Impact of Healthcare Location Concordance on Receipt of Preventive Care Among Children Whose Parents have a Substance Use and/or Mental Health Diagnosis.

AIMS: Children of parents with substance use and/or other mental health (SU/MH) diagnoses are at increased risk for health problems. It is unknown whether these children benefit from receiving primary care at the same clinic as their parents. Thus, among children of parents with >1 SU/MH diagnosis, we examined the association of parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations. DESIGN: Retrospective cohort study using electronic health record (EHR) data from the OCHIN network of community health organizations (CHOs), 2010-2018. Setting: 280 CHOs across 17 states. PARTICIPANTS/CASES: 41,413 parents with >1 SU/MH diagnosis, linked to 65,417 children aged 0 to 17 years, each with >1 visit to an OCHIN clinic during the study period. MEASUREMENTS: Dependent variables: rates of WCCs during (1) the first 15 months of life, and (2) ages 3 to 17 years; vaccine completeness (3) by the age of 2, and (4) before the age of 18. Estimates were attained using generalized estimating equations Poisson or logistic regression. FINDINGS: Among children utilizing the same clinic as their parent versus children using a different clinic (reference group), we observed greater WCC rates in the first 15 months of life [adjusted rate ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02-1.10]; no difference in WCC rates in ages 3 to 17; higher odds for vaccine completion before age 2 [adjusted odds ratio (aOR) = 1.12; 95% CI = 1.03-1.21]; and lower odds for vaccine completion before age 18 (aOR = 0.88; 95% CI = 0.81-0.95). CONCLUSION: Among children whose parents have at least one SU/MH diagnosis, parent-child clinic concordance was associated with greater rates of WCCs and higher odds of completed vaccinations for children in the youngest age groups, but not the older children. This suggests the need for greater emphasis on family-oriented healthcare for young children of parents with SU/MH diagnoses; this may be less important for older children.

A Qualitative Study of Two Oregon Family Medicine Clinics to Explain Parent and Child Healthcare Initiation and Engagement.

Background: Parental factors are associated with children's receipt of recommended care but not adequately described. Methods: We conducted a qualitative study of patients with at least two visits who were a primary caregiver for a child who also had at least two visits at the same clinic in 1/2018-12/2019 from two Oregon family medicine clinics. We stratified patients by child age and number of caregiver visits and randomly selected caregivers. Participants were interviewed in accordance with approval by our Institutional Review Board between 12/2020 and 4/2021. The data were analyzed using a grounded theory approach. Results: 12 caregivers (termed parents) were interviewed; half were single parents and three-quarters had a history of substance use disorder and/or a mental health condition. Parents focused on the importance of keeping themselves healthy to keep their families healthy. They described similar reasons for choosing to initiate and continue care for themselves and their children at the same clinic, including: convenience, trust, relationships, and receiving whole-person and whole-family care. Many valued having a healthcare "home" for their entire family. We developed a figure that highlights three themes that capture the interrelated factors parents identified as supporting healthcare use for themselves and their families. These overarching themes included: healthcare initiation; healthcare engagement and continuity; and parent bringing child to the same clinic for healthcare. Conclusion: Our data suggests that long-standing patient-clinic relationships for parents and children can support family-focused healthcare.

In-hospital interventions to promote relational practice with families in acute care settings: A scoping review.

Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families' needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions. Contribution: The scoping review has highlighted specific elements of relational practice that have been overlooked in the mapped interventions. This provides guidance on where future interventional research may be focused.

In-hospital interventions to promote relational practice with families in acute care settings: A scoping review

Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families' needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions. Contribution: The scoping review has highlighted specific elements of relational practice that have been overlooked in the mapped interventions. This provides guidance on where future interventional research may be focused.

Going blindly into the women's world: a reflective lifeworld research study of fathers' expectations of and experiences with municipal postnatal healthcare services.

Purpose: The aim of this study is to describe new fathers' expectations of and experiences with municipal postnatal healthcare services.Methods: A phenomenological reflective lifeworld research (RLR) approach has been used. Ten fathers were interviewed about their expectations of and experiences with municipal postnatal healthcare services, and the data were analysed to elucidate a meaning structure for the phenomenon.Results: The essential meaning of the phenomenon of fathers' expectations of and experiences with municipal postnatal health care described as going blindly into the women's world. The essential meaning is further explicated through its four constituents: not knowing what to ask for, feeling excluded, seeking safety for the family and longing for care.Conclusions: Entering the postnatal period with sparse knowledge about the child and family healthcare services available is difficult for the fathers who do not know what to ask for and what to expect. The fathers' feel excluded by the public health nurse, and the postnatal health care is seen as a mother-baby-public health nurse triad. The feeling of exclusion and inequality might be avoided if public health nurses focused both on mothers' and fathers' individual follow-up needs in the postnatal period and on seeing the newborn baby and the parents as a family unit.

Avaliação da estrutura das farmácias das Unidades de Saúde da Família para o atendimento aos portadores de hipertensão arterial sistêmica e diabetes mellitus em Pernambuco / Evaluation of the structure of the pharmacies in the family health units for the attendance of patients' systemic arterial hypertension and diabetes mellitus in Pernambuco

Resumo Introdução A hipertensão arterial e o diabetes mellitus são enfermidades crônicas que necessitam de cuidados contínuos e uso adequado de medicamentos para seu efetivo controle. A estrutura existente nas farmácias influencia no acesso, dispensação e armazenamento dos medicamentos e interfere na qualidade final da atenção. Objetivo Avaliar a estrutura das farmácias das Unidades de Saúde da Família no cuidado à hipertensão arterial e diabetes mellitus em Pernambuco, 2016. Método Estudo avaliativo do componente estrutura do modelo proposto por Donabedian. Entrevistou-se o responsável pela farmácia de uma amostra probabilística das equipes de saúde da família com questões sobre estrutura física, insumos e recursos humanos. Realizaram-se análises descritiva e de associação para verificar diferenças entre capital e interior. Resultados Mais de 90% das farmácias funcionavam nos turnos de manhã e tarde. Apenas 5,7% na capital e 2,7% no interior possuíam farmacêutico como responsável pelo serviço; essa atividade era desempenhada por outros profissionais, a maioria de nível médio e sem capacitação. A capital possuía maior variedade de medicamentos, contudo eles não eram suficientes para a demanda. Conclusão Identificaram-se problemas na estrutura das farmácias, principalmente na capacitação de recursos humanos e disponibilidade de insumos com poucas diferenças entre capital e interior.

Abstract Background Hypertension and diabetes mellitus are chronic diseases that require continuous care and the adequate use of medicines for effective control. The existing structure of pharmacies influences the access, dispensing, and storage of medicines and influence the quality of care. Objective To evaluate the structure of the pharmacies in the family health units in the care of arterial hypertension and diabetes mellitus in Pernambuco, 2016. Method This study is an evaluation of the structure component according to a model proposed by Donabedian. The person responsible for pharmacy from a probabilistic sample of family health teams was interviewed with questions about the physical structure, supplies, and human resources. A descriptive and association analysis was carried out to verify the differences between capital and interior. Results More than 90% of the pharmacies were operating in the mornings and afternoon shifts. Only 5.7% of the pharmacies in the capital and 2.7% in the interior had a pharmacist as responsible for service; this activity was performed by other professionals, most of whom were middle-level and without qualification. The capital had a greater variety of medicines; however, the quantities were insufficient for demand. Conclusion Problems in the pharmacies structure were identified, mainly in the training of human resources and supplies' availability with few differences between capital and interior.

Pobreza e desigualdades sociais: tensões entre direitos, austeridade e suas implicações na atenção primária / Poverty and social inequality: tensions between rights and austerity and its implications for primary healthcare

Resumo As relações entre pobreza e saúde são percebidas no cotidiano da sociedade brasileira, constituindo faces das desigualdades de um contexto social perverso. Este artigo é uma revisão da literatura sobre a política de saúde, especificamente no âmbito da atenção primária, evidenciando as tensões entre a questão social, os direitos sociais, as atuais políticas de austeridade e suas implicações nos cuidados em saúde da população mais pobre. A partir da Constituição de 1988, celebra-se um pacto social, que entra em contradição com as políticas de austeridade impostas pelo neoliberalismo. Com o agravamento da crise do capital e a Emenda Constitucional 95/2016, as políticas de proteção social pautadas na seguridade social, como o Sistema Único de Saúde, encontram-se ameaçadas, com consequências diretas para a população. Mesmo reconhecendo as conquistas no acesso à saúde da população mais pobre, as barreiras que atravessam essa realidade podem ser agravadas, pondo em risco os direitos conquistados. Portanto, ao considerar a Atenção Primária à Saúde como modelo de cuidado diferenciado, reitera-se sua relação com a dimensão social, uma vez que já se fazem sentir os impactos do desmonte das políticas sociais na saúde da população.

Abstract The relationship between poverty and healthcare is evident in Brazilian society, constituting one of the faces of the inequalities resulting from a perverse social context. Focusing specifically on primary healthcare, this review of the literature on health policy highlights the tensions between the social question, social rights, and current austerity policies, and the latter's effects on healthcare for the poorest segments of the population. The 1988 Constitution represents a social pact that goes against the principles of austerity policies imposed by neoliberalism. With the deepening financial crisis and approval of Constitutional Amendment 95/2016, social protection policies such as those underpinning Brazil's national health system ("Sistema Único de Saúde") find themselves under threat, with direct consequences for the country's population. Despite the country's achievements in improving access to healthcare for the poorest, austerity measures are likely to strengthen barriers, seriously threatening the progress made in operationalizing the right to health. Therefore, considering that primary healthcare is a differentiated care model, this study reiterates the relationship between primary care and the social dimension, given that the impacts of the dismantling of social policies on population health are already being felt.

A influência da Estratégia Saúde da Família no uso de serviços de saúde por crianças no Brasil: análise com escore de propensão dos dados da Pesquisa Nacional de Saúde / The influence of the Family Healthcare Strategy in the use of healthcare services by children in Brazil: an analysis using the Propensity Score Matching (PSM) method of National Health Survey data

Resumo Este estudo verificou a influência da Estratégia Saúde da Família (ESF) no uso de serviços de saúde por crianças brasileiras menores de 5 anos de idade entrevistadas na Pesquisa Nacional de Saúde (PNS) 2013. Utilizou-se o método de Escore de Propensão (EP) para corrigir a falta de comparabilidade entre os grupos de crianças em estudo. O EP foi estimado por meio de regressão logística e reflete a probabilidade condicional de receber o cadastro na ESF dado um conjunto de covariáveis que retratam aspectos socioeconômicos, demográficos, sanitários e de saúde das crianças e das famílias que estes compõem. Foram estimadas as prevalências de consultas médicas e de internações hospitalares e incorporaram-se os efeitos da amostragem complexa da PNS em todas as fases da análise. Verificou-se que as crianças residentes de domicílios com cobertura da ESF têm piores condições socioeconômicas, sanitárias e de saúde, porém elas tiveram estimativas de consultas médicas e de internações hospitalares próximas a de crianças sem esse vínculo assistencial. Os dados sugerem que ESF pode corrigir desigualdades individuais e contextuais que impactam a saúde dos brasileiros ao favorecer o uso de serviços de saúde por crianças mesmo quando possuem piores condições de vida e saúde.

Abstract The scope of this study was to establish the influence of the Family Healthcare Strategy (FHS) in the use of health services for Brazilian children under 5 years of age interviewed in the 2013 National Health Survey (NHS). The Propensity Score Matching (PSM) method was used to correct the lack of comparability between the groups of children under scrutiny. The PSM was estimated by logistic regression and reflects the conditional probability of receiving registration in the FHS given a set of covariates that depict the socioeconomic, demographic, sanitary and health aspects of children and families who comprise same. The prevalence of medical visits and hospitalizations were estimated and incorporate the effects of the complex sample of NHS on all phases of analysis. It was found that children living in households with FHS coverage have worse socioeconomic, sanitary and health conditions, although they had options of medical appointments and hospitalizations close to the children without this healthcare link. The data suggest that the FHS can correct individual and contextual inequalities that impact the health of Brazilians by promoting the use of health services for children even when they have worse living and health conditions.

Aspectos que Compõem o Perfil dos Profissionais Médicos da Estratégia Saúde da Família: o Caso de um Município Polo de Minas Gerais / Aspects of the Family Health Care Professionals' Profile: the Case of a Municipal Hub in Minas Gerais

RESUMO Estudo quali-quantitativo, de abordagem exploratória, que buscou identificar o perfil do médico da Estratégia Saúde da Família no município de Governador Valadares, bem como sua formação e características do seu trabalho. Foram realizadas entrevistas semiestruturadas com 36 médicos de equipes de Saúde da Família nesse município. Utilizou-se a estatística descritiva simples e análise de conteúdo, modalidade temático-categorial, para a organização e análise dos dados coletados. Os resultados indicaram a predominância do sexo feminino, e apontaram profissionais brasileiros com idades entre 24 e 35 anos, com formação em instituição pública, com especialização na área de Medicina de Família. A maioria dos entrevistados pertence ao Programa Mais Médicos, com tempo de permanência na mesma equipe de até três anos. As vantagens destacadas foram identificação com a proposta de trabalho e valorização profissional, ao passo que as desvantagens apontadas foram vínculo empregatício instável, desamparo da gestão, local de atuação de difícil acesso e excesso de cobranças. Foram relatados como pontos facilitadores o trabalho em equipe e boa relação com a comunidade, enquanto a falta de recursos humanos e materiais, de equipamentos, financeiros e de tecnologia é um dos pontos dificultadores. Salienta-se a importância da atenção da gestão diante dessas dificuldades a fim de adequar a infraestrutura das unidades de saúde para proporcionar um trabalho que colabore para a mudança da saúde da população do território adscrito. É necessário repensar a maneira de incentivar o médico a permanecer na Estratégia Saúde da Família, com segurança e perspectivas no trabalho. Cabe salientar a importância do perfil desse médico, que, muitas vezes, teve uma formação diferente da preconizada nas Diretrizes Curriculares Nacionais do Curso de Medicina, o que dificulta a resolução dos problemas apontados neste estudo, haja vista o desconhecimento do papel da atenção primária, da importância da integração da rede de saúde e dos atributos do médico nesse nível de atenção.

ABSTRACT This study is an exploratory, mixed methods study aimed at identifying the profile of family health care physicians in the municipality of Governador Valadares, Minas Gerais, Brazil, as well as his/her training and work characteristics. We conducted semi-structured interviews with 36 physicians from family health care teams, using simple descriptive statistics and content analysis in a thematic-categorical mode to organize and analyze the data. The results indicated a predominance of female, Brazilian professionals aged between 24 and 35 years, trained in public institutions and specialized in the field of Family Medicine. Most interviewees belong to the Mais Médicos Program , and have remained in the same team for up to 3 years. The prominent advantages were the identification of the professionals with the work proposal and professional valuation, while the disadvantages were the unstable employment relationship, disregard by management, workplace of difficult access, and excessive demands imposed on them. The facilitating points were teamwork and good relationship with the community, while the most challenging points were the lack of human resources, equipment, finances, and technology. We highlight the importance of the attention given by management to the difficulties to adapt the infrastructure of the Health Care Units and provide a work that contributes to change the health care of the population in this region. Therefore, it is necessary to rethink how physicians can be encouraged to remain in the Family Health Care Strategy, providing them with enhanced job security and prospects. However, it is worth underlining the importance of the profile of family doctors, whose training often diverges from the National Curricular Directives for medical training. These differences make it challenging to solve the issues indicated in this study due to the lack of knowledge about the role of primary healthcare, the importance of integration of the health care network, and lack of knowledge about the physician's attributes at this level of care.

Between hope and hopelessness: COPD patients' and their family members' experiences of interacting with healthcare providers - a qualitative longitudinal study.

BACKGROUND: Patient-family-healthcare provider interaction seems important for patients with chronic obstructive pulmonary disease (COPD) and their family members' self-management practices. Because the need for support might be enhanced after a hospitalisation, it might be beneficial to explore this interaction further in follow-up health care. AIM: To explore the meaning of patients' and their family members' experiences of interacting with healthcare providers to their daily self-management over time. METHODS: Participant observations and in-depth interviews were conducted repeatedly with 10 patients and seven family members during follow-up visits at hospital and at the participants' homes between 2014 and 2016. A phenomenological-hermeneutical approach was used to interpret the data. RESULTS: 'Between hope and hopelessness' involved frustrations, concerns and doubts, all of which could relate to the interaction with healthcare providers. 'Seeking support from healthcare services', 'navigating between healthcare providers' and 'collaborating with healthcare providers at home' could entail opportunities to strengthen self-management and hope; however, it could also entail reduced faith in getting the right help and hopelessness. CONCLUSION: During a period of transition after hospitalisation, available and well-coordinated healthcare services, and alliances with healthcare professionals are crucial to COPD patients and their family members in terms of their self-management, hope and well-being.

Patients' attitudes and knowledge about drug use: a survey in Turkish family healthcare centres and state hospitals

Background/aim: Irrational drug use is a common problem. This study aimed to evaluate patients' knowledge and habits concerning drug use, and compare them in terms of some sociodemographic characteristics. Materials and methods: A face-to-face questionnaire was given to outpatients from family healthcare centres (FHCs) and state hospitals (SHs) in 12 provinces in Turkey during May 2010. A total of 4470 patients (FHCs: 2209; SHs: 2261) responded to the questionnaire (response rate: 93.1%). Results: Getting prescriptions without a physical examination was common (second place in FHCs; third place in SHs); 51.0% stated that they wanted physicians to prescribe drugs that they had used before. More than half stated that antibiotics cured every illness. In addition, 55.9% reported that their relatives recommended drugs to them when they got ill; 37.1% reported that they recommended them to relatives as well. Of the survey respondents, 70.5% stated that they had stopped their medications before the recommended time. Patients' knowledge and attitudes about drug use showed significant differences in comparisons of sex, age, educational level, and social security. Conclusion: Patients' knowledge and attitudes about drugs were far from rational. To eliminate irrational use of drugs, public education about drug use is needed.

Unidades de Saúde Familiar e Clínicas da Família - essência e semelhanças / Family Healthcare Units in Portugal and Family Clinics in Rio de Janeiro - their essence and similarities

Resumo O desenvolvimento, desde 2009, das Clínicas da Família (CF) no Rio de Janeiro tem paralelismos com as Unidades de Saúde Familiar (USF) implementadas em Portugal desde 2006. Neste ensaio, os autores assinalam o encontro em Portugal, em outubro de 2009, com gestores do Ministério da Saúde e da Subsecretaria de Atenção Primária, Vigilância e Promoção da Saúde do Rio de Janeiro, e destacam alguns aspetos essenciais tais como: a organização em equipes multiprofissionais com caráter estrutural permanente; as características das equipes; o seu desenvolvimento ("teambulding"); a organização e a autonomia técnica; os laços emocionais entre os elementos de cada equipe; os instrumentos formais de regulação da autonomia; a responsabilização e a prestação de contas/contratualização; os dispositivos de monitorização e de avaliação; o sistema de lideranças; fatores motivacionais dos profissionais e das equipes; as USF e as CF como organizações aprendentes. Estes aspectos podem resumir-se em "3P": propósitos, orientação para objetivos de saúde e de bem estar; pessoas, que são a razão das organizações de saúde; processos, continuamente questionados, avaliados e aperfeiçoados.

Abstract The authors address parallel developments in Family Healthcare Units (USF) in Portugal (since 2006) and in primary care Family Clinics (CF) in Rio de Janeiro (since 2009). In this essay, they highlight the meeting that took place in Portugal with Brazilian Health Ministry and Rio de Janeiro Department of Health members in October 2009. Being directly involved (since May 2016) in the development of USF in the Lisbon Region, and having visited, in November 2016, several CF in Rio de Janeiro, they analyze aspects such as: organization in permanent structural multi-professional teams; main common characteristics of the teams; teambuilding processes; organization and technical autonomy; instruments to regulate autonomy; responsibility and accountability - contracting processes; monitoring and evaluation; leadership system; motivational factors for professionals and for the team as a whole; learning organizations. All these aspects converge to a "3P" framework: "purposes" - organizing and orienting multi-professional teams towards health gains and the wellbeing of the individuals and the population; "people" - both those who are beneficiaries of health care services, as well as the health care professionals; "processes" - that must be permanently questioned, evaluated and enhanced.

Pediatric Traumatic Brain Injury: Families and Healthcare Team Interaction Trajectories During Acute Hospitalization.

PURPOSE: To identify common or unique family-healthcare team interactions during acute hospitalization for pediatric patients with a traumatic brain injury (TBI) using a life course trajectory (LCT) theoretical approach. DESIGN AND METHODS: A 3-year prospective observational study of 35 children, ages 5 days to 15 years who were admitted to an urban Level-1 trauma hospital for a TBI. We defined brain injury severity using the admission Glasgow Coma Scale score (mild 13-15, moderate 9-12, and severe 3-8). Using a life course trajectory theoretical approach, we extracted from the patient's electronic health record the first eight-days of hospitalization and plotted the number and type of daily family-healthcare team interactions to visualize patterns or phases. RESULTS: A general trajectory for each severity group was determined. When individually compared, family trajectories were similar based on injury severity. Visual interpretations of family-healthcare interactions based on the brain injury severity yielded three phases. The interactions phases included: (1) information seeking, (2) watchful waiting and (3) decision making. CONCLUSION: Using a LCT approach, phases identified based on injury severity and family interactions support the need for proper timing of tailored communication and support. The findings also support the development of future best care practices that facilitate family's needs, decrease caregiver burden to improve functional outcomes.

Time-Series Analysis of the Medical District Through the Establishment of Family Healthcare Clinics -A Case Study in Kikukawa City, Shizuoka Prefecture- / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>To regenerate the problematic regional healthcare system in Japan, the introduction of family healthcare doctors and clinics has been focused on recently. This study revealed the effects of the establishment of family healthcare clinics through a time-series analysis of the medical district in Kikukawa city, Shizuoka prefecture.</p><p><b>Methods: </b>To know the change of outpatient visits before and after the establishment of a family healthcare clinic (K clinic), health insurance claims for the existing K hospital and new K clinic were analyzed. Claims were collected for 3 years before and after the establishment of K clinic at 3 months intervals.</p><p><b>Results: </b>Based on the analysis of the number of patients and their attributes, migration from K hospital to K clinic after the establishment of K clinic was low. The clinic is especially favored by neighboring elderly people.</p><p><b>Conclusion: </b>There is a clear distinction between a hospital and a clinic in accordance with their differences of expected functions.</p>

Avaliação da estratégia saúde da família na perspectiva dos profissionais de saúde / Evaluation of the family healthcare strategy from the perspective of health professionals / Evaluación de la estrategia de salud de la familia en la perspectiva de profesionales de salud

Objetivo: Avaliar a qualidade da Estratégia Saúde da Família (ESF) através dos atributos da Atenção Primária na perspectiva dos profissionais de saúde e verificar associação entre esses atributos e as características sociodemográficas e profissionais da equipe. Métodos: Estudo seccional, realizado nas unidades de saúde da família do município de Serra, Espírito Santo. Para coleta de dados utilizou-se questionário denominado de Instrumento de Avaliação da Atenção Primária (PCATool). O instrumento foi aplicado a 205 profissionais atuantes nas equipes de saúde da família. Para verificar associações realizaram-se os testes Exato de Fisher e Qui-quadrado de Pearson. Resultado: As dimensões melhor avaliadas foram: a orientação familiar e a longitudinalidade. A associação entre o atributo essencial e o nível de instrução e experiência anterior na ESF foi significativa. Conclusão: Os profissionais percebem a atenção ofertada de maneira positiva, contribuindo para o fortalecimento e humanização da atenção básica.

Objective: To evaluate the quality of the Family Health Strategy (FHS) by the attributes of Primary Healthcare in the healthcareprofessional's perspective; and to VERIFY the association between These attributes and the socio-demographic and professionalcharacteristics of the FHS staff. Methods: This is a cross-sectional study. For data collection, the questionnaire That Is validatedin Brazil was used, called 'The Primary Care Assessment Tool' (PCATool). The instrument was applied to 205 professionalsacting in Family Healthcare Teams. To VERIFY the associations, the Fisher Exact Test, the Pearson chi-square test's, andlogistic regression Were used. Results: The dimensions more positively Were Evaluated: Family Instruction and Longitudinality.When Associating the essential attributes of Instruction Level and Previous Experience in the FHS was found to be significant.Conclusion: The professionals perceive the attention offered the successful, contributing positively to strengthening andhumanizing basic healthcare.

Objetivo: Evaluar la calidad de la Estrategia Salud de la Familia a través de los atributos de la Atención Primaria en la perspectivade los profesionales de la salud y verificar la asociación entre eses atributos y las características sociodemográficas y profesionalesdel equipo. Métodos: Estudio seccional, realizado en las unidades de salud de la familia del municipio de Serra, Espírito Santo.Para colecta de datos se utilizó 'Herramienta de Evaluación de los Cuidados Primarios'(PCATool). Fue aplicado a 205 profesionalesen los equipos de salud de la familia. Para verificar asociaciones, se realizaron los testes Exacto de Fisher y Qui-quadrado dePearson. Resultado: Las dimensiones mejor evaluadas han sido: la instrucción familiar y la longitudinalidad. La asociación entreel atributo esencial y el nivel de instrucción y experiencia anterior en la ESF fue significativa. Conclusión: Los profesionalesven la atención ofrecida de manera positiva, contribuyendo para el fortalecimiento y la humanización de la atención básica.

Potencialidades da Residência Multiprofissional em Saúde da Família: o olhar do trabalhador de saúde / Potential of multiprofessional residency for family healthcare: the view of healthcare workers / Potencialidades de la Residencia Multi-profesional en Salud de la Familia: la mirada del trabajador de la salud

Para a consolidação da proposta da Residência Multiprofissional em Saúde da Família (RMSF), torna-se imprescindível a participação do profissional de saúde atuante no serviço. Assim, o objetivo deste estudo foi revelar a percepção do trabalhador de saúde sobre as potencialidades da inserção da RMSF nas Unidades de Saúde da Família (USF). Trata-se de um estudo qualitativo, realizado com 25 trabalhadores das USF contempladas com a RMSF. Os discursos revelaram que a atuação dos residentes nas USF foi potente para induzir mudanças no processo de trabalho destas e para a formação de profissionais capacitados para atuar na Estratégia Saúde da Família (ESF). Deste modo, a residência contribui para que a ESF se torne um dispositivo de mudança do modelo de assistência à saúde e constitui uma forma de operar o proposto na Política de Educação Permanente em Saúde (EPS)...

To consolidate the proposal of multiprofessional residency for family healthcare (MRFH), participation by healthcare professionals working in this service becomes essential. Thus, the objective of this study was to reveal healthcare workers’ perceptions about the potential for inserting MRFH in family healthcare units (FHUs). This was a qualitative study, conducted among 25 workers at FHUs covered by MRFH. The discourse revealed that the actions of residents at FHUs had the power to induce changes in the work process at FHUs and to train professionals who would be qualified to act within the family health strategy (FHS). Thus, residency contributes towards making the FHS a tool for changing the healthcare model and constitutes a way of operating the proposals of the continuing health education policy...

Para la consolidación de la propuesta de la Residencia Multi-profesional en Salud de la Familia (RMSF) resulta imprescindible la participación del profesional de la salud que actúa en el servicio. De tal forma, el objetivo de este estudio fue el de revelar la percepción del trabajador de la salud sobre las potencialidades de la inserción de la RMSF en las Unidades de Salud de la Familia (USF). Se trata de un estudio cualitativo, realizado con 25 trabajadores de las USF que cuentan con la RMSF. Los discursos revelaron que la actuación de los residentes en las USF tuvo gran fuerza para inducir cambios en el proceso de trabajo de las mismas y para la formación de profesionales capacitados a actuar en la Estrategia Salud de la Familia (ESF). Siendo así, la residencia contribuye para que la ESF pase a ser un dispositivo de cambio del modelo de asistencia a la salud y constituye una forma de operar lo propuesto en la Política de Educación Permanente en Salud (EPS)...

An assessment of primary care attributes from the perspective of female healthcare users / Avaliação dos atributos da atenção primária na perspectiva das usuárias que vivenciam o cuidado / Evaluación de los atributos de la atención primaria en la perspectiva de las usuarias que experimentan el cuidado

this study sought to assess the quality of the Family Health Strategy (FHS) and investigated the association between primary care attributes (PCAs) and the sociodemographic characteristics of users.

avaliar a qualidade da Estratégia Saúde da Família e verificar a associação dos atributos da atenção primária com as características sociodemográficas das usuárias.

evaluar la calidad de la Estrategia Salud de la Familia y verificar la asociación de los atributos de la atención primaria con las características sociodemográficas de las usuarias.

Desenvolvimento de instrumentais para avaliação da estratégia saúde da família em Natal / Development of instruments for assessing the family health strategy in Natal-RN

A Estratégia Saúde da Família (ESF) é a principal porta de entrada dos serviços do Sistema Único de Saúde, necessitando ser constantemente avaliada para seu aperfeiçoamento. Dessa forma, a presente pesquisa correlacional objetivou avaliar a ESF apreendendo as crenças de seus profissionais, criando um novo instrumento, contando com uma amostra probabilística de 475 profissionais. O novo instrumento com 24 itens, com escala de notas (0 a 10), possui três fatores, todos mal avaliados pelas notas dos profissionais: (a) infraestrutura física (alpha=0,84), com 4,37 (± 1,61); (b) recursos materiais (alpha=0,85), nota 5,42 (± 1,47); e (c) eficiência no atendimento (alpha=0,82), com 3,99 (± 1,35). Conclui-se que a nova escala é relevante e que há necessidade de mudanças nos entraves na operacionalização dos serviços na ESF.

Family Health Strategy (FHS) is the main gateway to the Brazilian National Healthcare System services which needs to be constantly evaluated for its improvement. Therefore, this correlational study aimed to evaluate the FHS, understanding the beliefs of the professionals involved, creating a new instrument and counting with a probability sample of 475 professionals. The new instrument composed by 24 items, with grading scale (0 to 10), has three factors. All of them were poorly evaluated by scores given by the professionals: (a) physical infrastructure (alpha = .84) got 4.37 (± 1.61); (b) material resources (alpha = .85), grade 5.42 (± 1.47); and (c) health care efficiency (alpha = .82) got 3.99 (± 1.35). It is concluded that the new scale is relevant, but there is also the need for changes in the barriers found in the operationalization of the FHS service.

Desenvolvimento de instrumentais para avaliação da estratégia saúde da família em Natal / Development of instruments for assessing the family health strategy in Natal-RN

A Estratégia Saúde da Família (ESF) é a principal porta de entrada dos serviços do Sistema Único de Saúde, necessitando ser constantemente avaliada para seu aperfeiçoamento. Dessa forma, a presente pesquisa correlacional objetivou avaliar a ESF apreendendo as crenças de seus profissionais, criando um novo instrumento, contando com uma amostra probabilística de 475 profissionais. O novo instrumento com 24 itens, com escala de notas (0 a 10), possui três fatores, todos mal avaliados pelas notas dos profissionais: (a) infraestrutura física (alpha=0,84), com 4,37 (± 1,61); (b) recursos materiais (alpha=0,85), nota 5,42 (± 1,47); e (c) eficiência no atendimento (alpha=0,82), com 3,99 (± 1,35). Conclui-se que a nova escala é relevante e que há necessidade de mudanças nos entraves na operacionalização dos serviços na ESF.(AU)

Family Health Strategy (FHS) is the main gateway to the Brazilian National Healthcare System services which needs to be constantly evaluated for its improvement. Therefore, this correlational study aimed to evaluate the FHS, understanding the beliefs of the professionals involved, creating a new instrument and counting with a probability sample of 475 professionals. The new instrument composed by 24 items, with grading scale (0 to 10), has three factors. All of them were poorly evaluated by scores given by the professionals: (a) physical infrastructure (alpha = .84) got 4.37 (± 1.61); (b) material resources (alpha = .85), grade 5.42 (± 1.47); and (c) health care efficiency (alpha = .82) got 3.99 (± 1.35). It is concluded that the new scale is relevant, but there is also the need for changes in the barriers found in the operationalization of the FHS service.(AU)

A experiência dos diários reflexivos no processo formativo de uma residência multiprofissonal em saúde da família / La experiencia de los diarios reflexivos en el proceso de formación de una Residencia Multi-profesional en Salud de la Familia / The experience of reflective diaries in the training process of Multiprofessional Residence in Family Healthcare

O diário reflexivo foi adotado na Residência Multiprofissional em Saúde da Família da Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (Ensp/Fiocruz), Rio de Janeiro, Brasil. Durante dois anos acompanhamos uma equipe multiprofissional de três residentes em um módulo da Estratégia de Saúde da Família (ESF), buscando compreender as origens do instrumento no diário de campo da antropologia e no portfólio reflexivo da educação. O instrumento mostrou-se eficaz, possibilitando acompanhar as atividades práticas e a atuação das equipes e fornecendo subsídios para avaliação dos estudantes como recurso para a reformulação da prática; também propicia o desenvolvimento dos princípios éticos e da relação para com os indivíduos e comunidade. No momento em que os alunos se viram diante do desafio de enfrentar a realidade, o dia a dia da comunidade, ficou clara a importância do Diário.

Reflective diaries were brought into use for Multiprofessional Residence in Family Health at the National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Over a two-year period, we monitored a multiprofessional team of three residents at a Family Health Strategy module, seeking to understand the origins of this tool in anthropological field diaries and in reflective portfolios within education. The tool was shown to be effective tool and made it possible to monitor the practical activities and operations of teams. It provided support for assessing the students as a resource for reformulation of practice, and for developing ethical principles and relationships with individuals and the community. At the time when the students were faced with the challenge of dealing with reality, i.e. the daily life of the community, the importance of the diary became clear.

Presentamos el diario reflexivo adoptado en la Residencia Multi-profesional en Salud de la Familia de la Escuela Nacional de Salud Pública, Fundación Oswaldo Cruz, Rio de Janeiro, Brasil. Durante dos años seguimos un equipo multi-profesional de tres residentes en un módulo de la Estrategia de Salud de la Familia (ESF), buscando comprender sus orígenes en el diario de campo de la antropología y en el portafolio reflexivo de la educación. La herramienta se mostró eficaz en lo seguimiento de las actividades prácticas y la forma de actuar de los equipos. Provee subsidios para la evaluación de los estudiantes como recurso para la re-formulación de la práctica y de la relación para con los individuos y la comunidad. En el momento en que los alumnos se vieron ante el desafío de afrontar la realidad, el día a día de la comunidad, se quedó clara la importancia del diario.