Stakeholder involvement in setting priorities for implementation research on Health Care Planning

Almeida, Letícia Yamawaka de; Belotti, Lorrayne; Eshriqui, Ilana; Sousa, Ana Alice Freire de; Vesga-Varela, Andrea Liliana; Nunes, Gelza Matos; Bernardo, Debora; Bonfim, Daiana

doi:10.37689/acta-ape/2023AOSPE019644

Letícia Yamawaka de Almeida

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-5192-6052

Lorrayne Belotti

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-6111-8908

Ilana Eshriqui

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-7010-919X

Ana Alice Freire de Sousa

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-3945-4053

Andrea Liliana Vesga-Varela

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-7165-9791

Gelza Matos Nunes

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-7979-3362

Debora Bernardo

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-4351-8929

Daiana Bonfim

contributed to the conception and design of the study

writing of the article

relevant critical review of the intellectual content

and final approval of the version to be published

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-0591-0495

Corresponding author: Daiana Bonfim Email: bonfim.daiana@einstein.br

Guest Associate Editor: Danila Cristina Paquier Sala (https://orcid.org/0000-0003-3723-6706) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Conflicts of interest: none to declare.

Variables	Group A n(%)	Group B n(%)	Group C n(%)	Total n(%)
Age
20-30 years	1(7.7)	5(35.7)	9(15.8)	15(17.9)
31-40 years	2(15.4)	9(64.3)	26(45.6)	37(44.0)
41-50 years	3(23.1)	0(0.0)	18(31.6)	21(25.0)
More than 50 years	7(53.8)	0(0.0)	2(3.5)	9(10.7)
Not declared	0(0.0)	0(0.0)	2(3.5)	2(2.4)
Total	13(100.0)	14(100.0)	57(100.0)	84(100.0)
Sex
Female	10(76.9)	13(92.9)	44(77.2)	67(79.8)
Male	3(23.1)	1(7.1)	10(17.5)	14(16.7)
Not declared	0(0.0)	0(0.0)	3(5.3)	3(3.5)
Total	13(100.0)	14(100.0)	57(100.0)	84(100.0)
Race/Color
White	6(46.2)	7(50.0)	34(59.6)	47(56.0)
Brown	6(46.2)	3(21.4)	11(19.3)	20(23.8)
Black	1(7.7)	2(14.3)	10(17.5)	13(15.5)
Yellow	0(0.0)	1(7.1)	2(3.5)	3(3.6)
Indigenous	0(0.0)	1(7.1)	0(0.0)	1(1.2)
Total	13(100.0)	14(100.0)	57(100.0)	84(100.0)
Education
Up to Technician Training	0(0.0)	1(7.1)	4(7.0)	5(6.0)
Undergraduate	0(0.0)	1(7.1)	8(14)	9(10.7)
Residency	0(0.0)	0(0.0)	6(10.5)	6(7.1)
Specialization	4(30.8)	2(14.3)	26(45.6)	32(38.1)
Master degree	6(46.2)	8(57.1)	10(17.5)	24(28.6)
PhD degree	3(23.1)	2(14.3)	3(5.3)	8(9.5)
Total	13(100.0)	14(100.0)	57(100.0)	84(100.0)
Training
Medicine	1(7.7)	1(7.2)	4(7.0)	6(7.1)
Nursing	7(53.8)	4(28.5)	18(31.6)	29(34.5)
Psychology	0(0.0)	1(7.2)	4(7.0)	5(6.0)
Dentistry	1(7.7)	1(7.2)	11(19.3)	13(15.5)
Nutrition	1(7.7)	1(7.2)	2(3.5)	4(4.8)
Physiotherapy	1(7.7)	2(14.2)	1(1.8)	4(4.8)
Others¹1. Metz A, Jensen T, Farley A, Boaz A. Is implementation research out of step with implementation practice? Pathways to effective implementation support over the last decade. Implement Res Pract. 2022;3:26334895221105585.	0(0.0)	3(21.3)	13(22.8)	16(19.0)
Not declared	2(15.4)	1(7.2)	4(7.0)	7(8.3)
Total	13(100.0)	14(100.0)	57(100.0)	84(100.0)
Time in the position
Less than 1 year	6(46.1)	1(7.1)	7(12.3)	14(16.7)
1 and 3 years	1(7.7)	11(78.6)	18(31.6)	30(35.7)
More than 3 and less than 5 years	0(0.0)	2(14.3)	4(7.0)	6(7.1)
More than 5 and less than 10 years	3(23.1)	0(0.0)	17(29.8)	20(23.8)
More than 10 years	2(15.4)	0(0.0)	10(17.5)	12(14.3)
Not declared	1(7.7)	0(0.0)	1(1.8)	2(2.4)
Total	13(100.0)	14(100.0)	57(100.0)	84(100.0)

Topic	Category	Code	Group
Care to chronic conditions	Clinical management	Management of chronic conditions	A
	Clinical management	Management of mental health cases	C
	Case management	Follow-up and monitoring of people with chronic conditions	C
	Case management	Case management for people with epilepsy	C
Access to health care and services	Subpopulation access to the service	Barriers to men’s access and involvement in healthcare	C
	Subpopulation access to the service	Need to formulate actions to expand access to adolescents	C
	Timely access and use of the service	Guarantee the access to the service and SUS	C
		Characteristics of the actions offered at the UBS	C
		User understanding of care at the UBS	C
		Disparity between service use and health needs	C
	Scheduling templates	Insufficient supply for acute demand	C
	Scheduling templates	Need to organize access and scheduling	C
Determinants and results of HCP implementation	Local context	Weakness and fragmentation of SHD	A
		Lack of time to develop the HCP steps in the unit	A
		Professional turnover	A
	Tutor’s duties	Tutor task overlap	A
		Lack of an exclusive tutor for HCP	A
		Lack of financial incentive for the tutor	A
		Insufficient tutor workload	B
	Sustainability of the intervention	HCP sustainability	A
	Engagement of those involved	Management support for HCP	A
		Clarity from the manager of municipal and state departments about their role in HCP	A
		Need for involvement of the state secretariat with HCP	A
		Low adherence to available activities	B
		Low participation in workshops	B
	Capillarity of the intervention	HCP expansion	A
		Replication of skills for large-scale HCP	B
		Problems in executing the HCP expansion	B
	Adaptation of strategies	Development of educational technologies compatible with the needs of professionals	B
Care coordination	Coordination between HCN services	Lack of coordination between HCN services	A
		Weaknesses in the integration of HCN services	B
		Fragmentation of care in the HCN	C
		Difficulty in sharing cases with specialized care	C
		Professionals’ lack of clarity about competencies of the network	C
		Difficulty in providing comprehensive care to the user	C
		Discontinuation of care for people with suicidal behavior	C
	Coordination with intersectoral network	Weakness in articulation with intersectoral services	C
Development of professional skills	Professional qualification	Lack of professional qualification to work in a network	A
		Need to develop the clinical practice of physicians and nurses	A
		Weakness in clinical nursing practice	C
		Lack of permanent/continuing education initiatives	C
		Need to develop scientific skills in care professionals	C
Generating evidence on HCP	Evaluation strategies	Need to evaluate the impact of HCP	B
	Evaluation strategies	Lack of tools for evaluating the effectiveness of care	C
	Knowledge production	Gap in the literature on PASA	B
Population-based management	Territorialization processes	Difficulty implementing population-based management	B
	Territorialization processes	Challenges for territorialization and registration	C
	Organization of population care	Care to the person victim of violence	C
		Violence in the territory	C
		Care to minority groups	C
		Health care for older adults	C
		Increased demand from people with mental disorders	C
	Organization of community actions	Lack of health promotion actions	C
		Need for collective and community actions	C
		Lack of actions in the territory	C
		Difficulty in offering and organizing group activities	C
People management	Workforce planning and sizing	Lack of professionals in the FHS	A
	Workforce planning and sizing	Human resources sizing	C
	Overload and work conditions	Professional overload	B
		Professional overload	C
		Motivation of professionals in daily work	C
		Professional’s mental health	C
		Violence against professionals	C
Infrastructure and materials	Health Information System	Lack of integrated information system	A
		Lack of integration of information between services	A
		Lack of registration of processes	B
		Excess of recording tools	C
		Lack of tools for care management	C
		Weakness of service records	C
	Technological resources	Incorporation of technologies to qualify care	C
	Technological resources	Lack of technological resources	B
	Management of waste and inputs	Excessive use of disposable materials	C
	Management of waste and inputs	Lack of medicines	C
	Physical structure	Inadequate physical space	C
Continuous improvement in PHC processes	Standardization of practices	Weakness in quality and patient safety practices	B
		Multiplicity of protocols and guidelines	C
		Need to incorporate quality and safety practices	C
		Loss of vaccine doses	C
	Standardization of flows and processes	Weaknesses in the organization of the dentistry flow	C
		Weaknesses in the organization of the eMulti flow	C
		Need to qualify information to organize user flow	C
		Weakness in the organization and maintenance of work processes	C
		Difficulty in evaluating and monitoring collective actions	C
		Difficulty in prioritizing demands	C
	Social participation	Lack of integration with the management board	C
Qualification of Specialized Outpatient Care (SOC)	Resource allocation	Lack of co-financing from SOC	A
	Resource allocation	Inadequate SOC funding	A
	Organization and structuring of the SOC	Weakness of SHD support for SOC organization	A
		Lack of knowledge and adherence to the SOC model	A
		Lack of SOC policy	A
	PASA model costs	High cost of maintaining the PASA model	A
Interdisciplinary management and work	Collaborative practice	Difficulty in carrying out multidisciplinary practice	C
	Management model	Centralization in decision making	C
	Team work	Weakness in communication between teams	C
		Lack of team alignment	C
		Lack of team involvement	C
		Difficulty in team working	C
Person-centered care	Therapeutic adherence and self-care	Lack of adherence to women’s health screening exams	C
		Lack of adherence to STI treatment	C
		Non-adherence to treatment	C
		Need for user empowerment	C
	Relationship between user and team	Weakness in the user and team relationship	C
	Relationship between user and team	Need for qualifications in communicating with users	C

Topics
Order	Group A	Points	%
1	Determinants and results of HCP implementation	20	45.5
2	Qualification of Specialized Outpatient Care (SOC)	15	34.1
3	Care to chronic conditions	6	13.6
4	Infrastructure and materials	2	4.5
5	Development of skills	1	2.3
Order	Group B	Points	%
1	Generating evidence on HCP	17	41.5
2	Determinants and results of HCP implementation	10	24.4
3	Infrastructure and materials	6	14.6
4	Continuous improvement in PHC processes	4	9.8
5	Population-based management	2	4.9
6	Care coordination	1	2.4
7	People management	1	2.4
Order	Group C	Points	%
1	Access to health care and services	35	22.7
2	People management	22	14.3
3	Population-based management	20	13.0
3	Interdisciplinary management and work	20	13.0
4	Care coordination	12	7.8
5	Continuous improvement in PHC processes	12	7.8
6	Person-centered care	11	7.1
7	Infrastructure and materials	9	5.8
8	Care for chronic conditions	6	3.9
9	Generating evidence on HCP	4	2.6
10	Development of skills	3	2.0

[1] Corresponding author: Daiana Bonfim Email: bonfim.daiana@einstein.br

Brasil

Brasil

Stakeholder involvement in setting priorities for implementation research on Health Care Planning

Abstract

Objective

Methods

Results

Conclusion