Avaliação da qualidade organizacional dos serviços ambulatoriais que assistem as pessoas vivendo com HIV no SUS - Mato Grosso

Abstract

In Brazil, the specialized health services that deliver care to people living with HIV/AIDS were implemented since the beginning of the country’s coping with the epidemic. This study’s goal was to assess the organizational quality of outpatient services of Brazilian Unified Health System(SUS) on assisting people living with HIV/AIDS in the state of Mato Grosso in 2016.This is a health services research based on the Qualiaids System database, composed of 15 services in 2016 and 12 services in 2010. The analysis was performed by the three dimensions (resource availability, technical work management and organization of the assistance process) descriptively made in the format of absolute frequencies, measures and proportions of central tendency and dispersion (mean, median and standard deviation). To the quality groups, the services were ranked by the k-means clustering technique with two defined quality groups. To compare the results of the assessment of 2016 with the one from 2010, there were selected only the services which answered to both questionnaires (12) and percentage variation(P2016-P2010/P201*100) was used. The study revealed that there was a balance in the number of indicators showing satisfactory and unsatisfactory results in the three dimensions evaluated in this set of services. The availability of inputs is the strong suit of resource availability, standing out from other indicators of the same dimension with ten services at the expected standard. In management of service delivery, the indicator which stood out was the medical record registry/filing type, with 13 services at the expected standard. Now the organization of service delivery dimension had two indicators with 14 services at the expected standard, standing out among peers: the fulfillment of PEP and the actions made in the first treatment.All services of the first group (n=7) achieved scores above average (1,00) in every dimension and in organization of service delivery while every service in the second group (n=8) achieved below average scores, except in the organization of service delivery dimension, where five services from the second group achieved above average scores.There were significant differences among the indicators from 2010 to 2016 and the majority presented worsening, however, between the few indicators that presented improving, they were significant: availability of viral load tests (from 8.3 to 50%, PV of 502.4) and CD4 cell tests (from 16.7 to 58.3%, PV of 249.1), cardiologist availability (from 25 to 50%, PV of 82.6), meetings for case discussion (from 8.3 to 25%, PV of 201.2), activities of the responsible for the technical coordination (from 33,3 to 66,7%, PV of 100,3) and monitoring of the use of antiretroviral (from 16,7 to 41,7, PV of 149,7). It was observed the heterogeneity in the performance of services in the three dimensions evaluated and that there are still many challenges to be overcome, since many indicators are still far from the desired standard in all dimensions evaluated.