Regionalização da atenção ao parto e nascimento no Sus: revisão sistemática emodelização.
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Data
2021
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Universidade Federal do Oeste da Bahia
Resumo
O Sistema Único de Saúde (SUS) deve assegurar às mulheres, gestantes ou puérperas uma atenção humanizada e integral. Contudo, mortes maternas e neonatais persistem em altos índices, sobretudo nas regiões Sudeste e Nordeste do país, embora
desde 2011 o Brasil tenha instituído um modelo assistencial de parto e nascimento
regionalizado. Apesar da existência de estudos que abordam a assistência regionalizada ao parto e nascimento, não há uma sistematização da literatura sobre quais características devem ter a gestão e a atenção perinatal nas diferentes regiões de saúde.
O presente estudo teve como objetivo sistematizar na literatura nacional e internacional, e em normativas, as características da gestão e da atenção perinatal regionalizada e propor um modelo lógico avaliativo. Trata-se de um estudo metodológico, a
partir de revisão sistemática da literatura. Incluíram-se artigos nacionais e internacionais, selecionados nas seguintes bases de dados: PUBMED, LILACS, Scielo, Web of
Science e SCOPUS, e Catálogo de Teses e Dissertações da CAPES. A seleção dos
artigos foi realizada por duas revisoras de forma duplo-cega, obedecendo aos seguintes critérios de inclusão: estudos avaliativos sobre atenção perinatal com foco na diretriz da regionalização de sistemas de saúde; que avaliaram características da atenção e gestão perinatal regionalizada; com abordagem quantitativa, qualitativa e de
métodos mistos; publicados de 2010 a 2020, nas línguas inglesa e portuguesa. A sistemática de seleção, exclusão e inclusão dos artigos seguiu as recomendações do
protocolo Prisma para estudos de revisão sistemática e seu gerenciamento contou
com o apoio dos softwares Mendeley (exclusão de duplicatas) e Ryyan (exclusão por
título e resumo). A avaliação da qualidade metodológica dos artigos incluídos foi realizada com o instrumento MMAT (Mixed Methods Appraisal Tool – Versão 2011). Incluíram-se na pesquisa também, normativas do Ministério da Saúde brasileiro sobre
a política de atenção materno-infantil. Foram incluídos na revisão sistemática 17 estudos, sendo 11 internacionais e seis nacionais. Os estudos internacionais focaram,
sobretudo, na assistência perinatal, por meio da análise das percepções das gestantes sobre o local de parto. Já os estudos nacionais buscaram compreender o funcionamento da rede materno-infantil. Com base nesta revisão, as dimensões a saber
foram: infraestrutura, planejamento e pactuação regional, gestão regional, qualificação regional, atenção perinatal e vigilância regional. O modelo foi validado em estudo
de caso na Macrorregião de Saúde Oeste da Bahia. Esse estudo, e os produtos advindos dessa pesquisa são ferramentas de grande importância para a avaliação de
políticas de saúde no SUS, pois possibilitam um melhor planejamento dos serviços de
atenção perinatal.
The Unified Health System (SUS) must ensure humanized and comprehensive care for women, pregnant or postpartum women. However, maternal and neonatal deaths persist at high rates, especially in the Southeast and Northeast regions of the country, although since 2011, Brazil has instituted a delivery and birth care model regionalized. Despite the existence of studies that address regionalized assistance to childbirth and childbirth, there is no systematization of the literature on which characteristics perinatal management and care should have in different health regions. The present study aimed to systematize the characteristics of management and regionalized perinatal care in the national and international literature, and in regulations, and to propose a logical evaluative model. This is a methodological study, the from a systematic review of the literature. National and international articles were included, selected from the following databases: PUBMED, LILACS, Scielo, Web of Science and SCOPUS, and CAPES Catalog of Theses and Dissertations. The selection of articles was carried out by two reviewers in a double-blind manner, obeying the following inclusion criteria: evaluative studies on perinatal care focused on the guideline of regionalization of health systems; who evaluated characteristics of regionalized perinatal care and management; with a quantitative, qualitative and mixed methods; published from 2010 to 2020, in English and Portuguese. The systematic selection, exclusion and inclusion of articles followed the recommendations of the Prisma protocol for systematic review studies and its management relied on with the support of the software Mendeley (duplicate deletion) and Ryyan (deletion by title and abstract). The evaluation of the methodological quality of the articles included was performed using the MMAT instrument (Mixed Methods Appraisal Tool – Version 2011). The research also included regulations from the Brazilian Ministry of Health on the mother-infant care policy. Seventeen studies were included in the systematic review, of which 11 were international and six were national. International studies have focused, especially in perinatal care, through the analysis of pregnant women's perceptions about the place of delivery. National studies, on the other hand, sought to understand the functioning of the maternal-infant network. Based on this review, the dimensions namely were: infrastructure, regional planning and agreement, regional management, regional qualification, perinatal care and regional surveillance. The model was validated in a study case study in the West Bahia Health Macroregion. This study, and the products resulting from this research, are very important tools for the evaluation of health policies in the SUS, as they enable better planning of healthcare services perinatal care.
The Unified Health System (SUS) must ensure humanized and comprehensive care for women, pregnant or postpartum women. However, maternal and neonatal deaths persist at high rates, especially in the Southeast and Northeast regions of the country, although since 2011, Brazil has instituted a delivery and birth care model regionalized. Despite the existence of studies that address regionalized assistance to childbirth and childbirth, there is no systematization of the literature on which characteristics perinatal management and care should have in different health regions. The present study aimed to systematize the characteristics of management and regionalized perinatal care in the national and international literature, and in regulations, and to propose a logical evaluative model. This is a methodological study, the from a systematic review of the literature. National and international articles were included, selected from the following databases: PUBMED, LILACS, Scielo, Web of Science and SCOPUS, and CAPES Catalog of Theses and Dissertations. The selection of articles was carried out by two reviewers in a double-blind manner, obeying the following inclusion criteria: evaluative studies on perinatal care focused on the guideline of regionalization of health systems; who evaluated characteristics of regionalized perinatal care and management; with a quantitative, qualitative and mixed methods; published from 2010 to 2020, in English and Portuguese. The systematic selection, exclusion and inclusion of articles followed the recommendations of the Prisma protocol for systematic review studies and its management relied on with the support of the software Mendeley (duplicate deletion) and Ryyan (deletion by title and abstract). The evaluation of the methodological quality of the articles included was performed using the MMAT instrument (Mixed Methods Appraisal Tool – Version 2011). The research also included regulations from the Brazilian Ministry of Health on the mother-infant care policy. Seventeen studies were included in the systematic review, of which 11 were international and six were national. International studies have focused, especially in perinatal care, through the analysis of pregnant women's perceptions about the place of delivery. National studies, on the other hand, sought to understand the functioning of the maternal-infant network. Based on this review, the dimensions namely were: infrastructure, regional planning and agreement, regional management, regional qualification, perinatal care and regional surveillance. The model was validated in a study case study in the West Bahia Health Macroregion. This study, and the products resulting from this research, are very important tools for the evaluation of health policies in the SUS, as they enable better planning of healthcare services perinatal care.
Descrição
Palavras-chave
Saúde Pública - Brasil, Parto humanizado, Serviços de saúde materno-infantil
Citação
CASTRO, Sabrina Miranda de Abreu; ALELUIA, Ítalo Ricardo Santos (Orientador). Regionalização da atenção ao parto e nascimento no Sus/ revisão sistemática e modelização. Barreiras, BA, 2021. 102f. il. TCC - Graduação em Medicina, Universidade Federal do Oeste da Bahia. Centro das Ciências Biológicas e da Saúde - Barreiras, BA, 2021.