Implantação da gerência de processos em um Centro de Referência Nacional em Hanseníase do Brasil: impacto na prevenção de incapacidades

Abstract

Process management requires the need to establish indicators for the quality and development measurement of the processes implemented. The current work picked out the level of disability on diagnosis (GID) and on patient´s discharge (GIA), as well as the number of assessments performed by the physiotherapy sector (a process experienced by the patient in a health unit of national reference in terms of Hansen s disease in Brazil) aiming to assess the impact in the prevention of disabilities in patients under treatment, in two periods, before (2003-2005) and after (2006-2008) the application of the processes. A study carried out with 351 predominantly male patients in both periods: 58.8% on P1 and 58.6% on P2 in the age-group from 31 to 60 years of age. In terms of occupation, domestic work prevailed for women and retirement and general services predominated amongst men. The MB patients (66.0% on P1 and 61.8% on P2) and the borderline-tuberculoid clinical form (41.2% on P1 and 40.8% on P2) were the most widespread in both periods. On P2 there were more patients diagnosed with GID=0 and GID=2, but on the patient´s discharge period there was a reduction of 1.9% in the cases with GIA=2 in relation to the P1, in which there was an increase of 1.6% in patients with GIA=2. From P1 to P2, between the diagnosis and the discharge period, there was an increase of 16% in the assessment average per patient (p=0.009). This is the first epidemiological study assessing the impact of the process management in the prevention of disabilities in patients treated in a Hansen´s Disease National Reference Center in Brazil, which resulted in a reduction of the GIA-2 and a significant increase in the number of assessments on P2, showing that the patients had a greater adherence to the full treatment. It also evidences that a health service aiming to be a technical reference in any disease cannot put aside the application of management by process for its organization. Also, this model must be a prerequisite for the Health Ministry of Brazil and other countries for the certification of the services aiming to work as Hansen´s Disease National Reference Center.