Health evaluation: health assessment for people with ostomies

a qualitative methodology was used, with a collaborative approach of the participants using the service, based on the seven elements proposed by Thurston and Ramaliu, which include service modeling and evaluation model proposal. Document analysis, direct observation, consensus workshops, and interviews with key informants were used.

Results:

the description and construction of the theoretical-logical model of the ostomy care service, the development of evaluative questions, the construction of the analysis and judgment matrix, and the evaluation proposal were presented.

Final Considerations:

it was found that it is feasible to systematically evaluate the service based on its structural elements, such as its theory, material and human resources. The proposed evaluation aims to provide support for improving the quality of care.

Descriptors:
Health Evaluation; Ostomy; Public Policy; Interdisciplinary Placement; Health Services

Document	Year	Main deliberations / objectives
Ordinance GM/MS nº 400	2009	Establishes orientation actions for self-care, prevention of ostomy complications, providing safe collection supplies and adjuvant equipment.
Ordinance GM/MS nº 793	2012	Deliberates the expansion of access and qualification of care for people with disabilities in the SUS; limits the linking of people with disabilities and their families to the points of care.
Ordinance GM/MS nº 835	2012	Contemplates the financial incentive for the construction of CER, orthopedic workshops, renovation or extension for qualification of CER II, CER III and CER IV, acquisition of equipment and other permanent materials.
Ordinance GM/MS nº 2.602	2012	Establishes financial resources to support the activities of the various care centers, incorporating them into the Medium and High Complexity Financial Ceiling (MAC Ceiling) of the States, Federal District and Municipalities.
Deliberation CIB-RJ no 2.790	2014	Upgrades the Care Centers for People with Ostomy of the State of RJ
Book of activity records	2016 to Feb./2018	Records the daily activities of the Care Center, training, service meetings.
Individual sheets of supply dispensing	2016 to Feb./2018	Records the monthly quantity of safe collection supplies, distributed to the patient, and schedule for return.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Diana Mary Araújo de Melo Flach. E-mail: dianamflach@gmail.com

Component - Organization and planning
Category	Criterion/Indicator	P	MS	VS
Human resources	Coordinator and / or other professionals with specialization in public health, or >2 years of experience in the service	5	15	DA; I.
	Minimum team for care actions (1 nurse, 1 physician, and 1 social worker)	5
	At least one technician for administrative support	5
Reception and register	Reception and registration room, side table, and chair	1	3	DA; OD.
	Reception and registration room, coffee table, chair, and computer	2
	Reception and registration room, coffee table, chair, computer and telephone	3
Clinic	Waterproof gurney	1	10	DA; OD.
	Step ladder	1
	Hand washing sink, liquid soap dispenser, and paper towel	1
	Exclusive bathroom with hygienic shower	1
	Mirror with minimum dimensions of 120 × 50 cm	1
	Sphygmomanometer and stethoscope	1
	Thermometer	1
	Dressing material	1
	Ostomy cleaning and hygiene material	1
	Irrigation material	1
Storage area for collecting supplies	Cabinet with closed doors	3	3	DA; OD.
Storage area for collecting supplies	Open shelves	2	3	DA; OD.
Technical quality of equipment	Unexpired material	2.5	5	DA; OD.
Technical quality of equipment	Entry and Exit Control material record	2.5	5	DA; OD.
Collecting and adjuvant material	Monthly distribution of sufficient collecting and adjuvant material over the past year	10	10	DA; OD, I.
	Lack of sufficient collection and adjuvant material over the past year, hampering delivery to patients for up to two months	3
	Lack of sufficient collection and adjuvant material over the past year, for more than two months	2
Group meeting room	Meeting room for group service	2	2	DA; OD, I.
Available standards, charts and protocols	Presence of norms, medical records and protocols	1	1
Quantitative and qualitative planning of collection and adjuvant equipment	No annual planning meeting	0	2	DA; I.
	One or more annual planning meetings	2	2	DA; I.
SER user registration	No user registration in SER	0
SER user registration	Proof of registration of users in SER	2
Quality of Records	No record of control or patient history in digital media	0	3	DA; OD.
	Presence of control record and patient history in digital media, with at least 75% of fields completed	3
	Presence of control record and patient history in full digital media, below 75% of fields completed	2
Component - Health Care
Category	Criteria or Indicators	P	MS	VS
Dispensation (scheduling and / or spontaneous demand)	Dispensing of bags and adjuvants sufficient for a period of 30 days or more	10	10	DA; OD; I.
Dispensation (scheduling and / or spontaneous demand)	Bags or adjuvants for dispensing not sufficient for 30 days	0	10	DA; OD; I.
Consultations with social worker	100% of appointments scheduled for the same month	2.5	5	DA; OD; I
Consultations with social worker	100% of consultations performed by spontaneous demand	2.5	5
Stomatherapy care	100% of appointments scheduled for the same month	2.5	5
Stomatherapy care	100% of consultations performed by spontaneous demand	2.5	5
Medical care	100% of appointments scheduled for the same month	2.5	5
Medical care	100% of consultations performed by spontaneous demand	2.5	5
Nutritional support	100% of appointments scheduled for the same month	2.5	5
Nutritional support	At least 50% of consultations performed by spontaneous demand	2.5	5
Component - Health Care
Category	Criteria or Indicators	P	MS	VS
Treatment and / or referral of ostomy complications	Presence of physician to treat complications	5	10	DA.
	Presence of nurse to treat complications	5
	Lack of specialized references for ostomy complications	0
Component - Permanent education and formation
Category	Criteria or Indicators	P	MS	VS
Self-care Groups	No self-care group meetings	0	3	DA; I.
	At least one self-care group meeting every two months	2
	A monthly self-care group meeting	3
Knowledge of legal regulations	Lack of knowledge about legal instruments governing care services	0	3	DA; I
	At least the coordinator with knowledge of laws governing care services	2
	All professionals with knowledge of laws governing care services	3
Participation in training courses	Lack of training of technicians, promoted by any management level, regarding the service	0	3	DA; I.
	Training of 10% of the technicians, promoted by any management level, regarding the service, in the last 2 years.	2
	Training of more than 10% of technicians, promoted by any level of management, related to the service, in the last 2 years.	3