Concordância interavaliadores do Protocolo de Acolhimento e Classificação de Risco em Obstetrícia do Ministério da Saúde / Inter-rater agreement of the Reception Protocol and Risk Classification in Obstetrics of the Ministry of Health

Introdução: A classificação de risco é definida como uma ferramenta utilizada nos serviços de urgência e emergência que auxilia na identificação de pacientes que necessitam atendimento prioritário. Em obstetrícia o surgimento de um protocolo específico por intermédio do Ministério da Saúde que conta com 12 fluxogramas tem sido uma medida adotada para organização e humanização dos serviços que atendem obstetrícia, no intuito de minimizar danos relacionados à saúde dessas usuárias que aguardam atendimento . O objetivo do estudo foi: determinar o grau de concordância interavaliador na aplicação do protocolo de acolhimento e classificação de risco em obstetrícia do Ministério da Saúde em uma unidade de pronto atendimento obstétrico. Métodos: Trata-se de um estudo transversal, com abordagem metodológica, que analisou a reprodutibilidade do protocolo em obstetrícia do Ministério da saúde. Para a coleta dos dados: foram avaliados prontuários com o registro de atendimentos ocorridos entre novembro 2019 e maio de 2020. Foram entrevistados enfermeiros que possuem treinamento em classificação de risco e também enfermeiros que não possuem treinamento em classificação de risco. Para análise estatística dos dados foram calculados através do coeficiente de Kappa, sensibilidade e especificidade. Resultados: Os resultados do estudo demonstraram que o grau de confiabilidade interavaliadores foi considerado de moderado a forte representado pelo coeficiente Kappa que variou entre (0,47 e 0,77), foi observado também uma tendência na subestimação do grupo prioritário vermelho e amarelo, e uma tendência de superestimação nas prioridades clínicas amarelo e verde. Apesar de ter acontecido casos de subestimação e superestimação não ocorreram diferenças significativas nos grupos de enfermeiros treinados versus não treinados para utilização do protocolo de A&CR-O. Assim, os resultados desta dissertação corroboram com a hipótese que o protocolo de A&CR ­ O é confiável para o que se propõe. Conclusão: Esse estudo possibilitou verificar que o protocolo é confiável para sua utilização no campo da obstetrícia, uma vez que demonstrou concordância moderada a forte entre os grupos de avaliadores, além disso contribuiu para a análise da reprodutibilidade do protocolo de classificação de risco em obstetrícia que vem sendo implantado desde se sua publicação podendo ser utilizado com maior segurança por Enfermeiros. Palavras-chave: Protocolos. Protocolos clínicos. Confiabilidade. Obstetrícia. Classificação de risco. Serviços de emergência obstétrica. Reprodutibilidade. Enfermagem. Enfermagem Obstétrica. Estudos de avaliação.

Introduction: Risk classification is defined as a tool used in urgent and emergency services that helps to identify patients who need priority care. In obstetrics, the emergence of a specific protocol through the Ministry of Health, which has 12 flowcharts, has been a measure adopted to organize and humanize the services that attend obstetrics, in order to minimize the health-related damage of these users who are awaiting care. The objective of the study was: to determine the degree of inter-rater agreement in the application of the welcoming protocol and risk classification in obstetrics of the Ministry of Health in an obstetric emergency care unit. Methods: This is a cross-sectional study, with a methodological approach, which analyzed the reproducibility of the protocol in obstetrics of the Ministry of Health. For data collection: medical records were evaluated with the record of visits that took place between November 2019 and May 2020. Nurses who have training in risk classification and nurses who do not have training in risk classification were interviewed. For statistical analysis of the data, they were calculated using the Kappa coefficient, sensitivity and specificity. Results: The results of the study showed that the degree of inter-rater reliability was considered moderate to strong, represented by the Kappa coefficient that varied between (0.47 and 0.77), a tendency was also observed in the underestimation of the red and yellow priority group, and a tendency to overestimate the yellow and green clinical priorities. Despite cases of underestimation and overestimation, there were no significant differences in the groups of trained versus untrained nurses to use the A & CR-O protocol. Thus, the results of this dissertation corroborate the hypothesis that the A&CR - O protocol is reliable for what it is proposed. Conclusion: This study made it possible to verify that the protocol is reliable for its use in the field of obstetrics, since it demonstrated mode rate to strong agreement between the groups of evaluators, in addition it contributed to the analysis of the reproducibility of the risk classification protocol in obstetrics that it has been implemented since its publication and can be used more safely by nurses.

Lags in the provision of obstetric services to indigenous women and their implications for universal access to health care in Mexico.

Through quantitative and qualitative methods, in this article the authors describe the perspectives of indigenous women who received antenatal and childbirth medical care within a care model that incorporates a non-governmental organisation (NGO), Partners in Health. They discuss whether the NGO model better resolves the care-seeking process, including access to health care, compared with a standard model of care in government-subsidised health care units (setting of health services networks). Universal health coverage advocates access for the most disadvantaged and vulnerable populations as a priority. However, the issue of access includes problems related to the effect of certain structural social determinants that limit different aspects of the obstetric care process. The findings of this study show the need to modify the structure of organisational values in order to place users at the centre of medical care and ensure respect for their rights. The participation of agents outside the public system, such as NGOs, can be of great value for moving in this direction. Women's participation is also necessary for learning how they are being cared for and the extent to which they are satisfied with obstetric services. This research experience can be used for other countries with similar conditions.

Health facility readiness and facility-based birth in Haiti: a maximum likelihood approach to linking household and facility data.

BACKGROUND: Haiti has one of the world's highest maternal mortality ratios. Comprehensive obstetric services could prevent many of these deaths, though most births in Haiti occur outside health facilities. Demand-side factors like a mother's socioeconomic status are understood to affect her access or choice to deliver in a health facility. However, analyses of the role of supply-side factors like health facility readiness have been constrained by limited data and methodological challenges. We sought to address these challenges and determine whether Haiti could increase rates of facility-based birth by improving facility readiness to provide delivery services. METHODS: Our task was to characterize facility delivery readiness and link it to nearby births. We used birth data from the 2012 Haiti DHS and facility data from the 2013 Haiti SPA. Our outcome of interest was facility-based birth. Our predictor of interest was delivery readiness at the DHS sampling cluster level. We derived a novel likelihood function that used Kernel Density Estimation to estimate cluster-level readiness alongside the coefficients of a logistic regression. RESULTS: We analyzed data from 389 facilities and 1,991 births. Rural facilities were less ready than urban facilities to provide delivery services. Women delivering in health facilities were younger, more educated, wealthier, less likely to live in rural areas, and had fewer previous children. Our model estimated that rural facilities (σ = 12.28, standard error [SE] = 0.16) spread their readiness over larger areas than urban facilities (σ = 7.14, SE = 0.016). Cluster-level readiness was strongly associated with facility-based birth (adjusted log-odds = 0.031; p = 0.005), as was socioeconomic status (adjusted log-odds = 0.78; p < 0.001). CONCLUSIONS: Health system policymakers in Haiti could increase rates of facility-based birth by supporting targeted interventions to improve facility readiness to provide delivery-related services, alongside efforts to reduce poverty and increase educational attainment among women.