Evaluation of primary care from the perspective of users: EUROPEP adaptation of the instrument for major urban centers in Brazil - an application in the community of Manguinhos

Submitted by Gilvan Almeida ([email protected]) on 2016-08-10T18:29:03Z No. of bitstreams: 2 1108.pdf: 1244432 bytes, checksum: 00696d4df6e721d2943b4e1e2adb4d4c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Maria Arruda ([email protected]) on 2017-11-27T16:35:02Z (GMT) No. of bitstreams: 2 1108.pdf: 1244432 bytes, checksum: 00696d4df6e721d2943b4e1e2adb4d4c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2017-11-27T16:35:02Z (GMT). No. of bitstreams: 2 1108.pdf: 1244432 bytes, checksum: 00696d4df6e721d2943b4e1e2adb4d4c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.No Brasil, durante as últimas décadas, mudanças foram realizadas na organização do sistema de saúde, e a atenção básica (AB) obteve destaque, com a introdução de programas inovadores com objetivos de realizar mudanças no modelo assistencial como o Programa de Agentes Comunitários de Saúde e o Programa de Saúde da Família. A consolidação da Estratégia Saúde da Família (ESF) trouxe a necessidade de qualificação da AB ofertada à população, tornando necessário dessa forma o desenvolvimento de ferramentas que permitam a avaliação da Estratégia. Muitas iniciativas com foco na avaliação da ESF vêm sendo desenvolvidas no Brasil, contudo a avaliação da ESF desde a perspectiva dos usuários ainda é escassa e não estão disponíveis instrumentos de fácil aplicação para uso rotineiro. Estudos de satisfação podem contribuir para a institucionalização da avaliação e reorganização dos serviços e ser uma ferramenta para a participação popular. A satisfação com os cuidados de saúde é um conceito multidimensional e pode ser caracterizada como uma avaliação individual de várias dimensões dos cuidados de saúde, desde aspectos relacionados ao acesso, infra-estrutura, organização dos serviços, interação usuário-profissional, até resultados em saúde. O objetivo do presente estudo foi adaptar um instrumento de avaliação da satisfação do usuário, adequado à ESF, tendo por base o instrumento europeu de avaliação da qualidade em APS o European Task Force on Patient Evaluation of General Practice Care (EUROPEP), que é um instrumento de medição da satisfação dos usuários de serviços médicos de medicina geral e familiar na Europa. O questionário EUROPEP começou a ser desenvolvido em 1995 por pesquisadores de oito países e sua validação finalizou em 1998. O instrumento é constituído por 3 partes: i) Indicadores chaves (relação e comunicação, cuidados médicos, informação e apoio, continuidade e cooperação, e, organização dos serviços); ii) Indicadores de áreas específicas de satisfação (consulta, marcação e acessibilidade, características dos profissionais, condições do centro de saúde e os serviços prestados); iii) Informações sobre os usuários (dados socioeconômicos, de saúde e, atitudes após a experiência). O presente estudo foi composto por duas fases. Uma de revisão e adaptação do instrumento, onde foram realizados: tradução do questionário, reuniões de consenso com profissionais da ESF, com usuários e ACS e pré- teste. A segunda fase foi a aplicação do instrumento a uma amostra representativa dos usuários da ESF do Centro de Saúde Escola Germano Sinval Farias no município do Rio de Janeiro. Foram aplicados questionários a 289 usuários no período de junho a agosto de 2010. Para análise dos resultados foram calculadas médias das proporções das respostas “muito bom” e “bom” para cada indicador chave, e utilizando esses valores foi possível obter o índice de satisfação global. Foram realizados cruzamentos entre variáveis, para verificar possíveis associações entre os padrões de resposta e as características dos usuários, com a comparação das respostas entre sexos, usuários com distintos níveis de escolaridade, auto - percepção de saúde boa e ruim, e diferentes faixas etárias dos usuários. Os usuários entrevistados eram mulheres em sua maioria (84%), com faixa etária média entre 30 a 39 anos e baixa escolaridade (53% não possuíam o ensino elementar completo). Na auto percepção de saúde, 40% dos entrevistados indicaram saúde regular. O indicador Relação e Comunicação entre profissional e usuário foi o que mais se destacou positivamente em comparação aos outros. O item que obteve a maior satisfação foi o interesse do profissional sobre o usuário. O indicador chave Organização dos Serviços foi o que recebeu a pior avaliação em comparação aos outros. A pior avaliação de todas as perguntas foi o tempo de espera para consulta (56% dos usuários não estavam satisfeitos). Foi avaliada a relação entre características dos usuários e padrões de satisfação. A população com menor nível de escolaridade se mostrou mais satisfeitas. Pessoas com boa auto percepção de saúde tendem a estar mais satisfeitas com os serviços prestados, e, os usuários mais jovens tendem a ser menos satisfeitos. Esses resultados corroboram achados da literatura. Ao final da entrevista o usuário era convidado a expressar opiniões e sugestões do que precisava ser melhorado no Centro de Saúde. As contribuições foram principalmente relacionadas a três características: a mais mencionada foi a dificuldade para o acesso oportuno, a segunda foi a ampliação da oferta de profissionais e serviços e a terceira agregou sugestões relacionadas à organização dos fluxos da ESF no centro de saúde. Vale ressaltar que as sugestões de melhorias propostas para a unidade são em sua maioria factíveis, não demandam grandes investimentos financeiros e sim reorganização dos processos de trabalho, bem como otimização dos fluxos internos do centro de saúde. Como limitação do método realizado, destaca-se que o instrumento foi adaptado de uma versão européia para uma realidade de grande centro urbano da região sudeste do Brasil. Pode não ser adequado para todo o país, onde estão em jogo outras realidades (econômicas, sociais, demográficas, etc), sendo necessárias outras adaptações. Além disso, o instrumento foi idealizado para avaliar a atuação do profissional médico de família e como a ESF é composta por equipe multiprofissional, é necessário complementar o instrumento com perguntas específicas aos outros profissionais. Como potencialidade do método, destaca-se ser um instrumento de fácil manejo e rápida aplicação, que pode ser utilizado rotineiramente para monitoramento da ESF, e comparação entre unidades de Saúde da Família e entre municípios, e, principalmente, na mesma unidade de saúde ao longo do tempo, representando, assim, uma importante ferramenta para a institucionalização da avaliação na ESF.Over the past twenty years, changes have been made to health system organization in Brazil. Primary health care (PHC) has come to prominence and innovative programs – such as the community health worker program (Programa de Agentes Comunitários de Saúde) and the family health program (Programa de Saúde da Família) – have been introduced in order to modify the model of care. Establishment of the Family Health Strategy (Estratégia Saúde da Família, ESF) brought with it the need to improve the quality of PHC offered to the population, in turn requiring the development of tools with which to evaluate the strategy. Many initiatives focusing on evaluation of the ESF are underway in Brazil. However, evaluation of the ESF from the user standpoint is still scarce, and no easily applicable tools are available for routine use. Satisfaction studies can contribute to institutionalizing evaluation and reorganizing services, and serve as a tool for public participation. Satisfaction with health care is a multidimensional concept that can be characterized as individual evaluation of several dimensions of health care, ranging from aspects relating to access, infrastructure, service organization, user-health personnel interaction, through to health outcomes. The aim of this study was to adapt an instrument for evaluating user satisfaction, which was suited to the ESF. This was based on the European Task Force on Patient Evaluation of General Practice Care (EUROPEP) questionnaire, an instrument used for evaluating PHC quality as user satisfaction with general practice and family medical services in Europe. The EUROPEP questionnaire began to be developed in 1995 by researchers in eight countries, and validation was completed in 1998. The instrument comprises 3 parts: i) key indicators (relationship and communication, medical care, information and support, continuity and cooperation, and service organization); ii) indicators of specific areas of satisfaction (consultations, appointments and accessibility, characteristics of doctors, conditions at the health center, and the services provided); iii) user information (socioeconomic and health data, and post-questionnaire attitudes). This Brazilian study comprises two phases. The first was to review and adapt the instrument, which included: translating the questionnaire, consensus meetings with ESF personnel, users and CHWs, and pre-testing. The second phase was to apply the instrument to a representative sample of ESF users from the Centro de Saúde Escola Germano Sinval Farias health center in the municipality of Rio de Janeiro. Questionnaires were applied to 289 users between June and August 2010. In order to analyze the results, means of the proportions of responses “very good” and “good” were calculated for each key indicator; using those values it was possible to obtain an overall satisfaction index. Correlations were made between variables, so as to ascertain possible associations between the response patterns and user characteristics: responses were compared by sex, level of schooling, self-perceived good and poor health, and age group. Most of the users interviewed (84%) were women, with mean ages between 30 and 39 years and low levels of schooling (53% had not completed elementary schooling). In response to self-perceived state of health, 40% of the interviewees responded verage. The indicator group “relationship and communication between doctor and patient” stood out most from the others as the most favorably assessed. The item that showed greatest user satisfaction was the doctor’s interest in the user. The key indicator “service organization” received the worst evaluations. The question on appointment waiting times returned the worst evaluations (56% of users were dissatisfied). The relationship between user characteristics and satisfaction patterns was examined. The population with least schooling expressed most satisfaction. People with self-perceived good health tended to be more satisfied with the services provided, and younger users tended to be less satisfied. These results corroborate the findings of the literature. At the end of the interview, the user was invited to offer opinions and suggestions as to what needed improving at the health center. The contributions related mainly to three characteristics: the most mentioned was difficulty of timely access; the second was expansion of health personnel and services; and the third group of suggestions related to ESF flows at the health center. Note that most of the suggestions for improvements to the health center are feasible and do not call for major financial investments, but rather reorganization of the work and optimization of flows internal to the health center. A salient limitation on the method used is the instrument’s having been adapted from a European version to conditions in a large city in southeastern Brazil. It thus may not be appropriate to the country as a whole, where other economic, social, demographic etc. realities are in play. In addition, the instrument was designed to evaluate the activities of family doctors and, as the ESF is based on a multi-professional team, the instrument has to be complemented with questions specific to the other personnel. One particular potential of the method is that it is easy to handle and quick to apply, and can be used routinely to monitor the ESF and compare among Family Health units and among municipalities and, most importantly, within the same health center over time. It thus represents an important tool for institutionalizing evaluation of the ESF

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved