Evaluation of Reference Centers for Special Immunobiologicals implementation

Nóbrega, Laura Andrade Lagôa; Novaes, Hillegonda Maria Dutilh; Sartori, Ana Marli Christovam

doi:10.1590/S1518-8787.2016050006183

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Original Articles • Rev. Saúde Pública 50 • 2016 • https://doi.org/10.1590/S1518-8787.2016050006183 copy

Evaluation of Reference Centers for Special Immunobiologicals implementation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To describe the Reference Centers for Special Immunobiologicals and evaluate their implementation considering formal regulations.

METHODS

We conducted a program evaluation, of evaluative research type. From August 2011 to January 2012, a questionnaire was applied to the 42 Reference Centers for Special Immunobiologicals existing in the Country, approaching the structure, human resources, and developed activities dimensions. We conducted a descriptive analysis of data and used a clustering for binary data with the squared Euclidean distance, by the farthest neighbor method, to aggregate services with similar features.

RESULTS

We observed great diversity among the services in the three dimensions. The clustering resulted in five service profiles, named according to their characteristics. 1) Best structure: 12 Reference Centers for Special Immunobiologicals with the highest proportion of services with the minimum of rooms recommended, purpose-built vaccine refrigerators, preventive maintenance of the cold chain, and oxygen source. 2) Immunobiologicals distributor: six Reference Centers for Special Immunobiologicals that distributed more than applied immunogens; no doctor present for more than half of the working hours and no purpose-built vaccine refrigerators . 3) Incipient implementation: five Reference Centers for Special Immunobiologicals with inadequate structure, such as absence of purpose-built vaccine refrigerators, preventive maintenance of the cold chain and oxygen source; none had computer. 4) Vaccination rooms: 13 Reference Centers for Special Immunobiologicals, everyone did routine immunization, most participated in vaccination campaigns. 5) Teaching and research: six services, all inserted into teaching hospitals, developed researches and received trainees; most had doctors in more than half of the working hours.

CONCLUSIONS

The evaluation of the Reference Centers for Special Immunobiologicals implementation was based on the profiles found and considered the official regulations: services categorized as “better structure” and “teaching and research” were considered implemented; “immunobiologicals distributor” and “vaccination room” services, partially implemented, and the ones with the “incipient implementation” profile, not implemented. The results of this evaluation can contribute to the reformulation of the services, considering the current context.

Immunization; Health Centers; Immunization Programs, organization & administration; Vaccines, supply & distribution; Program Evaluation; Health Services Evaluation

Characteristics	Profile

	G1	G2	G3	G4	G5	Total

	(n = 12)	(n = 6)	(n = 5)	(n = 13)	(n = 6)	(N = 42)

	%	%	%	%	%	%
Structure
Proportion of services that are inserted into teaching institution^a	58.0	0	0	0	100	31.0
Proportion of services that have minimal physical structure, according to the recommendation (reception, doctor’s office, preparation and/or vaccination room)^a	92.0	50.0	60.0	54.0	83.0	69.0
Proportion of services that are inserted into building where other services operate^a	75.0	100	80.0	92.0	100	88.1
Proportion of services that share the working area with other activities^a	17.0	17.0	100	62.0	50.0	45.2
Proportion of services that have purpose-built vaccine refrigerator^a	58.0	0	20.0	54.0	50.0	42.9
Proportion of services with preventive maintenance for cold chain^a	92.0	83.0	20.0	0	83.0	52.4
Proportion of services that have electrical power generator^b	91.7	50.0	80.0	46.2	100	71.4
Proportion of services that have oxygen source^a	92.0	33.0	20.0	69.0	17.0	57.1
Proportion of services that have computer^a	75.0	100	0	100	100	80.1
Proportion of services that have fax^a	42.0	33.0	0	69.0	83.0	50.0
Human Resources
Proportion of services that have doctor in more than 50.0% of working hours^a	66.7	0	60.0	23.1	83.3	45.2
Proportion of services that have human resources training to meet emergencies^a	100.0	17.0	20.0	69.0	67.0	64.3
Developed activities
Proportion of services that apply routine immunobiologicals^a	92.0	33.0	60.0	100	100	83.3
Proportion of services that apply more than 80.0% of the released immunobiologicals in their own CRIE^a	50.0	33.3	60.0	92.3	83.3	66.7
Proportion of services that participated in vaccination campaigns in the last 5 years^a	67.0	83.0	80.0	69.0	83.0	73.8
Proportion of services that meet non-presential solicitations (only the requests)^a	100	67.0	60.0	85.0	83.0	83.3
Proportion of services that provide a counter-reference document to the patient/requester, when there is no indication of immunobiological^a	100	67.0	40.0	54.0	67.0	69.0
Proportion of services that register the cases seen to which the immunobiological was not released^b	16.7	16.7	20.0	23.1	33.3	21.4
Proportion of services with operation to the public more than 40 hours a week^a	58.3	66.7	40.0	84.6	50.0	59.5
Proportion of services that have available telephone contact for 24 hours^a	67.0	83.0	60.0	46.0	67.0	61.9
Proportion of services that meet people who received immunobiologicals in other health units and present adverse events following immunization^a	83.0	83.0	80.0	92.0	100	88.1
Proportion of services that have support of experts for cases of adverse events following immunization^b	91.7	100	80.0	76.9	83.3	85.7
Proportion of services that have laboratory support for cases of adverse events following immunization^b	83.3	83.3	40.0	61.5	50.0	66.7
Proportion of services that have hospital support for cases of adverse events following immunization^b	91.7	100	80.0	76.9	50.0	81.0
Proportion of services that rely on technical support Group for the discussion of cases of adverse events following immunization^b	58.3	0	40.0	53.8	66.7	47.6
Proportion of services that receive trainees^a	75.0	33.0	60.0	85.0	100	73.8
Proportion of services that do or did researches in immunizations^a	42.0	0	0	15.0	100	31.0

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[1] Correspondence: Laura Andrade Lagôa Nóbrega. Av. Dr. Enéas de Carvalho Aguiar, 470 1º andar sala 102 Cerqueira César. 05403-000 São Paulo, SP, Brasil. E-mail: lagoalaura@yahoo.com.br