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Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the ...

This book presents some of the results from the international research project "Impact on equity of access and efficiency of Integrated Health care Networks in Colombia and Brazil (Equity-LA)". Equity-LA was funded by the European Union and had the participation of six institutions from Spain, Belgium, Colombia and Brazil. The project's main objective was to understand the impact of implementing integrated health care networks on access, coordination, efficiency, and equity of access in different Latin American contexts. This study provided results, but also generated new questions that led to Equity LA II project (www.equity-la.eu). Currently undergoing and funded by the European Union, Equity LA II will include data from four additional countries in Latin America (Argentina, Chile, Mexico, and Uruguay) with the objective of broadening this understanding. The analyses described in this work refer exclusively to questions of access, coordination, continuity, and quality of care in health service networks, which are analyzed through a cases study, based on qualitative and quantitative data collected between 2009 and 2012. En este libro se presenta una parte de los resultados del proyecto internacional de investigación "Impacto en la equidad de acceso y la eficiencia de las redes integradas de servicios de salud en Colombia y Brasil (Equity-LA)", financiado por la Unión Europea y en el que participaron seis instituciones de cuatro países, dos europeos (España y Bélgica) y dos latinoamericanos (Colombia y Brasil). La investigación se diseñó con el propósito de mejorar la comprensión sobre el impacto de la implementación de las redes integradas de servicios de salud en el acceso, la coordinación, la eficiencia y la equidad de acceso, en diferentes contextos de Latinoamérica. El estudio además de evidencia, generó nuevas preguntas, que dieron lugar al proyecto Equity LA II (www.equity-la.eu), actualmente en desarrollo, también financiado por la Unión Europea, que profundiza en sus resultados y amplía el análisis a ...

RESUMO O objetivo do estudo foi analisar a continuidade da assistência a mulheres com câncer de colo uterino. Estudo de caso qualitativo, em redes de saúde. Realizaram-se entrevistas com roteiro semiestruturado e técnica de análise narrativa de conteúdo. As mulheres perceberam barreiras no diagnóstico, no tratamento e na acessibilidade entre níveis de atenção. Observaram comunicação informal entre especialistas; limitações na comunicação entre níveis de atenção; inexistência de contrarreferência; e que o vínculo paciente-serviço era maior na esfera da oncologia. A falta de contrarreferência dificultou a acumulação de conhecimento e a coordenação do cuidado pela Atenção Básica.

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills. © 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and ...

Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved. © 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A Atenção Primária à Saúde tem sido um espaço de reconhecimento e amparo para o Enfermeiro de Prática Avançada dentre elas a prescrição de medicamentos por enfermeiros. O objetivo deste estudo é conhecer as especificidades da prescrição de medicamentos por enfermeiros da Estratégia Saúde da Família na Paraíba. Trata-se de um Estudo de Caso de abordagem qualitativa em municípios da Paraíba, na região nordeste. Os dados foram coletados por meio da pesquisa documental e observação não participante. Sendo realizado em 12 unidades, resultando na observação de 97 consultas de Enfermagem e análise de 410 prontuários. A maioria dos enfermeiros realizaram a prescrição de medicamentos, mas apenas quatro enfermeiros dos doze observados, participaram de capacitação específica para prescrever. Observou-se que a prática prescritiva do enfermeiro atende aos critérios da prescrição segura. A linha de cuidado de saúde da mulher teve um maior destaque com relação às prescrições de medicamentos. As prescrições discricionárias ocorreram em menor número dentre as consultas. Evidencia-se que os enfermeiros da Atenção Básica da Paraíba realizam uma prática prescritiva ampla e dentro do escopo ministerial.

En este libro se presenta una parte de los resultados del proyecto internacional de investigación "Impacto en la equidad de acceso y la eficiencia de las redes integradas de servicios de salud en Colombia y Brasil (Equity-LA)", financiado por la Unión Europea y en el que participaron seis instituciones de cuatro países, dos europeos (España y Bélgica) y dos latinoamericanos (Colombia y Brasil). La investigación se diseñó con el propósito de mejorar la comprensión sobre el impacto de la implementación de las redes integradas de servicios de salud en el acceso, la coordinación, la eficiencia y la equidad de acceso, en diferentes contextos de Latinoamérica. El estudio además de evidencia, generó nuevas preguntas, que dieron lugar al proyecto Equity LA II (www.equity-la.eu), actualmente en desarrollo, también financiado por la Unión Europea, que profundiza en sus resultados y amplía el análisis a cuatro países más de América Latina: Argentina, Chile, México y Uruguay. Los resultados contenidos en esta obra se refieren únicamente a los aspectos de acceso, coordinación, continuidad y calidad de la atención en las redes de servicios de salud, que se analizan mediante un estudio de casos, basado en estudios cualitativos y cuantitativos y cuyos datos se recogieron entre 2009 y 2012. ; This book presents some of the results from the international research project "Impact on equity of access and efficiency of Integrated Health care Networks in Colombia and Brazil (Equity-LA)". Equity-LA was funded by the European Union and had the participation of six institutions from Spain, Belgium, Colombia and Brazil. The project's main objective was to understand the impact of implementing integrated health care networks on access, coordination, efficiency, and equity of access in different Latin American contexts. This study provided results, but also generated new questions that led to Equity LA II project (www.equity-la.eu). Currently undergoing and funded by the European Union, Equity LA II will include data from four additional countries in Latin America (Argentina, Chile, Mexico, and Uruguay) with the objective of broadening this understanding. The analyses described in this work refer exclusively to questions of access, coordination, continuity, and quality of care in health service networks, which are analyzed through a cases study, based on qualitative and quantitative data collected between 2009 and 2012.