ABSTRACT
BACKGROUND: The application of cell phones, similar portable devices (ie, tablets), apps, the internet, and GPS in evaluation have established new ways of collecting, storing, retrieving, transmitting, and processing data or information. However, evidence is incipient as to which technological resources remain at the center of assessment practice and the factors that promote their use by the assessment community. OBJECTIVE: This study aimed to analyze the relationship between the use of the National Program for Improving Primary Healthcare Access and Quality's (PMAQ-AB; Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica) mobile app and management system and the external evaluation quality of Brazil's PMAQ-AB. METHODS: We conducted a qualitative case study during the external evaluation of Brazil's PMAQ-AB. Data collection consisted of interviews, focus groups, and document analysis. A total of 7 members from the Department of Primary Care of the Ministry of Health and 47 researchers from various higher education and research institutions across the country participated in the study. Data were categorized using the ATLAS.ti software program, according to the quality standards of the Joint Committee on Standards for Educational Evaluation, following the content analysis approach by Bardin. RESULTS: The results related to feasibility, thematic scope, field activity management, standardized data collection, data consistency, and transparency. They demonstrated improvements and opportunities for advancements in evaluation mediated by the use of information technology (IT), favored the emergence of new practices and remodeling of existing ones, and took into account the multiple components required by the complex assessment of access and quality in primary health care. Difficulties in technology operation, inoperative systems, and lack of investment in equipment and human resources posed challenges to increasing the effectiveness of IT in evaluation. CONCLUSIONS: The use of technology-based tools-the app and the management system-during the external evaluation offered evaluators a greater opportunity for stakeholder engagement. This also allowed the insertion of different organizational, operational, and methodological components that are capable of triggering influences and confluences. In addition, this allowed connections in collaborative and synergistic networks to increase the quality and allow the development of a more consistent and efficient evaluation process with greater possibility of incorporating the results into public health policies.
ABSTRACT
BACKGROUND: In many countries, the inclusion of nurses as prescribers is considered to be an advanced practice. In Brazil, such prescriptions are legally regulated and restricted to primary health care protocols. The presence of prescribing nurses has provoked a debate among medical and nursing corporations. However, there are few studies examining the qualifications, protocols and in-service training that are aimed at prescribing nurses in primary health care. OBJECTIVE: We sought to investigate possible gaps between the education, qualifications, self-assessments and practice of prescribing medicine in primary health care from the perspective of nurses. DESIGN: This investigation is a case study with a qualitative approach. SETTING: This research was conducted in a Brazilian municipality with 84.04% family health strategy coverage and 400,002 inhabitants in northeast Brazil. PARTICIPANTS: The participants were an intentional sample of 37 nurses in primary health care who were linked to the family health strategy. METHODS: The study was conducted between August and November 2011 with four focus groups, a script validated by the Delphi technique, and a pilot study. This study addressed the qualifications for the prescription of medication, the sufficiency of the Ministry of Health protocols and self-assessments of the ability to prescribe. Qualitative analysis was applied. RESULTS: All nurses reported having received insufficient training in the discipline of pharmacology to qualify them for prescriptive practice. The nurses emphasised the need for post-graduate training, the importance of clinical experience, and the lack of discussions and training. Only a small number of nurses self-assessed themselves as competent in prescribing drugs, and the others revealed fears of causing adverse reactions to medication. CONCLUSIONS: There are gaps in the education, training, and daily demands of the prescription of medication by nurses in primary health care. It is suggested that prescription practices should be incorporated into undergraduate studies and continuing education in health services.
