The overall purpose of this study was to examine the relevance of policy factors identified by Mulvale and Bourgeault (2007) on interprofessional collaboration in PHC, by soliciting stakeholders’ perspectives. / ABSTRACT Background: Interprofessional team-based approaches to primary health care (PHC) delivery have gained support in the literature. Interprofessional primary health care (IPC) models of service delivery allow for different professionals to work together to address patients’ needs. Family Health Teams (FHTs) are a newly introduced model of IPC delivery in Ontario. A variety of factors can influence collaboration between professionals in IPC teams. Purpose/Research Objectives: The purpose of this study was to examine stakeholders’ perspectives about policy factors that influence IPC team collaboration, using the example of FHTs in Ontario. Methods: This descriptive study employs semi-structured interviews with key informants from select Ontario FHTs. Directed content analysis was used to examine the Mulvale and Bourgeault (2007) framework. Interviews were conducted with FHT professionals to describe their perspectives on the influence of policy factors in shaping collaboration within their teams and whether identified policy factors acted to enhance or hinder collaboration. Findings: Key informants cited, with highest agreement, economic and regulatory factors as influencing collaboration. Factors agreed upon unanimously by all key informants included funding, provider payment/remuneration, and practice scope. Key informants identified a range of policy factors that hinder collaboration. These included provider payment/remuneration, legal accountability, and the existence of multiple governing bodies. Implications/Conclusion: A number of policy factors were reported to influence collaboration in FHTs in Ontario. Although the findings suggest that incremental reform is possible, widespread policy reform of physician incentives, a key barrier to collaboration, is unlikely. Prospects for reform of this factor may be more promising at an organizational level. / Thesis / Master of Science (MSc)

As polÃticas pÃblicas de saÃde na Ãrea materno-infantil tÃm como foco principal a atenÃÃointegral Ãs mulheres durante o ciclo gravÃdico-puerperal e à crianÃa no primeiro ano de vida, visando garantir a saÃde da gestante e da crianÃa, alÃm de prevenir a morte materna e/ouinfantil. As aÃÃes de saÃde nesta Ãrea no Brasil tÃm sido priorizadas e apresentaram avanÃos ao longo das Ãltimas dÃcadas. O objetivo deste estudo foi analisar a partir do Sistema deInformaÃÃo da AtenÃÃo BÃsica, a evoluÃÃo da saÃde infantil e das gestantes, nos Ãltimos dez anos em Fortaleza. Trata-se de um estudo observacional, descritivo, com abordagem quantitativa. O estudo foi realizado em Fortaleza, tendo sido a coleta dos dados realizada no perÃodo de 2 a 30 de janeiro de 2012. A populaÃÃo foi composta por crianÃas menores de dois anos e gestantes cadastradas no Sistema de InformaÃÃo da AtenÃÃo BÃsica. Fez-se a anÃlise dos principais indicadores da saÃde materno-infantil, atravÃs de tabelas (apÃndice A) e grÃficos produzidos nos programas Word e Excel do Microsoft Office. No perÃodo analisado, ocorre uma variaÃÃo de 6,7% (2005) a 7,9% (2002 e 2008) para o baixo peso ao nascer. O aumento nos Ãndices de baixo peso ao nascer, a partir de 2006, provavelmente se deve a ampliaÃÃo da cobertura das equipes da estratÃgia saÃde da famÃlia no municÃpio, levando a uma expansÃo no monitoramento deste indicador, atravÃs do registro das equipes de saÃde da famÃlia. No perÃodo analisado, a prevalÃncia das infecÃÃes respiratÃrias agudas foi superior à prevalÃncia da diarreia em crianÃas menores de dois anos. Para a diarreia, a proporÃÃo variou de 6,5% (2010) a 12,75% (2006). Enquanto para as infecÃÃes respiratÃrias agudas houve uma variaÃÃo de 8,9% (2010) a 17,3% (2002). As taxas elevadas de diarrÃia e infecÃÃo respiratÃria aguda em menores de dois anos em Fortaleza, indicam a necessidade de um acompanhmento mais rigoroso para as crianÃas dessa faixa etÃria. Verificou-se um decrÃscimo na taxa de mortalidade infantil a cada ano, tendo o ano de 2002 uma taxa de mortalidade infantil de 22,4 por mil nacidos vivos e chegando ao ano de 2011 com uma taxa de 1,7 por mil nascidos vivos. As trÃs situaÃÃes que foram avaliadas em relaÃÃo Ãs gestantes acompanhadas pelas equipes de saÃde da famÃlia, permitem inferir que o atendimento as gestantes deve passar por melhorias e qualificaÃÃo profissional. A captaÃÃo precoce das gestantes deve ser intensificada, para que as mesmas compareÃam à consulta de prÃ-natal e para que o inÃcio deste ocorra o mais precocemente possÃvel, e as vacinas sejam aplicadas em tempo hÃbil. O estudo permitiu realizar uma anÃlise da situaÃÃo de saÃde das crianÃas e das gestantes nos Ãltimos dez anos em Fortaleza, podendo contribuir para que as equipes da estratÃgia saÃde da famÃlia possam refletir sobre a necessidade de mudanÃas e de melhor planejar as intervenÃÃes no territÃrio adscrito sob sua responsabilidade sanitÃria. / The public health policies on maternal infant health have mainly focused on comprehensive care to women during the pregnancy and puerperal cycle and also to the child in the first year of life. This is done in order to ensure the health of the mother and also the child so that to prevent maternal deaths and / or child. Health actions in this area in Brazil have been prioritized and have presented advances over the past decades. The objective of this study is to analyze the health situation of children and women in the last ten years in Fortaleza based on the Information provided by the System of Primary Care. This is an observational descriptive study with a quantitative approach. The study was conducted in Fortaleza. The data collection happened from January 2nd to 30th, 2012. The population consisted of children under two years old, and pregnant women enrolled in the Information System of Primary Care. It was done an analysis of key indicators of maternal and infant health, through tables(Appendix A) and graphs produced in Word and Excel programs of Microsoft Office. Over the analysed period, there is a variation of 6.7% (2005) to 7.9% (2002 and 2008) to low weight birth. The increase in rates of low weight birth since 2006, probably occured due to the increased number of teams of strategy family health care in the city leading to an expansion of the monitoring of this indicator, through registration done by the family health teams. Over this period, the prevalence of acute respiratory infections was higher than the prevalence of diarrhea in children under two years. For diarrhea, the proportion ranged from 6.5% (2010) to 12.75% (2006). As for acute respiratory infections there was a variation from 8.9% (2010) to 17.3% (2002). The high rates of diarrhea and acute respiratory infections in children under two years in Fortaleza, indicate the need for a more rigorous monitoring for this age group. There was a decrease in infant mortality rate each year and the year 2002 had an infant mortality rate of 22.4 per thousand born alive and reaching the year 2011 a rate of 1.7 per thousand live births. The three situations that were evaluated in relation to pregnant women accompanied by family health teams, allow us to infer that the care of pregnant women should be improved and and have a better professional qualification. The early uptake of pregnant women must be intensified so that pregnant women attend the prenatal appointments and the start of prenatal care occurs as early as possible, and vaccines are applied in a timely manner. The study allowed us an analysis of the health situation of children and pregnant women in Fortaleza over the last ten years, contributing to the family health teams strategy in order to prepare adequately the planning of interventions in the territory under their sanytary responsibility.