Abstract
Introduction: Clinical Protocols and Therapeutic Guidelines (PCDT) and Therapeutic Diagnostic Guidelines (DDT) are documents that guide the diagnosis, treatment, and monitoring of various conditions by the SUS. Their implementation involves several actors and complex processes. This study aims to identify the perceptions of professionals who use these guidelines within the scope of state and municipal management. Methods: This is a cross-sectional survey study with nationwide scope. The sample was of convenience and included state and municipal health secretaries (group 1), managers and collaborators linked to specialized care and regulatory areas (group 2), superintendents, directors, and coordinators of pharmaceutical assistance (group 3). Sociodemographic data of the participants and their perceptions regarding the implementation were collected via an online questionnaire, from December/2022 to August/2023, and analyzed by descriptive statistics in absolute frequency. The project was approved by the Research Ethics Committee of the Hospital Alemão Oswaldo Cruz (CAAE: 53806821.9.0000.0070). Results: 129 participants agreed to participate in the study, of which 93, 26 and 7 represented groups 2, 3 and 1, respectively; three did not inform which group they belonged to. The participants were 42 years old on average (minimum 26 and maximum 63), the majority (88) were female and from São Paulo (23), Minas Gerais (17), Santa Catarina (13) and Rio Grande do Sul (11). Only 46 participants answered all the questionnaires, of which 39, 6 and 1 represented groups 2, 1 and 3, respectively. 39 responded that they knew about PCDT/DDT; 36 participants stated that there are barriers to implementing PCDT/DDT, the main ones being related to infrastructure (26), human resources (23), logistics (19), finances (19), and professionals' habits and preferences (19). For 23 participants, states and municipalities are capable of meeting the requirements of the documents, 18 responded that they are partially capable and 5 that they are not, with the main barriers identified being related to difficulties in accessing diagnostic services (19), the need for a referral center for treatment (16), and medication shortages (15). States were most frequently identified as responsible for logistical support for implementing PCDT/DDT (40), followed by the Ministry of Health (34), municipalities (27), and companies (11). Discussion and conclusions: The findings suggest that participants are aware of PCDT/DDT and believe that states and municipalities are capable of meeting the requirements of the guidelines, despite the barriers identified. Studies suggest that the adherence of potential respondents to survey-type research is around 30%. However, it is estimated that less than 3% of the population of interest participated in the ASPAS study. Thus, some limitations of the study are the low adherence to the research, the reduced representativeness and the voluntary participation bias (i.e., participants who volunteer to participate in a study intrinsically have different characteristics from the population of interest). Despite this, this work has great relevance for public policies and contributes to filling the shortage of studies on the implementation of PCDT/DDT. Strategies to optimize the engagement of professionals, such as workshops combined with focus groups, may be relevant to identify perceptions and encourage the implementation of PCDT/DDT.
