Navegando por Palavras-chave "quality of health care"
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- ItemSomente MetadadadosAvaliação da qualidade dos seviços prestados pelas equipes da estrategias saude da familia(Universidade Federal de São Paulo (UNIFESP), 2013-09-25) Oliveira e Silva, Carla Silvana de [UNIFESP]; Barbosa, Dulce Aparecida Barbosa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This research aimed to evaluate the Primary Health Care (PHC), focusing on its attributes, in the adult health at Family Health Strategy (FHS), and to evaluate the association between attributes of PHC and professional qualification of family health nursing. This is a cross-sectional, descriptive and quantitative study. For data collection, we used validated questionnaire in Brazil called Instrument for Assessment of Primary Care (PACTooL adult version). This was applied to adult users of Primary Health Care service in Montes Claros, Minas Gerais. Were assigned scores for the eight dimensions of PHC. Were applied, also, tool for professionals in the family health unit to characterize the teams and professionals. The results showed that there is significant difference between the population using the FHS and using other services. When evaluating the dimensions together, we found the same score of the PHC, being this close to ideal among adult users of the FHS, as source of health attention and statistically different from the scores assigned to users of other services. To identify the variables associated with the high score of the PHC, were found that using the FHS as a regular source of health care for the adult and nursing professionals possess training in family health and community are related to better general score of PHC. Concludes that the ESF is the preferred space for the promotion of adult health, as well as the training of nurses in family health and community have the potential to transform the model of attention, from attributes of PHC.
- ItemAcesso aberto (Open Access)Evaluation of prenatal care at basic health units in the city of São Paulo(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2008-12-01) Succi, Regina Célia de Menezes [UNIFESP]; Figueiredo, Elisabeth Niglio de [UNIFESP]; Zanatta, Letícia de Carvalho [UNIFESP]; Peixe, Marina Biffani [UNIFESP]; Rossi, Marina Bertelli [UNIFESP]; Vianna, Lucila Amaral Carneiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The aim of this study was to evaluate the quality of prenatal care offered in 12 Basic Health Units (BHU) in the city of São Paulo, Brazil, through a review of medical and nurse charts, before and after the municipalization of the public health system. The indicator used considered excellence in care as: starting prenatal care in the first quarter of pregnancy; at least six medical visits; at least two results of blood screening for syphilis and one for HIV; returning to BHU up to 42 days after delivery. This indicator was not present in any care delivered in 2000, and only 7.7% of the care delivered in 2004 obtained it (1.1% to 30% of the care per unit assessed). Although there was an evident improvement in care during the period, the low proportion of excellent prenatal care shows an urgent need to improve this care in the BHU of São Paulo city.
- ItemAcesso aberto (Open Access)Métodos de avaliação de resultados da assistência de enfermagem(Associação Brasileira de Enfermagem, 2003-02-01) Adami, Nilce Piva [UNIFESP]; Yoshitome, Aparecida Yoshie [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This review study aimed at the theoretical and methodological assessment of nursing care outcome. The study focused on the element outcome as a means to assess the nursing care service quality as well as on the nursing care classification and on the main methods and strategies used for assessing the outcome of nursing care, provided by health services.
- ItemSomente MetadadadosQualidade da atenção pré-natal em unidades básicas de saúde do município de Cruzeiro do Sul/Acre(Universidade Federal de São Paulo (UNIFESP), 2016-01-29) Costa, Kleynianne Medeiros de Mendonca [UNIFESP]; Schirmer, Janine Schirmer [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the quality of Prenatal care performed in Basic Health Units (UBS) of the urban area of Cruzeiro do Sul city (Acre-Brasil). From the description and analysis of the structure related to human resources available, to process and outcome of care developed by nurses prenalists. Method: The study population was composed of all the nurses responsible for prenatal care 39 and by all the pregnant women who started prenatal care in 2012 (1428). The sample was composed of 29 nursing professionals and 481 pregnant women (handbooks). The variables selected for the interview with the nurses were grouped in three phases: The first being by socioeconomic characteristics and training; In the second phase it was characterization of professionals by catchment, organization and care to pregnant women; And the third phase it was characterization of professionals by difficulties in the care to pregnant women. In relation to the analysis of medical handbooks the variables were allocated and divided into five levels: 1- the beginning of the prenatal and number of consultations; 2- laboratory tests; 3- anamnesis; 4- procedures related to general physical exams and gynecological-obstetrical; 5- actions related to maternal health promotion and prevention maternal, perinatal and neonatal. For the analysis of the result of the care process were used the numbers of cases of congenital syphilis, neonatal tetanus, maternal and neonatal deaths. The data collection was performed through interviews with the nurses; analysis of medical handbooks, besides the data request to the Municipal Epidemiological Surveillance. For the variables concerning the analysis of medical handbooks were established degrees of adequacy according to the normative criterions and calculated indices of adequacy. The initial statistical analysis was descriptive. For the categorical variables were presented as absolute and relative frequencies, and for numerical variables, summary-measures. Results: The descriptive analysis of the characterization of the nurses pre-natalist identified a greater percentage of nurses 86.2 per cent, married 44.8 per cent, with children 58.6 per cent, work journey exceeding 40 weekly hours 65.5 per cent, graduated over seven years ago 58.6 per cent, without post-graduation 58.6 per cent or update course on prenatal 69.0 per cent. About the organization of its consultations, meet by spontaneous demand 86.2 per cent, the community health agents perform the active search of defaulting pregnant women 79.3 per cent, the prenatal care is offered daily 58.6 per cent, there are risk rating for the pregnant women 96.6 per cent and puerperal consultations 72.4 per cent). The unit does not offer courses for the pregnant women 93.1 per cent. The professionals reported difficulties in the provision of assistance 69.0 per cent, especially with respect to issues of structural. They believe that the public management can contribute to improving the quality of the attention 100 per cent. They use as a care protocol the manual of prenatal care of low risk of Ministry of Health 86.2 per cent. About the care process was identified low index of adequacy 44.0 per cent, mainly with respect to maternal health and prevention of maternal offenses, perinatal and neonatal 19.0 per cent, anamnesis 29.0 per cent and general physical examination and gynecological-obstetrical 33 per cent. The comparison between variables showed that health units of the rural area, units without courses for pregnant women, professionals with less qualification and those who do not have work overload develop better prenatal care. As regard to the result of the care process, despite not having been registered the case of neonatal tetanus, there was congenital syphilis, and high rate of maternal and neonatal mortality. Conclusions: prenatal care is developed basically by the professional nurse; the normative criterions are not fulfilled in their totality, consequently occurs low adequacy of prenatal care quality offered. The reeavalution of this service by the professional, manager and the user, is essential to the establishment of strategies aimed at improving the quality of prenatal care.
- ItemAcesso aberto (Open Access)Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública(Sociedade Brasileira de Cardiologia - SBC, 2012-11-01) Caluza, Ana Christina Vellozo [UNIFESP]; Barbosa, Adriano H. [UNIFESP]; Gonçalves, Iran [UNIFESP]; Oliveira, Carlos Alexandre L. de [UNIFESP]; Matos, Lívia Nascimento de [UNIFESP]; Zeefried, Claus; Moreno, Antonio Célio C.; Tarkieltaub, Elcio; Alves, Claudia Maria Rodrigues [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Serviço de Atendimento Móvel de Urgência; Prefeitura Municipal de São Paulo Secretaria de Saúde; Hospital Municipal Prof. Dr. Alípio Correa NettoBACKGROUND: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles. OBJECTIVE:To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). METHODS: Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya) of the periphery of the city of São Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis. RESULTS: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding. CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.
- ItemAcesso aberto (Open Access)Rede de infarto com supradesnivelamento de ST: sistematização em 500 casos diminui eventos clínicos na rede pública(Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Caluza, Ana Christina Vellozo [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: The major cause of deaths in the city of Sao Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15-20% due to difficulties inherent in large metropoles. Objectives: To describe in-hospital mortality in ST Elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). Methods: Health care teams of seven emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé, Saboya, João XXIII, Pirituba, Público municipal) of the periphery of the São Paulo and advanced ambulances of Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni and multivariate analysis. Results: From November 2009 to November consecutive patients used the STEMI network, and the findings were as follows: anterior wall infarctions, 37 complete atrioventricular blocks, 41 cases occurring cardiogenic shock PCR, 2 cases of hemorrhagic stroke and intra-hospital mortality was 6,5% (33 cases). There was no difference in mortality relation to initial reperfusion (PCIxFI), both in-hospital (>0,05) and late (p=0,566). Late mortality was 8 % and adverse events were 10.7% of angina, 4.1% reinfarction, 1.4% and 0.5 % of stroke. The late ejection fraction was higher in cases of FI (p = 0.023). Conclusions: The organization in a public health system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer and a tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.