ANALYSIS OF THE DRESSING PRODUCTION RECORDS CARRIED OUT IN BRAZIL, 2017 – 2019

1. Universidade do Vale do Rio do Sinos – Escola de Saúde − Porto Alegre (RS), Brazil. 2. Universidade Federal de Ciências da Saúde de Porto Alegre – Ciências da Saúde − Porto Alegre (RS), Brazil. 3. Ministério da Saúde − Secretaria de Atenção Hospitalizada à Saúde – Brasília (DF), Brazil. *Correspondence author: scheilamaienf@gmail.com Section Editor: Juliano Teixeira Moraes Received: Mar. 08, 2021 | Accepted: Jan. 05, 2021 How to cite: Mai S; Micheletti VCD; Herrmann F; Machado DO; Prazeres S. Analysis of the dressing production records carried out in Brazil, 2017 – 2019. ESTIMA, Braz. J. Enterostomal Ther., 2021, 19: e0821. https://doi.org/10.30886/estima.v19.1009_IN ABSTRACT


INTRODUCTION
The Sistema de Informação em Saúde (SIS) facilitates the actions of monitoring and evaluating public health services 1 . The supply of the national databases with the information registered in the health services must be carried out with a regulated periodicity, according to the ministerial ordinances. It is up to the Ministry of Health (MH) to consolidate and make these data available 2 .
These instruments are used to process the data and transform it into information, so that they can contribute to the production of knowledge about a certain context 3 . These systems have national coverage and are relevant sources of secondary data. However, it is observed that the quality of the information in the SIS in Brazil is still a challenge, and it is necessary to consider the occurrence of problems in the information production cycle 2 . Among the national public banks that provide health information, the Departamento de Informática do Sistema Único de Saúde-DATASUS (Department of Informatics of the Unified Health System) stands out.
Information systems often fail to translate the work process, activities and actions developed by the health professional.
In this sense, studies indicate the need for these professionals to be involved in the qualification of the information fed into the databases [4][5][6] . com valor aprovado de R$ 380.142.162,10. Dos quais 31,6% em 2017, 32,6% no ano de 2018 e 35,8% em 2019. A denominação do procedimento de curativos se difere da Atenção Básica para os demais níveis de atenção, apesar de no SISAB os curativos serem denominados curativo simples e curativo especial, ambos estão relacionados ao código SIGTAP: 0401010023 -Curativo Grau I. Enquanto no SIA/SUS os procedimentos relacionados ao curativo são 0401010023 -Curativo Grau I; e 0401010015 − Curativo Grau II, dificultando a comparação entre os procedimentos. Official Gazette) and details the attributes of each procedure, compatibilities and values 9 . SISAB is the current national information system for the processing and dissemination of data and information related to Atenção Básica-AB (Primary Care). Since e-SUS AB is fully integrated with this official system for monitoring AB's actions at national level 10 .The SIA, implemented since 1994, allows the recording of the physical and financial movement of outpatient procedures and exams registered by public and private providers hired/accredited by SUS. Managers must send data regarding the performance of outpatient procedures, which after the conference receive authorization and the transfer of budgetary resources 8,9 . The variables collected in the SIGTAP were: description of the procedure; service modality; service complexity; assigned value; and Brazilian classification of occupation to register a certain procedure. At SIA they were: frequency; values; Brazilian classification of occupation related to the two procedure codes (0401010023 -Grade I dressing, with or without debridement and 0401010015 -Grade II dressing, with or without debridement). At SISAB, they were: simple curative procedure; special dressing; and professional category.
In SIGTAP there are two codes related to dressing procedures, namely: 0401010023 -Grade I dressing, with or without debridement; and 0401010015 -Grade II dressing, with or without debridement. The dressing 0401010023 - with a population representation of 0.3% (Table 1).  (Table 3).  Regarding the simple dressing procedure, 3,238,611 procedures were registered in SISAB. Of these, many were registered by the oral health teams, so it was decided to follow the analysis considering only the data from Among the 27 federative units, 25 registered a higher proportion of special dressings in SISAB compared to simple dressings. Only Rio Grande do Sul and Rondônia recorded a greater amount of simple dressings. It is also noteworthy that 10 states (40%) register more than 80% of the special dressing procedures. Regarding the records of SIA/SUS, considering the performance of grade I dressings and population representation, Minas Gerais has a population that represents 10.1% of the total Brazilian population, in relation to the records of grade I dressings, the state assumes 14 % of the total of this procedure registered in Brazil, which may indicate a population that requires more dressings when compared to the other Federative Units (FU). Rio Grande do Sul has a population that represents 5.4% of the total Brazilian population, in relation to the registrations of grade II dressings in the SIA/SUS, the state assumes 15.2% of the total of this procedure registered in Brazil, which it can indicate a population that would demand much more grade II dressing when compared to the other FUs, and/or qualification of these records.
As for the SISAB, referring to the types of teams and CBO, the registration of a simple and special dressing procedure performed at APS draws attention to the high amount of simple dressing and special dressing performed by the oral health team. It is noteworthy that most of the dressings were registered by the nursing technician and assistant, not being professionals who make up the oral health team. Thus, it is suggested inconsistency in the registration of information, and/or in the database is included the code 03.07.02.002-9, which refers to the delayed curative dental procedure, with or without biomechanical preparation. In view of the data analysis, only from the Family Health Team and the Primary Care Team, the state with the lowest record of simple dressings was Amapá, with 5 dressings in 2019, however it registered 4,000 special dressings. This reality of registration in higher quantities of special dressings occurred in 25 FU, with 40% (10 FU) registering 80% or more in special dressing procedures. Data that reflect that the AB has performed more special dressing when compared to the simple dressing.
In this context, a mistake in the registration and/or failure to clarify the difference between the two procedures is suggested.
It is also argued that nurses qualified to register on the e-SUS procedure sheet are those with the following CBO code: In view of the analysis at SIGTAP, it is noteworthy that the professional nurse stomatherapist is only qualified to register a dressing 0401010023 -Grade I dressing, with or without debridement, therefore, being a specialized professional for more complex curative procedures. This implies the valuation of specialization, because for managers it is more advantageous to register in the Sistema Nacional de Cadastro Nacional de Estabelecimentos de Saúde-SCNES (National System of National Registry of Health Establishments) as a generalist nurse, who is qualified to perform a grade II dressing, with an approved value for each dressing (R$ 32.40), instead of registering the professional stoma nurse, who does not approve the value of grade II dressings.
In this context, it is possible to explain the records at SCNES in Brazil, in February 2020, which showed that out of a total of 324,625 registered nurses, only 165 were registered as a stoma nurse 9 .
The results presented reveal that the different SIS do not communicate, causing deficiency in the analysis of the records.
The lack of a unified SIS has shown weaknesses regarding the quality of the information available, which implies the viability of health information for decision-making 16 .
In this context, with the study it was possible to list some suggestions about the SIS, which are: to invalidate or differentiate the production carried out by AB in SIA/SUS; expansion of the CBO list of professional nurses, especially the stoma nurse, qualified in SIGTAP to perform the grade II dressing, with or without debridement -0401010015; validate the financial transfer of R$ 32.40 per grade II dressing, with or without debridement, -0401010015, registered by the professional stomatherapy nurses and AB nurses, making it possible to invest in coverage resources more effectively; release the code of dressing procedure grade II to be registered in the SISAB or dismember the same code SIGTAP 0401010023 -dressing grade I, with or without debridement, for simple dressing and special dressing in APS, as it makes it impossible to analyze the complexity of the procedure the dressings (to exemplify, the human resource, material, time used for a simple dressing, such as a suture, is very different when compared to a large venous ulcer); include the CBO of the professional stoma nurse in the valid CBOs to feed the procedure file of the e-SUS; and the need for decentralized training on the proper way to record information in the different SIS;

CONCLUSION
The study reveals that the different information systems do not communicate, the production of dressings may be being reported inconsistently, suggesting problems in the quality and reliability of the information provided. It is emphasized that if these issues are not considered in the analysis, the knowledge generated may not represent the reality studied.

DATA STATEMENT AVAILABILITY
Data will be made available on request.