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Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro

OBJECTIVE: To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS: This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi...

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Autores principales: de Cerqueira, Brena Gabriella Tostes, da Silva, Eliane Pereira, Gama, Zenewton André da Silva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Faculdade de Saúde Pública da Universidade de São Paulo 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225322/
https://www.ncbi.nlm.nih.gov/pubmed/34133619
http://dx.doi.org/10.11606/s1518-8787.2021055002534
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author de Cerqueira, Brena Gabriella Tostes
da Silva, Eliane Pereira
Gama, Zenewton André da Silva
author_facet de Cerqueira, Brena Gabriella Tostes
da Silva, Eliane Pereira
Gama, Zenewton André da Silva
author_sort de Cerqueira, Brena Gabriella Tostes
collection PubMed
description OBJECTIVE: To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS: This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS: After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION: The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.
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spelling pubmed-82253222021-06-25 Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro de Cerqueira, Brena Gabriella Tostes da Silva, Eliane Pereira Gama, Zenewton André da Silva Rev Saude Publica Original Article OBJECTIVE: To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS: This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS: After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION: The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions. Faculdade de Saúde Pública da Universidade de São Paulo 2021-06-07 /pmc/articles/PMC8225322/ /pubmed/34133619 http://dx.doi.org/10.11606/s1518-8787.2021055002534 Text en https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
de Cerqueira, Brena Gabriella Tostes
da Silva, Eliane Pereira
Gama, Zenewton André da Silva
Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro
title Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro
title_full Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro
title_fullStr Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro
title_full_unstemmed Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro
title_short Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro
title_sort improvement of quality of care for gestational syphilis in the municipality of rio de janeiro
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225322/
https://www.ncbi.nlm.nih.gov/pubmed/34133619
http://dx.doi.org/10.11606/s1518-8787.2021055002534
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