons and couples, taking their sociocultural conditions into account, is not enough.

Alocação de recursos condicionada ao desempenho de prestadores de serviços de saúde: o caso das contratualizações de hospitais por uma Secretaria Municipal de Saúde no Brasil / Resource allocation conditional on performance of providers of health services: the case of hospitals contratualizações by a Municipal Health in Brazil

Trata-se de um Estudo de Caso Múltiplo (ECM), expondo aspectos da produção de ações de saúde, da inserção dos prestadores no SUS e da capacidade de coordenação da Secretaria Municipal de Saúde (SMS) em decorrência das contratualizações realizadas no Município. Foram analisados os hospitais participantes do sistema segundo a personalidade jurídica, complexidade, tipos de metas, volume, produção pactuada e alcançada e potencial de coordenação da SMS. Os dados levantados sugerem a aceitação da hipótese da pesquisa de maior capacidade de coordenação e maior inserção dos prestadores no SUS por meio da contratualização. Os casos ilustram o potencial da contratualização para subsidiar a gestão do SUS no Município e evidenciam algumas das dificuldades do novo modo de alocação de recursos e de gestão, sendo a maioria delas relacionadas à incipiência dos procedimentos da contratualização e de seu monitoramento por parte dos prestadores e da SMS.

Sistemas de alocação de recursos a prestadores de serviços de saúde - a experiência internacional / Resource allocation systems for health service providers - the international experience

O artigo apresenta as formas tradicionais de alocação de recursos a prestadores de serviços de saúde e se concentra na apresentação e discussão de experiências alternativas encontradas no contexto internacional. Aponta, ainda, as tendências atuais formuladas nos países da OECD, que consistem na adoção de sistemas mistos ou complementados pelo ajuste por desempenho, sendo este predominantemente referido a resultados sobre a saúde da população, ou seja, à efetividade dos serviços de saúde. Ainda, destaca-se uma tendência a adotar sistemas de alocação de recursos diferenciados, segundo o nível de atenção do prestador: aos centros de atenção primária responsáveis pela saúde da população de um dado território, corresponde a alocação de recursos per capita ajustada por risco (ou, em alguns casos, por linhas de cuidado), enquanto os hospitais são em alguns casos remunerados por orçamento global ajustado por desempenho e, em outros, por pagamento prospectivo por procedimento.

This article presents the traditional ways of allocating resources to health service providers and focuses on the presentation and discussion of alternative experiences found in the international context. It also shows the current trends in the OECD countries, involving the adoption of mixed systems or performance-related bonuses, the latter being predominantly referred to the effects on the health of the population, i.e. the effectiveness of the health services. It further stresses the tendency to adopt resource allocation systems that are differentiated according to the level of care provider: to primary care centers, responsible for the health of the population of a given territory, a per capita adjusted for risk factor is granted (or, in some cases, resource allocation defined for lines of care), while in other cases hospitals are either paid according to a performance-adjusted global budget or through prospective payment per procedure.

O papel necessário da Agência Nacional de Saúde Suplementar na regulação das relações entre operadoras de planos de saúde e prestadores de serviços / The necessary role of the National Supplementary Health Agency in the regulation of relations between managed care companies and service providers

Este artigo trata do papel regulatório que caberia à Agência Nacional de Saúde Suplementar (ANS) desempenhar, a partir do resultado de um conjunto de pesquisas e estudos sobre as práticas de microrregulação exercidas pelas operadoras de planos de saúde sobre os prestadores hospitalares privados. O trabalho se baseia em diversos estudos e, especialmente, nos resultados da pesquisa de Ugá et al. (2007), cujos resultados permitiram a problematização de questões relativas à necessidade de regular alguns elementos da relação entre operadoras e prestadores hospitalares, fundamentais para a garantia do acesso e da qualificação da atenção recebida por clientes de operadoras de planos privados de saúde; e também relativas à importância que os prestadores hospitalares privados possuem para o SUS. Busca-se, assim, a partir dos estudos sobre o tema, refletir tanto sobre o papel regulador a ser desempenhado pela ANS nas relações contratuais entre operadoras e prestadores, quanto sobre o papel que ao SUS caberia exercer.

This paper discusses the regulatory role that would fit the National Supplementary Health Agency (ANS), from the results of researches and studies on the practices of micro-regulation performed by private managed care companies on hospital providers they contract. It is based on several studies, especially on the research by Ugá el al (2007), whose results allowed the questioning of issues related to the necessary regulation of some elements of the relationship between health managed care companies and hospital providers, key to ensuring access and qualification of health care received by customers of those companies, as well as the importance that hospital providers have for the public health system, SUS. The paper aims, therefore, from the studies on the subject, to reflect on the regulatory role to be played by ANS in the contractual relations between managed care companies and providers and on the role that would fit to the SUS on this matter.

La calidad en salud, un compromiso de todos / Health quality, and obligation for everybody

La atención en salud y la calidad en los servicios de salud se han convertido en parte de un proceso de mejoramiento dentro del Sistema de Seguridad Social en Salud en Colombia. Es por eso que la normatividad vigente se hace cada día más puntual a ese respecto por considerarse de suma importancia el proceso de la consecución y la permanencia de la salud con calidad en el contexto de nuestro país, en el cual debe tomar parte cada uno de los entes prestadores de salud, sus profesionales y la población, para que se de cómo consecuencia un resultado satisfactorio en la solución verdadera de problemas de salud en el país.Las normas actuales pretenden dar importancia a un aspecto primordial que es el mejoramiento de los servicios de salud. En este proceso los entes prestadores y los profesionales tienen un compromiso con cada una de las partes del proceso que obliga la ley y con los usuarios como fin último de la atención. Se pretende resaltar un aspecto primordial que es el mejoramiento de los servicios de salud, y así entonces, los entes prestadores y los profesionales tienen un compromiso con cada una de las partes del proceso al que obliga la ley y con los usuarios como fin último de la atención.La ley 100 de 1993 ha traído consigo una serie de reflexiones que nos han involucrado en el mejoramiento de la calidad de vida de los usuarios; siendo el acceso a los servicios de salud uno de los más importantes aspectos por el cual se debe propender y para esto el proceso de consecución de la calidad se hace indispensable.

Health attention and quality in health service have become part of an improvement process in the SocialSecurity System in Colombia. That is whyregulations in force are each time more specificregarding this topic. The process to find and keephealth quality in our context is highly important.Every agent providing health, professionals andpopulation must participate, therefore, asconsequence, a satisfactory result in the real solutionof health problems in the country might appear.Current regulations intend to give importance to abasic aspect: health service improvement. In thisprocess every agent providing health andprofessionals have a commitment with every partin the process and with users as a final end ofattention. Law 100 of 1993 brought a series ofreflections which have involved us in users’ lifequality improvement. The access to health serviceis the most important aspect to tend towards andtherefore the process to obtain quality isindispensable.

Revisión de literatura para la administración de hospitales públicos en Bogotá D.C. / Literature review for the administration of public hospitals in Bogotá D.C.

Antecedentes Reformas normativas han reorganizado el sistema nacional de salud, descentralizando la administración de los servicios y la distribución de las fuentes de financiación. Los hospitales públicos fueron transformados en empresas sociales del Estado (ESE) y han afrontado graves problemas. Tema Revisión sistemática de literatura y definición de alternativas de administración aplicables a las ESE del Distrito. Dada la problemática que afrontan y la importancia que tienen en la prestación de salud a la población más pobre es necesario explorar técnicas administrativas empleadas en otros sistemas. Se consultaron textos, documentos e internet. Se realizó una búsqueda en Medline. Se definió un marco normativo y teórico de gestión, un diagnóstico de las ESE adscritas a la Secretaría Distrital de Salud (SDS) y se formuló un modelo de gestión aplicable a éstas. Conclusiones Una política clara de organización de las ESE en red es fundamental para el uso racional de sus recursos (humanos, financieros y técnicos) y el mejoramiento de la salud de la población. El sistema de pago fijo global prospectivo hace que se comparta el riesgo financiero derivado de la atención del paciente. Una selección adversa de pacientes daría como resultado un detrimento en la salud. La definición de tarifas debe considerar muchas variables soportadas estadísticamente en grandes muestras. El uso de guías de práctica clínica permite estandarizar la atención y hacer más racional y equitativa la prestación de los servicios. Las políticas implementadas por la SDS son buenas, aunque no se encuentran soportadas bajo un alto nivel de evidencia en la literatura.

Background Regulatory reforms have reorganized the national health system, decentralizing the administration of services and the distribution of funding sources. Public hospitals were transformed into state social enterprises (ESE) and have faced serious problems. Topic Systematic literature review and definition of management alternatives applicable to the District's ESE. Given the problems they face and the importance they have in providing health care to the poorest population, it is necessary to explore administrative techniques used in other systems. Texts, documents and Internet were consulted. A Medline search was conducted. A normative and theoretical management framework was defined, a diagnosis of the ESE assigned to the District Health Secretariat (SDS) was made and a management model applicable to them was formulated. Conclusions A clear policy for the organization of ESE in a network is essential for the rational use of their resources (human, financial and technical) and the improvement of the population's health. The prospective global flat-rate prospective payment system results in the sharing of the financial risk derived from patient care. An adverse selection of patients would result in a detriment to health. The definition of fees must consider many variables supported statistically in large samples. The use of clinical practice guidelines makes it possible to standardize care and make the provision of services more rational and equitable. The policies implemented by the SDS are good, although they are not supported by a high level of evidence in the literature.