Acesso a ambulatório pediátrico de um hospital universitário Evaluation of access to the pediatric service of a university hospital

INTRODUÇÃO: No Brasil verifica-se um descompasso entre o aumento das necessidades de atenção à saúde e de sua oferta. O Sistema Único de Saúde, cujas deretrizes preconizam a atenção universal e eqüânime, determina a relevância desta temática dentro do campo da avaliação dos serviços de saúde. Assim, foram estudados dois ambulatórios de pediatria de um hospital universitário, um geral e outro de uma subespecialiadade (pneumologia), comparando os usuários quanto ao acesso. MÉTODO: Foram aplicados 221 questionários entre clientes de ambos os ambulatórios de pediatria com o objetivo de se estudar e comparar variáveis socioeconômicas, procedência, acesso aos referidos ambulatórios e outros serviços de saúde. RESULTADOS: Evidenciou-se grande dificuldade de locomoção dos pacientes, a maioria dos quais são encaminhados por serviços de saúde locais. Dos pacientes atendidos 40% não receberam nenhum atendimento anteriormente à sua chegada ao hospital, fato que decorre principalmente de seu baixo nível socioeconômico, que os torna dependentes exclusivamente dos serviços públicos de saúde. A comparação entre os dois ambulatórios mostra que os pacientes do ambulatório de especialidade têm melhor nível socioeconômico e são menos dependentes dos serviços públicos, configurando desta forma uma situação de ineqüidade. CONCLUSÕES: É apontado o melhor nível socioeconômico dos usuários da especialidade bem como questões organizacionais do próprio serviço como os responsáveis pela iniqüidade verificada.<br>INTRODUCTION: In Brazil, one can verify an imbalance between the increase in the need for health care and its supply. The consolidation of the National Health System which recommends universality and equity in care, makes this issue important in the field of health service evaluation. Two pediatric services in a university hospital, one general and the other specialized are studied and compared in terms of their clients' access. METHOD: Questionnaires were applied to 221 users of the general pediatrics outpatient departments of one of the specialities with a view to studying and comparing socioeconomic and several other variables related to the access to these and other health services. RESULTS: A high level of difficulty in the users' locomotion from local health services to the hospital was noted.Of the patients attended, 40% did not receive any kind of care before their arrival and were dependent exclusively on State-run health services. The clients of the speciality were different as regards several variables when compared to the users of the general outpatients' department. The fact that they are at a better socioeconomic level and are less dependent on State-run services brings out the social inequalities involved. CONCLUSION: Socioeconomic conditions, as well as organizational aspects of the service, are seen to be both causes and consequences of social inequalitiy verified

Avaliação da qualidade de atendimento ambulatorial em pediatria em um hospital universitário Quality-of-care assessment in a university hospital pediatric clinic

Estudou-se o ambulatório de Pediatria do Hospital das Clínicas da Unicamp, um serviço didático-assistencial que, inserido no Sistema Único de Saúde, presta assistência secundária e terciária para crianças de 0 a 18 anos. Foram aplicados 221 questionários entre clientes do ambulatório geral de pediatria e de uma de suas especialidades, permitindo comparar diversos indicadores de qualidade da assistência médica prestada. Evidenciou-se um bom nível de conhecimento dos responsáveis pelos usuários sobre seus problemas de saúde. Encontrou-se alto grau de satisfação dos mesmos, embora houvesse baixíssima vinculação entre médico e paciente. Com relação ao atendimento, 43,4% relataram problemas, mas apenas 17,6% propuseram sugestões para melhorá-lo. O tempo de espera nas consultas foi bastante longo. A clientela da especialidade se diferenciou da do ambulatório geral com relação a diversos indicadores.<br>This study focuses on the Pediatric Clinic of the UNICAMP University Hospital, teaching and care facility belonging to the Brazilian National Health System, providing secondary and tertiary health care for children aged 0 to 18 years. A total of 221 questionnaires were applied with users of the general pediatric out-patient services and one of the specialties, allowing for comparison of various medical care indicators. Users were found to be quite knowledgeable about their health conditions and satisfied with the care received, despite a weak link in the physician-patient relationship. 43.4% reported problems related to the services, while only 17.6% made suggestions to improve them. Waiting time was found to be quite long. Users of specialized services differed from general care patients with regard to several indicators

Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>In primary health care, provider-patient interaction is fundamental platform and critically affects service delivery. Nevertheless, it is often ignored in medical research and practice and it is infrequently subjected to scientific inquiry, particularly in Ethiopia. This study aimed to assess patient satisfaction with health care provider interactions and its influencing factors among out-patients at health centers in West Shoa, Central Ethiopia.</p> <p>Methods</p> <p>A cross sectional facility based study was conducted on 768 out-patients of six health centers in West Shoa Zone, Central Ethiopia. The total sample size was allocated to each of the six health centers based on patient flow during the ten days prior to the start of data collection. Pre-tested instruments were used for data collection and the data were analyzed using SPSS version 16.0 statistical software. Factor score was computed for the items identified to represent the satisfaction scale by varimax rotation method. Using this regression factor score, multivariate linear regression analysis was performed and the effect of independent variables on the regression factor score was quantified.</p> <p>Results</p> <p>Seventy three percent of the respondents perceived that provider's empathy was good and 35% complained that providers were not technically competent enough. In addition, 82% of the respondents rated non-verbal communication by the providers to be good, very good or excellent on a five-point ordinal scale. Regardless of the process, only 34.1% of the patients implied that the consultations made a difference in understanding their illness and coping with it. Generally speaking, 62.6% of the patients reported that they have been satisfied with their visit. Perceived empathy, perceived technical competency, non-verbal communication, patient enablement, being told the name of once illness, type and frequency of visit, knowing the providers and educational status were main independent predictors of patient satisfaction in this study. Furthermore, very good empathy (Beta = -4.323), fair non-verbal communication (Beta = -0.188), fewer expectations met (Beta = -0.169) and disagreement to technical competency (Beta = -0.156) had greater negative influence on patient satisfaction. On the other hand, excellent non-verbal communication (Beta = 0.114) and being told the name of once illness (0.109) had pronounced positive influence on patient satisfaction.</p> <p>Conclusion</p> <p>The present study showed that interpersonal processes including perceived empathy, perceived technical competency, non-verbal communication and patient enablement significantly influence patient satisfaction. Therefore, health care providers should work towards improving the communication skill of their professionals along with having technically competent workers which could possibly affect the perception of the patient about all of the variables identified as independent predictors of patient satisfaction in this study.</p

Acessibilidade de indivíduos infectados pelo HIV aos serviços de saúde: uma revisão de literatura Accessibility to health services by HIV-infected patients: a literature review

Este trabalho tem por objetivo apresentar uma revisão de estudos que enfocam o tema da acessibilidade a ações e serviços de saúde. Tem-se demonstrado que indivíduos infectados pelo vírus da imunodeficiência humana (HIV) podem apresentar uma melhor sobrevida dependendo do tipo de acesso que tenham às ações e serviços de saúde, como, por exemplo, acesso a medicamentos profiláticos (por exemplo, zidovudina, pentamidina). Desta forma, o presente trabalho enfatiza e utiliza dados da epidemia do HIV como forma de abordar o tema proposto. O artigo inicia-se com uma exposição do marco teórico sobre acessibilidade, seguida de uma revisão bibliográfica estruturada em quatro tópicos, a saber: 1) aspectos epidemiológicos da AIDS; 2) avaliação de qualidade dos serviços de saúde; 3) acessibilidade às ações e serviços de saúde e 4) estudos de acessibilidade em pacientes infectados pelo HIV. Considerações finais sobre o tema enfocado apontam para a necessidade de se compreender as implicações das diversas barreiras de acesso aos serviços, levando-se em conta os custos sociais e humanos da infecção pelo HIV, as necessidades e demandas dos indivíduos infectados e as conseqüências que o não-atendimento em tempo hábil pode ter para estes indivíduos.<br>The aim of this paper is to provide a review of studies on accessibility to health care. It has been shown that patients infected by the human immunodeficiency virus (HIV) may present better survival estimates depending upon their access to adequate health care, such as the availability of prophylactic therapy (e.g. zidovudine, pentamidine). The present review has emphasized access to health care in light of data from the current HIV epidemic. Theorical aspects pertaining to accessibility are presented, followed by a brief literature review on four main topics: 1. epidemiological aspects of HIV; 2. evaluation of health service quality; 3. accessibility to health care; and 4. accessibility studies on HIV-infected patients. Final considerations indicate the need to understand the various consequences of barriers to health care, taking into account the social and human costs of HIV infection, the needs and demands of HIV-infected patients, and the consequences of delays in care for these individuals