Autor: resilisus

Este autor escreveu 48 artigos

Gatekeeper family doctors operating a decentralized referral prioritization system: Uncovering improvements in system resilience through a grounded-based approach

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The referral prioritization system from primary care to specialized ambulatory care in Rio de Janeiro, Brazil, was centralized until 2012. From 2012 onwards major reforms in course in the city’s public health care sector restructured referral prioritization to operate from primary care, elevating primary care coverage from 7% to 70% of the population. This paper aims at describing how this organizational change reshaped the system in a large city, and how strategies used by gatekeeper physicians contribute to system resilience. The criteria used to assess resilience improvements are the Hollnagel’s resilience cornerstones – Responding, Monitoring, Anticipation and Learning. The method used to disclose and describe the impacts of this organizational change to everyday work practices was semi-structured interviews with gatekeeper family physicians and the mapping of these interviews according to concept mapping guidelines. Thus the work-as-done was captured in concepts and its aspects were classified in mutually-exclusive categories. For data analysis we used the Functional Resonance Analysis Method – FRAM to depict the relations among the resilience cornerstones. The findings reveal that system decentralization paved the way for the emergence of situated strategies to cope with shortcomings at the sharp end of referral prioritization, allowing gatekeepers and primary care teams to employ and couple various adjustment maneuvers, improving overall resilience. The qualitative approach has led us to see gaps and identify support processes that are still peripheral to the formal planned assignments, pointing out innovation paths and potential future adjustments to public healthcare policies.

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Effects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas

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Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.

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Assessing community health workers’conditions for delivering care to patients in low-income communities

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In this paper we study the working conditions of Community Health Workers in performing house calls within low-income, violent communities in order to understand the challenges in delivering primary care in developing countries. We conducted field studies in two primary healthcare clinics and telephone surveys for 5 months in 2017 within systematic sample of 1690 community health workers based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. A number of 759 interviews were completed, approximately 50% of the sample, 86% men and 14% women. Most participants are 30-39 years old (35%), followed by 27% of 40-49 years old participants. Results show that exposure to territorial violence and environmental or health-related diseases significantly affects CHWs. Moreover, CHWs have to develop a significant set of skills to cope with aspects of the territory, and those skills are not present in their training. As community health workers work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.

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Supporting decision-making in patient risk assessment using a hierarchical fuzzy model

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Abstract In this paper, we present a hierarchical fuzzy model to support patient triage in primary health care. In developing countries like Brazil, public health must usually cover degraded territories; thus, allocating patients to health services is very hard due low availability, enormous demands, and the complexity of assessing patient conditions—which must account for more then physical aspects of patients, but their social conditions as well. This approach combines the fuzzy set theory under the AHP framework in order to illustrate the inherent imprecision in the evaluation of patient risk. Fieldwork was conducted in a primary healthcare facility in Brazil to demonstrate the applicability of the proposed approach. The proposed approach represents criterion in the formation of patients’ risk scores encompassing important aspects of primary care triage such as the structure of families, the conditions of residences, exposure to urban violence, and other aspects of patients’ lives, taking the risk assessment beyond the simple evaluation of symptoms and physiological conditions. Our approach focuses on enforcing decisions of public health workers by improving the awareness of patients’ conditions, which we believe will make the employment of triage criteria uniform and capable of showing tendencies on patients’ risks, as well as avoiding bias in patient triage.

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Patient visits in poorly developed territories: a case study with community health workers

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In this paper, we study the effects of poor conditions of territories in patient visits performed by community health workers and the consequences to primary care policies. We carried a case study with community health workers in Rio de Janeiro, Brazil, including ethnographic observations in two primary healthcare clinics. Moreover, we present an analysis of the collected data with the support of the function resonance analysis method and we point out relations between the findings and the execution of the primary healthcare policy in a systemic approach. Thus, our study highlights the impacts of work situations in the health assistance of poorly developed communities, indicating how community health workers cope with adverse conditions, and how such situations affect the effectiveness of primary care policies.

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Agenda de saúde sustentável para as Américas 2018-2030: Um chamado à ação para a saúde e o bem-estar na Região

Leitura que faz parte da curadoria do laboratório para as "Leituras Essenciais". O livro está hospedado no portal da Organização Pan-Americana da Saúde (OPAS), 2017. É possível realizar o acesso através…

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Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies

Increased attention to the strengthening of health systems would not be sustainable in the absence of a sound monitoring strategy that enables decision-makers to accurately track health progress and performance, evaluate impact, and ensure accountability at country and global levels. This handbook describes a set of indicators and related measurement strategies, structured around the WHO framework that describes health systems in terms of six “building blocks”: service delivery, health workforce, information, medicines, financing and governance.

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