EDUCAÇÃO PERMANENTE, INTERPROFISSIONALIDADE E PRÁTICAS COLABORATIVAS NA ATENÇÃO À SAÚDE

RESUMO O trabalho interprofissional e a prática colaborativa em saúde são estratégias para melhorar o funcionamento e organização do sistema de saúde na Atenção Primária à Saúde. Este trabalho tem como objetivo relatar a experiência das vivências de um grupo do PET-Saúde/Interprofissionalidade em um Centro de Saúde da Família, diante das ações interprofissionais. A princípio houve um momento de observação do serviço, a fim de conhecer sua dinâmica. Posteriormente, em momentos de conversas e Educação Permanente com a equipe de saúde e, foram discutidos os conceitos de inter, multi e uniprofissionalidade, destacando os pontos positivos e negativos, além de sugerir os possíveis locais onde a interprofissionalidade poderia se inserir. Deste modo, construímos e pactuamos junto com a equipe de saúde um quadro de serviços interprofissionais a serem desenvolvidos no Centro de Saúde da Família. Todavia, há uma necessidade de maior adesão de gestores, profissionais e população para apoiar as estratégias da Educação Interprofissional, ferramenta potente para a transformação das redes de Atenção Primária à Saúde. Palavras-chave: Interprofissionalidade. Educação Interprofissional. Prática Colaborativa. Educação Permanente. ABSTRACT Interprofessional work and collaborative health practice are strategies to improve the operation and organization of the health system in Primary Health Care (PHC). This work aims to relate the experience of a group from PET-Saúde / Interprofissionalidade at the Family Health Center, in face of interprofessional actions. First, there was a moment of observation of the service, to learn about its operation. Subsequently, in moments of conversations and Permanent Educacion with the health team, the concepts of inter, multi and uniprofessionality were discussed, highlighting the positive and negative points, in addition to suggesting the possible places where interprofessionality could be used. This way, we built and agreed with the health team a framework of interprofessional services to be developed at the Family Health Center. However, there is a need for greater accession by managers, professionals and the population to support as strategies of Interprofessional Education, a potent tool for the transformation of Primary Health Care networks. Keywords: Interprofessionality. Interprofessional Education. Collaborative Practice. Permanent Education.

Spatial and spatiotemporal dynamics of visceral leishmaniasis in an endemic North-eastern region of Brazil

Visceral Leishmaniasis (VL) is a neglected disease with increasing incidence in Brazil, particularly in the North-eastern. The aim of this study was to analyze the spatial and spatiotemporal dynamics of VL in an endemic region of North-eastern Brazil, between 2009 and 2017. Using spatial analysis techniques, an ecological and time series study was made regarding VL cases in Sergipe filed as notifiable disease events. With data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), a digital population and cartographic baseline was established. Segmented linear regression was used to examine the temporal trends. The statistical analysis methods of Global and Local Moran’ I, local Bayesian empirical methodology and spatial-temporal scanning were used to produce thematic maps. High instances were found among adults, males, urban residents, non-Whites and persons with low levels of education. A decrease in the recovery rate and an increase in the proportion of urban cases and lethality was found. A heterogeneous VL distribution with spatiotemporal agglomeration on the seaside of the state was seen in Sergipe. To better manage the disease, new research is encouraged together with development of public health strategies. Further, improving health care networks, especially primary care, is suggested as this approach has a key role in health promotion, prevention and monitoring of the most prevalent diseases.

Networked Health Care Governance in the European Union

The European Union (EU) increasingly resorts to new forms of governance to establish unified health and welfare policies without member states having to transfer their sovereignty to a supranational level. European Administrative Networks are important instruments in the toolbox of new forms of governance, dealing with rulemaking, rule monitoring, and rule enforcement. Operating beyond, but not above, the state, European networks of national administrative units allow for interaction and exchange to coordinate national responses to increased interaction across their borders. The authors use social network analysis to uncover the pattern of interaction among national representatives in two central EU health care networks. Their analysis finds not only that the network in the area of pharmacovigilance has more competences, resources, and capacity to improve the enforcement of EU rules than the network regarding cross-border health care but also that the driving forces behind network interaction appear to differ quite a bit as well. While the supranational character becomes apparent in the former network, network interactions in the latter seem aimed at mitigating the impact of patient mobility rather than improving cross-border health care take up.

ICD-10-CM–Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study

Objectives: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Methods: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). Results: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. Conclusions: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.

Genetic disease in the family: trajectories and experiences in public health services

Objective: To identify the trajectories and experiences of families of children with genetic diseases in health services. Method: A qualitative study, with data collected through interviews with 15 families and caregivers of children with Genetic Disease, living in the northern region of Rio Grande do Sul. Interviews were conducted from March to May 2018. Data analysis was based on thematic analysis. Results: A genetic disease diagnosis led to families' changes due to the demands of treatment, and also the needs of the child for being met by health services. To access specialized services, some families needed to travel to referral centers in larger cities. Families experienced difficulties such as unprepared health professionals, lack of organization of services, judicialization of resources, and need for structured Health Care Networks. Conclusion: The professional has the fundamental role of providing families with access to information and are responsible for decision making and for the organization and management of health and nursing services to meet the demands imposed on the individual and the family by the genetic disease.

Atendimento domiciliar da população idosa: potencialidades e desafios desta modalidade

O Atendimento Domiciliar é uma tendência mundial que vem sendo implementada como estratégia através do processo de desospitalização. Com o objetivo conhecer as potencialidades e desafios no Atendimento Domiciliar da população idosa, foi feita uma revisão integrativa sobre a temática nas bases de dados LILACS e SCIELO. Os resultados mostram que a população idosa atendida em domicílio é predominantemente do sexo feminino, cujos principais problemas são: Hipertensão Arterial, Acidente Vascular Cerebral e Demência. Como potencialidades, destacam-se a desospitalização, redução de infecções e aumento da autonomia. As estratégias estão voltadas à capacitação dos profissionais, utilização de tecnologias e integração com redes de atenção à saúde. Conclui-se que apesar dos desafios relacionados aos serviços de atendimentos domiciliares, esta modalidade tem muitas potencialidades, como a redução de custos em saúde e infecções, além do cuidado mais centrado no paciente e familiares.Descritores: Atendimento Domiciliar, Assistência Domiciliar aos Idosos, Serviços de Cuidados Domiciliares. Home care of the elderly population: potentialities and challenges of this modalityAbstract: Home care is a global trend that has been implemented as a strategy through the process of dehospitalization. With the objective of knowing the potentialities and challenges in the home care of the elderly population, an integrative review was made on the theme in the LILACS and SCIELO databases. The results show that the elderly population attended at home is predominantly female, whose main problems are: Arterial hypertension, cerebrovascular accident and dementia. As potentialities, we highlight the dehospitalization, reduction of infections and increased autonomy. The strategies are focused on training professionals, using technologies and integrating with health care networks. It is concluded that despite the challenges related to home care services, this modality has many potential, such as the reduction of health costs and infections, in addition to the care more centered on the patient and family.Descriptors: Home Care, Home Assistance to the Elderly, Household Services. Atención domiciliaria para la población de personas mayores: potencialidades y desafíos de este modoResumen: La Atención Domiciliaria es una tendencia global que se ha implementado como estrategia a través del proceso de deshospitalización. Con el objetivo de conocer las potencialidades y retos en el cuidado domiciliaria de la población anciana, se realizó una revisión integradora del tema en las bases de datos LILACS y SCIELO. Los resultados muestran que la población de edad avanzada atendida en casa es predominantemente femenina, cuyos principales problemas son: hipertensión arterial, accidente cerebrovascular y demencia. Como potencialidades, se destacan la deshospitalización, la reducción de infecciones y el aumento de la autonomía. Las estrategias se centran en la formación de profesionales, el uso de tecnologías y la integración con redes de atención médica. Se concluye que a pesar de los desafíos relacionados con los servicios de cuidado en el hogar, esta modalidad tiene muchos potenciales, como la reducción de los costes sanitarios y las infecciones, además de la atención más centrada en el paciente y la familia.Descriptors: Atención Domiciliaria, Asistencia domiciliaria a ancianos, Servicios para el hogar.