Maria Aparecida Rodrigues

Desempenho do PSF no Sul e no Nordeste do Brasil: avaliação institucional e epidemiológica da Atenção Básica à Saúde

A pesquisa, desenvolvida dentro dos Estudos de Linha de Base do Proesf analisou o desempenho do Programa Saude da Familia (PSF) em 41 municipios dos Estados de Alagoas, Paraiba, Pernambuco, Piaui, Rio Grande do Norte, Rio Grande do Sul e Santa Catarina. Utilizou delineamento transversal, com grupo de comparacao externo (atencao basica tradicional). Entrevistou 41 presidentes de Conselhos Municipais de Saude, 29 secretarios municipais de Saude e 32 coordenadores de Atencao Basica. Foram caracterizados a estrutura e o processo de trabalho em 234 Unidades Basicas de Saude (UBS), incluindo 4.749 trabalhadores de saude; 4.079 criancas; 3.945 mulheres; 4.060 adultos e 4.006 idosos. O controle de qualidade alcancou 6% dos domicilios amostrados. A cobertura do PSF de 1999 a 2004 cresceu mais no Nordeste do que no Sul. Menos da metade dos trabalhadores ingressaram por concurso publico e o trabalho precario foi maior no PSF do que em UBS tradicionais. Os achados sugerem um desempenho da Atencao Basica a Saude (ABS) ainda distante das prescricoes do SUS. Menos da metade da demanda potencial utilizou a UBS de sua area de abrangencia. A oferta de acoes de saude, a sua utilizacao e o contato por acoes programaticas foram mais adequados no PSF.

Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões Sul e Nordeste do Brasil

O objetivo deste estudo foi avaliar a prevalencia de acesso a medicamentos de uso continuo para tratar hipertensao arterial sistemica, diabetes mellitus e/ou problemas de saude mental e fatores associados. Foi desenvolvido estudo transversal no âmbito do Projeto de Expansao e Consolidacao Saude da Familia (PROESF) em 41 municipios do Sul e Nordeste do Brasil. A amostra incluiu 4.060 adultos e 4.003 idosos residentes na area das unidades basicas de saude (UBS). A prevalencia de acesso a medicamentos de uso continuo em adultos foi de 81% e em idosos, 87%. O maior acesso entre os adultos da Regiao Sul esteve associado com maior idade, melhor nivel economico, tipo de morbidade cronica e participacao em grupos na UBS; entre os adultos do Nordeste, com hipertensao arterial sistemica exclusiva ou combinada com diabetes mellitus; entre os idosos do Sul, com maior escolaridade; entre os idosos do Nordeste, com maior idade, maior escolaridade, nao fumantes, vinculo com a UBS e modelo de atencao Programa Saude da Familia (PSF). Os resultados revelam importante iniquidade em saude, reforcando a necessidade de politicas para ampliar o acesso principalmente para populacoes de menor poder aquisitivo.

Modificações nos padrões de consumo de psicofármacos em localidade do Sul do Brasil

OBJETIVO: Avaliar a prevalencia e padrao de consumo de psicofarmacos pela populacao e comparar esses resultados com outro estudo de 1994. METODOS: Estudo transversal de base populacional, com 3.542 individuos de 15 anos ou mais, residentes na zona urbana de Pelotas em 2003. Os dados referentes ao consumo de duas semanas foram coletados em entrevistas domiciliares, utilizando um questionario identico ao utilizado em 1994. As variaveis estudadas foram: idade, sexo, cor da pele, situacao conjugal, renda familiar, escolaridade, tabagismo, diagnostico medico de hipertensao e consulta medica nos ultimos tres meses. Na analise bivariada, utilizou-se teste de qui-quadrado de Pearson e de tendencia linear. A analise multivariada foi composta por quatro niveis. RESULTADOS: A prevalencia de consumo de psicofarmacos foi de 9,9% (IC 95%: 8,9-10,9). Ao comparar as prevalencias padronizadas por idade, nao houve diferenca significativa em relacao a prevalencia observada em 1994. O maior consumo de psicofarmacos associou-se significativamente a: ser do sexo feminino, o aumento da idade, o diagnostico medico de hipertensao e a utilizacao de servicos medicos. Dos entrevistados, 74% dos usuarios estavam utilizando psicofarmacos ha mais de tres meses. CONCLUSOES: Apos uma decada, a prevalencia permanece alta, porem o consumo de psicofarmacos nao aumentou. Os achados sugerem a importância da indicacao adequada dos psicofarmacos e do acompanhamento medico regular desses usuarios, dada a associacao encontrada entre as consultas e o consumo.

Perfil sócio-demográfico e epidemiológico dos trabalhadores da atenção básica à saúde nas regiões Sul e Nordeste do Brasil

In order to describe the profile of primary health care teams in 41 municipalities with more than 100 thousand inhabitants each, a total of 4,749 health workers in two States from the South (1,730) and five from the Northeast (3,019) of Brazil were included from a sample of traditional primary care units and the Family Health Program (FHP). After providing informed consent, the health workers answered a self-applied questionnaire with demographic, work-related, and their own health-related data. The principal differences between the two models involved the structuring of the teams, with the FHP including more community health agents, more women, more young workers, fewer hired on the basis of formal admissions exams, more with a single job, more precarious employment arrangements, less employment satisfaction, less time on the job, larger workloads, greater specialization in the area, and better pay. The FHP also showed worse self-perceived health and more medical appointments. Management efforts are needed to support these workers, who form the basis of the health system and are key protagonists in the development and consolidation of primary care.

Avaliação de efetividade da Atenção Básica à Saúde em municípios das regiões Sul e Nordeste do Brasil: contribuições metodológicas

The article presents the methodology used in the Baseline Study that evaluated the effectiveness of the Family Health Strategy as compared to traditional primary health care units. The study included 41 municipalities with more than 100 thousand inhabitants each, 21 from the South and 20 from the Northeast of Brazil. As the principal dependent variable and underlying premise for sampling in the Baseline Study, the effectiveness of program activities in the primary care units was analyzed in the population within the respective coverage areas, using an epidemiological survey. The health care model in the primary care units was the principal independent variable. Its effect on program activities was controlled according to geopolitical region, metropolitan area, and population size in the municipalities. Coverage of the activities was characterized according to socioeconomic, demographic, and health-related factors. The use of comparison groups, multiple-stage samples, standardized measures, adjustment for geographic and socio-demographic characteristics, and well-defined criteria for judging the findings are contributions by the methodology employed here for designing future studies to evaluate primary health care.

Gender and incidence of functional disability in the elderly: a systematic review

This systematic review aimed to assess the effect of gender on the incidence of functional disability in the elderly. The search for publications in the MEDLINE, EMBASE, and ProQuest electronic databases from January 1990 to March 2008 identified 879 publications, from which 21 cohort studies were selected that evaluated gender as an independent variable and incidence of functional disability in elderly as the outcome. Review of the studies found that after adjusting for socioeconomic, health, and social relations indicators, incidence of functional disability was similar between genders. The main risk factors for functional disability in the elderly, regardless of gender, were: lack of schooling, living in rental housing, chronic diseases, arthritis, diabetes, visual impairment, body mass index above 25, poor self-perceived health, cognitive impairment, depression, slow gait, sedentary lifestyle, tiredness while performing daily activities, and limited diversity in social relations.

Necessidades de saúde comuns aos idosos: efetividade na oferta e utilização em atenção básica à saúde

A efetividade na oferta de servicos basicos e sua utilizacao por idosos abordada no Estudo de Linha de Base do Proesf conduzido pela UFPel incluiu 41 municipios dos Estados de Alagoas, Paraiba, Pernambuco, Piaui e Rio Grande do Norte, Rio Grande do Sul e Santa Catarina. O delineamento transversal caracterizou a estrutura e o processo de trabalho de 234 UBS, 4.749 trabalhadores e 4.003 idosos. Os indicadores sociais revelaram pior comportamento na regiao Nordeste e nas comunidades do Programa Saude da Familia (PSF). A necessidade de cuidados domiciliares regulares, a prevalencia de Hipertensao Arterial Sistemica (HAS) e de Diabetes Mellitus (DM) foram elevadas. Metade dos servicos oferecia barreiras arquitetonicas. O uso de protocolos para o cuidado domiciliar foi pouco frequente e a capacitacao para o cuidado de HAS e DM alcancou a metade dos trabalhadores. Metade dos portadores de HAS e DM usaram a Unidade Basica de Saude (UBS) da area; praticamente todos usavam medicacao, a metade obtinha a medicacao na UBS e menos da metade participava das atividades de grupo na UBS. Perda de efetividade foi observada na oferta e na utilizacao de servicos. O desempenho do PSF foi melhor quando comparado ao modelo tradicional.

Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed

The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.

Efetividade da atenção pré-natal e de puericultura em unidades básicas de saúde do Sul e do Nordeste do Brasil

Objectives: the effectiveness of antenatal and well-baby programs was assessed in a sample of 4078 mothers and children living in the coverage area of Primary Health Care Services. Stratified by geographic region (South and Northeast) and primary care model (family health and traditional services) in 41 municipalities over to 100000 inhabitants. Methods: it was made a cross sectional study with compararison groups and differrent aggregation levels of analysis. Results: in the Northeast the availability of antenatal care was universal in both models. In the South it was significantly greater in the family health services. The well-baby care was more available in the family health services in both regions as well as the counseling groups. The antenatal and well-baby care guidelines were less used in the Traditional primary care services. The health workers from the family health services referred more participation in up date training in both regions. Around 40 percent of mothers and a half of babies were covered by the primary health care from their neighborhood. However considering four or more visits during antenatal care and nine or more visits during the first year of life the coverage drops to 31 percent for mothers and 20 percent for babies. The effectiveness of wellbaby care was greater in the family health program only in the Northeast regarding the Traditional services. Conclusions: the effectiveness was progressively smaller from the availability of antenatal and wellbaby programs through professional training and guideline utilization until population coverage.OBJECTIVES: the effectiveness of antenatal and well-baby programs was assessed in a sample of 4078 mothers and children living in the coverage area of Primary Health Care Services. Stratified by geographic region (South and Northeast) and primary care model (family health and traditional services), in 41 municipalities over to 100,000 inhabitants. METHODS: it was made a cross sectional study with compararison groups and differrent aggregation levels of analysis. RESULTS: in the Northeast the availability of antenatal care was universal in both models. In the South, it was significantly greater in the family health services. The well-baby care was more available in the family health services, in both regions, as well as the counseling groups. The antenatal and well-baby care guidelines were less used in the Traditional primary care services. The health workers from the family health services referred more participation in up date training, in both regions. Around 40 percent of mothers and a half of babies were covered by the primary health care from their neighborhood. However, considering four or more visits during antenatal care and nine or more visits during the first year of life, the coverage drops to 31 percent for mothers and 20 percent for babies. The effectiveness of well-baby care was greater in the family health program only in the Northeast, regarding the Traditional services. CONCLUSIONS: the effectiveness was progressively smaller from the availability of antenatal and well-baby programs, through professional training and guideline utilization, until population coverage.

Uso de serviços ambulatoriais por idosos nas regiões Sul e Nordeste do Brasil

This study evaluated the use of outpatient services by senior citizens (N = 4,003) drawing on data from the baseline study that evaluated the Project for Expansion and Consolidation of the Family Health Strategy (PROESF) in 41 cities in South and Northeast Brazil. Use of outpatient services was greater and more appropriate to the needs of the elderly in the South than in the Northeast. Primary care facilities in both regions met the demand by lower-income elderly, but those requiring more care were treated at other levels. The results highlight the need to increase the supply of outpatient services and ensure access by the elderly, particularly for individuals with functional impairments in the Northeast. In addition to promoting equity, primary care in both regions should adopt targeted approaches for the health needs of senior citizens.