Health workers' perspectives on asthma care coordination between primary and specialised healthcare in the COVID-19 pandemic: a protocol for a qualitative study in Ecuador and Brazil.

INTRODUCTION: Asthma is a common long-term disorder and strategies to improve asthma control are still a challenge. Integrated delivery of health systems is critical for effective asthma care: there is limited information on experiences of care coordination for asthma from Latin America, especially on perspectives of health personnel and in the context of the COVID-19 pandemic. METHODS AND ANALYSIS: This protocol details a qualitative approach to analyse health workers' perspectives of healthcare coordination for asthma control during COVID-19 pandemic in Ecuador and Brazil, at primary and specialised levels, through in-depth semistructured interviews using a video communications platform. The analysis will identify knowledge and perspectives based on coordination of clinical information, clinical management and administrative coordination. Theoretical sampling will be used to obtain approximately equal numbers of women and men within each level of healthcare; data saturation will be used to determine sample size. Transcripts will be analysed using content-coding procedures to mark quotations related to major topics and subthemes included in the interview guide, and narrative analysis will be based on a theoretical framework for healthcare coordination to identify new themes and subthemes. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics committees of Hospital General Docente Calderón, Quito, Ecuador; and Universidade Federal da Bahia, Salvador, Brazil. The findings of this study will be disseminated through peer-reviewed articles, conference presentations and condensed summaries for key stakeholders and partners.

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil / Determinants of the use of different healthcare levels in the General System of Social Security in Health in Colombia and the Unified Health System in Brazil

Objetivo. Analizar comparativamente la utilización de servicios de los distintos niveles asistenciales y sus determinantes, de dos sistemas de salud diferentes, Sistema General de Seguridad Social en Salud (SGSSS) y Sistema Único de Salud (SUS), en municipios de Colombia y Brasil. Métodos. Estudio transversal basado en encuesta poblacional en dos municipios de Colombia (n = 2163) y dos de Brasil (n = 2155). Variables resultado: utilización de los servicios de atención primaria, especializada y urgencias en los últimos 3 meses. Variables explicativas: necesidad, factores capacitantes y predisponentes. Análisis bivariado y regresiones logísticas multivariadas por nivel asistencial y país. Resultados. Los determinantes de la utilización varían según el nivel asistencial y el país. Padecer una enfermedad crónica se asocia a un mayor uso de atención primaria y especializada en Colombia, y además a las urgencias en Brasil. En Colombia, los afiliados al régimen contributivo utilizan más los servicios del SGSSS que los del subsidiado en atención primaria y especializada, o que los no asegurados en cualquier nivel; en Brasil, la población de baja renta y sin seguro privado hace un mayor uso del SUS en cualquier nivel de atención. En ambos países, conocer el centro de salud asignado y tener una fuente regular de atención incrementa el uso de la atención primaria y el conocimiento del hospital de referencia, el de especializada y urgencias. Conclusiones. La influencia de los determinantes del uso difiere según el nivel de atención utilizado en ambos países, por lo que se subraya la necesidad de analizarlo desagregando por nivel asistencial (AU)

Objective. To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. Methods. A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n = 2163) and two in Brazil (n = 2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. Results. The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. Conclusions. In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care (AU)

Objetivos de Desarrollo del Milenio (ODM): el hambre, la salud de las mujeres y de los niños en Latinoamérica / The Millennium Development Goals: the Hunger, the Children and Women Health in Latin America

Actualmente, la población mundial sobrepasa los 6.000 millones de personas. Aunque haya desacuerdos entre las diferentes organizaciones (gubernamentales y no gubernamentales) respecto a las estadísticas presentadas sobre el hambre en el mundo, es lamentable y a la vez preocupante el número de personas hambrientas. Según la Organización de las Naciones para la Agricultura y la Alimentación (FAO), 854 millones padecen de hambre y la cifra total de personas que presentan carencias nutricionales severas que les impiden el desarrollo normal de sus funciones vitales alcanza casi los 3.000 millones de seres humanos. Es lamentable porque esto sucede en un planeta que produce un volumen de alimentos capaz de alimentar adecuadamente a 12.000 millones de personas, casi el doble de su población. Es preocupante porque la historia de la humanidad está llena de experiencias de conflictos, guerras, migraciones, invasiones a causa del hambre endémica, epidémica o cíclica.

Currently, the world's population exceeds 6 billion people. Although there are disagreements among different organizations (governmental and non-governmental) regarding the statistics presented on world hunger, the number of hungry people is both unfortunate and worrisome. According to the Food and Agriculture Organization of the United Nations (FAO), 854 million people suffer from hunger and the total number of people suffering from severe nutritional deficiencies that prevent them from the normal development of their vital functions reaches almost 3 billion human beings. It is regrettable because this is happening on a planet that produces a volume of food capable of adequately feeding 12 billion people, almost twice its population. It is worrying because the history of humanity is full of experiences of conflicts, wars, migrations, invasions due to endemic, epidemic or cyclical hunger.

A hanseníase e o seu processo diagnóstico / The hansen's disease and its diagnostic process

Este estudo tem como objetivo identificar nos relatos de pacientes de hanseníase as principais dificuldades sentidas para obtenção do diagnóstico da doença.Utilizou-se uma abordagem qualitativa com análise de entrevistas semi-estruturadas feitas aos portadores de hanseníase no ambulatório de Dermatologia Sanitária do Centro Integrado de Saúde Amaury de Medeiros, Recife-PE. Entrevistaram-se 21 pacientes, entre 9 a 73anos, no período de dezembro de 2004 a janeiro de2005. A maioria dos entrevistados apresentou diagnóstico tardio da doença. Da análise do conteúdo emergiram quatro categorias: estigma da hanseníase, percepção de estar doente, conhecimento sobre a doença e baixa resolutividade do serviço. Sentimentos de medo, rejeição e negação da doença dificultaram o diagnóstico precoce de um dos entrevistados. Uma parte dos entrevistados só percebeu algum sinal da doença quando já apresentavam a doença nas formas clínicas polarizadas e transmissíveis. Outros, por desconhecimento ou conhecerem de forma limitada a doença retardaram a procura ao serviço. A maioria considerou que o diagnóstico tardio estava relacionado, sobretudo à baixa resolutividade do serviço na confirmação dos casos. Alguns demoraram cerca de 3 anos desde a primeira procura ao serviço até o diagnóstico.O estudo revelou que as dificuldades que os entrevistados encontraram para o diagnóstico da hanseníase estavam relacionadas ao estigma, a não percepção,ao desconhecimento ou conhecimento limitado da doença e a procura ao serviço. Os resultados sugerem que, o estigma da doença ainda persiste no imaginário da população, a qual apresenta um desconhecimento sobre as características da doença. O resultado mais preocupante se refere à qualificação dos profissionais no diagnóstico da enfermidade

The early diagnosis of Hansen’s disease is one the essential conditions for the disease control. This study has as an objective to identify on the report of the Hansen’s disease carriers the main problems faced to the early diagnosis of the disease. Qualitative methodology was employed with analysis of semi-structured interviews made with carriers in the Sanitary Dermatologyambulatory – CISAM, Recife – PE. 21 patients were interviewed aged within 9 and 73 years old. Most of them presented late diagnosis of the disease. The situations that delivered to this were grouped in 4 categories for analysis: Hansen’s disease stigma, being-ill perception, knowledge about the disease, the health assistance search. The last category was the most occurred, where patients took until 3 years from the first health service search to the diagnosis. Four patients had only noticed traces of the disease when it was already transmissible, others had no or precarious knowledge about the Hansen’s disease and delayed the health service search. Hansen’s disease must be diagnosed in its undetermined initial phase due to interrupt the “transmission chain” and avoid the evolution to more critical cases. So, the population must know the traces and symptoms of the disease and be motivated to look for the health service, which must be prepared with qualified professionals.