Papers by Monique Bourget
Tempus Actas de Saúde Coletiva, Nov 30, 2007
A evolução da assistência à saúde no modelo hegemônico centrado no hospital levou a movimentos de... more A evolução da assistência à saúde no modelo hegemônico centrado no hospital levou a movimentos de reação culminando, no Brasil, com a implantação do SUS como política nacional de saúde para a reestruturação da assistência, induzindo novas propostas de produção do conhecimento, de organização dos serviços ou do desenvolvimento da assistência, pressupondo sua humanização. Surgem novas conceituações teóricas que apóiam estudos de humanização, porém focados no âmbito hospitalar, no cuidado ao paciente e na melhora das condições de trabalho dos profissionais da saúde, inseridos em um ambiente propício a agravos de ordem psicoocupacional. Na atenção básica, as abordagens sobre a questão da humanização são dirigidas à assistência neste nível de atenção, com pouca ênfase na saúde dos profissionais atuantes. Relata-se a experiência de implantação de um serviço de apoio psicossocial aos trabalhadores da Estratégia Saúde da Família, suas ações iniciais e proposições para seu avanço, no intuito de compartilhar experiências e contribuir para o desenvolvimento da humanização integral na Atenção Primária em Saúde, incluindo seus agentes.
ANAIS DO CBMFC, 2013
Introdução: Muitos são os fatores que dificultam a fixação dos profissionais médicos na atenção p... more Introdução: Muitos são os fatores que dificultam a fixação dos profissionais médicos na atenção primária nos municípios do Brasil. Com o intuito de reduzir a rotatividade dos profissionais e melhorar a satisfação dos médicos a Atenção Primária à Saúde Santa Marcelina realizou pesquisa de satisfação com os profissionais. Objetivos: Identificar fatores facilitadores e dificultadores da adesão dos profissionais médicos na atenção primária da rede pública. Metodologia ou Descrição da Experiência: Uma pesquisa quantitativa foi realizada com 78 profissionais médicos pela assessoria técnica do Santa Marcelina. O questionário consistia em 13 perguntas fechadas (múltipla escolha) e 4 perguntas abertas(resposta discursiva). Entre os profissionais participantes, apenas 58 autorizaram a divulgação dos dados. Resultados: A maioria dos entrevistados (79,31%) estava a menos de 10 anos na atenção primária. Quase metade, ou 44,83% (26) não possuíam residência, mestrado ou qualquer outra formação complementar. O stress era referido por 63,79% dos médicos. 56,90 % da amostra se dizia satisfeita ou muito satisfeita com seu trabalho. Os fatores motivadores mais citados foram: o trabalho em equipe (77,59%), o sentimento de valorização pela equipe (58,62%) e pela comunidade (56,90%). Entre os pontos negativos, os mais citados foram as metas impostas de atendimento (50,00%), a distância de casa ao trabalho (25,86%) e o número elevado de consultas (6,90%). Conclusão ou Hipóteses: Os dados levantados são pertinentes e serão utilizados pela gestão de pessoas na procura de melhorar a fixação dos profissionais. Muitos problemas levantados, como os salários insuficientes (3,45%) e a ausência de plano de carreira (3,45%), a despeito de outros, inerentes à pratica na atenção primária, podem ser modificados.
Revista APS, 2007
RESUMO O climatério é a fase da vida da mulher que compreende o final da vida reprodutora eo iníc... more RESUMO O climatério é a fase da vida da mulher que compreende o final da vida reprodutora eo início da senilidade, marcado por eventos importantes como a última menstruação (menopausa). Síndrome do climatério, ou moléstia menopausa1 ou síndrome ...
Revista Brasileira de Medicina de Família e Comunidade, 2007
Este artigo é uma versão adaptada, para este número suplementar da Revista Brasileira de Medicina... more Este artigo é uma versão adaptada, para este número suplementar da Revista Brasileira de Medicina de Família e Comunidade, do documento original da Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC), editado em 2005, sob o mesmo título . disponível na íntegra no portal www.sbmfc.org.br. O texto situa a Medicina de Família e Comunidade (MFC) como uma especialidade médica centrada no paradigma da integralidade biopsicossocial que prioriza a APS, fazendo um nítido contraste com as especialidades focais. As políticas de saúde historicamente adotadas no Brasil privilegiaram, no entanto, um modelo assistencial hospitalocêntrico, bloqueando o desenvolvimento da APS e da MFC. Esta é uma tendência em mudança em face da Estratégia Saúde da Família e da experiência internacional nesta área. Neste contexto, a SBMFC, em parceria com o MS, vem incentivando a expansão dos programas de residência em MFC. Considerando a importância de que tal expansão seja implementada sem prejuízo da ...
Physician turnover in primary health care services in the East Zone of São Paulo City, Brazil: incidence and associated factors, Feb 5, 2022
Background: The shortage and high turnover of physicians is a recurrent problem in health care s... more Background: The shortage and high turnover of physicians is a recurrent problem in health care systems; this is
especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze
incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo
City.
Methods: This is a retrospective cohort study of 1378 physicians over a 15 years’ time period based on physicians’
administrative records from two distinct secondary databases. Physicians’ individual characteristics were analyzed
including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were
used to analyze the termination of contract.
Results: One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95
8.0–11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving
the service was 2.14 years (CI95% 1.98–2.29 years) and 1.17 years [(CI95% 1.05–1.28 years)]. The probability of contract
interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were
identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4–2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95
1.64–2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18–1.56), p < 0.001]; and the conclusion of
residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40–2.04), p < 0.001].
Conclusions: The time of employment of the physician in PHC was relatively short, with a high probability of TEC in
the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and
need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible
for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the
periphery of a metropolitan area, the study provides support for the planning, implementation and management of
policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.
Keywords: Employment, Physicians, Primary health care, Personnel turnover, Health centers, Survival analysis
Background: The shortage and high turnover of physicians is a recurrent problem in health care sy... more Background: The shortage and high turnover of physicians is a recurrent problem in health care systems; this is especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo City. Methods: This is a retrospective cohort study of 1378 physicians over a 15 years' time period based on physicians' administrative records from two distinct secondary databases. Physicians' individual characteristics were analyzed including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were used to analyze the termination of contract. Results: One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95 8.0-11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving the service was 2.14 years (CI95% 1.98-2.29 years) and 1.17 years [(CI95% 1.05-1.28 years)]. The probability of contract interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4-2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95 1.64-2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18-1.56), p < 0.001]; and the conclusion of residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40-2.04), p < 0.001]. Conclusions: The time of employment of the physician in PHC was relatively short, with a high probability of TEC in the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the periphery of a metropolitan area, the study provides support for the planning, implementation and management of policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.
Revista panamericana de salud publica = Pan American journal of public health, 2012
OBJECTIVE To describe the strategies and results obtained by the early diagnosis and prevention o... more OBJECTIVE To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. METHODS The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. RESULTS In 2001, 90,886 elderly were examined vs. 629,613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consol...
Journal of the American College of Cardiology
Journal of Transcatheter Interventions
Implementing telemedicine in the initial care for ST-segment elevation myocardial infarction Impl... more Implementing telemedicine in the initial care for ST-segment elevation myocardial infarction Implementação da telemedicina no atendimento inicial do infarto agudo do miocárdio com supradesnivelamento do segmento ST
Revista Brasileira de Educação Médica
Medical training is current topic of discussion both on the national and international stage due ... more Medical training is current topic of discussion both on the national and international stage due to changes in contemporary society and the consequent health demands. In Brazil, insertion into the workplace of the Primary Health Care (PHC) student is recommended throughout the medical course. However, such insertion is hampered by inadequate practical scenarios, the lack of preceptors, insufficient training of general practitioners to receive students, teachers without adequate training in teaching in the area and resistance by teachers of traditional disciplines. This article describes and analyzes a model for insertion into PHC and Family and Community Medicine (FCM) of students from a medical course in São Paulo, the challenges of teaching-management integration and the actions that help to address these issues. The proposal is based on educational objectives aimed at developing competences (knowledge, skills and attitudes) so that the student can offer comprehensive care, unders...
Family medicine, Jun 8, 2018
There is a limited evidentiary base on the development of family medicine in different contexts a... more There is a limited evidentiary base on the development of family medicine in different contexts and countries. The lack of evidence impedes our ability to compare and characterize family medicine models and identify areas of success that have led to the effective provision of care. This paper offers a comparative compilation and analysis of the development of family medicine training programs in seven countries: Brazil, Canada, Ethiopia, Haiti, Indonesia, Kenya, and Mali. Using qualitative case studies, this paper examines the process of developing family medicine programs, including enabling strategies and barriers, and shared lessons. An appreciative inquiry framework and complex adaptive systems thinking inform our qualitative study. Committed partnerships, the contribution of champions, health policy, and adaptability were identified as key enablers in all seven case studies. The case studies further reveal that some enablers were more salient in certain contexts as compared to ...
Revista Brasileira de Educação Médica
RESUMO Em contexto nacional e internacional, discute-se a formação médica devido às mudanças na s... more RESUMO Em contexto nacional e internacional, discute-se a formação médica devido às mudanças na sociedade contemporânea e suas demandas de saúde. No Brasil, preconiza-se a inserção do aluno na Atenção Primária à Saúde (APS) durante todo o curso médico. Tal inserção é dificultada pelos cenários práticos inadequados, pela falta de preceptores, pela formação insuficiente dos médicos generalistas para receber estudantes, pelos docentes sem capacitação adequada para o ensino na área e pela resistência de docentes de disciplinas tradicionais. Este artigo descreve e analisa um modelo de inserção da APS e Medicina de Família e Comunidade (MFC) em um curso médico no município de São Paulo, os desafios da articulação ensino-gestão e as ações que ajudam a enfrentá-los. A proposta parte de objetivos educacionais que visam desenvolver competências (conhecimentos, habilidades e atitudes) para que o aluno possa oferecer cuidado integral, compreendendo o indivíduo no contexto de vida familiar, soci...
Nouvelles pratiques sociales, 2002
Revista Brasileira de Medicina de Família e Comunidade, 2017
Tempus Actas de Saúde Coletiva, 2007
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Papers by Monique Bourget
especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze
incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo
City.
Methods: This is a retrospective cohort study of 1378 physicians over a 15 years’ time period based on physicians’
administrative records from two distinct secondary databases. Physicians’ individual characteristics were analyzed
including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were
used to analyze the termination of contract.
Results: One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95
8.0–11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving
the service was 2.14 years (CI95% 1.98–2.29 years) and 1.17 years [(CI95% 1.05–1.28 years)]. The probability of contract
interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were
identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4–2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95
1.64–2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18–1.56), p < 0.001]; and the conclusion of
residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40–2.04), p < 0.001].
Conclusions: The time of employment of the physician in PHC was relatively short, with a high probability of TEC in
the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and
need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible
for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the
periphery of a metropolitan area, the study provides support for the planning, implementation and management of
policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.
Keywords: Employment, Physicians, Primary health care, Personnel turnover, Health centers, Survival analysis
especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze
incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo
City.
Methods: This is a retrospective cohort study of 1378 physicians over a 15 years’ time period based on physicians’
administrative records from two distinct secondary databases. Physicians’ individual characteristics were analyzed
including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were
used to analyze the termination of contract.
Results: One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95
8.0–11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving
the service was 2.14 years (CI95% 1.98–2.29 years) and 1.17 years [(CI95% 1.05–1.28 years)]. The probability of contract
interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were
identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4–2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95
1.64–2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18–1.56), p < 0.001]; and the conclusion of
residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40–2.04), p < 0.001].
Conclusions: The time of employment of the physician in PHC was relatively short, with a high probability of TEC in
the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and
need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible
for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the
periphery of a metropolitan area, the study provides support for the planning, implementation and management of
policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.
Keywords: Employment, Physicians, Primary health care, Personnel turnover, Health centers, Survival analysis