| | | | | |
Select: All | None | Toggle Preview: Open All | Close All |
2005
|
| |  | Teixeira, Ricardo R. | Humanização e Atenção Primária à Saúde read moreAbstract: The principal aim of this article is to discuss the possible senses of humanization in the production of primary health care. For the fulfillment of this aim, the article opens a brief interlocution with the reference literature about humanization of health services identifying those senses that come closer to the approach that will be adopted here. From that point, it performs a discussion that will bring other senses to the proposals of humanization not yet explored in this debate, centralizing in a philosophical questioning of the ways of defining the human. At the end, considering determined characteristics of the production of primary health care, it explores how these new senses could contribute not only on the humanization of services, but how the services can contribute to our own humanization. | 2005 |
2004
|
| | | Travassos, Claudia | Uma revisão sobre os conceitos de acesso e utilização de serviços de saúde read moreAbstract: The purposes of this article are to review the concepts of health services access and utilization and to analyze how these concepts interrelate. Access is a complex concept (often used inaccurately) which changes over time and according to the context. Health services utilization is at the core of health systems functioning. Despite some disagreement, according to this review the prevailing perspective is that access is related to characteristics of services supply. Health care services utilization can be applied as a measure of access, but use of services depends on other factors. Individual and contextual factors influence the use of services. The article shows that the concept of access is becoming more comprehensive and is changing its focus from entry into the health system to outcome of care. Access is valued in relation to its impact on health and depends on the effectiveness of care delivered. As an outcome measure, access becomes multidimensional and difficult to operationalize. Finally, the article discusses how health determinants differ from those of health services utilization, which impacts directly on illness, but only indirectly on health. | 2004 |
| | | Maciel-Lima, Sandra M. | Acolhimento solidário ou atropelamento? A qualidade na relação profissional de saúde e paciente face à tecnologia informacional read moreAbstract: In the services sector, the product of labor is not a commodity that can be traded easily. What is sold is a specialized service, basically through an exchange of information to meet the client's needs and expectations. What emerge are thus the social relations between individuals: professionals and clients/consumers. This article presents evidence that the introduction of information technology undermines the quality of the relationship between the health professional and the patient. The article begins by discussing concepts pertaining to quality in the health sector. The health professional-patient relationship is then discussed through a brief review of the health/disease concept and specifically the physician-patient relationship. Analysis of primary data shows some indication that technological, physical, and management changes in health care units are undermining the quality of health care: many technological changes, but few operational changes, and many machines, but few professionals to treat patients. | 2004 |
| | | Santos, Iná S. | Serviços de saúde: epidemiologia, pesquisa e avaliação read moreAbstract: Health services epidemiological research generally involves testing the efficacy of new programs or strategies and the evaluation of health services quality. Repeating the evidence-based medicine model that has flourished in the clinical field, evaluations of public health programs' effectiveness has preferentially proposed and employed randomized studies as a way of guaranteeing a scientific standard of credibility in the results. A new trend among researchers of epidemiology applied to health services has challenged this premise and proposes that randomized studies be adapted to encompass the broad causal chain linking the implementation of programs to a given impact indicator. Others designs are proposed at different levels of causal inference, but sufficiently rigorous for their results to be reliable. | 2004 |
| | | Hartz, Zulmira M. | Integralidade da atenção e integração de serviços de saúde: desafios para avaliar a implantação de um "sistema sem muros" read moreAbstract: The premise of this paper is that comprehensive health care is a major component in the investigation and evaluation of health services and systems, structured as inter-organizational health care networks articulating clinical, functional, normative, and systemic dimensions in their operationalization and based on the understanding that no organization combines all the necessary resources and capabilities to solve the health problems of a population with its various life cycles. Given the complex nature of this "system without walls", eliminating barriers to access in the various health care levels in response to local and regional health, we take this opportunity to share a few "preliminary lessons" from our experience and from the literature on integrated health services which may interest researchers and managers concerned with the implementation of such services. | 2004 |
2003
|
| | | Carneiro Jr., Nivaldo | Organização das práticas de atenção primária em saúde no contexto dos processos de exclusão/inclusão social read moreAbstract: This article reports on a primary health care and training center in São Paulo, Brazil, and the organization of its activities based on equity and positive discrimination. Operating in the city center of São Paulo, the policy aims to provide health services access to certain target groups (homeless, sex workers, and slum-dwellers). It also raises discussion on the various forms of social life found in downtown areas, mainly those of vulnerable groups lacking access to public goods and services. The experience demonstrates the feasibility of implementing health policies based on universal access. | 2003 |
2002
|
| | | Uchimura, Kátia Y. | Qualidade e subjetividade na avaliação de programas e serviços em saúde read moreAbstract: Este ensaio versa sobre a avaliação de programas e serviços de saúde, dando ênfase à subjetividade imanente ao processo de avaliar. Trata-se de uma construção teórica que focaliza os diversos sentidos da avaliação, a influência do paradigma positivista no campo da avaliação de programas e serviços de saúde, o caráter polissêmico do termo qualidade e sua estreita imbricação com a subjetividade. Em adição, procuramos indicar a importância dos estudos que incorporam as perspectivas dos atores sociais nos processos de avaliação, apontando a metodologia qualitativa de pesquisa social como sendo um profícuo instrumento. | 2002 |
| | | González Pérez, Ubaldo | El concepto de calidad de vida y la evolución de los paradigmas de las ciencias de la salud read moreAbstract: Medicine emerged as a pragmatic response to the need of relieving pain, suffering and disability, but when it developed in interaction with the predominant conceptions of the rest of disciplines and technologies, its paradigms were also developed. Research and medical interventions moved from the disease of an individual at critical state and with disturbing symptoms to educational actions for preserving the health of the community. Great landmarks in the approaches to causality in medicine were the observations made by the Greek doctors about the importance of air, waters and places for the health and diseases as well as the ideas of Renaissance utopists when they predicated the possibility of creating a better society and a healthier life by providing higher quality lifestyles. Raminici also presented another transcendental approach when he spoke about the influence of the way of life of dunghill cleaners on the genesis of their diseases. All this brought the attention to working environment, housing, hygiene and hunger and hence famous physicians and economists performed studies on the living conditions of workers and impoverished sectors to explain the diseases and epidemics that hit the industrial development areas in Europe during the 17th and 18th centuries. This gave rise to the development of social medicine, social hygiene and public health, and from that moment on, it was clear that hunger and wars could kill and cause illness in more people than the bacteria did, because the role of the quality of life for health and disease had been finally understood. Regardless of this advanced conception, the first accomplishments of chemotherapy and the microscopic identification of biological agents brought about progress but at the same time a naive optimism that set out the unlimited possibilities of the chemotherapeutical drugs. The development of the drug industry was subjected to the interests of the market, leading some medical sectors and population sections to biologicism at all costs that made them believe that the solution of health problems and disease depend on the production and use of efficient drugs. The technologies aimed at intensive therapy, transplantation and cloning were led by the hand by the market, so, once again the danger represented by sudden changes in the way of life, environmental pollution and the poor quality of life caused by excessive development, excessive consumption and social insecurity was neglected. Recognizing these mistakes may be attenuated by making good use of (determinar) to study the quality of life in a context of integration of biological conditions with environmental, economic-social, psychological and ethical factors. This means to assume a conception within the paradigm of health to face the present society's problems. | 2002 |
2000
|
| | | Langer, A. | Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links read moreAbstract: Gracias a una mayor atención internacional, muchos países de América Latina y el Caribe están reformando actualmente sus sectores sanitarios, y aplicando además un enfoque integrado a la atención de salud reproductiva. Dada la grave carga personal, económica y social que suponen los problemas de salud reproductiva en los países de ingresos bajos y medios de América Latina y el Caribe, el acceso universal a unos servicios de salud reproductiva de alta calidad debería ser teóricamente una prioridad de las reformas del sector sanitario. Además de brindar nuevas oportunidades para la salud reproductiva, esas reformas obligan a mejorar la sostenibilidad y el desempeño de los servicios de salud reproductiva. Pese a la existencia de un terreno común entre las reformas del sector sanitario y la atención de salud reproductiva, no hay ninguna garantía respecto a los resultados finales. A fin de comprender mejor las oportunidades que brindan las reformas para mejorar la salud reproductiva, así como los vínculos entre los dos procesos, el Consejo de Población de América Latina y el Caribe organizó en 1999 tres talleres, que congregaron a funcionarios públicos, representantes de organizaciones no gubernamentales y profesores universitarios de 12 países de la región. Los talleres pusieron de relieve el paralelismo de los objetivos de la atención de salud reproductiva y de la reforma del sector sanitario, en el sentido de que ambas aspiran a promover un acceso equitativo a una asistencia de alta calidad mediante la aplicación de enfoques integrados de la atención primaria y la participación del público general en el establecimiento de prioridades sanitarias en lo relativo al gasto asistencial y al diseño y la prestación de servicios. Sin embargo, existe un grave riesgo de que las actividades de reforma sanitaria se vean impulsadas fundamentalmente por criterios financieros y/o políticos, y no por la necesidad de mejorar la calidad de los servicios como derecho humano básico. En esas circunstancias, las reformas podrían dificultar, incluso socavar, los progresos en materia de atención primaria, incluida la atención reproductiva. Se identificaron tres temas importantes que estaban cobrando importancia en la región en relación tanto con la salud reproductiva como con las reformas del sector sanitario, a saber, la descentralización, los cambios experimentados por la financiación de los servicios de salud, y el papel del sector privado. Respecto a la descentralización, se habló de su utilidad para respaldar un enfoque integrado y centrado en el usuario de la salud reproductiva, al delegarse la autoridad en actores locales que suelen conocer mejor las necesidades de los usuarios. Entre los problemas asociados a la descentralización, cabe citar la falta de capacidad técnica y de gestión, los intentos de las instancias superiores de mantener el control central, y la limitada experiencia en los procesos participativos. Se habló de nuevos enfoques en la financiación de la atención sanitaria. La búsqueda de la autosuficiencia financiera dentro del sistema de salud es muy importante, pero puede entrañar graves amenazas para la salud reproductiva. Si se llega a considerar la atención sanitaria como un producto económico, existe el riesgo de que el proceso de reforma se vea presidido por la reducción de costos, en detrimento de la mejora de la calidad, lo cual puede perjudicar a la salud reproductiva. Se abordó el papel crucial desempeñado por el sector privado, en particular por las organizaciones no gubernamentales, en la promoción de la salud reproductiva y en el suministro de información y servicios en ese campo. Se reconoció que es muy poco lo que se sabe sobre el sector lucrativo, y se plantearon importantes interrogantes acerca de la capacidad del Estado para implantar medidas de vigilancia y regulación. No obstante, la enorme proliferación de hospitales, dispensarios y farmacias privados de que va acompañada la urbanización en la región hace de este sector un interesante ámbito de estudio. Los cambios experimentados por los sistemas de salud en muchos países de América Latina y el Caribe son limitados, y no abundan los ejemplos de progresos conseguidos gracias a las reformas, de modo que el desfase entre la teoría y la práctica sigue siendo importante. Los procesos relacionados con las reformas del sector sanitario y la salud reproductiva no se han coordinado bien hasta la fecha. La falta de voluntad política, unida a los limitados recursos disponibles y la deficiente capacidad técnica y de gestión, también ha dificultado el desarrollo de políticas y programas en el nivel de ejecución. Es necesario sin duda elaborar e institucionalizar los mecanismos de diálogo, emplear procedimientos participativos para vigilar los progresos realizados, y llevar a cabo nuevas investigaciones sobre la interrelación entre las reformas sanitarias y la atención de salud reproductiva. | 2000 |
| | | Novaes, Hillegonda M. | Avaliação de programas, serviços e tecnologias em saúde read moreAbstract: The field of program, services and technology evaluation in general, and in health care in particular, is going through an important growth and conceptual and methodological diversification. It is also the object of an increasing demand for its participation as an effective supportive instrument in the decision-making process, and a constant need in the dynamics of health systems and services. In this paper, based on literature review, nuclear criteria involved in the organization of all evaluation processes are identified, and articulated with the existing institutionalized evaluation practices in developed countries, that is, program evaluation, quality assessment and management and technology assessment. In conclusion, the incipient development of a methodological evaluation output in Brazil is analyzed. | 2000 |
Add To Cart
Add To Report
Email
Export
1 