Freire Mariana Lourenço, Noronha Beatriz Prado, Cota Gláucia, Silva Sarah Nascimento
Pesquisa Clínica E Políticas Públicas Em Doenças Infecto-Parasitárias, Núcleo de Avaliação de Tecnologias Em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.
BMC Health Serv Res. 2025 Sep 23;25(1):1207. doi: 10.1186/s12913-025-13117-6.
The implementation of technologies in the Unified Health System (SUS) faces significant challenges in Brazil due to the diversity of contexts, the specificities of the technologies, and resource limitations. This study aimed to identify and critically describe the theoretical models and strategies adopted, as well as the outcomes most frequently reported in SUS implementation studies.
The primary research question was: “How are health technologies implemented within the SUS context, and what outcomes are evaluated?”. A systematic literature search was conducted, followed by independent reviewers’ screening and selection of articles. Studies published up to April 2024 that described the implementation process within the SUS and reported at least one of the following outcomes were included: acceptability, adoption, adequacy, feasibility, fidelity, penetration, implementation cost, and sustainability. Non-original studies or those published in languages other than Portuguese, English, or Spanish were excluded.
A total of 45 studies were included, most of which were conducted in the Southeast region (53.0%) and focused on evaluating the implementation of good health practice processes (42.0%), with an emphasis on the perspectives of health professionals. Consolidated implementation frameworks were employed in 60% of the studies, with the framework from the Australian organization Joanna Briggs Institute (JBI) being the most frequently applied (17 studies), followed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) used in seven studies, and the Consolidated Framework for Implementation Research (CFIR) in three studies. Among the outcomes of interest, adequacy was the most frequently analyzed (66.7%), followed by penetration (24.4%) and fidelity (20.0%). In contrast, the outcomes of implementation cost (4.4%) and sustainability (4.4%) were the least explored.
This study highlights the variability in the models and methods used to evaluate the implementation of health technologies in the SUS. The absence of standardized approaches underscores the need for consistent guidelines to guide the implementation process. Future studies should prioritize outcomes that capture the impact of implementation strategies within universal health systems, such as the SUS.
The online version contains supplementary material available at 10.1186/s12913-025-13117-6.
由于背景的多样性、技术的特殊性和资源限制，巴西统一卫生系统（SUS）中技术的实施面临重大挑战。本研究旨在识别并批判性地描述所采用的理论模型和策略，以及SUS实施研究中最常报告的结果。
主要研究问题是：“卫生技术在SUS背景下如何实施，以及评估了哪些结果？”进行了系统的文献检索，随后由独立评审员筛选和选择文章。纳入截至2024年4月发表的描述SUS内实施过程并报告以下至少一项结果的研究：可接受性、采用率、适当性、可行性、保真度、渗透率、实施成本和可持续性。排除非原创研究或用葡萄牙语、英语或西班牙语以外的语言发表的研究。
共纳入45项研究，其中大部分在东南部地区进行（53.0%），重点是评估良好健康实践过程的实施情况（42.0%），重点是卫生专业人员的观点。60%的研究采用了综合实施框架，澳大利亚乔安娜·布里格斯研究所（JBI）的框架应用最为频繁（17项研究），其次是7项研究中使用的“覆盖、有效性、采用、实施和维持”框架（RE-AIM），3项研究中使用了实施研究综合框架（CFIR）。在感兴趣的结果中，适当性分析最为频繁（66.7%），其次是渗透率（24.4%）和保真度（20.0%）。相比之下，实施成本（4.4%）和可持续性（4.4%）的结果探索最少。
本研究强调了用于评估SUS中卫生技术实施的模型和方法的变异性。缺乏标准化方法凸显了制定一致指南以指导实施过程的必要性。未来的研究应优先关注能够体现普遍卫生系统（如SUS）内实施策略影响的结果。
在线版本包含可在10.1186/s12913-025-13117-6获取的补充材料。
