Made available in DSpace on 2016-06-02T19:48:21Z (GMT). No. of bitstreams: 1 4941.pdf: 1384090 bytes, checksum: 7b886818454f2629b492c4a2b6c82df7 (MD5) Previous issue date: 2013-02-07 / Financiadora de Estudos e Projetos / One of the main challenges faced by Family Health Strategy to change the model of care is the lack of professionals trained to this role in SUS. The Permanent Health Education is a tool that can lead to qualification in health care and a new logic in the process of health work. In this context, the educational role of nurses is strengthened, and the identification Social Representations education that permeate their educational practices aiming changes or stays in health care become relevant. To Understand the Social Representation of Continuing Education of Health Family nurses; analyze how their educational action influence in work processes and identify strengths and weaknesses in the actions of these Nurses. Qualitative research through semi-structured interviews with nurses from the Family Health of small towns in the Heart Region of DRIII Araraquara - SP. After interviews transcription, the contents were analyzed by comparing the thematic category and lexical analysis by software ALCESTE by using the Permanent Health Education references, Work Process and Social Representations. Four categories were made: 1) Influence of Permanent Education in the work process where fragmentation and professional specialty remains the focus of educational activities; 2) The Centralization of nurses in the actions of Continuing Education in where this role have been seen in two ways, one group recognizes that this their role and others consider that it should be shared with the team; Different conceptions of Continuing Education where the education to update knowledge is hegemonic, showing some movements leading to a conception of education to change the work process, and 4) Difficulties in perfoming educational activities characterized by low motivation of the time and lack of time to carry out the activities. The Social Representation Continuing Education for this group is based in the notion of traditional education, although although it is possible identify some movements that approximate the logic of Permanent Health Education, which may lead to a transformation of the representation. / Um dos principais desafios enfrentados pela Estratégia Saúde da Família para mudança do modelo de atenção é a falta de profissionais com formação adequada para atuar no SUS. A Educação Permanente em Saúde (EPS) se constitui uma ferramenta que pode levar à qualificação da atenção à saúde e à uma nova lógica no processo de trabalho em saúde. Neste contexto, a dimensão educativa do enfermeiro é reforçada, sendo relevante a identificação das Representações Sociais (RS) de educação que permeiam suas práticas educativas enquanto disparadoras de transformações ou permanências no cuidado à saúde. Objetivos: compreender as RS de Educação Permanente dos enfermeiros da Saúde da Família; analisar como suas ações educativas influenciam nos processos de trabalho e identificar potencialidades e fragilidades nas ações destes enfermeiros. A pesquisa qualitativa que realizou entrevistas semi-estruturadas com 24 enfermeiros da Saúde da Família dos municípios de pequeno porte da Região Coração da DRS III Araraquara SP. Após transcrição, os conteúdos foram analisados através da comparação das análises categorial temática e lexical pelo software ALCESTE, à luz dos referenciais da EPS, Processo de Trabalho e RS. Constituíram-se quatro categorias: 1) Influência da Educação Permanente no processo de trabalho em que a fragmentação e a especialidade profissional continuam sendo o foco das ações educativas; 2) Centralidade do enfermeiro nas ações de Educação Permanente em que esta função é vista de duas formas, um grupo reconhece que este é seu papel e outro que ela deveria ser compartilhada com a equipe; 3) Diferentes concepções de Educação Permanente em que a concepção de educação para atualização de conhecimentos é hegemônica, aparecendo alguns movimentos em direção à uma concepção de educação para mudança do processo de trabalho; e 4) Dificuldades na realização das ações educativas caracterizadas pela baixa de motivação da equipe e na falta de tempo para a realização das atividades. A RS de Educação Permanente para este grupo está ancorada na noção da educação tradicional, embora se identifique movimentos que se aproximam da lógica da EPS, que poderá levar a uma transformação da representação.

Esta tese teve por objetivo geral analisar a implicação profissional com os apoiadores de humanização e os articuladores de Educação Permanente em Saúde (EPS) dos municípios do Departamento Regional de Saúde (DRS) de Araraquara/São Paulo. Trata-se de uma pesquisa-intervenção Socioclínica, de abordagem qualitativa, realizada com os apoiadores de humanização e os articuladores de EPS dos 24 municípios que compõem o DRS em questão. Foram realizadas entrevistas individuais com 07 sujeitos que desenvolviam ambas as funções em seus municípios e 12 entrevistas grupais, sendo 11 compostas pelo apoiador e articulador e 01 composta por um grupo de 06 apoiadores do município. Portanto, 35 apoiadores e articuladores participaram da pesquisa-intervenção em questão. Foram também utilizados enquanto dispositivos analíticos para a produção dos dados desta pesquisa-intervenção: dez encontros mensais com os apoiadores e articuladores; sete encontros de planejamento e análise e o diário de pesquisa. As entrevistas e os encontros com os apoiadores e articuladores foram transcritos e as apreensões feitas nos encontros de planejamento e análise foram redigidos no diário de pesquisa. Todo esse material, bem como outras anotações feitas em diário, foi analisado a partir dos princípios da Socioclínica Institucional, sendo que um deles corresponde aos momentos de restituição, possibilitando um aprofundamento coletivo das análises realizadas. Os resultados foram apresentados a partir das dimensões libidinal, ideológica e organizacional que compõem a implicação profissional. Dessa forma, identificamos e analisamos com os apoiadores e articuladores os atravessamentos que a profissão inicial (enfermeiro, dentista, psicólogo, etc.) exerce sobre o fazer apoio; a contradição em se pensar em um perfil pronto para o desenvolvimento dessa função; os sentimentos de desânimo, pessimismo e otimismo enquanto componentes da dimensão ideológica que também atravessam o fazer apoio e a articulação de EPS; o tempo, o modo de fazer a gestão e o poder político enquanto analisadores da dimensão organizacional dos apoiadores e dos articuladores; e a ausência/presença do desejo, a vontade de agradar os profissionais de saúde, desenvolvendo uma relação harmônica no trabalho enquanto pistas analisáveis da dimensão libidinal dos apoiadores e dos articuladores. Na medida que o trabalho de análise com os apoiadores e articuladores prosseguiu, mudanças nos modos de se pensar e fazer apoio às equipes de saúde e também o pensar sobre o trabalho de apoiar e articular a EPS foi se modificando, fazendo com que esses profissionais entrassem, eles mesmos, em processos de EPS, refletindo e interrogando o próprio trabalho. O pesquisador ao realizar a análise de implicação também se colocou em processo de interrogação de sua prática, experienciando também a EPS em ato. Concluímos que a análise de implicação profissional consiste em um potente dispositivo disparador de processos de EPS / This thesis had as general objective to analyze the professional implication with the humanization supporters and the articulators of Permanent Health Education (PHE) of the municipalities of the Regional Department of Health (RDH) of Araraquara/São Paulo. It is a Socioclinic intervention research, with a qualitative approach, carried out with the humanization supporters and the articulators of PHE of the 24 municipalities that compose the mentioned RDH. Individual interviews were carried out with 07 participants who performed both functions in their municipalities and 12 group interviews, of which 11 were composed of the supporter and articulator and 01 were composed of a group of 06 supporters of the municipality. Therefore, 35 supporters and articulators participated in the intervention research in question. They were also used as analytical devices for the production of the data of this intervention research: ten monthly meetings with the supporters and articulators; seven planning and analysis meetings and the research diary. The interviews and meetings with the supporters and articulators were transcribed and the apprehensions made in the planning and analysis meetings were written in the research diary. All this material, as well as other diary entries, were analyzed based on the principles of Socioclinic Institutional, one of which corresponds to the moments of restitution, allowing a collective deepening of the analyzes carried out. The results were presented from the libidinal, ideological and organizational dimensions that make up the professional implication. In this way, we identify and analyze with the supporters and articulators the crossings that the initial profession (nurse, dentist, psychologist, etc.) exercises on making support; the contradiction in thinking of a ready profile for the development of this function; the feelings of discouragement, pessimism and optimism as components of the ideological dimension that also cross the support and articulation of PHE; time, management and political power as analysts of the organizational dimension of supporters and articulators; and the absence/presence of desire, the willingness to please health professionals, developing a harmonious relationship at work as analysable clues to the libidinal dimension of supporters and articulators. As the work of analysis with the supporters and articulators continued, changes in ways of thinking and supporting health teams and also thinking about the work of supporting and articulating the PHE was changing, causing these professionals to enter, themselves, in processes of PHE, reflecting and questioning the work itself. The researcher, when performing the implication analysis, also put himself in the process of interrogating his practice, also experiencing PHE in action. We conclude that the professional implication analysis consists of a powerful device triggering PHE processes

Historicamente, as diferentes concepções de Saúde Coletiva influenciaram tanto no ensino específico deste campo do saber como na formação geral do médico. Partindo deste pressuposto, o presente trabalho teve como objetivo estudar o ensino da Saúde Coletiva na graduação médica, buscando apreender suas configurações e as conseqüentes implicações nas propostas curriculares de três universidades do Paraná (Brasil): Universidade Estadual de Londrina (UEL), Universidade Federal do Paraná (UFPR) e Universidade Positivo (UnicenP). Constituíram-se também em eixos de investigação, além das concepções de Saúde Coletiva, a relação ensino-aprendizagem, as ênfases assumidas pelo programa e os vínculos com os serviços de saúde. A pesquisa qualitativa foi realizada com base na análise documental dos projetos pedagógicos (os cursos instituídos) considerando como eles são efetivamente vividos, de acordo com a ótica dos agentes envolvidos. Para tanto, foram feitas entrevistas com 11 gestores, 18 professores, e foram constituídos 4 grupos focais de estudantes, considerados atores-chave nos três cursos de Medicina. Os resultados evidenciaram a inserção de 5% a 20% da área de Saúde Coletiva nos currículos, dependendo das estratégias de ensino, mas sempre em abordagens acadêmicas fortemente vinculadas aos serviços de saúde, uma realidade que é fortalecida pelo grau de consolidação do SUS em ambas as cidades (Curitiba e Londrina). Independentemente da natureza da universidade, da configuração organizacional e acadêmica do curso e dos diferentes modos de inserção docente, a Saúde Coletiva se faz presente e se assume com considerável relevância para a formação médica. Ainda que não se constitua um eixo articulador da graduação em dois casos estudados, a área traz à dimensão técnica do saber médico o equilíbrio necessário representado pela consciência dos desafios e o compromisso com a realidade. De modo inverso, em função da complexidade da formação, a presença maciça da Saúde Coletiva ao longo de um curso não garante necessariamente o ideal da profissionalização médica. / Historically, different concepts of Public Health have influenced the specific teaching of this field of knowledge as well as medical education. The objective of this paper is to study the teaching of Public Health in medical schools, focusing on its structure and implications in curriculum design in three universities in Paraná - Brazil: State University of Londrina (UEL), Federal University of Paraná (UFPR) and the Positivo University (UnicenP). The research questions focused on the content of Public Health selected in their respective curricula, the teaching-learning relationships, program emphasis and the partnerships established with public health services. Qualitative research data collection from the perspective of key informants was carried out based on the analysis of pedagogical projects and on how they were effectively experienced. Eleven managers and 18 teachers were interviewed and 4 focus groups with students were developed in the three universities. Outcomes showed the presence of between 5% to 20% of Public Health themes in the course syllabi, depending on the teaching strategies used. However, they always appeared associated with academic issues strongly linked to health services, which were strengthened by the local development of the Comprehensive Health Care System in the two cities, Curitiba and Londrina in which studies were carried out. Public Health is present and very relevant in the curriculum required for doctors qualification regardless of the characteristics of the university studied, the bureaucratic and academic course structures and the different methods for hiring teachers. Besides not being a main articulator axis in two of the medical courses studied, Public Health provides the necessary balance for the technical dimension of medical knowledge, represented by the awareness of the challenges and commitment to the reality. On the contrary, because of the complexity of medical education, the strong presence of Public Health in the other medical course studied not necessarily guarantees the ideal qualification of the medical professional

Orientador: Gastão Wagner de Souza Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-19T22:25:13Z (GMT). No. of bitstreams: 1 Furlan_PaulaGiovana_D.pdf: 3258026 bytes, checksum: 161325145be0e5f7a985d9564f1a0225 (MD5) Previous issue date: 2012 / Resumo: Na saúde pública brasileira, constatamos a dificuldade dos profissionais em atuar em contextos coletivos e o escasso desenvolvimento de metodologias voltadas para a intervenção junto aos grupos na atenção básica à saúde. Pretendemos com esta pesquisa analisar como são produzidas as práticas de grupo com usuários na atenção básica, compreender os efeitos de um processo de formação em gestão do cuidado, incluindo as possíveis contribuições das estratégias de ensino, para a mudança da prática clínica e de gestão dos profissionais, no trabalho em equipe e no governo de si. Adotamos como referencial a pesquisa qualitativa hermenêutica e avaliativa (quarta geração), com métodos participativos de produção de dados (grupos focais, construção de narrativas coletivas e observação de grupos assistenciais com usuários em unidades de saúde). Destacamos as teorias de grupo do campo da psicossociologia, da saúde coletiva, da análise e da psicoterapia institucionais para a compreensão do movimento dessas práticas na atenção básica e da formação profissional. Constatamos que o dispositivo grupo ainda é visto enquanto atividade de educação, com vistas à prevenção de doenças, promoção e vigilância em saúde. Não se valoriza seu efeito terapêutico na prática clínica, como estratégia de tratamento e como meio de intervenção no acompanhamento dos pacientes em longo prazo. Os grupos na atenção básica se mostraram potentes para o compartilhamento de experiências de adoecimento e como estratégia para a comunicação com a equipe. Consideramos que o uso do grupo como dispositivo formador e a estratégia da discussão de casos possibilitaram o aprendizado sobre manejo de grupos e a aplicação de conceitos e de práticas aprendidos para o cotidiano da atenção básica, tais como o trabalho em equipe, a clínica ampliada e compartilhada. Apresentamos uma proposta de mapas para análise e cogestão dos grupos, como estratégia para a prática clínica e a formação profissional. Concluímos apontando elementos para qualificação dos grupos na atenção básica como coletivos que possam incorporar a discussão dos processos de adoecimento e sofrimento, incluindo a pessoa como participante no processo de coprodução de sua saúde e da reorganização institucional / Abstract: In the Brazilian public health, we note the difficulty of professionals in acting in collective contexts and the insufficient development of methodologies focused on action within groups in the primary health care. We intend with this research to analyze how assistance groups with users are produced during the primary care, understand the effects of an education process of care management, including the possible contributions of the teaching strategies to the change of clinical practice and professional management in teamwork and in Government itself. We adopt as a referential the evaluative and hermeneutical qualitative research (fourth generation), with participatory methods of data production (focus groups, building of collective narratives and observation of assistance groups with users in health facilities). We highlight the group theories of the psycho-sociology field, collective health, institutional analysis and psychotherapy for the understanding of the movement of such practices during the primary care and professional education. We find that the group device is still seen as educational activity, focused on disease prevention, promotion and health surveillance. Its therapeutic effect is not valorized in the clinical practice as a care strategy and as a means of action in long-term monitoring of patients. The groups in primary health care were powerful in sharing illness experiences and as a strategy for team communication. We consider that the use of the group as a trainer device and the strategy of discussing cases enabled the learning and the application of concepts and learned practices to the everyday primary health care, such as teamwork, and the expanded and shared clinic. We present a proposal of maps for analysis and co-management of the groups, as a strategy for clinical practice and professional education. We conclude highlighting elements for qualifying primary care groups as collectives that can incorporate the discussion of illness and suffering processes, including the individual as a participant in the process of co-production of his/her health and institutional reorganization / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Research confirms inactivity increases in adolescence and that unfit youth are at risk of acquiring cardiovascular diseases, diabetes, obesity, or other significant physical disorders later in life. Thus, the purpose of this phenomenological study was to describe the experience of chronically inactive children who were exposed to an exercise intervention program. The specific focus of the research was to better understand the essential educational needs of the participants and the effective elements of the program, Moving for Fun (MFF), a 7-week after-school fitness intervention program designed to modify chronic inactivity. Open-ended interviews and 3 observations were conducted with 8 middle school students (4 males and 4 females) identified as scoring low on a standardized assessment protocol of health-related physical fitness. Interview data were transcribed and coded using a combination of open and a priori coding to extract significant statements that were analyzed into clusters of meaning that described key elements of the students' experience. Video-taped observations were analyzed to use behaviors during MFF activities as a means of checking interpretations of the interview data. Interpretation of the final structural analysis suggested that students did not have a good understanding health-related fitness or how it is achieved; however they enjoyed participating in inclusive physical activity, and were planning to add more physical activity to their lives. Recommendations include an examination of physical activity programming and an increase in programs that serve participants with varied needs. Developing more student-centered programs that teach or include fitness education can decrease the number of students lacking physical fitness and increase the population of those who carry fitness activities and better health with them into the future.

Background: The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol. Objective: The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use. Methods: We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level. Results: Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education. Conclusions: The efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached.

How do teachers’ attitudes and beliefs impact how HIV/AIDS education is implemented in Kenyan schools for the deaf? How do these attitudes and beliefs reflect how teachers think about Deafness? While there is extensive literature exploring in-school HIV/AIDS-related education in East Africa, there are few studies focusing on segregated schools for the deaf. There are also few studies exploring how educators think about Deafness as culture in this region. Western Kenya offers a useful site for the exploration of these topics with mandated, in-school HIV/AIDS curriculum and a high density of schools for the deaf. Related research also argues that teachers’ attitudes and beliefs and the politics of schooling are useful in exploring socio-cultural constructions of Deafness. While previous studies have argued that “Deaf-friendly” HIV/AIDS education is not occurring in this region, this study found examples in these schools. Data from this study also revealed that this education was shaped by the beliefs and attitudes teachers held about sexuality, and Deafness and sign language. Furthermore, this study found that these attitudes and beliefs revealed underlying beliefs about Deafness that illustrate a range of constructions within this group of teachers. This study spanned 15 weeks of fieldwork gathering data through interviews, questionnaires and observations with 81 participants. Data focused primarily on interviews and questionnaires with 43 teachers in three segregated schools for the deaf in the Nyanza and Western provinces. There were 8 Deaf teachers who participated from these school sites supplemented by an additional 24 Deaf participants working in schools across Kenya to balance data. This study found that while the nationally-mandated HIV/AIDS course curriculum was not implemented in these schools, there was a significant presence of “embedded” and informal HIV/AIDS education. Teachers had a range of feelings about this education, some of which were unique to teaching Deaf children and children using sign language. They also reported how “Deaf stereotypes” shaped how they approached and implemented this education. In some cases these beliefs and attitudes simply heightened preexisting concerns about HIV/AIDS education in similar ways to parallel studies of “regular” schools in this region. However the most striking conclusion from this research was that the presence of “Deaf culture” and the use of sign language among the student population changed the way teachers approached, implemented and reflected upon this education in unique ways not seen in “regular” schools. Interviews also showed that some teachers rationalized their approach to this education because they felt that the Deaf were “different” in certain ways, especially in terms of sexuality. These conclusions are helpful for those in HIV/AIDS education, Comparative and International Education, Disability Studies, Deaf Studies and Medical Anthropology.

For adolescents with asthma, adhering to asthma regimes implies not only taking medications to relieve asthma attacks, but also adjusting their life styles in order to prevent asthma attacks. These life style modifications, such as avoiding allergens or having to limit physical activity, sometimes force adolescents to compromise their social life. On the other hand, the impact of such life style modifications on their social life may in turn force adolescents to give up adhering to asthma regimes. Indeed, adolescents are learning to be more independent while they enjoy a more complicated social life at home and at school than previously, and this rapid social development may thus be a great life challenge to adolescents with asthma. This thesis reports four studies which investigated the relationship between multi-dimensional asthma management (in medication and life style regimes) and the social life of young people with asthma at the transitional age from childhood to adolescence (or early adolescence, age 9-14), which also marks the transition from primary school to secondary school. In line with the literature on other adolescent chronic illnesses, study 1 demonstrated a downward trend of multi-dimensional asthma management in early adolescence. This developmental change was further investigated in study 2, 3 and 4, in which theories in behavioural psychology were followed to emphasise human behaviour influenced by the social activities and social relationships in the living environment, or the social environment. This was supplemented by theories in developmental psychology to identify relevant aspects of the social environment in early adolescence, especially the social relationships with parents, school staff and peers. Using quantitative and qualitative approaches, the studies not only supported the direct influence of asthma-specific social support, but also explored some mechanisms with which social relationships influenced asthma management in a more subtle and context-dependent way. By approaching asthma management behaviour with theories from behavioural and developmental psychology, it is also hoped that this thesis could be an example that shows the importance of recognising and to understanding the social life of young adolescents when adolescent behaviour is concerned.

A presente dissertação, inserida na área temática da Saúde Pública de Regulação e Fiscalização em Saúde (categoria SP1.011.127), destacou aspectos relacionados à política nacional de regulação em saúde. Com base na revisão da literatura relacionada com o tema, o estudo teve como objetivo principal apresentar e discutir os desdobramentos da realização de intervenção no sistema de regulação do acesso à assistência às especialidades médicas de um município de 250 mil habitantes no período de 2009 a 2011. Teve também, como objetivo secundário, analisar estratégias de desenvolvimento e operacionalização de protocolos de regulação do acesso à assistência ambulatorial em perspectiva municipal. Como referencial metodológico foi adotado o estudo de caso com abordagem descritiva predominantemente qualitativa. O capítulo de introdução versou sobre o cenário relacionado com a regulação do acesso à assistência e as intervenções aplicadas. Como resultados foram apresentadas as ações desenvolvidas no município no campo de infraestrutura e tecnologia da informação, aperfeiçoamento logístico e de processos, educação permanente e o desenvolvimento de protocolos de regulação do acesso. Na discussão, foram analisados os processos desenvolvidos, escolhas e ferramentas adotadas para o aperfeiçoamento do acesso à atenção ambulatorial, suas características e vulnerabilidades, discutindo-se as potencialidades desta implementação e o impacto no acesso aos serviços de saúde municipal / This dissertation, inserted in the thematic area of Health Care Coordination and Monitoring (SP1.011.127 category), emphasized issues related to national policy health regulation in Brazil. Based on a review of literature related to the topic, the study had, as main objective, present and discuss the unfolding of intervention performed in the medical specialties accessibility settled in a city of 250 000 inhabitants in the period from 2009 to 2011. Also sought, as a secondary objective, examine strategies to develop and manage regulatory access protocols in that city. The methodological framework was a case study with predominantly qualitative descriptive approach. The introductory chapter was about the scenario related to the regulation of access to care and interventions applied. Results presented the actions developed in the field of municipal infrastructure and information technology, logistics and process improvement, Public Health Professional Education and the development of regulatory access protocols. In the discussion were analyzed the processes developed, choices and tools used for the improvement of Health Services Accessibility, their characteristics and vulnerabilities, discussing the potential of this implementation and the impact on local health services

A presente dissertação, inserida na área temática da Saúde Pública de Regulação e Fiscalização em Saúde (categoria SP1.011.127), destacou aspectos relacionados à política nacional de regulação em saúde. Com base na revisão da literatura relacionada com o tema, o estudo teve como objetivo principal apresentar e discutir os desdobramentos da realização de intervenção no sistema de regulação do acesso à assistência às especialidades médicas de um município de 250 mil habitantes no período de 2009 a 2011. Teve também, como objetivo secundário, analisar estratégias de desenvolvimento e operacionalização de protocolos de regulação do acesso à assistência ambulatorial em perspectiva municipal. Como referencial metodológico foi adotado o estudo de caso com abordagem descritiva predominantemente qualitativa. O capítulo de introdução versou sobre o cenário relacionado com a regulação do acesso à assistência e as intervenções aplicadas. Como resultados foram apresentadas as ações desenvolvidas no município no campo de infraestrutura e tecnologia da informação, aperfeiçoamento logístico e de processos, educação permanente e o desenvolvimento de protocolos de regulação do acesso. Na discussão, foram analisados os processos desenvolvidos, escolhas e ferramentas adotadas para o aperfeiçoamento do acesso à atenção ambulatorial, suas características e vulnerabilidades, discutindo-se as potencialidades desta implementação e o impacto no acesso aos serviços de saúde municipal / This dissertation, inserted in the thematic area of Health Care Coordination and Monitoring (SP1.011.127 category), emphasized issues related to national policy health regulation in Brazil. Based on a review of literature related to the topic, the study had, as main objective, present and discuss the unfolding of intervention performed in the medical specialties accessibility settled in a city of 250 000 inhabitants in the period from 2009 to 2011. Also sought, as a secondary objective, examine strategies to develop and manage regulatory access protocols in that city. The methodological framework was a case study with predominantly qualitative descriptive approach. The introductory chapter was about the scenario related to the regulation of access to care and interventions applied. Results presented the actions developed in the field of municipal infrastructure and information technology, logistics and process improvement, Public Health Professional Education and the development of regulatory access protocols. In the discussion were analyzed the processes developed, choices and tools used for the improvement of Health Services Accessibility, their characteristics and vulnerabilities, discussing the potential of this implementation and the impact on local health services