ABSTRACT
This paper presents the results obtained from qualitative research conducted with a group of users involved in Case Management, a program which was developed by a company of a medical group to provide healthcare for patients in situations of high vulnerability. The study sought to create a perspective in which the experience of the user, instead of representing merely additional or superimposed information upon the quality of services, is considered an inherent part of the arrangement under scrutiny, with the ability to highlight its internal qualities and contradictions. The results show how patients attribute high value to the healthcare they receive, with special emphasis on the bond that is created with the health team in charge, even when contact is only by telephone. Simultaneously, they are able to perceive the double-sided aspect presented by the regulation/assistance model found in the technological arrangement at issue, notably in relation to the prominent role played by the economic bias towards cost reduction--which lies in the forefront of its operationalization--and the final impact it has upon the final quality of healthcare.
Subject(s)
Delivery of Health Care , Insurance, Health , Adolescent , Adult , Aged , Case Management , Female , Humans , Male , TechnologyABSTRACT
O artigo apresenta os resultados de investigação realizada junto a usuários do case management, programa desenvolvido por uma empresa de medicina de grupo para o cuidado de pacientes vivendo situação de alta vulnerabilidade. Buscou-se construir uma perspectiva na qual a experiência do usuário, ao invés de representar apenas uma informação adicional ou superposta à qualidade dos serviços, é considerada parte indissociável do arranjo estudado, com potência para iluminar qualidades e contradições internas. Os resultados mostram como os pacientes dão alto valor aos cuidados recebidos, com especial ênfase no vínculo criado com a equipe responsável, mesmo que apenas por via telefônica. Ao mesmo tempo, conseguem perceber a dupla face regulação/modelo assistencial presente no arranjo tecnológico estudado, sobretudo o quanto o forte viés econômico de redução de custo que preside sua operacionalização impacta na qualidade final do cuidado.
This paper presents the results obtained from qualitative research conducted with a group of users involved in Case Management, a program which was developed by a company of a medical group to provide healthcare for patients in situations of high vulnerability. The study sought to create a perspective in which the experience of the user, instead of representing merely additional or superimposed information upon the quality of services, is considered an inherent part of the arrangement under scrutiny, with the ability to highlight its internal qualities and contradictions. The results show how patients attribute high value to the healthcare they receive, with special emphasis on the bond that is created with the health team in charge, even when contact is only by telephone. Simultaneously, they are able to perceive the double-sided aspect presented by the regulation/assistance model found in the technological arrangement at issue, notably in relation to the prominent role played by the economic bias towards cost reduction - which lies in the forefront of its operationalization - and the final impact it has upon the final quality of healthcare.
Subject(s)
Health Services Administration , Delivery of Health Care/organization & administration , Technological Development , Supplemental Health , Prepaid Health Plans , Professional-Patient RelationsSubject(s)
Prepaid Health Plans/economics , Prepaid Health Plans/standards , Prepaid Health Plans/organization & administration , Consumer Behavior , Health Services Accessibility/trends , Health Services Accessibility/ethics , Health Services Research , Health Services Research/methods , Health Services Research/ethicsABSTRACT
O setor de saúde suplementar no Brasil vem experimentando, nos últimos anos, novos modelos de atenção à saúde. O presente estudo teve como objetivo caracterizar como os usuários percebem e se posicionam em relação à implantação da Estratégia Saúde da Família (ESF) por uma operadora do tipo autogestão. Utilizando-se de grupos focais com usuários considerados "aderidos" e "não-aderidos" à ESF, a pesquisa revela que os usuários têm uma compreensão bastante clara do significado da estratégia, inclusive de seus fortes elementos racionalizadores, percebem as contradições e deficiências no seu processo de formulação e implantação e mantêm um elevado grau de autonomia na escolha dos serviços que lhe sejam mais adequados, muito influenciados pelo tipo de inserção que têm no estabelecimento bancário que mantém a operadora. O usuário percebe, ainda, o impasse da autogestão entre manter uma ampla rede credenciada de livre acesso ou conseguir avançar no sentido de fazer da ESF o eixo estruturante de sua rede assistencial.
The Brazilian supplemental health care sector has been experiencing new health care models in the last few years. This paper aims at featuring how users perceive and how they express themselves in relation to the deployment of a program known as Family Health Strategy (FHS) by a self-management health care provider. Through focal groups, the research reveals that users present a rather clear view on the meaning of strategy, including its remarkable rationalizing elements. In addition, they percept contradictions as well as deficiencies in the formulation and deployment process, and they keep a high level of autonomy in the choice for more adequate services, which are greatly influenced by the type of insertion that they exert in the bank institution that maintains the health care service provider. Users also perceive the predicament presented by self-management regarding the maintenance of a broad authorized free access network and the advance towards turning FHS into the structuring backbone of its assistance network.
Subject(s)
Humans , Health Services Accessibility/trends , Health Services Accessibility/ethics , Health Services Research/methods , Health Services Research , Health Services Research/ethics , Prepaid Health Plans/economics , Prepaid Health Plans/standards , Prepaid Health Plans/organization & administration , Consumer Behavior/legislation & jurisprudence , Brazil , Technological Development/economics , Technological Development/methods , Technological Development/policies , Technological Development/prevention & control , Technological Development/ethics , Equity in Access to Health Services , Total Quality Management , Organizational Innovation/economics , Technological Development and Innovation Projects , Family Health/ethnologyABSTRACT
This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.
Subject(s)
Delivery of Health Care/organization & administration , Health Personnel/psychology , Health Services Administration , Interprofessional Relations , Primary Health Care/organization & administration , Attitude of Health Personnel , Brazil , Delivery of Health Care, Integrated , Female , Focus Groups , Health Services Needs and Demand , Humans , Male , Organizational Case StudiesABSTRACT
Este artigo apresenta resultados de estudo de caso visando identificar desafios na oferta de atenção básica à saúde em um distrito de saúde da cidade de São Paulo, Brasil, considerando integralidade como dispositivo organizador do trabalho neste nível de atenção. Foram estudadas as cinco unidades que compõem a rede de atenção básica à saúde no distrito considerado. Os dados foram coletados mediante observação dos fluxos e rotinas de atendimento, realização de entrevistas com gerentes e profissionais de diferentes formações e ainda realização de grupos focais com equipes de saúde da família. A análise mostra um descompasso entre as características da clientela e suas necessidades presumidas e as ofertas dos serviços, e heterogeneidade nas percepções dos profissionais sobre seu trabalho. Falta de profissionais, de tempo, e dificuldades para encaminhamentos foram os principais problemas apontados pelos entrevistados.
This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.
Subject(s)
Female , Humans , Male , Delivery of Health Care/organization & administration , Health Services Administration , Health Personnel/psychology , Interprofessional Relations , Primary Health Care/organization & administration , Attitude of Health Personnel , Brazil , Delivery of Health Care, Integrated , Focus Groups , Health Services Needs and Demand , Organizational Case StudiesABSTRACT
Säo aqui relatados os resultados do censo abreugráfico de 1984 de uma empresa de grande porte, isenta de riscos ocupacionais para o aparelho respiratório. Em 5.308 abreugrafias realizadas foram detectados 53 casos de anormalidades abreugráficas (1%), dos quais apenas 4 de tuberculose ativa. O rendimento foi de 0,75/1.000 abreugrafias. O custo médio de detecçäo de cada caso de tuberculose ativa foi de 256,32 ORTN (ao redor de 1.850 dólares). Foi também constatado um menor comparecimento de funcionários ao exame abreugráfico periódico, 1,6% de ausências em 1982 e 7,8% em 1984, causado provavelmente pelo crescente conhecimento leigo sobre radiaçöes ionizantes. Os resultados säo discutidos e é apresentada uma revisäo sobre o emprego de exames radiológicos periódicos em saúde ocupacional