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Avaliação da cultura de segurança do paciente na atenção primária à saúde
(Universidade Federal de São Carlos, 2017-10-24) Galhardi, Nathalia Malaman; Figueiredo, Rosely Moralez de; https://lattes.cnpq.br/2597491235073085; https://lattes.cnpq.br/1172987410833035
The patient safety as a fundamental dimension for health quality is focused on improvement provides care in the prevention of errors, in learning from them and in the involvement of all health professionals. It is more common heard about this subject in the hospital services, however, it is known that errors and consequently adverse events also occur in the Primary Health Care (PHC) compromising the patient safety. Despite the initiative of the organizations in promote the patient safety, the adherence on the services is still low, precisely because they does not have a culture focused on patient safety. It is understood that the organization culture and team attitudes can influence directly the quality of the results and for this reason it is necessary study this subject in this work place. The aim of this study was to evaluate the perception of professionals about the culture of patient safety in primary health care. This was a quantitative, cross-sectional, descriptive and correlational study of the type of survey. It was did in the period from December 2016 to March 2017 at the Family Health Centers (CSF) in a city in the interior of the State of São Paulo, where 564 professionals work. It was used the questionnaire "Patient Safety Culture for Primary Care" that evaluates twelve dimensions of the patient safety culture and the quality of care provided. The response rate was 52%. Seven of the twelve dimensions evaluated presented high reliability in the responses and were analyzed. For the dimensions "overall perception of patient safety and quality", "organizational learning", "information exchange with other settings", "teamwork", "patient care tracking", "patient safety and quality issues", the practitioners demonstrated a positive perception of the patient's safety culture. The "leadership support" dimension has proven to be a weak area for the patient's safety culture. In the overall assessment of patient safety and quality of care, the service was rated by the participants as "Good". In the comparison of the variables of service time and professional category with the average of the percentages of positive responses there was a significant difference. For service time the lower the time the greater the positive perception for the dimensions "organizational learning" and "leadership support" and as for professional category, the physician showed more positive perception for the dimensions "overall perception of patient safety" and "teamwork". It was concluded that most of the dimensions presented had positive scores in the assessment of the patient safety culture and that the dimension that most needs improvement and actions focused on patient safety are mainly to the leadership. It is necessary to support a just culture, where the professional does not feel threatened from the occurrence of the error. Leadership involvement in patient safety encourages a safe and secure environment.
Testes de superioridade para modelos de chances proporcionais com e sem fração de cura
(Universidade Federal de São Carlos, 2017-10-24) Teixeira, Juliana Cecília da Silva; Cobre, Juliana; https://lattes.cnpq.br/1042802390444616; https://lattes.cnpq.br/9944342253270136
Studies that prove the superiority of a drug in relation to others already existing in the market are of great interest in clinical practice. Based on them the Brazilian National Agency of Sanitary Surveillance (ANVISA) grants superiority drugs registers which can cure faster or increase the probability of cure of patients, compared to standard treatment. It is of the utmost importance that hypothesis tests control the probability of type I error, that is, they control the probability that a non-superior treatment is approved for use; and also achieve the test power regulated with as few individuals as possible. Tests of hypotheses existing for this purpose or disregard the time until the event of interest occurrence (allergic reaction, positive effect, etc.) or are based on the proportional hazards model. However, in practice, the hypothesis of proportional hazards may not always be satisfied, as is the case of trials whose risks of the different study groups become equal over time. In this situation, the proportional odds survival model is more adequate for the adjustment of the data. In this work we developed and investigated two hypothesis tests for clinical trials of superiority, based on the comparison of survival curves under the assumption that the data follow the proportional survival odds model, one without the incorporation of cure fraction and another considering cure fraction. Several simulation studies are conducted to analyze the ability to control the probability of type I error and the value of the power of the tests when the data satisfy or not the assumption of the test for different sample sizes and two estimation methods of the quantities of interest. We conclude that the probability of type I error is underestimated when the data do not satisfy the assumption of the test and it is controlled when they satisfy, as expected. In general, we conclude that it is indispensable to satisfy the assumptions of superiority tests.