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Doctoral Thesis
DOI
https://doi.org/10.11606/T.6.2003.tde-05022021-173013
Document
Author
Full name
Regina Melchior
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2003
Supervisor
Committee
Buchalla, Cássia Maria (President)
Ayres, José Ricardo de Carvalho Mesquita
Cesar, Chester Luiz Galvão
Cordoni Junior, Luiz
Santos, Naila Janilde Seabra
Title in Portuguese
Avaliação da organização da assistência ambulatorial a pessoas vivendo com HIV/AIDS no Brasil: análise de 322 serviços em 7 estados brasileiros (CE, MA, MS, PA, RJ, RS, SP)
Keywords in Portuguese
AIDS
Assistência Ambulatorial
Avaliação de Programa
Qualidade do Cuidado
Abstract in Portuguese
Os resultados do Programa de Aids dependem da qualidade do cuidado prestado, especialmente no contexto de acesso universal à terapia tripla combinada de alto impacto (HAART). Este estudo objetivou avaliar a qualidade do cuidado de 322 serviços ambulatoriais que prestam cuidado a 72% (87.000) dos pacientes brasileiros em uso da HAART. As equipes dos serviços responderam 112 questões estruturadas que descrevem as características do serviço prestado, disponibilidade de recursos e de gerenciamento. Grupos focais e estudo piloto em 20 serviços definiram o questionário. As respostas foram classificadas em 3 escores: zero (baixo), 1 (médio) e 2 (alto). Os serviços foram classificados de acordo com as médias de todas as variáveis e foram agrupados baseados na técnica "K-means Cluster Analysis". A análise foi validada por comparação com avaliação qualitativa realizada previamente em 27 serviços. O resultado mostrou médias altas nos indicadores de disponibilidades de medicamentos, teste laboratoriais e recursos humanos. Os indicadores mostraram que o processo do cuidado e a gerência técnica têm médias baixas. A média geral dos serviços foi 1,128 (56% do máximo), a menor foi 0,563 (28%) e a maior foi 1,680 (84%). A análise das K'Médias distinguiu quatro grupos de qualidade. O melhor grupo inclui 76 serviços (23,6%), o segundo 53 (16,4%), o terceiro 113 (35%) e o pior 80 (24,8%). Estes resultados foram discutidos com administradores e profissionais do Programa de Aids. Eles serão usados para desenvolver um guia de condutas a ser disponibilizado pela Internet para ajudar os gerentes a monitorar a qualidade do cuidado em todo o país.
Title in English
Evaluation organization outpatient care for people living with HIV/AIDS in Brazil
Keywords in English
AIDS
Outpatient Care
Program Evaluation
Quality of Health Care
Abstract in English
The results of the AIDS Program depend on the quality of care provided especially in a context of HAART free access. This study aims to evaluate the quality of care of 322 Brazilian outpatient services providing care to 72% (87,000) of the Brazilian patients under HAART. Each service answered 112 structured questions describing the characteristics of the service delivery, resources availability and management. Focus groups and a pilot study in 20 services helped define the questionnaire. The answers were classified in 3 scores: 0 (the lowest) 1 (medium), 2 (the highest). The services were ranked according to the mean of scores of all variables and were grouped based on K-Means Cluster Analysis. The model of analysis was validated by comparison with a qualitative evaluation previously carried out in 27 services. The services showed high means in the indicators related to availability of medicines, lab tests and human resources. The indicators related to the process of care and management showed the lower means. The total average was 1,128 (56% of the maximum).The lowest score was 0,563 (28%) and the higher score was 1,680 (84%). The K-Means Cluster analysis distinguished 4 groups of quality. The best group includes 76 services (23,6%), the second 53 (16,4%), the third 113 (35%) and the worst 80 (24,8%). These results were discussed with the managers and professionals of the AIDS Program. They will be used to develop a guideline to be available on the Internet to help managers in monitoring quality of care in the whole country.
 
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Publishing Date
2021-06-11
 
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