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      Barreiras à implementação da educação interprofissional: uma análise do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) Translated title: Implementation barriers to interprofessional education: an analysis of the Educação pelo Trabalho para a Saúde Program (PET-Saúde)

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          Abstract

          Resumo Este estudo analisa as barreiras para a implementação da educação interprofissional de cursos de graduação em saúde do estado do Rio de Janeiro participantes do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde). Foi conduzido um estudo de caso exploratório e qualitativo, com 32 participantes do PET-Saúde, que busca promover mudanças curriculares nos cursos da saúde. Dados foram coletados em 2020 mediante entrevistas individuais e submetidos à análise temática. Foram identificadas barreiras sociopolíticas, institucionais e relacionais. As sociopolíticas incluem o sucateamento do sistema público de saúde e a violência nos territórios de atuação das equipes de atenção primária, enquanto as institucionais incluem a rigidez curricular, a rotatividade dos gestores universitários e a incipiência dos processos de avaliação das experiências inovadoras de ensino. Na dimensão relacional, o elemento central é a força dos silos profissionais e das relações de hierarquia e poder entre os diferentes profissionais de saúde. A superação dessas barreiras implica a mobilização de políticas públicas intersetoriais, maior integração entre os sistemas profissionais, de saúde e de educação, e o reconhecimento de que a educação interprofissional é uma rota potencial para melhorar a saúde da população, reduzir os custos da assistência e garantir satisfação e segurança aos profissionais.

          Translated abstract

          Abstract This study analyzes the barriers undergraduate health courses participating in the Educação pelo Trabalho para a Saúde (PET-Saúde), in Rio de Janeiro, face to implement interprofessional education. An exploratory and qualitative case study was conducted with 32 participants from PET-Saúde, a program that promotes curricular changes in undergraduate health courses. Data were collected in 2020 by means of individual interviews. Thematic analysis of the data identified sociopolitical, institutional, and relational barriers. Degradation of the health system and the regional violence hindering healthcare activities were the main sociopolitical barriers. In turn, institutional barriers included curriculum rigidity, university administrator turnover, and lack of evaluation methods for innovative interprofessional education. As for relational barriers, professional silos hindering collaborative efforts, top-down power hierarchies resistant to feedback, and unsatisfactory communications among stakeholders were the main complaints. Overcoming these barriers requires intersectoral public policies, greater integration among professionals, healthcare, and education systems, and recognizing that interprofessional education can improve public health, reduce healthcare costs, and ensure professional satisfaction and work safety.

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          Most cited references31

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          From triple to quadruple aim: care of the patient requires care of the provider.

          The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.
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            Brazil's unified health system: the first 30 years and prospects for the future

            In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.
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              The determinants of successful collaboration: a review of theoretical and empirical studies.

              Successful collaboration in health care teams can be attributed to numerous elements, including processes at work in interpersonal relationships within the team (the interactional determinants), conditions within the organization (the organizational determinants), and the organization's environment (the systemic determinants). Through a review of the literature, this article presents a tabulated compilation of each of these determinant types as identified by empirical research and identifies the main characteristics of these determinants according to the conceptual work. We then present a "showcase" of recent Canadian policy initiatives--The Canadian Health Transition Fund (HTF)--to illustrate how the various categories of determinants can be mobilized. The literature review reveals that very little of the empirical work has dealt with determinants of interprofessional collaboration in health, particularly its organizational and systemic determinants. Furthermore, our overview of experience at the Canadian HTF suggests that a systemic approach should be adopted in evaluative research on the determinants of effective collaborative practice.
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                Author and article information

                Journal
                sausoc
                Saúde e Sociedade
                Saude soc.
                Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. (, SP, Brazil )
                0104-1290
                1984-0470
                2023
                : 32
                : suppl 2
                : e230216pt
                Affiliations
                [1] Rio de Janeiro Rio de Janeiro orgnameUniversidade do Estado do Rio de Janeiro orgdiv1Instituto de Medicina Social Hesio Cordeiro Brazil kelbrinco@ 123456yahoo.com.br
                [3] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Departamento de Medicina Social Brazil joserodrigues.saude@ 123456gmail.com
                [2] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Departamento de Política, Gestão e Saúde Brazil carinne@ 123456usp.br
                Article
                S0104-12902023000600507 S0104-1290(23)03200000507
                10.1590/s0104-12902023230216pt
                188c0945-5c3d-4565-bb35-9e77fc5dbb40

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 31 March 2023
                : 16 June 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 0
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Serviços de Integração Docente-Assistencial,Teaching Care Integration Services,Interdisciplinary Practices,Interprofessional Relations,Interprofessional Education,Educação Interprofissional,Práticas Interdisciplinares,Relações Interprofissionais

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