nÃo hà / INTRODUÃÃO: O acesso ao seguimento de crianÃas egressas de unidades de terapia intensiva neonatal (UTIN), deve iniciar na prÃpria unidade, tendo continuidade apÃs a alta hospitalar em ambulatÃrio especializado e de atenÃÃo primÃria, com avaliaÃÃes sistemÃticas do crescimento e desenvolvimento, prevenÃÃo de riscos e danos. OBJETIVO: Analisar o acesso da atenÃÃo à saÃde ofertada a crianÃas egressas de cuidados intensivos neonatais no municÃpio de Fortaleza-CE. METODOLOGIA: Estudo transversal, aninhado a um estudo de coorte de recÃm-nascidos admitidos em UTIN, integrante da Rede Norte-Nordeste de SaÃde Perinatal. A amostra do estudo constituiu-se de 193 crianÃas, residentes em Fortaleza-CE. As entrevistas foram realizadas no domicÃlio das crianÃas no perÃodo de marÃo de 2010 a junho de 2011. Para a anÃlise de acesso ao serviÃo de atenÃÃo primÃria e de Follow-up, foi utilizado o modelo hierarquizado dos componentes individuais de acesso: Componente Predisponente (CaracterÃsticas sociais, demogrÃficas e individuais), Componente Capacitante (CaracterÃsticas socioeconÃmicas) e Componente Necessidade de SaÃde (condiÃÃes de saÃde). RESULTADOS: A regressÃo logÃstica mÃltipla hierarquizada mostrou que apÃs ajuste das variÃveis do componente predisponente permaneceu no modelo de determinaÃÃo de acesso adequado ao serviÃo de atenÃÃo primÃria (puericultura): residir com o companheiro e profissional que realizou o prÃ-natal na categoria mÃdico/enfermeiro, quando ajustada as variÃveis do componente predisponente e capacitante a renda familiar per capita foi esvaziada do modelo. Na etapa final, as variÃveis do componente necessidades de saÃde foram ajustadas as do componente anterior permanecendo no modelo hierarquizado: residir com o companheiro OR=2,28 (IC95% 0,93-5,60, p=0,07), profissional que realizou o prÃ-natal na categoria mÃdico/enfermeiro OR=0,39 (IC95% 0,17-0,87, p=0,02), comportamento de risco OR=5,88 (IC95% 1,16-29,76), p=0,03) e prematuridade OR=2,03 (IC95% 0,88-4,68, p=0,09). Para o segundo desfecho de determinaÃÃo do acesso adequado ao serviÃo de Follow-up, a regressÃo logÃstica mÃltipla hierarquizada mostrou que, apÃs ajuste das variÃveis do componente predisponente permaneceram no modelo: idade materna e profissional que realizou o prÃ-natal na categoria enfermeiro, quando ajustada as variÃveis do componente predisponente e capacitante a renda per capita foi esvaziada do modelo.Na etapa final, apÃs ajuste das variÃveis do componente necessidade de saÃde com as do modelo anterior foram determinantes de acesso adequado ao serviÃo de Follow-up: idade materna OR=0,17 (IC95% 0,33-0,96), p=0,04), profissional que realizou o prÃ-natal na categoria enfermeiro OR=2,88 (IC95% 0,78-10,55, p=0,10), e recÃm-nascido de alto risco OR=4,37 (IC95% 1,10-17,28, p=0,03).Conclui-se que a idade materna, residir com o companheiro, os profissionais que realizam o prÃ-natal da mÃe da crianÃa, comportamento de risco da mÃe, prematuridade, e recÃm-nascido de alto risco sÃo determinantes de acesso aos serviÃos de atenÃÃo a saÃde.

Orientador: Marcelo de Castro Meneghim / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-05T11:27:50Z (GMT). No. of bitstreams: 1 Santos_SusanaAbreudeSousa_M.pdf: 785851 bytes, checksum: 52f79f8081e73210cccf910db55237bd (MD5) Previous issue date: 2005 / Resumo: Este estudo teve como objetivo analisar os critérios usados na organização da demanda e avaliar o grau de satisfação do usuário e profissional das unidades de serviço público odontológico do Município de Campos dos Goytacazes (RJ). O estudo foi aprovado pelo CEP-FOP-UNICAMP n° 183/03. O estudo foi transversal, e a amostra de pacientes foi calculada, de forma representar 20% das unidades de cada região, totalizando em 320 pacientes e 153 dentistas, com erro amostral de 5%, por estrato e por conglomerados respectivamente. A forma de avaliação foi realizada utilizando questionários auto-aplicativos. A análise dos resultados foi descritiva. Os principais resultados foram que 61% dos pacientes consideraram organizado o sistema de agendamento da demanda. Quanto à avaliação da satisfação dos pacientes, o estudo mostrou que 70% estão satisfeitos em relação à facilidade no acesso aos serviços, e 75% dos mesmos estão satisfeitos com a qualidade do atendimento recebido. Em relação aos dentistas, o estudo mostrou que 81% gostariam que critérios de organização no agendamento dos pacientes fossem implantados nos serviços odontológicos do município. Conclui-se que em relação à organização da demanda o serviço não está organizado; em relação à satisfação do profissional esse se mostra insatisfeito; em relação à satisfação do usuário este mostra-se satisfeito / Abstract: The present papers aimed to análise the used criteria in the demand organization and evaluate the satisfaction level of the clients and employees of the odontology public service unit of the city of Campos dos Goytacazes (RJ). This study was approved by CEP-FOP-UNICAMP n° 183/03. It is a transversal study and the samples of patients was calculated, in a way it could represent 20% of the units of each region, quantifying 320 patients and 153 dentists, with sample error of 5%, by stratum and by conglomerate respectively. The evaluation was made with selfexplanatory questionnaire. The data analysis of the results was descriptive. The main results were that 61 % of the patients considered organized the demand booking system. Regarding the patients satisfation evaluation, this stady showed that 70% of them are satisfied in which concerns the availability of the services, and 75% of them are satisfied with the quality of the attending received. Regarding the dentists, the study showed that 81% of them wish they had the same patients booking organization criteria in the odontology servicer of the city. To conclude, considering the demand organisation, the service is not organised; regarding the satisfaction of the professional, these one showed themselves unsatisfied; regarding the satisfaction of the users of the system, these one showed themselves satisfied. / Mestrado / Saude Coletiva / Mestre em Odontologia

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / IntroduÃÃo: A Carta Magna de 1988 estabelece em seu art.196 que âa saÃde à um direito de todos e dever do Estadoâ, incluindo, ainda no campo de atuaÃÃo do Sistema Ãnico de SaÃde (SUS), a execuÃÃo de aÃÃes de assistÃncia terapÃutica integral, inclusive farmacÃutica. No Brasil, encontrar o meio de garantir efetivamente esse direito à saÃde tem sido um dos grandes desafios que os gestores do SUS tÃm enfrentado. Objetivo: Descrever os processos administrativos e judiciais de solicitaÃÃo de medicamentos a Secretaria de SaÃde do Estado do Cearà (SESA-CE) e discutir os seus aspectos crÃticos. Metodologia: Estudo descritivo, retrospectivo, realizado no NÃcleo de AssistÃncia FarmacÃutica (NUASF/SESA-CE). Foram coletados dados dos processos datados de 01 de janeiro de 2004 a 31 de junho de 2006. As principais informaÃÃes coletadas foram: tipo, condutor e motivo de instauraÃÃo do processo, doenÃas declaradas, unidade de atendimento e medicamentos solicitados. Resultados e DiscussÃo: No perÃodo foram pesquisados 841 processos entre administrativos e judiciais.Os tipos de processos mais frequentes foram os administrativos (84,9%). Os principais condutores foram a Promotoria da JustiÃa de Defesa da SaÃde PÃblica e o Grupo TÃcnico Social da SESA-CE (79,5%). O principal motivo para instauraÃÃo dos processos foi a falta de condiÃÃes financeiras para adquirir o medicamento (52,6%). As prescriÃÃes eram originÃrias principalmente de unidades pÃblicas (41,4%). As doenÃas mais declaradas foram: DoenÃa de Alzheimer (15,6%), e Diabetes mellitus insulino-dependente (7,5%). Durante o perÃodo estudado foram pleiteados 1.481 medicamentos, divididos em 400 especialidades farmacÃuticas (EF). Os medicamentos mais solicitados foram: rivastigmina (12,7%) e insulina glargina (6,4%). Dos medicamentos solicitados, 60% nÃo tinham financiamento definido, 23,0% eram medicamentos excepcionais e 10% da AtenÃÃo BÃsica. Dos medicamentos sem financiamento, os mais freqÃentes foram: insulina glargina (8,6%), clopidogrel (5,2%) e aripiprazol (5,2%). ConclusÃo: Os processos administrativos e judiciais para fornecimento de medicamentos mostraram grande variabilidade entre os medicamentos solicitados, o que leva a supor que as tendÃncias de utilizaÃÃo se devam à introduÃÃo de inovaÃÃes terapÃuticas, a ausÃncia de alguns medicamentos nas listas padronizadas pelo Estado e ao desconhecimento e descumprimento dos protocolos clÃnicos pelos prescritores.

Background: Integrated working between health and social care services within England has been encouraged by Government policy in the last decade, and has been argued to provide a seamless, joined up experience for service users (Department of Health 2011). One way of integrating care is through the use of a single point of access to health and social care services. A single point of access to services has been trialled in mental health and learning disability services to improve access, and following on from policy (e.g. Department of Health 2007) and support from literature (Rogers, Entwistle & Pencheon 1998; Lovell & Richards 2000; Raine, Carter, Sensky & Black 2005) a single point of access to health and social care for older adults has been implemented in parts of the UK. This thesis examines the implementation of one such single point of access. Objectives: The aim of the study was to examine the single point of access and whether it had any impact upon integrated working within a county in England, UK. Methods: An ethnographic approach was taken, using a combination of methods including interviews, focus groups and observations. This was complemented by a grounded theory approach to analysis. Findings: The single point of access had an adverse effect upon integration. The poor management of change and lack of communication led to issues within the single point of access such as failure of IT systems and duplication. Staff became frustrated and disengaged from the process, and consequently reported feeling disempowered, retreating back to their professional 'tribes'. Conclusion: Firm conclusions about the efficacy of a single point of access with regard to its effect upon integrated working could not be reached. However, the findings suggest that clear communication, continued change management and recognition of professional culture are decisive factors when attempting to integrate health and social care. Further research into the impact of a single point of access upon integration as well as outcomes for service users is recommended.

Magister Educationis - MEd / Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined. / South Africa

Magister Commercii - MCom / The aim of this mini-thesis is to investigate the factors linked to access in the South African public health sector - using General Household Survey Data - in order to contribute to a better understanding of the role of access in achieving the National Department of Health’s primary goal of universal coverage. Even though the multi-dimensional interpretation of health system performance has gained acceptance and traction in recent years, much of the research linked to it remains supply-focused. The implicit truth is that demand-side health issues are largely ignored, under-researched and ominously absent from health policies. This is particularly true with regard to the access dimension of health performance, where research and policy focus almost exclusively on availability and affordability perspectives of access while neglecting demand-side aspects of health-seeking behaviour, such as acceptability. The study, therefore, pursues an in-depth exploration of access across its three dimensions - availability, affordability and acceptability - in the South African public health sector and aims to empirically investigate access to public health care from 2002 to 2012. It also identifies the underlying reasons for the observed trends, supplementing and reorienting the current understanding of access to public health care. The empirical findings reveal mixed results: it supports current literature by suggesting that equity has been achieved in terms of making public health care services more affordable, especially for the most vulnerable groups of South African society. However, acceptability and availability issues persist. It is safe to say that the availability of public health care – mainly a supply-side issue – is being addressed in the South African context with Government taking steps to address it. Unfortunately the same attention has not been given to issues of acceptability on the demand-side. Failure to fully understand the demand-side dimension of access and the role health-seeking behaviour plays in public health issues threatens to weaken health policies aimed at improving access. It is imperative that demand-side aspects of health-seeking behaviour and institutional responsiveness to health-demand occupy a more prominent role in South African public health debates, research and policy.

The purpose of the study was to assess the level of patient satisfaction with service provided in the Buffalo City sub-district following the implementation of the down-referral chronic medication distribution system between the tertiary(ELHC) and primary (clinics) levels of health care. The intervention was aimed at improving accessibility and availability of medication to the chronic patients. Research Design: A non-experimental descriptive quantitative research methodology was used. The sampling method for the study was the non-probability purposive sampling. Data was collected using a self-administered questionnaire that was given to respondents as they arrived at the facilities, and who, after completing the questionnaire, gave it back to the researcher. Findings: The results of the study revealed that the patients were generally satisfied about the down-referral chronic medication distribution system. However the patients were not satisfied about the services that they receive from the primary health care facilities when they go to collect their down-referred medication. Lack of communication to the patients regarding their medication by the hospital staff (pharmacists in particular) was a concern for patients. Conclusion: The down-referral chronic medication distribution system can benefit both the patients and the hospitals. Patient will receive their medication closer to their homes and save on the cost of transport. The hospital will have less patient congestion in the outpatient dispensaries and queues and waiting times will be reduced. Some strategies must be sought to improve the services at the primary health care facilities. The hospital should explore various communication methods to put into place, that will save pharmacists time and satisfy the needs of the patients. This would require the health services management from both the hospitals and the primary health care facilities to work together to ensure continued support for the patients.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Purpose: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. Methods: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. Results: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33–2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28–1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67–2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74–3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. Conclusion: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

Background: An adequate supply of medicines in health establishments will increase the possibility of adequate control of hypertension and diabetes. Objective: To determine the shortage of antidiabetic and antihypertensive drugs at the national level in the context of the initial stage of the COVID-19 pandemic in Peru. Material y methods: Analysis of the "Sistema Integrado de Suministro de Medicamentos e Insumos Médicos Quirúrgicos" (SISMED) Database, between June 13th and July 15th, 2020, according to the "National list for medicines of essential medicines" (PNUME) of Ministry of health. Results: And between 4 and 96% of the departments have a total shortage of at least one antidiabetic, and 4% and 96% of at least one antihypertensive. The most depleted antidiabetic was Metformin 500 mg, and the most depleted antihypertensive drugs were Labetalol 5 mg / ml iny, Atenolol 50 mg tab and Carvedilol 6.25 mg tab. The percentage of distribution was higher in hospitals and specialized institutes in comparison with primary health facilities. Conclusions: There is a shortage of antihypertensive and antidiabetic drugs in health centers in Peru. © 2021 Medical Body of the Almanzor Aguinaga Asenjo National Hospital. / Revisión por pares

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0969. Adviser: Charles E. Begley. Includes bibliographical references.