Melhoria da qualidade no cuidado multiprofissional às pessoas com anemia falciforme

Abstract

Introduction: Sickle cell anemia is the most prevalent genetic disease in Brazil and worldwide, with relevance in public health due to its chronic condition. This disease causes clinical manifestations throughout the body, requiring multidisciplinary health care throughout the individual's life. Multidisciplinary care and access to quality health care are essential and can ensure a satisfactory quality of life for these people. Thus, carrying out quality management activities in multidisciplinary care, such as improvement cycles, is relevant to improve the health levels of this population. Objective: To develop a quality improvement cycle in multidisciplinary care for people with sickle cell anemia in a hematology outpatient clinic. Method: This is an intervention study, with a quasi-experimental design, of the before-after type, without a control group, with a quantitative approach, carried out through a quality improvement cycle in a hematology outpatient clinic at the Blood Center of Alagoas. The improvement cycle consists of six stages: identification and prioritization of improvement; analysis of the causes of the problem; development of quality criteria; initial assessment of the quality level; planning and implementation of multifaceted interventions and reassessment of the quality level. The opportunity for quality improvement identified was irregular multidisciplinary monitoring of people with sickle cell anemia and from the analysis of the causes of the quality problem, seventeen criteria were defined to assess the quality level regarding the records of consultations by the multidisciplinary team and the records of the results of laboratory and imaging tests. These criteria were developed in accordance with the recommendations of the Ministry of Health, observing the precepts of face, content and criterion validity. The study was carried out from January 2023 to May 2024. Data analysis was performed by point estimates of criterion compliance. And to analyze the effect of the intervention, absolute and relative improvement values were estimated. Statistical significance was tested using the Z-value test and presented in a Pareto diagram. The study followed the ethical procedures required by Resolutions No. 510/2016 and No. 466/2012 and was approved by the Research Ethics Committee of the Onofre Lopes University Hospital/UFRN under opinion No. 6,416,792. Results: The first evaluation revealed decreased levels of compliance in most of the criteria evaluated, especially regarding the records of laboratory and imaging test results. The reevaluation, after the implementation of multifaceted interventions, showed significant levels of improvement in the criteria related to the records of nursing consultations (74%), social services (69%), physiotherapy (47%), and hematology (35%). The reevaluation of the test records showed a slight increase in the levels of compliance. Conclusion: The assessment of the quality level of records in outpatient follow-up proved to be important and timely in the service, as it increased the number of compliances with the evaluated criteria and implemented interventions at some strategic points of the care offered to people with sickle cell anemia. And the sum of the interventions brought a positive impact to the work process of the multidisciplinary team.