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Qualidade organizacional em cuidados de saúde primários: estudo de caso de uma unidade de saúde familiar
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| 3.2 MB | Adobe PDF |
Advisor(s)
Abstract(s)
A avaliação da qualidade nos Cuidados de Saúde Primários tem vindo a ganhar destaque ultimamente. Em Portugal, a organização atual do Sistema Nacional de Saúde incorpora vários tipos de Unidades Funcionais. As Unidades de Saúde Familiares (USF) são Unidades Funcionais multiprofissionais que prestam Cuidados de Saúde Primários a uma lista de utentes, podendo funcionar como modelo A ou modelo B, consoante o seu nível de desenvolvimento.
Em 2018, surgiu um novo instrumento obrigatório de avaliação da qualidade nos Cuidados de Saúde Primários, a nova Grelha Diagnóstico de Desenvolvimento Organizacional nos Cuidados de Saúde Primários (Grelha DiOr-CSP). Esta grelha é composta por critérios relacionados com três tipos de processos (Gestão, Assistenciais e Suporte). Para além desta grelha, a avaliação dos Cuidados de Saúde Primários em Portugal é feita através do Índice de Desempenho Global (IDG). O IDG que permite avaliar as USF e é composto por cinco áreas (Desempenho Assistencial; Serviços; Qualidade Organizacional; Formação; e Atividade Científica). Considerando que não existe discussão sobre a Grelha DiOr-CSP na literatura, entendeu-se como relevante compreender o impacto que esta terá na qualidade organizacional de uma USF bem como a sua relação com o IDG. Estes dois instrumentos permitem avaliar uma USF para transitar de modelo A para modelo B.
O objetivo deste estágio foi de explorar a aplicação da Grelha DiOr-CSP para avaliar a qualidade organizacional de uma USF modelo A. Desta forma, entendeu-se necessário analisar os critérios das três temáticas da Grelha DiOr-CSP, com o intuito de detetar oportunidades de melhoria, avaliar o desempenho da USF antes e após auditorias internas com recurso à Grelha DiOr-CSP e analisar se uma possível melhoria no cumprimento dos critérios da Grelha DiOr-CSP irá beneficiar o IDG da USF em causa.
Por forma a atingir o objetivo proposto, durante a realização do estágio ocorreu o acompanhamento de uma USF modelo A do Agrupamento de Centros de Saúde Algarve I – Central, e foram utilizados a Grelha DiOr-CSP e o IDG. Por um lado, a Grelha DiOr-CSP foi avaliada no início do estágio (outubro de 2019) e no fim do estágio (março 2020) e, por outro lado, o IDG foi avaliado com os dados referentes aos meses de outubro, novembro e dezembro de 2019.
Após a realização do estágio, foi possível verificar uma melhoria da qualidade avaliada com base na Grelha DiOr-CSP (cumprimento de 26,92% para 46,92%) e também existiu uma melhoria no IDG (de 64,90% para 76,70%). A melhoria do IDG não foi provocada pelos critérios da Grelha DiOr-CSP que estão diretamente relacionados com os indicadores com impacto no IDG. Na generalidade, a melhoria do IDG foi justificada pelo cumprimento de atividades integradas no Relatório de Atividades da Unidade Funcional, tendo-se verificado uma melhoria significativa em três das quatro áreas contratualizadas para 2019.
Embora se tenha verificado uma melhoria em ambos os instrumentos, na data de conclusão do estágio a USF ainda não reunia os requisitos necessários para transitar de modelo A para modelo B. Não obstante, o trabalho realizado durante este estágio foi considerado útil do ponto de vista da aprendizagem que gerou para os profissionais de saúde desta USF e para o aluno.
The evaluation of quality in Primary Health Care has been gaining attention lately. In Portugal, the current organization of the National Health System incorporates several types of Functional Units. Family Health Units (USF) are multi-professional Functional Unites that provide Primary Health Care to a list of patients, and can function as model A or model B, depending on their level of development. In 2018, a new mandatory instrument for quality evaluation in Primary Health Care emerged in Portugal, the new Diagnostic Grid for Organizational Development in Primary Health Care (Grelha DiOr-CSP). This grid is composed of criteria related to three types of processes (Management; Assistentials and Support). Besides this grid, the evaluation of Primary Health Care in Portugal is done through the Global Performance Index (IDG). The IDG that allows to evaluate the USF and is composed of five areas (Assistential Performance; Services; Organizational Quality; Training; and Scientific Activity). Considering that there is no discussion about the Grelha DiOr-CSP in the literature, it was considered relevant to understand the impact it will have on the organizational quality of a USF, as well as its relationship with the IDG. These two instruments allow us to evaluate a USF to transit from model A to model B. The objective of this internship was to explore the application of the Grelha DiOr-CSP to evaluate the organizational quality of a USF model A. Thus, it was considered necessary to analyze the criteria of the three themes of the Grelha DiOr-CSP in order to detect opportunities for improvement, to evaluate the performance of the USF before and after internal audits using the Grelha DiOr-CSP and to analyze whether a possible improvement in meeting the criteria of the Grelha DiOr-CSP will benefit the IDG of the USF concerned. To achieve the proposed objective during the internship, a USF model A from of the Health Centers Grouping Algarve I – Central was followed, and the Grelha DiOr-CSP and IDG were used. On one hand, the Grelha DiOr-CSP was evaluated at the beginning of the internship (October 2019) and at the end of the internship (March 2020) and, on the other hand, the IDG was evaluated with the data for the months of October, November and December 2019. After the internship, it was possible to verify an improvement in quality evaluated based on the Grelha DiOr-CSP (compliance of 26.92% to 46.92%) and there was also an improvement in the IDG (from 64.90% to 76.70%). The improvement in the IDG was not caused by the criteria of the Grelha DiOr-CSP that are directly related to the indicators with impact on the IDG. In general, the improvement in IDG was justified by the fulfillment of activities integrated in the Functional Unit Activity Report, and there was a significant improvement in three of the four areas contracted for 2019. Although there has been an improvement in both instruments, at the end of the internship, the USF still did not meet the necessary requirements to transition from model A to model B. Nevertheless, the work carried out during this internship was considered useful since it provided new skills and competences to all health professionals of this USF and to the student.
The evaluation of quality in Primary Health Care has been gaining attention lately. In Portugal, the current organization of the National Health System incorporates several types of Functional Units. Family Health Units (USF) are multi-professional Functional Unites that provide Primary Health Care to a list of patients, and can function as model A or model B, depending on their level of development. In 2018, a new mandatory instrument for quality evaluation in Primary Health Care emerged in Portugal, the new Diagnostic Grid for Organizational Development in Primary Health Care (Grelha DiOr-CSP). This grid is composed of criteria related to three types of processes (Management; Assistentials and Support). Besides this grid, the evaluation of Primary Health Care in Portugal is done through the Global Performance Index (IDG). The IDG that allows to evaluate the USF and is composed of five areas (Assistential Performance; Services; Organizational Quality; Training; and Scientific Activity). Considering that there is no discussion about the Grelha DiOr-CSP in the literature, it was considered relevant to understand the impact it will have on the organizational quality of a USF, as well as its relationship with the IDG. These two instruments allow us to evaluate a USF to transit from model A to model B. The objective of this internship was to explore the application of the Grelha DiOr-CSP to evaluate the organizational quality of a USF model A. Thus, it was considered necessary to analyze the criteria of the three themes of the Grelha DiOr-CSP in order to detect opportunities for improvement, to evaluate the performance of the USF before and after internal audits using the Grelha DiOr-CSP and to analyze whether a possible improvement in meeting the criteria of the Grelha DiOr-CSP will benefit the IDG of the USF concerned. To achieve the proposed objective during the internship, a USF model A from of the Health Centers Grouping Algarve I – Central was followed, and the Grelha DiOr-CSP and IDG were used. On one hand, the Grelha DiOr-CSP was evaluated at the beginning of the internship (October 2019) and at the end of the internship (March 2020) and, on the other hand, the IDG was evaluated with the data for the months of October, November and December 2019. After the internship, it was possible to verify an improvement in quality evaluated based on the Grelha DiOr-CSP (compliance of 26.92% to 46.92%) and there was also an improvement in the IDG (from 64.90% to 76.70%). The improvement in the IDG was not caused by the criteria of the Grelha DiOr-CSP that are directly related to the indicators with impact on the IDG. In general, the improvement in IDG was justified by the fulfillment of activities integrated in the Functional Unit Activity Report, and there was a significant improvement in three of the four areas contracted for 2019. Although there has been an improvement in both instruments, at the end of the internship, the USF still did not meet the necessary requirements to transition from model A to model B. Nevertheless, the work carried out during this internship was considered useful since it provided new skills and competences to all health professionals of this USF and to the student.
Description
Keywords
Grelha DiOr-CSP IDG USF Cuidados de saúde primários Avaliação Qualidade