Difficulties in accessing services that are of medium complexity in small municipalities: a case study. / Dificuldade de acesso a serviços de média complexidade em municípios de pequeno porte: um estudo de caso.

The study aimed to describe the specialized health services and to identify areas of greater difficulty of access to specialized consultations offered by SUS in small cities in the 18th Regional Health Area of Paraná State, Brazil, using case study methodology. The data were collected between January and April 2015. Managers, management teams and the board of directors of the CIS (Consórcio Intermunicipal de Saúde) were interviewed. The 21 studied specialist areas were rated like Sufficient Quota, Insufficient Quota, Inexistent Supply, and Assistance Gap. The services with more difficulty of access were Vascular Surgery, Proctology, Geriatrics, Endocrinology, and Neurology, considered Inexistent Supply/Assistance Gap, and Orthopedics, Neuro-pediatrics, Urology, Rheumatology, Ophthalmology, and Otorhinolaryngology, were considered Insufficient Share. Contribute to the magnitude of the problem: lack of specialist doctors, private sector dependence and de decrease of the Federal and State Governments in financing the Health Sistem. Therefore, the gap in specialized healthcare is complex and difficult to solve in the short-terms, proving that this services have become a "bottleneck" in the SUS.

[Assessment of the follow-up of adult patients with arterial hypertension and/or diabetes mellitus by the Family Health Strategy and identification of associated factors in the city of Cambé, Brazil, 2012]. / Avaliação do acompanhamento de pacientes adultos com hipertensão arterial e ou diabetes melito pela Estratégia Saúde da Família e identificação de fatores associados, Cambé-PR, Brasil, 2012.

OBJECTIVE: to assess the follow-up of adults with arterial hypertension and/or diabetes by the Family Health teams and identify associated factors in the city of Cambé-PR, Brazil, in 2012. METHODS: evaluation research using document analysis with calculation of the following indicators: coverage and concentration of household visits, medical consultation, and nursing consultation. RESULTS: 386 of the 687 individuals with hypertension or diabetes had records of their condition at the Primary Healthcare Units; medical consultation coverage (69.2%) was regular, while nursing consultation (1.5%) and household visit (12.2%) indices were critical; concentration was critical for household visits, nursing consultations, and medical consultations for high-risk groups; medical consultation coverage was higher among women, those with lower schooling, and those attending Primary Healthcare Units (p<0.05), but did not differ with regard to cardiovascular risk. CONCLUSION: follow-up by the teams does not meet the healthcare standard set for the programmatic groups analyzed.

[Dental treatment of pregnant women: the role of healthcare professionals]. / Atenção odontológica à gestante: papel dos profissionais de saúde.

The scope of this article involved qualitative research conducted together with pregnant women attended by the Brazilian Unified Health System (SUS) and private services, seeking to identify the perception of these women on the role of health professionals in relation to dental care during pregnancy. The data were collected through recorded, semi-structured interviews based on a questionnaire and analyzed by assessment of thematic content. It was noted that some health professionals propagate and reinforce misconceptions and fears about dental care and oral health during pregnancy. The need for investment in education on dental care during pregnancy, both at undergraduate and graduate level, was clearly revealed, since knowledge on the subject can contribute to a review of concepts, and consequently the manifest behavior vis-à-vis this segment of the population.

[Public health financing by the Paraná State Government, Brazil, 1991-2006]. / Financiamento público da saúde pelo governo do Estado do Paraná, Brasil, 1991-2006.

This study discusses public health financing by the State Government of Paraná, Brazil. Expenditures by the State Health Department were analyzed as a proxy for health expenditures by the State Government of Paraná from 1991 to 2006. Three criteria were used: (1) expenditures as a percentage of net revenue, in accordance with Constitutional Amendment no. 29; (2) expenditures as a percentage of total budget outlay; and (3) per capita health expenditures with the State's own resources. The findings showed distinct trends in expenditures during the period studied, the most recent being an expansion in spending of funds from the State treasury.

[Inter-municipal health consortia: the case of Paraná State, Brazil]. / Consórcios Intermunicipais de Saúde: o caso do Paraná, Brasil.

Inter-municipal health consortia emerged in Brazil's Unified National Health System (SUS) policy in the late 1980s. Municipal health administrators adhered to this strategy with the aim of upgrading health services supplied to the population. This research analyzes the profile of such consortia in Paraná State, focusing on specialized medical care. Data were obtained from reports by the State Health Council and questionnaires sent to all 20 existing municipal health consortia. Governmental Decree no. 1,101 and data published in 2000 on the profile of the health system in Paraná were used as references. Of the 399 municipalities in Paraná State, 81.5% have joined municipal consortia. Specialists are allocated by municipalities (4.4%), the State government (13.6%), or Federal Government (12.8%); another 69.2% are hired by the consortia themselves. The supply of consultations with specialists is either insufficient or inadequately distributed, and there are flaws in the referral and counter-referral system. Municipal health consortia serve as viable instrument for expanding and increasing the capacity of municipalities to supply specialized care, although there is a need for well-defined criteria, planning, and improving of the referral and counter-referral system.