ABSTRACT
Introducción. El clima organizacional dentro de las instituciones de salud y la satisfacción del paciente se utilizan para evaluar y mejorar la calidad de los servicios de salud. Objetivo. Determinar el clima organizacional y la satisfacción del usuario externo sobre la atención medica recibida en los servicios de hospitalización del Instituto Nacional Salud del Niño (INSN). Métodos. En el año 2017 se aplicó una encuesta para calificar el clima organizacional a los trabajadores de los servicios de hospitalización del Departamento de Medicina del INSN. La satisfacción del usuario externo se midió mediante la encuesta SERVQUAL aplicada a los usuarios externos. Resultados. La calificación del clima organizacional fue de 76,3%, considerada como mejorable; y la satisfacción global del usuario externo fue de 64,4%. El clima organizacional en las dimensiones de identidad, comunicación organizacional y estructura lograron el calificativo de saludable y la dimensión remuneración obtuvo el calificativo de no saludable. La dimensión mejor valorada por los usuarios externos fue: ¿durante su hospitalización recibió visita médica todos los días?; y la menos valorada: ¿los trámites para el alta fueron rápidos?. Conclusión. La calificación global del clima organizacional fue de 76,3% y la satisfacción global del usuario externo fue de 64,4% en el INSN.
Introduction. The organizational climate within health institutions and patient satisfaction are used to evaluate and improve the quality of health services. Objective. Determine the organizational climate and the satisfaction of the external user regarding the medical care received in the hospitalization services of the Instituto Nacional Salud del Niño (INSN). Methods. In the year 2017 a survey was applied to qualify the organizational climate to the workers of the hospitalization services of the Department of Medicine of the INSN. The satisfaction of the external user was measured through the SERVQUAL survey applied to external users. Results. The qualification of the organizational climate was 76,3%, considered as improvable; and the overall satisfaction of the external user was 64,4%. The organizational climate in the dimensions of identity, organizational communication and structure achieved the qualification of healthy and the remuneration dimension obtained the qualification of unhealthy. The dimension best valued by external users was: during your hospitalization did you receive a medical visit every day? and the least valued: were the procedures for discharge high?. Conclusion. The overall rating of the organizational climate was 76,3% and the overall satisfaction of the external user was 64,4% in the INSN.
ABSTRACT
BACKGROUND: Perinatally HIV-infected (PHIV) children are at risk for under-vaccination and poor vaccine response at 4 years of age. Childhood vaccine coverage and immune response were compared between PHIV and HIV-exposed uninfected (HEU) children in Latin America and the Caribbean. METHODS: PHIV and HEU children were enrolled prospectively at 15 sites from 2002 to 2009. Full vaccination by age 4 years was defined as: 3 hepatitis B virus vaccine doses; 4 tetanus toxoid-containing vaccine doses; 3 doses of Haemophilus influenzae type b vaccine by age 12 months or ≥1 dose given after age 12 months; one measles-containing vaccine dose; one rubella-containing vaccine dose. Immunity was defined by serum antibody titer. Fisher exact test (for categorical measures) and t test (for continuous measures) were used for comparisons. RESULTS: Among 519 children seen at age 4 years, 191 had serum specimens available (137 PHIV, 54 HEU). Among those with specimens available, 29.3% initiated combination antiretroviral therapy (cART) <12 months of age, 30.9% initiated at ≥12 months of age, and 39.8% had not received cART by the time they were seen at 4 years of age. At 4 years of age, 59.9% were on PI-containing cART (cART/PI), and 20.4% were on no ART. PHIV children were less likely than HEU children to be fully vaccinated for tetanus (55.5% vs. 77.8%, P = 0.005) and measles and rubella (both 70.1% vs. 94.4%, P < 0.001). Among those fully vaccinated, immunity was significantly lower among PHIV than HEU for all vaccines examined: 20.9% versus 37.8% for hepatitis B virus (P = 0.04), 72.0% versus 90.5% for tetanus (P = 0.02), 51.4% versus 68.8% for H. influenzae type b (P = 0.05), 80.2% versus 100% for measles (P < 0.001) and 72.9% versus 98.0% for rubella (P < 0.001) vaccine, respectively. CONCLUSIONS: Compared with HEU, PHIV children were significantly less likely to be immune to vaccine-preventable diseases when fully vaccinated. Strategies to increase immunity against vaccine-preventable diseases among PHIV require further study.
