Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provid... more Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provided surveillance after the end of the study, difficulty in referring cases and changes in the leadership of the unit Luz et al. BMC Pregnancy and Childbirth 2014, 14:122
Background: The Brazilian Network for Surveillance of Severe Maternal Morbidity was established i... more Background: The Brazilian Network for Surveillance of Severe Maternal Morbidity was established in 27 centers in different regions of Brazil to investigate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and associated factors, and to create a collaborative network for studies on perinatal health. It also allowed interventions aimed at improving the quality of care in the participating institutions. The objective of this study was to evaluate the perception of the professionals involved regarding the effect of participating in such network on the quality of care provided to women. Methods: A mixed quantitative and qualitative study interviewed coordinators, investigators and managers from all the 27 obstetric units that had participated in the network. Following verbal informed consent, data were collected six and twelve months after the surveillance period using structured and semi-structured interviews that were conducted by telephone and recorded. A descriptive analysis for the quantitative and categorical data, and a thematic content analysis for the answers to the open questions were performed. Results: The vast majority (93%) of interviewees considered it was important to have participated in the network and 95% that their ability to identify cases of severe maternal morbidity had improved. They also considered that the study had a positive effect, leading to changes in how cases were identified, better organization/ standardization of team activities, changes in routines/protocols, implementation of auditing for severe cases, dissemination of knowledge at local/regional level and a contribution to local and/or national identification of maternal morbidity. After 12 months, interviewees mentioned the need to improve prenatal care and the scientific importance of the results. Some believed that there had been little or no impact due to the poor dissemination of information and the resistance of professionals to change practice. In this second interview, a lack of systematic surveillance after the end of the study, difficulty in referring cases and changes in the leadership of the unit were mentioned. Conclusion: In the opinion of these professionals, participating in a network for the surveillance of severe maternal morbidity represented a good strategy for improving services, even in reference centers.
O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas da peri... more O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas da periferia do município de São Paulo. A partir da análise da história de mobilização social nas áreas enfocadas e o desempenho dos conselhos locais, busca examinar as relações entre a arquitetura desses conselhos gestores, o histórico de mobilização comunitária e os debates sobre políticas de saúde em cada uma dessas áreas. Por fim, procura situar os conselhos de saúde no contexto do debate internacional sobre a gestão participativa e o aprofundamento da democracia.
Background: The Brazilian Network for the Surveillance of Severe Maternal Morbidity was developed... more Background: The Brazilian Network for the Surveillance of Severe Maternal Morbidity was developed in Brazil with the participation of 27 centers in different regions of the country. The objective of the network project was to evaluate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and the factors involved with these clinical conditions. Over the data collection period, this project implemented a surveillance system to identify these cases in the participating institutions. The objective of the present study was to evaluate the perspective of the professionals who participated in this network regarding the surveillance of cases of severe maternal morbidity, the facilities and difficulties encountered in involving colleagues in the process, and participants' proposals to give continuity to this practice of qualifying maternal healthcare. Methods: A descriptive study with a qualitative approach was conducted in which coordinators, investigators and managers at all the 27 obstetric units participating in the network were interviewed. Data were collected at 6 and 12 months after implementation of the network during semi-structured telephone interviews that were recorded following verbal informed consent. Thematic content analysis was performed of the responses to the open questions in the interviews. Results: In the opinion of 60% of the participants, involving their colleagues in the surveillance process proved difficult, principally because these professionals were not very interested in the research project, but also because they found it difficult to review concepts and professional practices, because they had an excessive workload or due to operational and technical difficulties. The great majority considered that support from government agencies providing financial resources would be crucial to enable surveillance to be maintained or expanded and also to train a larger number of professionals and improve work conditions. The majority of participants found it difficult to define the ideal time interval at which surveillance should be conducted. Conclusion: The investigators, coordinators and managers involved in the Brazilian network project mentioned several problems that had to be confronted during this process; however, in their opinion the project should be maintained and even expanded in view of its potential to contribute towards improving obstetric care.
To evaluate the proportion of health services that fill out the compulsory notification and what ... more To evaluate the proportion of health services that fill out the compulsory notification and what the main difficulties to fill it out are. Methods: A study was carried out with two different approaches. For the quantitative approach, a cross sectional study was performed, with telephone data collection. In the state of São Paulo, 291 health services that had reported providing care to women who suffer from sexual violence were identified. The sample was composed of 172 services that reported providing emergency care to women. In the qualitative approach, case studies were conducted. Six cities were chosen by intention and convenience. For each of them, professionals from two health services were invited to participate. Forty-five semi-structured interviews were conducted. For quantitative data, a descriptive analysis was carried out. For qualitative data, a thematic analysis of content was performed. Results: The proportion of health services which reported always filling out the notification in cases of sexual violence was 79.1%. More than half (53.5%) reported difficulties concerning the assisted women, one third reported reasons related to the form, and 29.7%, to the professionals. In the qualitative approach, the main difficulties were the size of the form, the problems to obtain the information about the woman and the difficulty for the professional to obtain this information. Conclusion: Although most health services claimed to fill out the compulsory notification, they also mentioned several difficulties to do so, especially with regard to the workload of professionals and the misunderstanding about the importance of the notification in the context of comprehensive care to women who suffer from sexual violence.
Resumo O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas ... more Resumo O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas da periferia do município de São Paulo. A partir da análise da história de mobilização social nas áreas enfocadas e o desempenho dos conselhos locais, busca examinar as relações entre a arquitetura desses conselhos gestores, o histórico de mobilização comunitária e os debates sobre políticas de saúde em cada uma dessas áreas. Por fim, procura situar os conselhos de saúde no contexto do debate internacional sobre a gestão participativa e o aprofundamento da democracia.
Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provid... more Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provided surveillance after the end of the study, difficulty in referring cases and changes in the leadership of the unit Luz et al. BMC Pregnancy and Childbirth 2014, 14:122
Background: The Brazilian Network for Surveillance of Severe Maternal Morbidity was established i... more Background: The Brazilian Network for Surveillance of Severe Maternal Morbidity was established in 27 centers in different regions of Brazil to investigate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and associated factors, and to create a collaborative network for studies on perinatal health. It also allowed interventions aimed at improving the quality of care in the participating institutions. The objective of this study was to evaluate the perception of the professionals involved regarding the effect of participating in such network on the quality of care provided to women. Methods: A mixed quantitative and qualitative study interviewed coordinators, investigators and managers from all the 27 obstetric units that had participated in the network. Following verbal informed consent, data were collected six and twelve months after the surveillance period using structured and semi-structured interviews that were conducted by telephone and recorded. A descriptive analysis for the quantitative and categorical data, and a thematic content analysis for the answers to the open questions were performed. Results: The vast majority (93%) of interviewees considered it was important to have participated in the network and 95% that their ability to identify cases of severe maternal morbidity had improved. They also considered that the study had a positive effect, leading to changes in how cases were identified, better organization/ standardization of team activities, changes in routines/protocols, implementation of auditing for severe cases, dissemination of knowledge at local/regional level and a contribution to local and/or national identification of maternal morbidity. After 12 months, interviewees mentioned the need to improve prenatal care and the scientific importance of the results. Some believed that there had been little or no impact due to the poor dissemination of information and the resistance of professionals to change practice. In this second interview, a lack of systematic surveillance after the end of the study, difficulty in referring cases and changes in the leadership of the unit were mentioned. Conclusion: In the opinion of these professionals, participating in a network for the surveillance of severe maternal morbidity represented a good strategy for improving services, even in reference centers.
O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas da peri... more O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas da periferia do município de São Paulo. A partir da análise da história de mobilização social nas áreas enfocadas e o desempenho dos conselhos locais, busca examinar as relações entre a arquitetura desses conselhos gestores, o histórico de mobilização comunitária e os debates sobre políticas de saúde em cada uma dessas áreas. Por fim, procura situar os conselhos de saúde no contexto do debate internacional sobre a gestão participativa e o aprofundamento da democracia.
Background: The Brazilian Network for the Surveillance of Severe Maternal Morbidity was developed... more Background: The Brazilian Network for the Surveillance of Severe Maternal Morbidity was developed in Brazil with the participation of 27 centers in different regions of the country. The objective of the network project was to evaluate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and the factors involved with these clinical conditions. Over the data collection period, this project implemented a surveillance system to identify these cases in the participating institutions. The objective of the present study was to evaluate the perspective of the professionals who participated in this network regarding the surveillance of cases of severe maternal morbidity, the facilities and difficulties encountered in involving colleagues in the process, and participants' proposals to give continuity to this practice of qualifying maternal healthcare. Methods: A descriptive study with a qualitative approach was conducted in which coordinators, investigators and managers at all the 27 obstetric units participating in the network were interviewed. Data were collected at 6 and 12 months after implementation of the network during semi-structured telephone interviews that were recorded following verbal informed consent. Thematic content analysis was performed of the responses to the open questions in the interviews. Results: In the opinion of 60% of the participants, involving their colleagues in the surveillance process proved difficult, principally because these professionals were not very interested in the research project, but also because they found it difficult to review concepts and professional practices, because they had an excessive workload or due to operational and technical difficulties. The great majority considered that support from government agencies providing financial resources would be crucial to enable surveillance to be maintained or expanded and also to train a larger number of professionals and improve work conditions. The majority of participants found it difficult to define the ideal time interval at which surveillance should be conducted. Conclusion: The investigators, coordinators and managers involved in the Brazilian network project mentioned several problems that had to be confronted during this process; however, in their opinion the project should be maintained and even expanded in view of its potential to contribute towards improving obstetric care.
To evaluate the proportion of health services that fill out the compulsory notification and what ... more To evaluate the proportion of health services that fill out the compulsory notification and what the main difficulties to fill it out are. Methods: A study was carried out with two different approaches. For the quantitative approach, a cross sectional study was performed, with telephone data collection. In the state of São Paulo, 291 health services that had reported providing care to women who suffer from sexual violence were identified. The sample was composed of 172 services that reported providing emergency care to women. In the qualitative approach, case studies were conducted. Six cities were chosen by intention and convenience. For each of them, professionals from two health services were invited to participate. Forty-five semi-structured interviews were conducted. For quantitative data, a descriptive analysis was carried out. For qualitative data, a thematic analysis of content was performed. Results: The proportion of health services which reported always filling out the notification in cases of sexual violence was 79.1%. More than half (53.5%) reported difficulties concerning the assisted women, one third reported reasons related to the form, and 29.7%, to the professionals. In the qualitative approach, the main difficulties were the size of the form, the problems to obtain the information about the woman and the difficulty for the professional to obtain this information. Conclusion: Although most health services claimed to fill out the compulsory notification, they also mentioned several difficulties to do so, especially with regard to the workload of professionals and the misunderstanding about the importance of the notification in the context of comprehensive care to women who suffer from sexual violence.
Resumo O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas ... more Resumo O artigo apresenta um estudo sobre as dinâmicas de conselhos de saúde existentes em áreas da periferia do município de São Paulo. A partir da análise da história de mobilização social nas áreas enfocadas e o desempenho dos conselhos locais, busca examinar as relações entre a arquitetura desses conselhos gestores, o histórico de mobilização comunitária e os debates sobre políticas de saúde em cada uma dessas áreas. Por fim, procura situar os conselhos de saúde no contexto do debate internacional sobre a gestão participativa e o aprofundamento da democracia.
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