Single Health System Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(11):563-569
DOI 10.1590/S0100-72032010001100008
PURPOSE: to evaluate the evolution of adequacy of the care process among pregnant users of the Brazilian Single Health System (SUS, acronym in Portuguese) and to consolidate a methodology for monitoring the prenatal care. METHODS: this is a multiple time series study with auditing of prenatal cards of pregnant women who were attended for prenatal care in a city of the Brazilian Southeast (Juiz de Fora, Minas Gerais) in the initial semesters of 2002 and 2004 (370 and 1,200 cards, respectively) and gave birth using SUS services in term pregnancies (p < 0.05). A three complementary level sequence was respected: utilization of prenatal care (beginning and number of visits) at level 1; utilization of prenatal care and obligatory clinical-obstetric procedures during prenatal visits (assessment of blood pressure (BP), weight, uterine fundal height (FH), gestational age (GA), fetal heart rate (FHR) and fetal presentation) at level 2; and utilization of prenatal care, obligatory clinical-obstetric procedures and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (PHPN, acronym in Portuguese) (ABO/Rh, hemoglobin/hematocrit (Hb/Htc), VDRL, glycemia and urinalisys) at level 3. RESULTS: it was confirmed the high prenatal care coverage (99%), the increased mean number of visits per pregnant woman (6.4 versus 7.2%) and the decreased gestational age at the time of the first visit (17.4 versus 15.7 weeks). The proper registration of procedures and exams (exceptions: fetal presentation and blood typing) has significantly increased: BP (77.8 versus 83.9%); weight (75.4 versus 83.5%); FH (72.7 versus 81.3%); GA (58.1 versus 71.5%); FHR (79.5 versus 86.7%); Hb/Htc (14.9 versus 29%), VDRL (11.1 versus 20.7%), glycemia (16.5 versus 29%) and urinalisys (13.8 versus 29.8%). As a result, there was significant (p < 0.001) improvement of the adequacy between 2002 and 2004: 27.6 versus 44.8% (level 1); 7.8 versus 15.4% (level 2); 1.1 versus 4.5% (level 3). This trend was also noted in care provided by the majority of the municipal services/teams. CONCLUSIONS: the persistence of low adequacy, despite good coverage and PHPN implementation, confirmed the need to increase health managers, professionals and users' compliance with the rules and routines of care, including the institutionalization of a monitoring program of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(11):563-569
DOI 10.1590/S0100-72032010001100008
PURPOSE: to evaluate the evolution of adequacy of the care process among pregnant users of the Brazilian Single Health System (SUS, acronym in Portuguese) and to consolidate a methodology for monitoring the prenatal care. METHODS: this is a multiple time series study with auditing of prenatal cards of pregnant women who were attended for prenatal care in a city of the Brazilian Southeast (Juiz de Fora, Minas Gerais) in the initial semesters of 2002 and 2004 (370 and 1,200 cards, respectively) and gave birth using SUS services in term pregnancies (p < 0.05). A three complementary level sequence was respected: utilization of prenatal care (beginning and number of visits) at level 1; utilization of prenatal care and obligatory clinical-obstetric procedures during prenatal visits (assessment of blood pressure (BP), weight, uterine fundal height (FH), gestational age (GA), fetal heart rate (FHR) and fetal presentation) at level 2; and utilization of prenatal care, obligatory clinical-obstetric procedures and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (PHPN, acronym in Portuguese) (ABO/Rh, hemoglobin/hematocrit (Hb/Htc), VDRL, glycemia and urinalisys) at level 3. RESULTS: it was confirmed the high prenatal care coverage (99%), the increased mean number of visits per pregnant woman (6.4 versus 7.2%) and the decreased gestational age at the time of the first visit (17.4 versus 15.7 weeks). The proper registration of procedures and exams (exceptions: fetal presentation and blood typing) has significantly increased: BP (77.8 versus 83.9%); weight (75.4 versus 83.5%); FH (72.7 versus 81.3%); GA (58.1 versus 71.5%); FHR (79.5 versus 86.7%); Hb/Htc (14.9 versus 29%), VDRL (11.1 versus 20.7%), glycemia (16.5 versus 29%) and urinalisys (13.8 versus 29.8%). As a result, there was significant (p < 0.001) improvement of the adequacy between 2002 and 2004: 27.6 versus 44.8% (level 1); 7.8 versus 15.4% (level 2); 1.1 versus 4.5% (level 3). This trend was also noted in care provided by the majority of the municipal services/teams. CONCLUSIONS: the persistence of low adequacy, despite good coverage and PHPN implementation, confirmed the need to increase health managers, professionals and users' compliance with the rules and routines of care, including the institutionalization of a monitoring program of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(2):75-81
DOI 10.1590/S0100-72032009000200005
PURPOSE: to evaluate the factors leading to delays in obtaining definitive diagnosis of suspicious lesions for breast cancer. METHODS: a cross-sectional, observational study was carried out with 104 women attending a cancer hospital with a diagnosis or suspected diagnosis of breast cancer. A semistructured questionnaire on the patients' demographic, clinical characteristics and the use of services was applied.Variables were compared using t-Student test, Mann-Whitney test, Pearson's χ2 test or Fisher's exact test, as appropriate. In order to identify the variables associated with delays in breast cancer diagnosis, the Odds Ratio (OR) were calculated together with their respective 95% confidence intervals (95%CI) and a logistic regression model was constructed. RESULTS: age of patients was 54±12.6 years (mean±standard deviation). Most of the women were white (48.1%), married (63.5%), living in the city of Rio de Janeiro (57.7%) and poorly educated (60.6%). The median time between the first sign or symptom of the disease and first consultation was one month and the mean time between first consultation and confirmation of diagnosis was 6.5 months. In 51% of the women, diagnosis was late (stages II-IV). Symptomatic presentation and longer delay between symptom onset and the first evaluation and between symptom onset and the diagnosis were found to be significant factors (p<0.05) for delays in obtaining definitive diagnosis of suspicious lesions. CONCLUSIONS: the results of this study suggest that efforts must be made to reduce the time needed to get an appointment with a doctor and to confirm a diagnosis of suspicious lesions, as well as to educate physicians and the women themselves regarding the importance of breast symptoms and the value of prompt evaluation, diagnosis, and treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(2):75-81
DOI 10.1590/S0100-72032009000200005
PURPOSE: to evaluate the factors leading to delays in obtaining definitive diagnosis of suspicious lesions for breast cancer. METHODS: a cross-sectional, observational study was carried out with 104 women attending a cancer hospital with a diagnosis or suspected diagnosis of breast cancer. A semistructured questionnaire on the patients' demographic, clinical characteristics and the use of services was applied.Variables were compared using t-Student test, Mann-Whitney test, Pearson's χ2 test or Fisher's exact test, as appropriate. In order to identify the variables associated with delays in breast cancer diagnosis, the Odds Ratio (OR) were calculated together with their respective 95% confidence intervals (95%CI) and a logistic regression model was constructed. RESULTS: age of patients was 54±12.6 years (mean±standard deviation). Most of the women were white (48.1%), married (63.5%), living in the city of Rio de Janeiro (57.7%) and poorly educated (60.6%). The median time between the first sign or symptom of the disease and first consultation was one month and the mean time between first consultation and confirmation of diagnosis was 6.5 months. In 51% of the women, diagnosis was late (stages II-IV). Symptomatic presentation and longer delay between symptom onset and the first evaluation and between symptom onset and the diagnosis were found to be significant factors (p<0.05) for delays in obtaining definitive diagnosis of suspicious lesions. CONCLUSIONS: the results of this study suggest that efforts must be made to reduce the time needed to get an appointment with a doctor and to confirm a diagnosis of suspicious lesions, as well as to educate physicians and the women themselves regarding the importance of breast symptoms and the value of prompt evaluation, diagnosis, and treatment.