Avaliação e melhoria da qualidade da assistência à sífilis gestacional na atenção primária à saúde

Abstract

Introduction: Improving the quality of care for syphilis, especially syphilis during pregnancy, is an urgent need in countries such as Brazil, where there is an increase in the detection of syphilis in pregnant women and in the incidence of congenital syphilis. Objectives: To evaluate the quality of care provided to pregnant women with syphilis and to test the effect of an improvement strategy. Methodology: The project was carried out in 26 Basic Health Units of the city of Rio de Janeiro between January and December 2017. The design was quasiexperimental mixed with before and after analyzes and time series. The care was evaluated in all pregnant women with syphilis and prenatal care already completed (n = 178) using 10 quality criteria and a contractual indicator. The intervention was planned based on data, in a participatory and multifaceted way, covering permanent education, improvement of registration and information systems, auditing and feedback, patient education and organizational changes and work processes. Estimates of conformity of the criteria, absolute and relative improvements and statistical significance were calculated using unilateral z-test and statistical control rules (α = 5%). The context was analyzed according to the categories of the MUSIQ model. Results: The quality of care in the first evaluation ranged from 42.8% to 91.4%. In a positive way, the pregnant women were receiving the appropriate treatment regimen as recommended (criterion 5 = 91.4%). On the other hand, the main opportunities for improvement were related to the testing and treatment of sexual partnerships and to adequate recording of treatment in the medical record (criteria 6, 7 and 10 = 42.8%). The intervention was effective, since eight of the 10 criteria had absolute improvement, being significant (p <0.05) in four of them. The monthly indicator has also improved significantly and sustainably, although there is still ample room for progress. Contextual factors such as the pressure to improve the results of the indicator, once it composes the matrix of the Organization's performance evaluation, and the political-economic crisis experienced by the municipality in 2017, interacted with the intervention both as facilitators and as obstacles to the process of improvement. Conclusions: The project was instrumental in identifying priorities and guiding interventions to improve the quality of syphilis care. The improvement cycle must be continued to increase its results and new strategies for change must consider the contextual factors of this study.