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2005
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| |  | 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
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| | | 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
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| | | 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
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| | | 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 |
2000
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| | | 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 |
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