MARIA INES BAPTISTELLA NEMES
Projetos de Pesquisa
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Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
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- Avaliação de serviços de Atenção Básica em municípios de pequeno e médio porte no estado de São Paulo: resultados da primeira aplicação do instrumento QualiAB(2014) CASTANHEIRA, Elen Rose Lodeiro; NEMES, Maria Ines Battistella; ZARILI, Thais Fernanda Tortorelli; SANINE, Patrícia Rodrigues; CORRENTE, José EduardoThe QualiAB questionnaire involves 65 indicators of health care organization and management. In its first application in 2007, QualiAB was answered by 598 Primary Health Care services from 115 municipalities in the state of São Paulo. The mean performance was 64% of desirable standards. Clustering according to K-means produced three quality groups. Family Health Units and facilities located in municipalities under 50,000 inhabitants were more likely to belong to the best quality group. Focusing on how to organize local health care procedures, QualiAB readily supports professionals and can be included in quality improvement initiatives addressing all levels of management.
- Evaluation of outpatient services in the Brazilian Unified National Health System for persons living with HIV: a comparison of 2007 and 2010(2018) LOCH, Ana Paula; NEMES, Maria Ines Battistella; SANTOS, Maria Altenfelder; ALVES, Ana Maroso; MELCHIOR, Regina; BASSO, Caritas Relva; CARACIOLO, Joselita Maria de Magalhaes; ALVES, Maria Teresa Seabra Soares de Britto e; CASTANHEIRA, Elen Rose Lodeiro; CARVALHO, Wania Maria do Espirito Santo; KEHRIG, Ruth Terezinha; MONROE, Aline AparecidaHealth services play a crucial role in reaching the 90-90-90 target of controlling the HIV epidemic. This study evaluates the organization of Brazilian health services in improving, monitoring, and retention in HIV care and adherence support. Percentage variation (PV) was used to compare the responses by services to an evaluation questionnaire on organizational quality (Qualiaids) in 2007 and 2010. The study analyzed the 419 services that completed the questionnaire in 2007 (83.1% of respondents) and 2010 (63.6%). Management actions of retention and support although increased in the period, but remained at low rates, for example: systematic meetings for case discussion (32.7% in 2010; PV = 19.8%) and recording of missed medical appointments (35.3%; PV = 36.8%). Patient care actions related to adherence to ART remained largely exclusive to the attending physician. The supply of funds and resources from the Federal Government (medicines and specific HIV tests) remained high for the vast majority of the services (similar to 90%). It will not be possible to achieve a significant decrease in HIV transmission as long as retention in treatment is not a priority in all the health services.
- Assessment in the primary care of the State of Sao Paulo, Brazil: incipient actions in sexual and reproductive health(2017) NASSER, Mariana Arantes; NEMES, Maria Ines Battistella; ANDRADE, Marta Campagnoni; PRADO, Rogerio Ruscitto do; CASTANHEIRA, Elen Rose LodeiroOBJECTIVE: The objective of this study is to assess performance in sexual and reproductive health of primary health care services of the Brazilian Unified Health System, in the State of Sao Paulo, Brazil. METHODS: An evaluative framework was built for sexual and reproductive health with the categorization of 99 indicators in three domains: sexual and reproductive health promotion (25), sexually transmitted infections/AIDS prevention and care (43), and reproductive health care (31). This framework was applied to assess the services responses to the questionnaire of Quality Evaluation of Primary Health Care in the Municipalities of Sao Paulo State (QualiAB), in 2010. Percentages were calculated for positive responses to indicators and performance in the sexual and reproductive health dimension, according to domains, and their contribution to the overall score in sexual and reproductive health (Friedman), relative participation (Dunn), and correlation (Spearman) was verified. RESULTS: Overall, 2,735 services participated in the study. They were located in 586 municipalities (distributed throughout the 17 regional health departments of Sao Paulo), of which 70.6% had fewer than 100,000 inhabitants. The overall average performance of these services for sexual and reproductive health is 56.8%. The actions are characterized by: prenatal with adequate beginning and exams, better organization for immediate rather than for late postnatal care, and selective reproductive planning for some contraceptives; prevention based on specific protection, limitations in the prevention of congenital syphilis, in the treatment of sexually transmitted infections, and in the screening of cervical and breast cancer; specific educational activities, with a restricted vulnerability approach, focus on sexuality over reproduction. The domain of reproductive health has greater participation in the overall score, followed by prevention/care and promotion. The three domains are correlated; the domain of prevention/care has the highest correlation with the other ones. CONCLUSIONS: The implementation of sexual and reproductive health in primary health care in the services studied is incipient. The revision of the purpose of the work, the dissemination of technologies, and the investing in permanent education are needed. The evaluative framework built can be used by the sexual and reproductive health program services and management in primary health care, thereby contributing to their actions.
- Performance assessment of primary health care facilities in Brazil: Concordance between web-based questionnaire and in-person interviews with health personnel(2023) NUNES, Luceime Olivia; CASTANHEIRA, Elen Rose Lodeiro; SANINE, Patricia Rodrigues; AKERMAN, Marco; NEMES, Maria Ines BaptistellaThis study is a concordance analysis comparing answers to two external assessment tools for Primary Health Care (PHC) facilities that use two different data collection methodologies: (a) external assessment through structured interviews and direct observation of facilities conducted by the National Program for Improvement of Access and Quality of Primary Care (AE-PMAQ-AB), and (b) a computerized web-based self-administered questionnaire for Assessment of the Quality of Primary Health Care Services (QualiAB). The two surveys were answered by 1,898 facilities located in 437 municipalities in the state of Sao Paulo, Brazil, between 2017 and 2018. Both surveys aimed to assess the management and organization of PHC facilities. A total of 158 equivalent questions were identified. The answers were grouped by thematic similarity into nine domains: Territory characteristics; Local management and external support; Structure; Health promotion, disease prevention, and therapeutic procedures; Attention to unscheduled patients; Women's health; Children's health; Attention to chronic conditions; and Oral health. The results show a high level of concordance between the answers, with 81% of the 158 compared questions showing concordance higher than 0.700. We showed that the information obtained by the web-based survey QualiAB was comparable to that of the structured interview-based AE-PMAQ-AB, which is considered the gold standard. This is important because web-based surveys are more practical and convenient, and do not require trained interviewers. Online assessment surveys can allow immediate access to answers, reports and guidelines for each evaluated facility, as provided by the QualiAB system. In this way, the answers to this type of survey can be directly employed by users, allowing the assessment to fulfill all phases of an assessment process.
- Delphi Technique in the validation process of the national application of the Questionnaire for Primary Care Assessment (QualiAB)(2021) ZARILI, Thais Fernanda Tortorelli; CASTANHEIRA, Elen Rose Lodeiro; NUNES, Luceime Olivia; SANINE, Patricia Rodrigues; CARRAPATO, Josiane Fernandes Lozigia; MACHADO, Dinair Ferreira; RAMOS, Nadia Placideli; MENDONCA, Carolina Siqueira; NASSER, Mariana Arantes; ANDRADE, Marta Campagnoni; NEMES, Maria Ines BattistellaThis article aims to describe the use of the Delphi Technique in a process of updating and validating the content of the Primary Care Services Quality Assessment Questionnaire (QualiAB) for national application. In this study, 19 experts with experience in research in health evaluation, care and management in primary Health Care (PHC) agreed to participate. A revised version of the QualiAB instrument with 105 indicators was submitted for evaluation as to its relevance, national applicability and acceptability. The modified Delphi Technique was performed in two rounds. The response rate of experts in the first round was 73.6%, 40 indicators were accepted and 65 did not reach consensus. of which 54 obtained suggestions to change the question and/or indicator. In the second, the response rate was 92.8%, and 65 indicators were resent with incorporation of changes, of which six were accepted Of the remaining 59, 51 obtained suggestions for change The modified Delphi technique contributed to the Improvement of the QualiAB instrument as an intermediate step in an iterative validation process. However, the performance in two rounds proved to be insufficient to validate the organizational quality indicators in view of the scope and diversity of the actions performed by the PHC services.
article 11 Citação(ões) na Scopus QualiAB: desenvolvimento e validação de uma metodologia de avaliação de serviços de atenção básica(2011) CASTANHEIRA, Elen Rose Lodeiro; NEMES, Maria Ines Battistella; ALMEIDA, Margareth Aparecida Santini de; PUTTINI, Rodolfo Franco; SOARES, Ivete Dalben; PATRICIO, Karina Pavao; NASSER, Mariana Arantes; CALDAS JUNIOR, Antonio Luis; MACHADO, Dinair Ferreira; VASCONCELOS, Roseli d'Avilla; PISSATO, Stella Brasil; CARRAPATO, Josiane Fernandes Lozigia; BIZELLI, Sabrina Sinabucro KanesiroThis paper presents the development, validation and utilization of a methodology for assessing the quality of the primary health care services of Sistema Unico de Sa de (SUS - Brazil's National Health System), the Questionnaire for the Assessment of the Quality of Primary Health Care Services - QualiAB. It is addressed to all primary health care services, organized according to different care models, including Family Health. It contains 50 indicators about availability and organization of the care and programmatic work, and 15 about local management, in the form of multiple choice questions self-responded through the Web by the local service team. It attributes to every answer the values zero, one or two; the general average attributes a 'quality degree' to the service, expressed by the distance to the best standard corresponding to the average two. It was built by an interactive consensual process, which included qualitative methodologies, pilot-testing, application to 127 services, construct validation and reliability. It was answered in 2007 by 598 (92%) services of 115 municipalities of the State of Sao Paulo, showing good sensitivity to differentiate quality levels. It was adopted in 2010 as part of a supporting program to the Primary Health Care of Sao Paulo's State Health Department, being answered by 95% (2735) of the services of 586 cities (90,8% of the State). The results were sent to the municipalities. QualiAB provides a valid and simple assessment, with immediate feedback to managers and professionals. It has shown feasibility, acceptability, power to differentiate quality levels and utility to help the management of the primary health care network of SUS in Sao Paulo. This experience might be extended to Brazil as a whole.- Evaluation of comprehensive care for older adults in primary care services(2020) PLACIDELI, Nadia; CASTANHEIRA, Elen Rose Lodeiro; DIAS, Adriano; SILVA, Pedro Alcantara da; CARRAPATO, Josiane Lozigia Fernandes; SANINE, Patricia Rodrigues; MACHADO, Dinair Ferreira; MENDONCA, Carolina Siqueira; ZARIL, Thais Fernanda Tortorelli; NUNES, Luceime Olivia; MONTI, Jose Fernando Casquel; HARTZ, Zulmira Maria de Araujo; NEMES, Maria Ines BattistellaOBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of Sao Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern Sao Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains dl (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.
- Importance of local management for delivery of primary health care according to Alma-Ata principles(2018) NUNES, Luceime Olivia; CASTANHEIRA, Elen Rose Lodeiro; DIAS, Adriano; ZARILI, Thais Fernanda Tortorelli; SANINE, Patricia Rodrigues; MENDONCA, Carolina Siqueira; MONTI, Jose Fernando Casquel; CARRAPATO, Josiane Fernandes Lozigia; PLACIDELI, Nadia; NEMES, Maria Ines BattistellaObjective. To describe the characteristics of the management process in primary health care units as well as the profile of managers, and to discuss the implications of these elements for the attainment of Unified Health System principles in Brazil in accordance with the propositions of the Alma-Ata Declaration. Method. This descriptive, cross-sectional study used data collected with the Primary Care Service Quality Assessment tool (QualiAB), a self-administered, web-based instrument. QualiAB was voluntarily answered by 157 unit managers from 41 municipalities in the state of Sao Paulo from October to December 2014. Results. Of 157 units, 67 (42.7%) were family health care units and 58 (36.9%) were ""traditional"" units; 95 (60.5%) were located in urban peripheries. At the time of the study, eight (5.0%) units did not have a manager and eight (5.0%) were managed by the city health secretary. Almost 80% of the managers were nurses and performed multiple tasks in addition to management. Multidisciplinary support (technical supervision as a means of continuing education) was available in 75 (47.7%) units; 60 (38.2%) units did not have any kind of multidisciplinary support. Participation in evaluative processes was mentioned in 130 (82.8%) units. The main results of evaluations were planning and reprogramming of activities with the engagement of the multiprofessional team in 40 units (25.5%) and definition of an annual activity plan in 38 (24.2%). Twenty-nine units (17.8%) did not have access to the results of evaluations. Conclusion. The study supports the importance of work process management and the need to (re)invest in training and recognition of local management as a strategy to produce primary health care that is capable of promoting health as a right and a condition of citizenship.
- Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007(2013) NEMES, Maria Ines Battistella; ALENCAR, Tatianna Meirelles Dantas; BASSO, Caritas Relva; CASTANHEIRA, Elen Rose Lodeiro; MELCHIOR, Regina; ALVES, Maria Teresa Seabra Soares de Britto e; CARACIOLO, Joselita Maria Magalhaes; SANTOS, Maria AltenfelderOBJECTIVE: To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS: The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS: 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and user's organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS: The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.
- The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions(2019) NEMES, Maria Ines Battistella; CASTANHEIRA, Elen Rose Lodeiro; ALVES, Ana Maroso; ADANIA, Carolina Simone Souza; LOCH, Ana Paula; MONROE, Aline Aparecida; SOUZA, Rosa Alencar; GIANNA, Maria Clara; CAMINADA, Sirlene; FARIAS, Norma Suely de Oliveira; SOUSA, Paula de Oliveira e; DOMINGUES, Carmen Silva Bruniera; SILVA, Mariliza Henrique da; CERVANTES, Vilma; YAMASHIRO, Juliana; CARACIOLO, Joselita Maria de Magalhães; SILVA, Fabiano Lima da; NEMES FILHO, Alexandre; JESUS, Gabriel Lima de; HELENA, Ernani Tiaraju de Santa; ALBIERO, José Francisco Gontan; LIMA, Marcela Soares Silveira; BELLENZANI, Renata; KEHRIG, Ruth Terezinha; VALE, Felipe Campos do; NUNES, Luceime Olivia; MENDONÇA, Carolina Siqueira; ZARILI, Thais Fernanda Tortorelli; VILELA, Mara Cristina; DANTAS, Jean Carlos de Oliveira; PAULA, Ivone de; TAYRA, Ângela; COELHO, Débora Moraes; SANTOS, Glauber Palha dos; QUEVEDO, Dulce Castro; SILVA, Marcia Aparecida da; SILVA, Iraci Batista da; NASSER, Mariana Arantes; ANDRADE, Marta Campagnoni; SANTOS, Maria Altenfelder; MERCURI, Juliana; TRINDADE, Katia Valeska; NEVES, Maria Aparecida Teixeira das; TOLEDO, Renata Villanueva Alves de; ALMEIDA, Maria Cecília Rossi de; LIMA, Iraty NunesABSTRACT Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility’s process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. Conclusion: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.