At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes. The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected. Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered. Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration. Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1986, härtill 6 uppsatser.</p> / digitalisering@umu

O estudo tem por tema o cuidar paliativo na atenção ambulatorial, em particular as percepções sobre esse cuidado sob o ponto de vista dos usuários do Ambulatório de Cuidados Paliativos em Oncologia, do Hospital do Câncer IV, do Instituto Nacional de Câncer - INCA/MS. O palco do nosso estudo sofreu transformações em sua estrutura física e na forma do atendimento dispensado a partir de março de 2009. Na atualidade, e diferentemente do que é mais comum na maioria dos ambulatórios das demais unidades INCA, os pacientes, quando chamados para consulta, entram para uma sala de atendimento e aguardam os profissionais, ao invés de percorrem as salas de consulta de cada especialidade. Buscamos trazer e compreender a percepção dos sujeitos através de suas falas, bem como as dificuldades por eles vivenciadas na assistência do cuidado, e sua relação com a Integralidade. Esta última foi entendida como tecnologia que permeia as ações, favorecendo e aprimorando o cuidado em saúde. Ao relacionar os pilares da integralidade isto é, o acesso, o acolhimento, o vínculo, a autonomização e a responsabilização procuramos entender os parâmetros desse conceito e sua aplicabilidade no sistema do INCA. Demarcamos como caminhos teóricos desta pesquisa, as questões voltadas à Integralidade e às tecnologias como orientadoras dos processos de trabalho em serviço de saúde. O elemento decisivo e norteador para seguir este caminho foi o conceito de tecnologias leves formulado por Merhy, que guarda em suas definições uma ponte entre as mesmas e a integralidade conceitos estes básicos para a investigação proposta. Optamos pela metodologia qualitativa, com o uso de entrevistas semi-estruturadas que possibilitariam um maior aprofundamento na compreensão das percepções dos sujeitos sobre o atendimento à saúde naquela Unidade Hospitalar. Os relatos dos pacientes e cuidadores entrevistados revelam, sem nenhuma exceção, que eles apreciam bem mais este modo de atendimento do que aquele experimentado em outras unidades hospitalares. Os usuários expressaram, como aspectos positivos, a redução no tempo de espera e a qualidade da atenção dispensada, uma vez que suas necessidades (físicas, psicológicas e emocionais) são mais emergenciais, dada a fragilidade do seu estado bio-psico-socio-espiritual. Em suma, foi possível observar que os principais pilares da Integralidade estão expressos nas percepções dos usuários, mesmo que eles não saibam que o fazem. Ao ressaltar as percepções sobre as práticas que os usuários identificaram como positivas e negativas no sistema de atendimento do ambulatório do HC IV, apontamos para possibilidades de melhoria da qualidade assistencial com base na Integralidade / The present study is about ambulatory attention in palliative care, particularly users perceptions over this care given in the Oncologic Ambulatory for Palliative Care of the Brazilian National Cancer Institute-RJ. From this perspective we brought the users speech, as well as their difficulty, felt and experienced during the assistance, and its relation with the integrality. This one understood as a technology that is all through the actions facilitating and improving health care. When relating some of its pillars as, access, boundary, linkage, self-government and responsiveness, we can better understand the limits of this concepts and its applicability in the INCA system. We delimitate as theoretic path of this study, integrality issues and technologies to orient the work process in health services. The decisive element was the concept of soft technologies formulated by Merhy; within its definition there is a bridge to integrality basic concepts to the investigation proposed. This ambulatory underwent a transformation on its physical structure and on the assistance model offered to its users. The difference between this and the conventional ambulatory model of assistance that takes place on the other INCA ambulatory hospitals, for this one from HC IV, rely on the fact that this one is specific for patients undergoing oncological palliative care, in which the patients has walking difficulties. Because of those, a different model was build. In this new mode, patients are called to a room and wait for the assistance, the professionals alternates themselves between this and the other rooms, where there are other patients. This attitude prevents patients from walking from room to room to be assisted. As a reminder, this new assistance manner began on march 2009, with one year experience. The statement of the interviewed patients and their caretakers revealed, with not even one exception, that they prefer this new way of integrative care instead of the traditional experienced in other INCA hospital units. Patients appreciate the quietness of this process and the certainty of the scheduled appointment. Its impossible to deny that in this manner of assistance, not only the patients but also their caretakers have more privacy. One of its improvements for patients is the end of the walking from room to room to get assisted by all professionals. This new physical structure prevents undesirable walking and stress for patients under oncologic palliative care. And its also clear that users express, as positive aspect, the reduction of time waiting for the appointment in the ambulatory. Taking into consideration the particularity of these users revealed, was the quality of the assistance they acquire: faster, human and multidisciplinary, since their necessities are more urgent because of their bio-psycho-social-spiritual fragility state. Finally, was possible to observe that the main Integrality pillars are expressed in their perceptions, although they dont state this concepts specifically. About responsiveness, we found little evidence, as the users dont have their rights notion and there for they dont criticize the system. Only one of them marked his position, asking about a patients bath adapted for colostomy user`s

O estudo tem por tema o cuidar paliativo na atenção ambulatorial, em particular as percepções sobre esse cuidado sob o ponto de vista dos usuários do Ambulatório de Cuidados Paliativos em Oncologia, do Hospital do Câncer IV, do Instituto Nacional de Câncer - INCA/MS. O palco do nosso estudo sofreu transformações em sua estrutura física e na forma do atendimento dispensado a partir de março de 2009. Na atualidade, e diferentemente do que é mais comum na maioria dos ambulatórios das demais unidades INCA, os pacientes, quando chamados para consulta, entram para uma sala de atendimento e aguardam os profissionais, ao invés de percorrem as salas de consulta de cada especialidade. Buscamos trazer e compreender a percepção dos sujeitos através de suas falas, bem como as dificuldades por eles vivenciadas na assistência do cuidado, e sua relação com a Integralidade. Esta última foi entendida como tecnologia que permeia as ações, favorecendo e aprimorando o cuidado em saúde. Ao relacionar os pilares da integralidade isto é, o acesso, o acolhimento, o vínculo, a autonomização e a responsabilização procuramos entender os parâmetros desse conceito e sua aplicabilidade no sistema do INCA. Demarcamos como caminhos teóricos desta pesquisa, as questões voltadas à Integralidade e às tecnologias como orientadoras dos processos de trabalho em serviço de saúde. O elemento decisivo e norteador para seguir este caminho foi o conceito de tecnologias leves formulado por Merhy, que guarda em suas definições uma ponte entre as mesmas e a integralidade conceitos estes básicos para a investigação proposta. Optamos pela metodologia qualitativa, com o uso de entrevistas semi-estruturadas que possibilitariam um maior aprofundamento na compreensão das percepções dos sujeitos sobre o atendimento à saúde naquela Unidade Hospitalar. Os relatos dos pacientes e cuidadores entrevistados revelam, sem nenhuma exceção, que eles apreciam bem mais este modo de atendimento do que aquele experimentado em outras unidades hospitalares. Os usuários expressaram, como aspectos positivos, a redução no tempo de espera e a qualidade da atenção dispensada, uma vez que suas necessidades (físicas, psicológicas e emocionais) são mais emergenciais, dada a fragilidade do seu estado bio-psico-socio-espiritual. Em suma, foi possível observar que os principais pilares da Integralidade estão expressos nas percepções dos usuários, mesmo que eles não saibam que o fazem. Ao ressaltar as percepções sobre as práticas que os usuários identificaram como positivas e negativas no sistema de atendimento do ambulatório do HC IV, apontamos para possibilidades de melhoria da qualidade assistencial com base na Integralidade / The present study is about ambulatory attention in palliative care, particularly users perceptions over this care given in the Oncologic Ambulatory for Palliative Care of the Brazilian National Cancer Institute-RJ. From this perspective we brought the users speech, as well as their difficulty, felt and experienced during the assistance, and its relation with the integrality. This one understood as a technology that is all through the actions facilitating and improving health care. When relating some of its pillars as, access, boundary, linkage, self-government and responsiveness, we can better understand the limits of this concepts and its applicability in the INCA system. We delimitate as theoretic path of this study, integrality issues and technologies to orient the work process in health services. The decisive element was the concept of soft technologies formulated by Merhy; within its definition there is a bridge to integrality basic concepts to the investigation proposed. This ambulatory underwent a transformation on its physical structure and on the assistance model offered to its users. The difference between this and the conventional ambulatory model of assistance that takes place on the other INCA ambulatory hospitals, for this one from HC IV, rely on the fact that this one is specific for patients undergoing oncological palliative care, in which the patients has walking difficulties. Because of those, a different model was build. In this new mode, patients are called to a room and wait for the assistance, the professionals alternates themselves between this and the other rooms, where there are other patients. This attitude prevents patients from walking from room to room to be assisted. As a reminder, this new assistance manner began on march 2009, with one year experience. The statement of the interviewed patients and their caretakers revealed, with not even one exception, that they prefer this new way of integrative care instead of the traditional experienced in other INCA hospital units. Patients appreciate the quietness of this process and the certainty of the scheduled appointment. Its impossible to deny that in this manner of assistance, not only the patients but also their caretakers have more privacy. One of its improvements for patients is the end of the walking from room to room to get assisted by all professionals. This new physical structure prevents undesirable walking and stress for patients under oncologic palliative care. And its also clear that users express, as positive aspect, the reduction of time waiting for the appointment in the ambulatory. Taking into consideration the particularity of these users revealed, was the quality of the assistance they acquire: faster, human and multidisciplinary, since their necessities are more urgent because of their bio-psycho-social-spiritual fragility state. Finally, was possible to observe that the main Integrality pillars are expressed in their perceptions, although they dont state this concepts specifically. About responsiveness, we found little evidence, as the users dont have their rights notion and there for they dont criticize the system. Only one of them marked his position, asking about a patients bath adapted for colostomy user`s