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      Acesso e uso de serviços de Fonoaudiologia em Porto Alegre, Brasil: estudo populacional Translated title: Access and use of speech-language therapy services in Porto Alegre, Brazil: a population-based study

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          Abstract

          Resumo O objetivo deste artigo é estimar a prevalência de acesso e uso dos serviços de Fonoaudiologia e identificar as variáveis associadas ao acesso. Estudo transversal de base populacional. A amostra foi composta de indivíduos adultos residentes em Porto Alegre/RS. Os dados foram coletados a partir de um instrumento construído com domínios de questionários de pesquisas nacionais, com um módulo sobre Fonoaudiologia. O desfecho estudado foi o acesso ao fonoaudiólogo. Regressão de Poisson com variância robusta foi utilizada para cálculo de Razões de Prevalência com intervalos de confiança de 95%. Aceitaram participar deste estudo 214 pessoas, das quais 67,3% (n = 144) eram do sexo feminino. A média de idade foi de 54,28 (±18,83) anos. Referiram necessidade de consulta fonoaudiológica 56 (26,2%) pessoas. Todos os 56 indivíduos conseguiram realizar atendimento fonoaudiológico, dos quais 69,4% (n = 39) em consultório particular e 19,6% (n = 11) em consultório conveniado ao plano de saúde. No modelo final, maior prevalência de acesso foi associada ao sexo feminino (RP = 1,09; IC95% 1,01-1,18) e possuir alguma deficiência (RP = 1,09; IC95% 1,03-1,17). O acesso ao fonoaudiólogo é mais frequente de forma privada. Observa-se que as mulheres e deficientes possuem maior prevalência de acesso ao fonoaudiólogo.

          Translated abstract

          Abstract To estimate the prevalence of access and use of speech-language therapy services and identify the variables associated with access. Cross-sectional population-based study. The sample consisted of adult individuals living in Porto Alegre, southern Brazil. The data were collected using an instrument constructed with domains of national research questionnaires, with a module on speech-language therapy. The outcome was the access to a speech-language therapist. Poisson regression with robust variance was used to calculate Prevalence Ratios with 95% confidence intervals. A total of 214 people participated in the study, of which 67.3% (n = 144) were female. The mean age was 54.28 (SD±18.83) years. Fifty-six (26.2%) people mentioned the need for speech-language therapy consultation. All 56 subjects were able to perform speech-language therapy, of which 69.4% (n = 39) in private practice and 19.6% (n=11) used healthcare insurance plans at partnering providers. In the final model, the highest prevalence of access was associated with female (PR=1.09,95%CI1.01-1.18) and had some deficiency (PR = 1.09,95%CI1.03-1.17). Access to a speech-language therapist is more frequent in private services. It is observed that women and the disabled individuals have a higher prevalence of access to speech-language therapist.

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          Inequalities in access to medical care by income in developed countries.

          Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.
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            Acesso e acolhimento na atenção básica: uma análise da percepção dos usuários e profissionais de saúde

            Este artigo é parte da pesquisa avaliativa do Projeto de Expansão e Consolidação da Estratégia Saúde da Família, desenvolvida pelo Núcleo de Estudos em Saúde Coletiva da Universidade Federal do Rio Grande do Norte entre março e dezembro de 2005. Trata-se de avaliação de acesso e acolhimento na atenção básica, a partir de percepções de usuários e profissionais de saúde de unidades básicas de saúde e unidades de saúde da família, em três capitais do Nordeste brasileiro. Foi utilizada técnica de grupo focal com análise temática. Nos resultados, identificou-se ampliação do acesso, com desproporções entre oferta potencial, atendimento à demanda e dificuldades de referência. O acolhimento como tecnologia operacional é um processo em construção, variando nas unidades de saúde da família em níveis de concepção e estratégias de reorganização cotidiana do trabalho, e inexistente nas unidades básicas de saúde. A partir da realização deste estudo, recomenda-se incluir análises qualitativas em avaliação em saúde, por possibilitar maior valor explicativo aos aspectos subjetivos dos atores envolvidos.
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              Communicating about health care: observations from persons who are deaf or hard of hearing.

              Achieving patient-centered care requires effective communication between physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to communicating with physicians. To understand perceptions of health care experiences and suggestions for improving care among deaf or hard-of-hearing individuals. 4 semistructured group interviews, 2 conducted in American Sign Language (for deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-hearing individuals). Men and women were interviewed separately. Tapes of interviews were transcribed verbatim for analysis. Greater Boston, Massachusetts, and Washington, DC, in 2001. 14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74 years of age). Commonly expressed themes or views organized around dimensions of communication. Concerns coalesced around 6 broad themes: conflicting views between physicians and patients about being deaf or hard of hearing; different perceptions about what constitutes effective communication (such as lip reading, writing notes, and sign language interpreter); medication safety and other risks posed by inadequate communication; communication problems during physical examinations and procedures; difficulties interacting with office staff, including in waiting rooms; and problems with telephone communication, such as lengthy message menus. Participants offered extensive suggestions for improvements, starting with clinicians' asking patients about their preferred communication approach. Having patients repeat critical health information (such as medication instructions) can identify potentially dangerous miscommunication. As the population ages, physicians will encounter many more persons with hearing limitations. Physicians are not reimbursed for making some accommodations, such as hiring sign language interpreters. However, ensuring effective communication is essential to safe, timely, efficient, and patient-centered care.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                2020
                : 25
                : 3
                : 817-825
                Affiliations
                [2] Porto Alegre RS orgnameUFRGS orgdiv1Faculdade de Enfermagem orgdiv2Programa de Pós-Graduação em Saúde Coletiva Brazil
                [1] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Faculdade de Medicina orgdiv2Programa de Pós-Graduação em Epidemiologia Brazil bngoulart@ 123456gmail.com
                [3] Porto Alegre RS orgnameUFRGS orgdiv1Faculdade de Odontologia orgdiv2Programa de Pós-Graduação em Odontologia Brazil
                Article
                S1413-81232020000300817 S1413-8123(20)02500300817
                10.1590/1413-81232020253.17212018
                764ae05d-5343-4915-b077-79af45c731e9

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

                History
                : 02 July 2018
                : 17 October 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 9
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                SciELO Public Health

                Self URI: Texto completo somente em PDF (PT)
                Self URI: Full text available only in PDF format (EN)
                Categories
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                Prevalência,Acesso aos Serviços de Saúde,Fonoaudiologia,Prevalence,Access to Health Services,Speech-language therapy

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