Qualidade em Atenção Primária à Saúde: uma avaliação de padrões internacionais de acreditação e sua aplicação ao SUS
Data
2022-01-27
Autores
Teixeira, André Matsushima 
Orientadores
Demarzo, Marcelo Marcos Piva
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Discutir o conceito de qualidade desejado para a atenção primária do SUS, num horizonte de evolução para as próximas décadas do século XXI, a partir da observação e análise de seis padrões de acreditação de serviços de atenção primária à saúde adotados mundialmente, contextualizados à realidade do SUS.
Métodos: Através de pesquisa exaustiva na literatura, foram identificados 22 padrões de acreditação voltados a APS, dos quais foram selecionados, segundo critérios de disponibilidade de documentação, língua em que foram escritos e efetivo foco na APS, 6 padrões para estudo aprofundado. Seguindo o método das comparações constantes (grounded theory), um total de 15 entrevistas com gestores, especialistas e pesquisadores inseridos no setor de saúde, somando mais de 20 horas de diálogo sobre o tema foram realizados de forma concomitante com a leitura e codificação dos manuais dos padrões de acreditação selecionados. Categorias e subcategorias analíticas detalhadas foram extraídas dos manuais e das entrevistas, formando uma visão consistente da qualidade esperada pelos usuários de sistemas de saúde ao redor do mundo, bem como sua aplicação à realidade presente e futura do SUS. Ao longo da pesquisa, as observações foram continuamente confrontadas e entrelaçadas com o objetivo de formar uma teoria coerente e abrangente sobre o tema.
Resultados: A partir da análise das observações realizadas, propõe-se uma estruturação do tema ao redor de dois polos, a aspiração da sociedade por um sistema eficaz, eficiente e transparente; e o papel do Estado como promotor de parcerias e parceiros de qualidade.
Conclusões: A introdução de um ou mais esquemas de acreditação de qualidade na APS do SUS, se criados e avaliados por entidades isentas e de alta credibilidade, tem o potencial de suportar a reorganização do sistema em torno de um processo de melhoria de qualidade, englobando tanto os aspectos de Processo, Estrutura e Desfecho, como a eficiência do sistema, sua transparência e a qualidade da parceria e dos parceiros, possivelmente induzindo inovação e evolução na prestação dos serviços e de sua gestão.
Objective: Discuss the levels and the concept of quality desired for primary care services within Brazil’s SUS, considering its evolution across the next few decades of the 21st century, from the observation and analysis of 6 accreditation standards for primary care services adopted worldwide and from its contextualization to SUS reality and limitations. Methods: Through a comprehensive literature research, 22 accreditation standards geared toward primary care were identified. From those, 6 were selected, following availability, language and true focus on primary care criteria, for in-depth evaluation and analysis. Following the grounded theory method, 15 interviews with managers, specialists and researchers active in the health sector were conducted, for a total of more than 20 hours of dialogue, were conducted concurrently with study and codification of manuals for the selected accreditation standards. Detailed analytic categories and subcategories were extracted from manuals and from interviews, forming a consistent understanding of the quality desired by users of health systems across the globe, as well as its potential application to SUS present and future reality. Along the research work, observations were continually challenged and intertwined, with the goal to form a coherent and comprehensive theory on the subject. Results: From the analysis of field observations, a structure is proposed along two pillars: societal desire for an effective, efficient and transparent health system, and the State role to foster quality partners and partnerships in health care. Conclusions: The introduction of one or more quality accreditation schemes in primary care for SUS, if created and evaluated by impartial, highly credible organizations, has the potential to support the system’s reorganization towards a quality improvement process, encompassing Process, Structure and Outcome aspects, as well as the system’s efficiency, its transparency and the quality of partnerships and partners selected to provide care within the system, possibly introducing innovation and evolution in care provision and management.
Objective: Discuss the levels and the concept of quality desired for primary care services within Brazil’s SUS, considering its evolution across the next few decades of the 21st century, from the observation and analysis of 6 accreditation standards for primary care services adopted worldwide and from its contextualization to SUS reality and limitations. Methods: Through a comprehensive literature research, 22 accreditation standards geared toward primary care were identified. From those, 6 were selected, following availability, language and true focus on primary care criteria, for in-depth evaluation and analysis. Following the grounded theory method, 15 interviews with managers, specialists and researchers active in the health sector were conducted, for a total of more than 20 hours of dialogue, were conducted concurrently with study and codification of manuals for the selected accreditation standards. Detailed analytic categories and subcategories were extracted from manuals and from interviews, forming a consistent understanding of the quality desired by users of health systems across the globe, as well as its potential application to SUS present and future reality. Along the research work, observations were continually challenged and intertwined, with the goal to form a coherent and comprehensive theory on the subject. Results: From the analysis of field observations, a structure is proposed along two pillars: societal desire for an effective, efficient and transparent health system, and the State role to foster quality partners and partnerships in health care. Conclusions: The introduction of one or more quality accreditation schemes in primary care for SUS, if created and evaluated by impartial, highly credible organizations, has the potential to support the system’s reorganization towards a quality improvement process, encompassing Process, Structure and Outcome aspects, as well as the system’s efficiency, its transparency and the quality of partnerships and partners selected to provide care within the system, possibly introducing innovation and evolution in care provision and management.
Descrição
Citação
TEIXEIRA, A.M. Qualidade em atenção primária à saúde: uma avaliação de padrões internacionais de acreditação e sua aplicação ao SUS. São Paulo, 2022, 113 f. Dissertação (Mestrado em Saúde Coletiva) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2022.