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1.
Femina ; 50(2): 121-128, 20220228. tab
Article in Portuguese | LILACS | ID: biblio-1366127

ABSTRACT

Objetivo: Analisar o impacto das orientações médicas recebidas durante o pré-natal sobre o conhecimento adquirido de puérperas e gestantes, a respeito da importância dos principais exames solicitados para a assistência do pré-natal em uma Unidade Básica de Saúde (UBS). Métodos: Trata-se de um estudo observacional, descritivo, com grupo de comparação. A pesquisa foi realizada na UBS Júlia Seffer, localizada no município de Ananindeua, Pará, Brasil. A coleta de dados foi realizada mediante a aplicação de questionário a 50 mulheres, 25 gestantes e 25 mulheres pós-parto, que tinham entre 18 e 49 anos e fizeram o pré-natal de agosto de 2019 a agosto de 2020. Resultados: Entre os dados analisados, apenas 52% das gestantes e 44% das puérperas conseguiram descrever a medição da altura uterina. Em relação ao processo educativo durante o pré-natal, pode-se evidenciar que 88% das gestantes e 72% das puérperas não estavam envolvidas em nenhuma atividade educativa. Em relação à avaliação pré-natal, apenas 32% das gestantes e 44% das mulheres pós-parto avaliaram como excelente o atendimento realizado na UBS. Conclusão: Observou-se a presença de falhas no processo educativo, que indica a necessidade de maior cuidado e investimentos na atenção primária direcionada ao cuidado e orientação das mulheres no ciclo gravídico-puerperal.(AU)


Objective: To analyze the impact of medical guidance received during prenatal care on the knowledge acquired by postpartum and pregnant women regarding the importance of the main tests requested for prenatal care in a Basic Health Unit (BHU). Methods: This is an observational, descriptive study, with comparison group. The research was conducted at UBS Júlia Seffer, located in the municipality of Ananindeua, Pará, Brazil. Data collection was performed by applying a questionnaire to 50 women, 25 pregnant and 25 postpartum women, who were between 18 and 49 years old and had prenatal care from August 2019 to August 2020. Results: Among the data analyzed, only 52% of pregnant women and 44% of puerperal women were able to describe the measurement of uterine height. Regarding the educational process during prenatal care, it can be evidenced that 88% of pregnant women and 72% of puerperal women were not involved in any educational activity. Regarding prenatal evaluation, only 32% of pregnant women and 44% of postpartum women evaluated as excellent the care provided in the BHU. Conclusion: It was observed the presence of flaws in the educational process that indicate the need for greater care and investment in primary care directed to the care and guidance of women in the gravidic-puerperal cycle.(AU)


Subject(s)
Humans , Female , Pregnancy , Primary Health Care/statistics & numerical data , Prenatal Education/statistics & numerical data , Health Knowledge, Attitudes, Practice , Epidemiology, Descriptive , Postpartum Period , Health Impact Assessment
2.
Gac. méd. Méx ; 157(3): 323-326, may.-jun. 2021. tab
Article in Spanish | LILACS | ID: biblio-1346114

ABSTRACT

Resumen Introducción: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. Objetivo: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. Métodos: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. Resultados: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. Conclusiones: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.


Abstract Introduction: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. Objective: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. Methods: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. Results: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. Conclusions: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Telemedicine/methods , Diabetes Mellitus, Type 2/therapy , Ambulatory Care/methods , COVID-19 , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Cross-Sectional Studies , Prospective Studies , Telemedicine/statistics & numerical data , Ambulatory Care/statistics & numerical data
3.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(2): 419-428, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1340658

ABSTRACT

Abstract Objectives: to identify dietary patterns of children under two years of age in primary care, associating them with maternal variables. Methods: cross-sectional study carried out in basic health units. Sample selected for convenience with 321 children under two years old and their mothers. Food consumption was obtained through a 24-hour food record. The method of factor analysis by main components was used to determine dietary patterns. Associations between maternal variables and dietary patterns were tested. Results: "mixed", "porridge" and "snacks" patterns were identified. Receiving guidance on infant feeding was related to greater adherence to the "mixed" (p = 0.02; PR = 2.98; 95% CI95% = 1.49-5.96) and "porridge" (p = 0.026; PR = 2.10; CI95% = 1.09-4.02) patterns. Experience with breastfeeding showed greater adherence to the "porridge" standards (p=0.038; PR = 1.78; CI95%= 1.03-3.08) and "snacks" (p = 0.026; PR = 1.09; CI95% = 1.01-1.18) and children of overweight mothers showed less adherence to the "snacks" pattern (p = 0.042; PR = 0.51; CI95%= 0.26-0.98). Conclusions: patterns found were associated with guidance on infant feeding and breastfeeding, previous experience with breastfeeding, as well as with maternal excess weight, emphasizing the importance of professional guidance for greater adherence to more varied and healthy consumption patterns and that include the different food groups.


Resumo Objetivos: identificar padrões alimentares de crianças menores de dois anos na atenção primária associando-os com variáveis maternas. Métodos: estudo transversal desenvolvido em unidades básicas de saúde. Amostra selecionada por conveniência com 321 menores de dois anos e suas mães. O consumo alimentar foi obtido através de recordatório alimentar de 24 horas. O método de análise fatorial por componentes principais foi utilizado para determinação dos padrões alimentares. Associações entre variáveis maternas e padrões alimentares foram testadas. Resultados: padrões "misto", "mingaus" e "lanches" foram identificados. Receber orientações sobre alimentação infantil relacionou-se a maior aderência aos padrões "misto" (p= 0,02; RP= 2,98; IC95%= 1,49-5,96) e "mingaus" (p= 0,026; RP= 2,10; IC95%= 1,09-4,02). Experiência com aleitamento materno mostrou maior adesão aos padrões "mingaus" (p= 0,038; RP= 1,78; IC95%= 1,03-3,08) e "lanches" (p= 0,026; RP= 1,09; IC95%= 1,01-1,18) e filhos de mães com excesso de peso apresentaram menor aderência ao padrão "lanches" (p= 0,042; RP= 0,51; IC95%= 0,26-0,98). Conclusões: os padrões encontrados associaram-se com orientação sobre alimentação infantil e amamentação, experiência prévia com amamentação, bem como com excesso de peso materno, ressaltando a importância da orientação profissional para maior adesão a padrões de consumo mais variados e saudáveis e que contemplem os diversos grupos de alimentos.


Subject(s)
Humans , Female , Infant, Newborn , Infant , Primary Health Care/statistics & numerical data , Breast Feeding/statistics & numerical data , Nutritional Status , Eating , Child Nutrition , Feeding Behavior , Brazil , Health Centers , Cross-Sectional Studies , Mothers
4.
Med. infant ; 28(1): 10-15, Marzo 2021.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1282213

ABSTRACT

Los trastornos del desarrollo conforman la "nueva morbilidad" y su identificación oportuna facilita planear los apoyos específicos que pueden favorecer el pronóstico de estos pacientes. El objetivo de este proyecto es brindar información acerca del abordaje de los pacientes con diagnóstico de TEA en el primer nivel de atención, mediante la descripción de diferentes variables a través de la evaluación de sus historias clínicas. Se analizaron 35 historias clínicas y se obtuvieron los siguientes resultados. 85,7% sexo masculino con un promedio de edad de 8,1 años. El 48,57% poseían obra social. 14,29% fueron nacidos pretérmino. 8,57% presentaron síndrome genético/cromosómico asociado al autismo. 22.86% presentaban hermano con mismo diagnóstico. Retraso madurativo o discapacidad intelectual en el 22,8%. Edad de diagnóstico media de 45.05 meses, (DE 17.13). En el 65,71% de las HC no se consignaba si el familiar presentaba alguna preocupación con respecto al desarrollo. En el 40% de las HC figura alteración en la comunicación/ ausencia o retraso del lenguaje, como motivo de preocupación/ derivación. El 91,43% se realizó el diagnostico por el equipo especializado en el Hospital Garrahan. El 85,71% realiza o realizó tratamiento, 71,43% en un centro público. El 88,57% se encontraba escolarizado. 51,43% en escuela especial. El 68,57% tenían certificado de discapacidad. El 28,57% se encontraban en tratamiento psicofarmacológico. El análisis de las HC nos permitió acercarnos a describir nuestra población, con características de diagnóstico y seguimiento que se ajustan en mayor medida a la descripta en la bibliografía, pese a tratarse de una población con un bajo nivel socio económico (AU)


Developmental disorders are the "new morbidity" and their timely identification enhances the planning of specific support measures that may improve the prognosis of these patients. The aim of this project is to provide information on the approach of patients diagnosed with ASD at the first level of care, by describing different variables obtained from medical records (MR). Thirtyfive MR were analyzed and the following results were obtained: 85.7% were male and mean age was 8.1 years. Overall, 48.57% had a health insurance; 14.29% were born preterm; 8,57% had a genetic/chromosomal syndrome associated with autism; 22.86% had a sibling with the same diagnosis. Developmental delay or intellectual disability was observed in 22.8%. Mean age at diagnosis was 45.05 months (SD 17.13). In 65.71% of the MR it was not clear if the caregiver was worried about the development of the child. In 40% of the MR, communication disturbances or absence of language/language delay were mentioned as the reason for worry or referral. In 91.43% the diagnosis was made by the specialized team at Garrahan Hospital. Overall, 85.71% underwent or is undergoing treatment, of whom 71.43% at a public center. Of all the children, 88.57% was attending school, 51.43% of whom at a special school; 68.57% had a disability certificate; 28.57% received psychopharmacological treatment. Analysis of the MR allowed us to describe our population, with diagnostic and follow-up features that mostly agree with the findings reported in the literature, in spite of the low socio-economic level of the families (AU)


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Primary Health Care/statistics & numerical data , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/therapy , Cross-Sectional Studies , Retrospective Studies , Follow-Up Studies
5.
Evid. actual. práct. ambul ; 24(1): e002113, 2021. tab
Article in Spanish | LILACS | ID: biblio-1179134

ABSTRACT

Antecedentes. La continuidad del cuidado (CoC) suele describir en qué medida los pacientes ven al mismo profesional a lo largo del tiempo. Constituye un elemento necesario para garantizar la longitudinalidad en la atención, elemento clave dela atención primaria y de la medicina familiar en particular, entendido como el cuidado centrado en la persona a lo largo del tiempo, independientemente del tipo de problema consultado. Esta ha sido vinculada con una serie de beneficios para los pacientes y algunos indicadores duros de utilización de servicios de salud, por ejemplo visitas a la central de emergencias(CE), internaciones hospitalarias y mortalidad. En Argentina y América Latina no habíamos podido identificar estudios que dieran cuenta del nivel local de CoC o de su impacto en la utilización de los servicios de salud. Objetivo. Cuantificar los niveles de CoC de los afiliados de un Seguro de Salud de un Hospital Universitario Privado y describir su asociación con la utilización de servicios de salud, tales como consultas a la CE e internaciones hospitalarias. Métodos. Estudio observacional, descriptivo, de cohorte retrospectiva; realizado sobre la totalidad de afiliados que hubieran realizado al menos dos consultas programadas con un médico de atención primaria entre 2015 y 2016.Las mediciones principales consistieron dos indicadores: el índice del proveedor usual de cuidados y el índice de continuidad del cuidado (UPC y COC, respectivamente, por sus iniciales en inglés) -cuyos valores oscilan entre 0 y 1, y se interpretan como: el paciente siempre fue atendido por diferentes médicos vs siempre por el mismo médico-y el recuento de visitas a la CE e internaciones hospitalarias. Resultados. Fueron identificados 112.062 pacientes con una mediana de edad de 59 (P5-P95;4 a 87) años. Las medianas(P5-P95) de los indicadores de continuidad, UPC y COC, fueron 0,66 (0,25 a 1) y 0,33 (0,04 a 1), respectivamente. Se observó una asociación inversa y estadísticamente significativa entre los indicadores de CoC y la cantidad de visitas a la CE, evidenciada por una razón de incidencia decreciente de consultas contra quintilos crecientes de COC (tomando como referencia el quintilo más bajo de continuidad). Esta asociación no pudo demostrarse para las internaciones. Conclusiones. Los niveles de CoC alcanzados y su impacto en la utilización de servicios de salud reflejan valores semejantes a los de otros estudios publicados fuera de nuestra región y podrían aportar elementos útiles para delinear estrategias tendientes a la mejora de la calidad de la atención médica. (AU)


Background. Continuity of care (CoC) usually describes the extent to which patients see the same professional over time. It is a necessary element to ensure continuity of care, a key element of primary care and family medicine, in particular, understood as person-centred care over time, regardless of the type of problem consulted. It has been linked to a series of benefits for patients as well as to hard indicators of health services utilization (e.g. emergency room [ER] visits, hospitalizations) and mortality. In Argentina and Latin America, we have not been able to identify studies that account for the local level of CoC and its impact. Objective. To quantify the CoC levels among members of a private university hospital's health insurance scheme and to describe its association with the use of health services, such as ER visits and hospitalizations. Methods. Observational, descriptive, retrospective cohort study; conducted on the total number of members who hadmade at least two schedurivled consultations with a primary care physician between 2015 and 2016.The main outcomes were two indicators: the usual provider continuity index and the continuity of care index (UPC and COC, respectively) -both range between 0 and 1, and are interpreted as: the patient was always treated by different doctorsvs. always by the same doctor- and the number of visits to the ER and hospitalizations. Results. A total of 112,062 patients with a median age of 59 (P5-P95, 4 to 87) years were identified. The median (P5-P95) of the continuity indicators, UPC and COC, was 0.66 (0.25 to 1) and 0.33 (0.04 to 1), respectively. A significant inverse association was observed between the CoC indicators and the number of ER visits, evidenced by adecreasing incidence rate of consultations versus increasing quintiles of CoC (taking the lowest quintile of continuity as a reference). This association was not observed for hospitalizations. Conclusions. The levels of CoC reached and their impact on the use of health services reflect similar values to those of other studies published outside our region and could provide useful elements for outlining strategies aimed at improvingthe quality of medical care. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Quality of Health Care/statistics & numerical data , Continuity of Patient Care/statistics & numerical data , Argentina , Physician-Patient Relations , Primary Health Care/statistics & numerical data , Retrospective Studies , Patient-Centered Care , Family Practice , Health Services/statistics & numerical data , Hospitals, University/statistics & numerical data , Insurance, Health/statistics & numerical data
6.
Evid. actual. práct. ambul ; 24(1): e002112, 2021. tab
Article in Spanish | LILACS | ID: biblio-1179185

ABSTRACT

El concepto de continuidad del cuidado (CoC) suele utilizarse para describir en qué medida los pacientes ven al mismo profesional a lo largo del tiempo, aunque más específicamente es un atributo o característica del proceso de atención de salud de un individuo en el que la calidad de la conexión y retroalimentación de los eventos que se suceden influyen en la experiencia final de sentirse cuidado. La CoC abarca diferentes dominios conceptuales: la continuidad de la información, de la relación y del manejo. Se han utilizado diferentes instrumentos de medición que pueden agruparse en herramientas elaboradas a partir de reportes de pacientes (como por ej., encuestas) o a partir de datos administrativos (como los indicadores de prestador usual de cuidados o el indicador de Bice y Boxerman). Existen también investigaciones que evaluaron el impacto sanitario de la CoC. Si bien muchas de ellas muestran gran heterogeneidad en cuanto a los indicadores y los desenlaces utilizados, se observa una tendencia clara que parece indicar que a mayor nivel de continuidad del cuidado, mejores resultados en salud. (AU)


The concept of continuity of care (CoC) is often used to describe the extent to which patients see the same professional over time, but more specifically it is an attribute or characteristic of an individual's health care process in which the quality of the connection and feedback of the events that follow influences the final experience of feeling cared for. CoC encompasses different conceptual domains: continuity of information, relationship, and management. Different measurement instruments have been used, which can be grouped into tools developed from patient reports (e.g. surveys) or from administrative data (e.g. usual caregiver indicators or the Bice & Boxerman indicator). There is also research that has assessed the health impact of CoC. While many of them show great heterogeneity in terms of the indicators and outcomes used, there is a clear trend that seems to indicate that the higher the level of continuity ofcare, the better the health outcomes. (AU)


Subject(s)
Humans , Quality of Health Care/statistics & numerical data , Continuity of Patient Care/statistics & numerical data , Physician-Patient Relations , Primary Health Care/statistics & numerical data , Patient-Centered Care , Continuity of Patient Care/trends , Evidence-Based Medicine/trends , Health Services/statistics & numerical data
7.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 1037-1043, jan.-dez. 2021. tab, graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1252881

ABSTRACT

Objetivo: avaliar o acesso ao tratamento em pessoas com Tuberculose na Atenção Primária à Saúde. Métodos: trata-se de uma pesquisa transversal, descritivo e observacional, com abordagem quantitativa, realizada na cidade de Caxias-Maranhão. Obteve-se uma amostra de 133 participantes, porém foram entrevistados 100 pacientes. Resultados: as maiores prevalências ocorreram em homens 55 (55%), com ensino fundamental incompleto 57 (57%). Percebeu-se também, que o acesso ao tratamento é centralizado e os indicadores geográficos foram considerados satisfatórios, como, realização do tratamento na unidade mais próxima 100 (100%), consulta médica em 24 horas 91 (91%), medicamentos 99 (99%), tempo menor de 60 minutos para se consultar 87 (87%). Conclusão: desta forma, este estudo demonstrou associação significativa em relação ao tratamento de tuberculose diante das variáveis de estudo. Portanto, garantir o acesso não é suficiente para o êxito do tratamento, refletindo a necessidade de novas estratégias que visem a promoção da saúde da população


Objective: to evaluate access to treatment in people with Tuberculosis in Primary Health Care. Methods: this is a cross-sectional, descriptive and observational study, with a quantitative approach, carried out in the city of Caxias-Maranhão. A sample of 133 participants was obtained, but 100 patients were interviewed. Results: the highest prevalence occurred in men 55 (55%), with incomplete primary education 57 (57%). It was also noticed that access to treatment is centralized and geographic indicators were considered satisfactory, such as treatment at the nearest unit 100 (100%), medical consultation in 24 hours 91 (91%), medicines 99 (99 %), less than 60 minutes to consult 87 (87%). Conclusion: thus, this study demonstrated a significant association in relation to the treatment of tuberculosis in view of the study variables. Therefore, ensuring access is not sufficient for the success of treatment, reflecting the need for new strategies aimed at promoting the population's health


Objetivo: evaluar el acceso al tratamiento en personas con tuberculosis en Atención Primaria de Salud. Método: estudio transversal, descriptivo y observacional, con enfoque cuantitativo, realizado en la ciudad de Caxias-Maranhão. Se obtuvo una muestra de 133 participantes, pero se entrevistó a 100 pacientes. Resultados: la prevalencia más alta ocurrió en hombres 55 (55%), con educación primaria incompleta 57 (57%). También se observó que el acceso al tratamiento está centralizado y los indicadores geográficos se consideraron satisfactorios, como el tratamiento en la unidad más cercana 100 (100%), consulta médica en 24 horas 91 (91%), medicamentos 99 (99%), menor 60 minutos para consultar 87 (87%). Conclusión: por lo tanto, este estudio demostró una asociación significativa en relación con el tratamiento de la tuberculosis debido a las variables del estudio. Por lo tanto, garantizar el acceso no es suficiente para el éxito del tratamiento, lo que refleja la necesidad de nuevas estrategias destinadas a promover la salud de la población


Subject(s)
Humans , Male , Female , Primary Health Care/statistics & numerical data , Tuberculosis/epidemiology , Health Services Accessibility/statistics & numerical data , Communicable Disease Control/statistics & numerical data , Health Services Research/statistics & numerical data
9.
Rev. Bras. Saúde Mater. Infant. (Online) ; 20(4): 925-934, Oct-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1155288

ABSTRACT

Abstract Objectives: to identify the absence of one or more general child development milestones and by domains, and associated factors. Methods: cross-sectional study with 334 children under three years of age conducted out at Primary Health Care Facilities, São Paulo, Brazil. The dependent variable was the general child development and the fine motor, gross motor, social and psychic domains evaluated using the Developmental Surveillance Instrument of the Brazilian Ministry of Health. Data were obtained by interviewing the mothers and observing children. The chi-square test and logistic regression analyses were used. Results: absence of one or more milestones of general child development was found in 52.1% of children, especially, in the fine motor domain. We found an association between general child development with age (OR = 4.4; CI95%= 2.0-9.9) and the place of stay of the child who does not attend daycare (OR = 3.7; CI95%= 1.3-10.5). Conclusions: the absence of one or more milestones of general child development is high and associated with aspects of the child and the environment. This emphasizes the importance of promoting developmental surveillance in Primary Health Care Facilities among health professionals using the official instrument recommended by the Brazilian Ministry of Health.


Resumen Objetivos: identificar la ausencia de uno o más hitos del desarrollo infantil global y por dominios, y factores asociados. Métodos: estudio transversal con 334 menores de tres años de edad, realizado en centros de atención primaria de una ciudad de São Paulo, Brasil. La variable dependiente fue el desarrollo infantil global y los dominios madurativo, psicomotor, social y psíquico, evaluados utilizando el Instrumento de Vigilancia del Desarrollo del Ministerio de Salud de Brasil. Los datos fueron obtenidos por entrevista a las madres y observación de los niños. Se utilizó prueba de chi-cuadrado y regresión logística. Resultados: 52,1% de los niños presentaron ausencia de uno o más hitos del desarrollo infantil global, con mayor proporción de ausencia de hitos en el dominio madurativo. Se encontró asociación del desarrollo infantil global con la edad (OR= 4,4; IC95%= 2,0-9,9) y lugar de permanencia del niño que no asiste a guardería (OR= 3,7; IC95%= 1,3-10,5). Conclusiones: la ausencia de uno o más hitos del desarrollo infantil global es elevada, asociada a factores infantiles y ambientales. Esto refuerza la importancia de promover entre los profesionales de la salud la vigilancia del desarrollo infantil en la atención primaria, utilizando el instrumento oficial estipulado por el Ministerio de Salud de Brasil.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Primary Health Care/statistics & numerical data , Child Development , Child Health , Comprehensive Health Care , Brazil , Cross-Sectional Studies
10.
Article in Spanish | LILACS | ID: biblio-1148362

ABSTRACT

La pandemia por COVID-19 ha desafiado a los equipos profesionales en cuanto a la provisión de servicios sanitarios en Atención Primaria de Salud (APS). Los fonoaudiólogos que se desempeñan en este nivel han diversificado sus quehaceres, por lo que se vuelve necesario reflexionar sobre la práctica en este contexto. El objetivo de esta revisión narrativa es actualizar el estado del arte respecto a los dominios de la provisión de servicios en fonoaudiología y la pertinencia de los mismos en APS, a propósito de la pandemia. Los diversos ámbitos de actuación fonoaudiológica resultan atingentes para afrontar las demandas derivadas de la pandemia en APS. Existe una ampliación del quehacer fonoaudiológico que considera la continuidad del cuidado y el acompañamiento terapéutico. Dicha ampliación tiene como fin fortalecer las acciones de prevención y promoción de la salud, considerando la comunicación como una herramienta para cumplir con este fin. En este contexto, se requiere reflexionar sobre el papel disciplinar del fonoaudiólogo desde su práctica en ámbitos genéricos y específicos a nivel local, reconociendo la existencia de una hibridación en la provisión de servicios tanto a nivel individual como colectivo. También, se vuelve necesaria la formulación de documentos de posición, basados en la evidencia y sustentados en recomendaciones internacionales, así como en los requerimientos de la comunidad, respecto al rol del fonoaudiólogo en APS. La formulación y difusión de investigaciones que visibilicen los aportes de la Fonoaudiología en este ámbito parecen fundamentales.


COVID-19 pandemic has challenged professional teams regarding the provision of health services in Primary Health Care (PHC). Speech pathologists who work at this level have diversified their work, so it becomes necessary to reflect on their practice in this context. The objective of this narrative review is to update the state of theart regarding the domains of the provision of services in speech therapy and their relevance in PHC, regarding the pandemic. The various areas of speech therapy action are pertinent to face the demands derived from the pandemic in PHC. There is an extension of scope of speech therapy practice that considers the continuity of care and therapeutic accompaniment. Such an extension incorporates the needto strengthen prevention and health promotion actions, observing communication as a tool for this purpose. In this context, it is necessary to reflect on the disciplinary role of the speech therapist from his practice in generic and specific areas at the local level, recognizing the existence of a hybridization in the provision of services both individually and collectively. It becomes also necessary to formulate position papers, based on evidence and supported by international recommendations as well as the requirements of the community, regarding the role of the speech therapist in PHC. The formulation and dissemination of research that make visible the contributions of speech therapy in this area seem fundamental


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Primary Health Care/statistics & numerical data , Coronavirus Infections/prevention & control , Speech, Language and Hearing Sciences/statistics & numerical data , Pandemics
11.
Washington; Organización Panamericana de la Salud; jul. 2, 2020. 4 p.
Non-conventional in English, Spanish, Portuguese | LILACS, BDENF, Inca | ID: biblio-1103376

ABSTRACT

Atenção centrada na resposta à COVID-19: identificar, informar, conter, manejar e encaminhar. Os sistemas de informação em saúde ­ por meio do acesso oportuno a dados devidamente desagregados, a correta integração dos sistemas nacionais e locais, a saúde digital e o uso das tecnologias da informação (TIC) de uso frequente ­ facilitam a identificação eficaz, informação e análise de casos e contatos; a busca e detecção de casos em tempo hábil; e a identificação e seguimento da população de risco, dos casos e de seus contatos. A contenção é fortalecida com as plataformas de seguimento e monitoramento de casos, contatos, quarentena e isolamento social. Por sua vez, esses sistemas possibilitam a difusão maciça a toda a sociedade dos comunicados sobre medidas preventivas. As plataformas de teleconsulta, monitoramento remoto de pacientes e comunicação a distância permitem à atenção primária manejar a assistência médica e facilitam o seguimento domiciliar das pessoas com COVID-19. Esses mesmos mecanismos, integrados aos prontuários eletrônicos e aos sistemas locais e nacionais de informação, permitem e facilitam as referências, em âmbito hospitalar, dos pacientes com sinais e sintomas graves ou com fatores de risco.


Atención centrada en la respuesta a la COVID-19: identificar, reportar, contener, manejar y referir. Los sistemas de información para la salud ­a través del acceso oportuno a datos correctamente desagregados, la correcta integración de los sistemas nacionales y locales, la salud digital y la utilización de las tecnologías de la información (TIC) de uso frecuente­ facilitan la identificación eficaz, el reporte y análisis de casos y contactos; la búsqueda y detección tempranas de casos; y la identificación y el seguimiento de la población de riesgo, los casos y sus contactos. La contención se ve fortalecida con las plataformas de seguimiento y monitoreo de casos, contactos, cuarentena y aislamiento social. Estos sistemas permiten a su vez la difusión masiva a toda la sociedad de las comunicaciones sobre medidas preventivas. Las plataformas de teleconsulta, monitoreo remoto de pacientes y comunicación a distancia permiten al primer nivel de atención el manejo de la asistencia médica y facilitan el seguimiento domiciliario de las personas con COVID-19. Estos mismos mecanismos, integrados con los registros electrónicos de salud y los sistemas locales y nacionales de información, permiten y facilitan las referencias al nivel hospitalario de los pacientes con signos y síntomas graves o factores de riesgo.


Care centered on the response to COVID-19: Identify, report, contain, manage, and refer. Information systems for health­through timely access to correctly disaggregated data, proper integration of national and local systems, digital health, and the application of widely used information and communication technologies (ICTs)­facilitate the effective identification, reporting, and analysis of cases and contacts; early search for and detection of cases; and identification and monitoring of at-risk populations, cases, and contacts. Containment is strengthened through platforms for follow-up and monitoring of cases, contacts, quarantine, and social isolation. These systems, in turn, enable mass dissemination of information on preventive measures to all of society. Platforms for telemedicine visits, remote monitoring of patients, and remote communication enable health workers at the first level of care to manage medical care and facilitate home monitoring of people with COVID-19. These same mechanisms, together with electronic health records and local and national information systems, facilitate hospital referrals of patients with severe signs and symptoms or risk factors.


Subject(s)
Pneumonia, Viral/epidemiology , Primary Health Care/statistics & numerical data , Information Systems/statistics & numerical data , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Health Information Management/statistics & numerical data , Data Science/statistics & numerical data , Telemedicine/organization & administration , Electronic Health Records/statistics & numerical data , Epidemiological Monitoring
12.
Ciênc. Saúde Colet ; 25(4): 1389-1400, abr. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1089536

ABSTRACT

Resumo Na Atenção Primária à Saúde (APS) acesso e integralidade são fortemente influenciados pela coordenação do cuidado, que por sua vez recebe impacto positivo da articulação de ações de telessaúde para a telerregulação da assistência. Criamos uma metodologia de telerregulação (Projeto RegulaSUS) baseada em protocolos específicos firmemente alicerçados em evidências. A partir de dados do sistema de regulação e do TelessaúdeRS exploramos os efeitos do RegulaSUS na APS e no acesso ao cuidado especializado. A metodologia foi capaz de criar protocolos abrangentes, com expressiva redução média da fila de consultas especializadas de 30% em 360 dias. Reduziu o tempo de espera na marcação de consultas em especialidades clínicas (mediana de 66 dias), mas não em cirúrgicas. Tempos de espera nos casos mantidos em fila variaram de forma inversa, aumentado em especialidades clínicas e diminuindo em cirúrgicas. O uso de teleconsultorias espontâneas aumentou com a exposição dos profissionais ao RegulaSUS. A intervenção tem potencial na integração de sistemas de saúde, principalmente em países de baixa e média renda, e faz com que a telessaúde atue como metasserviço, construindo redes eficientes, qualificadas e equânimes.


Abstract In Primary Health Care (PHC), access, and integrality are strongly influenced by the coordination of care, which in turn receives a positive impact from the articulation of telehealth actions for teleregulation of care. We created a teleregulation method (RegulaSUS Project) based on specific protocols firmly grounded in scientific evidence. From data of the regulatory system and TelessaúdeRS, we explored the effects of RegulaSUS on PHC and access to specialized care. This method set comprehensive protocols, with a significant mean reduction of 30% in the specialized visits queue over 360 days. It reduced waiting time for medical clinical visits (median of 66 days) but not for surgical appointments. Waiting times for queued cases varied inversely, increasing for clinical and declining for surgical specialties. The use of teleconsultations unrelated to regulation increased with the exposure of professionals to RegulaSUS. The intervention evidence potentiality in the integration of health systems, mainly among low- and middle-income countries, and makes telehealth act as a meta-service, building efficient, qualified, and equitable networks.


Subject(s)
Humans , Primary Health Care/organization & administration , Telemedicine/organization & administration , Health Services Accessibility/organization & administration , Appointments and Schedules , Primary Health Care/statistics & numerical data , Referral and Consultation/organization & administration , Referral and Consultation/statistics & numerical data , Time Factors , Brazil , Waiting Lists , Telemedicine/statistics & numerical data , Capacity Building , Data Analysis , Health Services Accessibility/statistics & numerical data
13.
Ciênc. Saúde Colet ; 25(4): 1375-1388, abr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089502

ABSTRACT

Abstract Hospitalizations for ambulatory care sensitive conditions have been used to measure access, quality and performance of the primary health care delivery system, as timely and adequate care could potentially avoid the need of hospitalization. Comparative research provides the opportunity for cross-country learning process. Brazil and Portugal have reformed their primary health care services in the last years, with similar organizational characteristics. We used hospitalization data of Brazil and Portugal for the year 2015 to compare hospitalizations for ambulatory care sensitive conditions between the two countries, and discussed conceptual and methodological aspects to be taken into consideration in the comparative approach. Brazil and Portugal presented similarities in causes and standardized rates of hospitalizations for ambulatory care sensitive conditions. There was great sensitivity on rates according to the methodology employed to define conditions. Hospitalizations for ambulatory care sensitive conditions are important sources of pressure for both Brazil and Portugal, and there are conceptual and methodological aspects that are critical to render the country-comparison approach useful.


Resumo As internações por condições sensíveis à atenção primária têm sido usadas para medir o acesso, a qualidade e o desempenho da atenção primária à saúde, uma vez que o atendimento oportuno e adequado poderia evitar a necessidade de internação. A pesquisa comparativa oferece oportunidade para o processo de aprendizagem entre países. Brasil e Portugal reformaram seus serviços de atenção primária à saúde nos últimos anos, com características organizacionais semelhantes. Utilizamos dados de internação do Brasil e de Portugal para o ano de 2015 para comparar internações por condições sensíveis à atenção primária entre os dois países, e discutimos aspectos conceituais e metodológicos a serem considerados na abordagem comparativa. Brasil e Portugal apresentaram semelhanças nas causas e taxas padronizadas de internações por condições sensíveis à atenção primária. Houve grande sensibilidade nas taxas de acordo com a metodologia empregada para definir as condições. Internações por condições sensíveis à atenção primária são importantes fontes de pressão tanto para o Brasil quanto para Portugal, e há aspectos conceituais e metodológicos que são fundamentais para tornar a abordagem comparativa entre países útil.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Primary Health Care/statistics & numerical data , Ambulatory Care/statistics & numerical data , Medical Overuse/statistics & numerical data , Hospitalization/statistics & numerical data , Portugal , Brazil , Medical Overuse/prevention & control , Middle Aged
14.
Ciênc. Saúde Colet ; 25(4): 1181-1188, abr. 2020.
Article in Portuguese | LILACS | ID: biblio-1100986

ABSTRACT

Resumo Em 2019, o governo brasileiro lançou uma nova política para a Atenção Primária à Saúde (APS) no Sistema Único de Saúde (SUS). Chamada de "Previne Brasil", a política modificou o financiamento da APS para municípios. No lugar de habitantes e de equipes de Estratégia Saúde da Família (ESF), as transferências intergovernamentais passaram a ser calculadas a partir do número de pessoas cadastradas em serviços de APS e de resultados alcançados sobre um grupo selecionado de indicadores. As mudanças terão um conjunto de impactos para o SUS e para a saúde da população que precisaram ser identificados e monitorados. Neste artigo, discute-se os possíveis efeitos da nova política a partir de uma breve análise de contexto sobre tendências globais de financiamento de sistemas de saúde e de remuneração por serviços de saúde, bem como dos avanços, desafios e ameaças à APS e ao SUS. Com base na análise realizada, entende-se que a nova política parece ter objetivo restritivo, que deve limitar a universalidade, aumentar as distorções no financiamento e induzir a focalização de ações da APS no SUS, contribuindo para a reversão de conquistas históricas na redução das desigualdades na saúde no Brasil.


Abstract In 2019, the Brazilian government launched a new Primary Health Care (PHC) policy for the Unified Health System (SUS). Called "PrevineBrasil", the policy changed the PHC funding for municipalities. Instead of inhabitants and Family Health Strategy (ESF) teams, intergovernmental transfers are calculated from the number of people registered in PHC services and the results achieved in a selected group of indicators. The changes will have a set of impacts for the SUS and the health of the population, which must be observed and monitored. In this paper, possible effects of the new policy are discussed from a brief context analysis of global trends in health systems financing and health services' remuneration models, as well as on the advances, challenges, and threats to PHC and the SUS. Based on the analysis, the new policy seems to have a restrictive purpose, which should limit universality, increase distortions in financing and induce the focus of PHC actions on the SUS, contributing to the reversal of historic achievements in reducing health inequalities in Brazil.


Subject(s)
Humans , Primary Health Care/economics , Healthcare Financing , National Health Programs/economics , Primary Health Care/statistics & numerical data , Reimbursement, Incentive/economics , Brazil , Capitation Fee , Family Health , Health Expenditures , Health Care Reform/economics , Healthcare Disparities/economics , Health Plan Implementation/economics , Health Policy
15.
Rev. Bras. Saúde Mater. Infant. (Online) ; 20(1): 145-155, Jan.-Mar. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136405

ABSTRACT

Abstract Objectives: to perform a comparative assessment of the nutritional care process in the prenatal and puerperium periods at a primary care unit in the city of Santos, SP, Brazil before and after the implantation of the Prenatal and Puerperium Nutritional Care Strategy. Methods: a cross-sectional study was composed of 58 pairs of women and their children, of whom, 30 underwent prenatal care before and 28 of them after the implantation by collecting data from perinatal registrations and children's charts. The care was evaluated by the official National guidelines. The chi-square test was used to compare variables between the pre and post intervention groups. Results: there was a significant improvement after the nutritional intervention, regarding to height (p=0.001), registration on pre-pregnancy weight (p=0.032), follow up on Body Mass Index/gestational week (p=0.001), registration on newborn's weight at discharge (p=0.011) and daily weight gain at the first pediatric consultation (p=0.019). Conclusions: the Prenatal and Puerperal Nutritional Care Strategy contributed to improve maternal-child nutritional care and the data registration on patients' charts, demonstrating the necessity to establish processes/flows and an integral care for this population.


Resumo Objetivos: avaliar comparativamente o processo da atenção nutricional ao pré-natal e ao puerpério em Unidade Básica de Saúde do município de Santos, SP, Brasil antes e após intervenção para implantar uma Estratégia de Atenção Nutricional ao Pré-natal e Puerpério-EANPP. Métodos: estudo transversal cujo universo foi composto por 58 pares de mulheres e seus filhos, das quais 30 realizaram o pré-natal antes e 28 após a implantação, utilizando registros das fichas perinatais e dos prontuários das crianças. Avaliou-se a atenção segundo diretrizes oficiais nacionais. Para comparar as variáveis entre os Grupos PRÉ e PÓS-intervenção utilizou-se o teste qui-quadrado. Resultados: houve melhora significante na atenção nutricional após a intervenção, destacando-se: aferição da estatura (p=0,001), registro de peso pré-gestacional (p=0,032), acompanhamento do Índice de Massa Corporal/semana gestacional (p=0,001), registro de peso do recém-nascido na alta (p=0,011) e ganho ponderal diário na primeira consulta pediátrica (p=0,019). Conclusão: a EANPP contribuiu para aprimorar os registros em prontuários e a atenção nutricional materno infantil, demonstrando a necessidade de estabelecer fluxos/processos e fomentando o cuidado integral a essa população.


Subject(s)
Humans , Female , Pregnancy , Prenatal Care , Primary Health Care/statistics & numerical data , Nutrition Programs and Policies , Health Strategies , Nutrition Policy , Postpartum Period , Health Evaluation/statistics & numerical data , Brazil , Health Centers , Chi-Square Distribution , Nutrition Surveys/statistics & numerical data , Cross-Sectional Studies
16.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 321-327, Mar. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136206

ABSTRACT

SUMMARY OBJECTIVE To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. RESULTS 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. CONCLUSIONS The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.


RESUMO OBJETIVO Analisar a relação entre o processo de trabalho dos médicos do Programa Mais Médicos (PMM) no Brasil e alguns indicadores socioeconômicos no período de 2015. MÉTODO Trata-se de uma pesquisa quantitativa que utilizou dados secundários dos relatórios de supervisão do PMM. A variável dependente foi a qualidade do processo de trabalho e as variáveis independentes foram o tipo de município, expectativa de anos de estudo, índice de Gini, investimento em Atenção Primária à Saúde (APS) e cobertura de unidades de saúde. Na análise dos dados foi realizada a modelagem múltipla por regressão de Poisson com variância robusta. RESULTADOS Foram analisados dados de 3.816 municípios, abrangendo 1.537 profissionais. Destacam-se como variáveis socioeconômicas estratégicas e que explicam o modelo do processo de trabalho do PMM: o investimento e a cobertura da atenção básica. Tornou-se bastante evidente o princípio da equidade, pois os municípios mais vulneráveis e de maior cobertura realizam maior número de atividades em seu processo de trabalho. CONCLUSÕES Com a implantação do PMM e o provimento de médicos em regiões desassistidas ocorreu a consolidação do tripé processo de trabalho em saúde, atenção básica e equidade, tornando possível a efetivação de um processo de trabalho focado na APS. Isso implica a realização de maior número de atividades inerentes à APS, as quais não eram realizadas em função da ausência do profissional médico. Nesse sentido, o programa cumpre o seu papel de combater as desigualdades em municípios mais vulneráveis.


Subject(s)
Humans , Physicians/supply & distribution , Primary Health Care/statistics & numerical data , Primary Health Care/organization & administration , Socioeconomic Factors , Brazil , Government Programs , Health Workforce , Health Services Accessibility , Medically Underserved Area
17.
Article in English | LILACS | ID: biblio-1058888

ABSTRACT

ABSTRACT OBJECTIVE To evaluate the attributes of Primary Health Care (PHC) for rural workers; to analyze sociodemographic conditions, history of poisoning and hospitalizations for pesticides and use of personal protective equipment; and to verify exposure to pesticides by determining bioindicators. METHODS Cross-sectional, descriptive-analytical study with a sample of 1,027 rural workers living in municipalities belonging to a regional health department in Southern Minas Gerais, whose PHC is governed by the Family Health Strategy model. We used the adult version of the Primary Care Assessment Tool (PCATool Brazil) and a structured questionnaire to collect socioeconomic data, history of poisoning and hospitalization for pesticides and use of personal protective equipment. Blood samples were collected to measure biomarkers of pesticide exposure and signs of renal and hepatic sequelae. RESULTS Low education was prevalent, as well as the intense contact of workers with pesticides. Frequent use of personal protective equipment was higher among men, as was the history of poisoning and hospitalizations for pesticides. Rates of 20% poisoning, 15% liver disease and 2% nephropathy were detected. Signs of hepatotoxicity were more frequent in men. Gender differences were all statistically significant. Regarding PHC, only the attribute "degree of affiliation" had a high score. None of the poisoning cases detected in the study were previously diagnosed. CONCLUSIONS Despite the high coverage of the Family Health Strategy, occupational risk and its consequences have not been detected by health services, which do not seem oriented to primary care, even lacking their essential attributes. There is a need for immediate and effective adaptation of public policies regarding the health of rural workers, with adequate training of teams and review of the portfolio of PHC services offered.


ABSTRACT OBJETIVO Avaliar os atributos da atenção primária à saúde (APS) na assistência à saúde de trabalhadores rurais; analisar condições sociodemográficas, histórico de intoxicação e internações por agrotóxicos e uso de equipamentos de proteção individual; e verificar a exposição aos praguicidas pela determinação de bioindicadores. MÉTODOS Estudo transversal, descritivo-analítico, com amostra de 1.027 trabalhadores rurais residentes em municípios pertencentes a uma superintendência regional de saúde do sul de Minas Gerais, cuja APS é regida pelo modelo da Estratégia Saúde da Família. Utilizou-se o Instrumento de Avaliação da Atenção Primária (PCATool Brasil) versão adulto e um questionário estruturado para coleta de dados socioeconômicos, histórico de intoxicação e internação por agrotóxicos e uso de equipamentos de proteção individual. Foram coletadas amostras sanguíneas para dosagem de biomarcadores de exposição a praguicidas e de sinais de sequelas renais e hepáticas. RESULTADOS A baixa escolaridade foi prevalente, bem como o contato intenso dos trabalhadores com praguicidas. O uso frequente de equipamentos de proteção individual foi maior entre os homens, assim como o histórico de intoxicação e de internações por agrotóxicos. Detectaram-se índices de 20% de intoxicação, 15% de hepatopatia e 2% de nefropatia. Os sinais de hepatotoxicidade foram mais frequentes em homens. As diferenças entre sexos foram todas estatisticamente significantes. Com relação à APS, apenas o atributo "grau de afiliação" apresentou escore elevado. Nenhum dos casos de intoxicação detectados no estudo tinha diagnóstico prévio. CONCLUSÕES A despeito de uma alta cobertura da Estratégia Saúde da Família, o risco ocupacional e suas consequências não têm sido detectados pelos serviços de saúde, que se apresentam como não orientados à atenção primária, carecendo mesmo de seus atributos essenciais. Percebe-se a necessidade de adequação imediata e efetiva das políticas públicas no que concerne à saúde do trabalhador rural, com adequada capacitação das equipes e revisão da carteira de serviços da APS ofertados.


Subject(s)
Humans , Male , Female , Adult , Pesticides/toxicity , Primary Health Care/statistics & numerical data , Occupational Exposure/statistics & numerical data , Agricultural Workers' Diseases/chemically induced , Rural Population , Socioeconomic Factors , Brazil/epidemiology , Rural Health , Family Health , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Occupational Exposure/adverse effects , Agricultural Workers' Diseases/epidemiology , Personal Protective Equipment , Insecticides/poisoning , Middle Aged
18.
Article in English | LILACS | ID: biblio-1058880

ABSTRACT

ABSTRACT OBJECTIVE To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.


RESUMO OBJETIVO Avaliar o desempenho da atenção integral ao idoso em serviços de atenção primária do Sistema Único de Saúde no estado de São Paulo, Brasi lMÉTODOS Um total de 157 serviços de atenção primária de cinco regiões de saúde do centro-oeste paulista respondeu, de outubro a dezembro de 2014, o instrumento pré-validado Questionário de Avaliação e Monitoramento de Serviços de Atenção Básica 2014. Foram selecionadas 155 questões, com base nas políticas e diretrizes nacionais sobre essa temática. As respostas indicam o desempenho do serviço na atenção ao idoso, agrupadas em três domínios de análise: atenção à saúde para o envelhecimento ativo e saudável (45 indicadores, d1), atenção às doenças crônicas não transmissíveis (89 indicadores, d2) e rede de apoio na atenção ao envelhecimento (21 indicadores, d3). A medida de desempenho foi a soma de respostas positivas (valor 1) ou negativas (valor 0) para cada indicador. Os serviços foram agrupados segundo k-médias dos escores de desempenho de cada um dos domínios. Após a ponderação dos domínios (testes Z), foram estimadas as associações entre os escores de cada domínio e variáveis independentes de gestão (tipologia, planejamento e avaliação dos serviços), por meio de regressão linear simples e múltipla. RESULTADOS A atenção às doenças crônicas não transmissíveis (d2) mostrou, para todos os agrupamentos, melhor desempenho médio (55,7) do que os domínios d1 (35,4) e d3 (39,2). O desempenho do serviço na área geral de planejamento e avaliação esteve associado ao desempenho da atenção ao idoso. CONCLUSÕES Os serviços avaliados apresentaram implementação incipiente da atenção integral ao idoso. O quadro avaliativo pode contribuir para processos de melhoria da qualidade da atenção primária à saúde.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Primary Health Care/statistics & numerical data , Comprehensive Health Care/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Health Services for the Aged/statistics & numerical data , Primary Health Care/organization & administration , Brazil , Cross-Sectional Studies , Cohort Studies , Comprehensive Health Care/organization & administration , Health Services Accessibility/organization & administration , Health Services for the Aged/organization & administration , Middle Aged , National Health Programs
19.
Rev. saúde pública (Online) ; 54: 18, 2020. tab, graf
Article in English | LILACS | ID: biblio-1058882

ABSTRACT

ABSTRACT OBJECTIVE This study aimed to identify the treatment demands coming from primary health care units and, based on that, the demand for referrals to medical specialties in reference services. This study is justified by the scarcity of scientific literature on the subject. METHODS This is a cross-sectional study using secondary data on the treatments and referrals made by the primary health care units, throughout 2014, in a municipality of the State of São Paulo, Brazil. The total population treated in 2014 was considered, resulting in 411,177 treatments. RESULTS Out of all treatments performed, the percentage of referrals was of 4.42%, showing that 95,58% of the problems did not need to be referred to another service. A number of 8,897 referrals were made, to 6,850 users, who were mostly women (60.74%). The mean of referrals per patient was 1.3 (min. 1 and max. 8), and 1,604 patients (23.5%) were referred at least twice. CONCLUSIONS Primary health care services have been responsible for a large number of treatments, whereas the demand for referrals has decreased, suggesting that such services have established themselves as a gateway to the health system and achieved the expected solvability, although the waiting time for some specialties is very long.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Primary Health Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Waiting Lists , Health Services Needs and Demand/statistics & numerical data , Specialization , Brazil , Cross-Sectional Studies , Middle Aged
20.
Rev. saúde pública (Online) ; 54: 32, 2020. tab, graf
Article in English | LILACS | ID: biblio-1094411

ABSTRACT

ABSTRACT OBJECTIVE To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03) CONCLUSION Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Primary Health Care/statistics & numerical data , Hospitalization/statistics & numerical data , Pneumonia/therapy , Pneumonia/epidemiology , Asthma/therapy , Asthma/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Cross-Sectional Studies , Delivery of Health Care/statistics & numerical data , Diarrhea/therapy , Diarrhea/epidemiology
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