Lisiane Hauser

Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil

PURPOSE To investigate the relation of hospitalization for ambulatory care sensitive conditions (ACSC) with the quality of public primary care health services in Porto Alegre, Brazil. METHODS Cohort study constructed by probabilistic record linkage performed from August 2006 to December 2011 in a population ≥18 years of age that attended public primary care health services. The Primary Care Assessment Tool (PCATool-Brazil) was used for evaluation of primary care services. RESULTS Of 1200 subjects followed, 84 were hospitalized for primary care sensitive conditions. The main causes of ACSC hospital admissions were cardiovascular (40.5%) and respiratory (16.2%) diseases. The PCATool average score was 5.3, a level considerably below that considered to represent quality care. After adjustment through Cox proportional hazard modelling for covariates, >60 years of age [hazard ratio (HR): 1.13; P = 0.001), lesser education (HR: 0.66; P = 0.02), ethnicity other than white (HR: 1.77; P = 0.01) and physical inactivity (HR: 1.65; P = 0.04) predicted hospitalization, but higher quality of primary health care did not. CONCLUSION Better quality of health care services, in a setting of overwhelmingly low quality services not adapted to the care of chronic conditions, did not influence the rate of avoidable hospitalizations, while social and demographic characteristics, especially non-white ethnicity and lesser schooling, indicate that social inequities play a predominant role in health outcomes.

Avaliação dos usuários crianças e adultos quanto ao grau de orientação para Atenção Primária à Saúde na cidade do Rio de Janeiro, Brasil

In the first half of 2014, 6,675 adults and caregivers of children using Primary Care (PC) services in Rio de Janeiro were interviewed using the Primary Care Assessment Tool - PCATool-Brazil. The aim was to arrive at an accurate overview of the extent to which PC services in all of the Planning Areas (PA) of the Rio de Janeiro City Health Department (CHD) – Municipal Health Secretariat have the essential and derivative attributes. This was a cross-sectional study of random, independent samples of the service users (children and adults). Results were measured using the scores assigned to PC attributes. In the opinion of adults and children using PC services, Type A Units – Municipal Healthcare Centers and Family Clinics staffed only with Family Health Teams, performed better than Type B units. The scores for the attributes “first contact accessibility”, “comprehensive service – services provided”, “community orientation” and “family orientation” still need to be improved. On the other hand “coordinated care” and “continuity” are on their way to quality scores, being always rated at around 6.0 or even higher.

Dimensionamento da amostra para a estimação da média de precipitação pluvial mensal em diferentes locais do Estado do Rio Grande do Sul

It was used data from 19 locations of the Rio Grande do Sul State, Brazil, collected from 1953 to 2007, with the objective to determine the sample size to estimate the average monthly rainfall. The central tendency, variability and asymmetry was calculated for each of the 228 time series (12 months x 19 locations) and the aleatory and normality data were tested. Then it was verified the homogeneity of variance among months in each locality and among places in each month and it was determined the sample size to estimate the average monthly rainfall in each month and locality. The sample size (number of years) to estimate the average monthly rainfall is dependent on the month and locality. One concluded that 51 years of data are enough to predict the average monthly rainfall, with an estimation error equal to 25% of estimated average, with a degree confidence of 95%.

Adaptação transcultural do instrumento Patient-Doctor Relationship Questionnaire (PDRQ-9) no Brasil

OBJETIVO Descrever o processo de adaptacao transcultural do Patient-Doctor Relationship Questionnaire (PDRQ-9), alem de comparar a concordância entre duas diferentes formas de aplicacao. METODOS Estudo transversal, com 133 usuarios adultos de uma Unidade Basica de Saude de Porto Alegre, RS. O PDRQ-9 foi respondido pelos participantes de maneira autoaplicada e por meio de entrevista. O […]ABSTRACT OBJECTIVE To describe the process of cross-cultural adaptation of the Patient-Doctor Relationship Questionnaire (PDRQ-9), as well as compare the agreement between two different types of application. METHODS This is a cross-sectional study with 133 adult users of a Primary Health Service in Porto Alegre, State of Rio Grande do Sul, Brazil. The PDRQ-9 was answered by the participants as a self-administered questionnaire and in an interview. The instrument was also validated by interview, using data from 628 participants of the Mais Médicos Program Evaluation Research, which is a cross-sectional study with a systematic sample of Primary Care Services in all regions of Brazil. We evaluated the semantic, conceptual, and item equivalence, as well as factor analysis and reliability. RESULTS All items presented factor loading > 0.5 in the different methods of application and populations in the factor analysis. We found Cronbach’s alpha of 0.94 in the self-administered method. We found Cronbach’s alpha of 0.95 and 0.94 in the two different samples in the interview application. The use of PDRQ-9 with an interview or self-administered was considered equivalent. CONCLUSIONS The cross-cultural adaptation of the PDRQ-9 in Brazil replicated the factorial structure found in the original study, with high internal consistency. The instrument can be used as a new dimension in the evaluation of the quality of health care in clinical research, in the evaluation of services and public health, in health management, and in professional training. Further studies can evaluate other properties of the instrument, as well as its behavior in different populations and contexts.

A qualidade da Atenção Primária à Saúde na Rocinha – Rio de Janeiro, Brasil, na perspectiva dos cuidadores de crianças e dos usuários adultos

Resumo O objetivo deste artigo e avaliar a extensao dos atributos da APS, desde a experiencia dos usuarios, tanto adultos quanto cuidadores de criancas, comparando a area atendida pelas unidades de saude do bairro da Rocinha com as demais areas do distrito sanitario 2.1, no municipio do Rio de Janeiro. O instrumento de medida utilizado para avaliar a qualidade dos servicos prestados foi o Primary Care Assement Tool. Foi realizado estudo transversal, com amostras aleatorias independentes, com 802 entrevistados. Os resultados apontam melhor desempenho para o cuidado das criancas, quando comparado aos adultos. Os atributos “acesso” e “integralidade – servicos disponiveis” foram aqueles que tiveram os piores desempenhos, provavelmente devido a grande migracao externa e interna existente dentro da propria Rocinha. Para melhoria desses atributos, recomendamos a adocao de uma lista unica de moradores por ESF, com um numero maximo de pessoas, contemplando alem da delimitacao territorial, a mobilidade interna das pessoas. Destacamos tambem a importância do fortalecimento do Programa de Residencia em Medicina de Familia e Comunidade, que desde 2012 forma especialistas, com apoio de preceptores, e viabiliza a ampliacao da oferta da carteira de servicos de APS.