Avaliação da rede de núcleos hospitalares de epidemiologia do Estado de São Paulo
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Data
2018-03-01
Autores
Cardozo, Érica Morais
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Universidade Estadual Paulista (Unesp)
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Introdução: O Subsistema Nacional de Vigilância Epidemiológica em Âmbito Hospitalar visa aumentar a sensibilidade e oportunidade na detecção de doenças de notificação compulsória (DNC) e, assim, possibilitar a adoção, oportuna, de medidas de controle, possibilitando a interrupção da cadeia de transmissão de doenças entre a população. Tendo-se em vista a importância de estudos avaliativos para o aprimoramento do sistema e a escassez de estudos nesta área, propôs-se a presente pesquisa que teve por objetivo descrever e avaliar a rede dos NHE do Estado de São Paulo, do ponto de vista de estrutura, com enfoque nos recursos humanos, e de processo. Método: Trata-se de estudo transversal, que incluiu 34 dos 41 NHE do Estado de São Paulo. Os dados foram obtidos de julho de 2017 a janeiro de 2018 por meio de questionário eletrônico e analisados com base nas Portarias 183/2014 GM/MS e 204/2016 GM/MS e no Guia de Vigilância Epidemiológica, segundo referencial de avaliação de Donabedian (1980), considerando-se estrutura e processo. Para a avaliação de estrutura foram selecionados 4 indicadores relacionados à composição e capacitação das equipes e para o processo, 4 indicadores relativos à organização e gestão do processo de trabalho e 7 referentes às atribuições previstas nas legislações. Os dados foram analisados por meio de estatística descritiva. Resultado: A maioria (73,5%) dos coordenadores eram mulheres, tinham 30 a 59 anos (64,7%) e a totalidade ensino superior completo. Dentre os 34 NHE analisados, 27 foram classificados, com base no número total de notificações e de leitos hospitalares, em notificadores de pequeno porte, 5 de médio e 2 de grande porte. A vigilância epidemiológica (VE) era realizada predominantemente por enfermeiros nos serviços de pequeno e médio porte e por médicos naqueles de grande porte. A maioria dos serviços (64,7%) estava sob a coordenação de médicos e a totalidade dos NHE realizava busca ativa de agravos de notificação compulsória por meio de várias estratégias, sendo a triagem de exames laboratoriais (96,8%) e visita às unidades de internação (90,3%) as mais empregadas. A maioria (74,2%) dos NHE não dividia os agravos de notificação compulsória entre os membros da equipe, suas equipes reuniam-se rotineiramente para discussão de casos (77,4%) e 45,2% deles não possuía instrumento de comparação entre o número de fontes de dados consultadas e o total de notificações produzidas. Apenas 24,1% dos núcleos elaboravam relatório trimestral com perfil de morbidade e mortalidade hospitalar dos agravos de notificação compulsória. A maioria dos serviços teve processo classificado como adequado em relação às atribuições esperadas (21) e na organização e gestão do processo de trabalho (27). Entretanto, quanto à estrutura, apenas 19 classificaram-se como adequados. Conclusão: a avaliação da rede de NHE do Estado de São Paulo, de modo geral, mostrou-se favorável quanto ao processo e, apesar da análise de estrutura ter sido menos favorável, tendo em vista que 15 NHE foram classificados como parcialmente adequados, a maioria destes tinha processo adequado. Este estudo aponta a necessidade de adequação de parte dos NHE quanto à constituição e carga horária da equipe e sugere discussão junto às equipes do importante papel da produção de relatórios analíticos e emprego de instrumentos de gestão do processo de trabalho, oportunizando visibilidade da complexidade das práticas de VE e, assim, sensibilização de gestores e profissionais da assistência.
The Hospital - based Epidemiological Surveillance Subsystem aims t o increase sensitivity and opportunity in the detection of notifiable diseases through the timely adoption of control measures, enabling the interruption of the chain of transmission of diseases among the population. Considering the importance of evaluati ve studies for the improvement of the System and the scarcity of studies in this area , the purpose of the present study was to describe and evaluate the network of the NHE of the State of São Paulo, from the point of view of structure, focusing on human re sources, and process. Method: This is a cross - sectional study, which included 34 of the 41 NHE's in the State of São Paulo. The data were obtained from July 2017 to January 2018 by means of an electronic questionnaire and analyzed based on Ordinances 183/2 014 GM/MS and 204/2016 GM/MS and on the Guide of Epidemiological Surveillance, according to the Donabedian evaluation referential (1980), considering structure and process. For the evaluation of the structure, 4 indicators related to the composition and qu alification of the teams and for the process 4 indicators related to the organization and management of the work process and 7 related to the attributions provided in the legislations were selected. Data were analyzed using descriptive statistics. Outcome: The majority (73.5%) of the coordinators were women, were between 30 and 59 years old (64.7%) and the entirety of them had complete higher education. Of the 34 NHE analyzed, 27 were classified based on the total number of reports and of hospital beds in s mall notifiers, 5 medium and 2 large. The Epidemiological Surveillance was predominantly performed by nurses in small and medium - sized services and by physicians in large ones. Most of the services (64.7%) were under the coordination of physicians and all the NHE carried out an active search for disease compulsory notification through several strategies, being the screening of laboratory tests (96.8%) and visits to hospitalization units (90.3%) the most employed. The majority (74 .2%) of NHE did not share d isease compulsory notification among team members, their teams routinely met for case discussion (77.4%) and 45.2% did not have a comparison tool between the number of data sources consulted and the total number of notifications produced. Only 24.1% of the centers produced a quarterly report with a hospital morbidity and mortality profile of disease compulsory notification. Most of the services were classified as adequate in relation to the expected tasks (21%), and in the organization and management of the work process (27%). However, regarding structure only 19 were adequate. Conclusion: the evaluation of the NHE network in the state of São Paulo, in general, was favorable and although the structure analysis was less favorable, considering 15 NHE classifie d as partially adequate, most had an adequate process. This study points out the need for adequacy of the NHE regarding the constitution and workload of the team and suggests discussion with the teams about the important role of the production of analytica l reports and the use of work process management tools, giving visibility to the complexity of Epidemiological Surveillance practices and thus raising the sensitivity of managers and care professionals.
The Hospital - based Epidemiological Surveillance Subsystem aims t o increase sensitivity and opportunity in the detection of notifiable diseases through the timely adoption of control measures, enabling the interruption of the chain of transmission of diseases among the population. Considering the importance of evaluati ve studies for the improvement of the System and the scarcity of studies in this area , the purpose of the present study was to describe and evaluate the network of the NHE of the State of São Paulo, from the point of view of structure, focusing on human re sources, and process. Method: This is a cross - sectional study, which included 34 of the 41 NHE's in the State of São Paulo. The data were obtained from July 2017 to January 2018 by means of an electronic questionnaire and analyzed based on Ordinances 183/2 014 GM/MS and 204/2016 GM/MS and on the Guide of Epidemiological Surveillance, according to the Donabedian evaluation referential (1980), considering structure and process. For the evaluation of the structure, 4 indicators related to the composition and qu alification of the teams and for the process 4 indicators related to the organization and management of the work process and 7 related to the attributions provided in the legislations were selected. Data were analyzed using descriptive statistics. Outcome: The majority (73.5%) of the coordinators were women, were between 30 and 59 years old (64.7%) and the entirety of them had complete higher education. Of the 34 NHE analyzed, 27 were classified based on the total number of reports and of hospital beds in s mall notifiers, 5 medium and 2 large. The Epidemiological Surveillance was predominantly performed by nurses in small and medium - sized services and by physicians in large ones. Most of the services (64.7%) were under the coordination of physicians and all the NHE carried out an active search for disease compulsory notification through several strategies, being the screening of laboratory tests (96.8%) and visits to hospitalization units (90.3%) the most employed. The majority (74 .2%) of NHE did not share d isease compulsory notification among team members, their teams routinely met for case discussion (77.4%) and 45.2% did not have a comparison tool between the number of data sources consulted and the total number of notifications produced. Only 24.1% of the centers produced a quarterly report with a hospital morbidity and mortality profile of disease compulsory notification. Most of the services were classified as adequate in relation to the expected tasks (21%), and in the organization and management of the work process (27%). However, regarding structure only 19 were adequate. Conclusion: the evaluation of the NHE network in the state of São Paulo, in general, was favorable and although the structure analysis was less favorable, considering 15 NHE classifie d as partially adequate, most had an adequate process. This study points out the need for adequacy of the NHE regarding the constitution and workload of the team and suggests discussion with the teams about the important role of the production of analytica l reports and the use of work process management tools, giving visibility to the complexity of Epidemiological Surveillance practices and thus raising the sensitivity of managers and care professionals.
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Palavras-chave
vigilância epidemiológica, saúde pública, avaliação em saúde, epidemiological surveillance, public health, health assessment