Maria Fernanda Pereira Gomes

Primary health care assessment tools: a literature review and metasynthesis

This study comprises a systematic review and metasynthesis of qualitative literature on national and international databases to identify the main tools used to assess Primary Health Care (PHC). A total of 3,048 results were returned for literature written in Portuguese, Spanish and English published between 1979 and 2013. Thirty-three articles/studies were selected after thorough reading and analysis. Eight of these studies addressed the use of one or more of the following validated PHC assessment tools: the WHO Primary Care Assessment Tool (PCET); the ADHD Questionnaire for Primary Care Providers (AQ-PCP); the General Practice Assessment Questionnaire (GPAQ), PACOTAPS (primary health care software); and the PCAT (Primary Care Assessment Tool). The study showed that the majority of these tools were used internationally. The PCAT and EUROPEP were used in Brazil and the most commonly used tool in this country was the PCAT. The results show that the use of research tools to assess PHC may assist in the creation of new proposals to improve family healthcare and that PCAT is the most adequate tool for this purpose.

Percepções de gestores municipais sobre ações de promoção da saúde: em foco os agentes comunitários de saúde

Abstract Considering the importance of investigating the competence of health promotion in the practice of community health workers and the fact that health managers’ view influences on the development of this competence, this article describes health ma-nagers’ perceptions on health promotion actions taken by community health workers. This is a qualitative research whose study setting was the Regional Management Board of Alto Capivari of the Regional Health Department of Presidente Pruden -te, Sao Paulo, Brazil. Municipal health secretaries were the research subjects. Data were collected by means of a questionnaire with open questions in July and August 2011. The answers underwent the content analysis technique proposed by Bardin. The results pointed out that health managers confuse the competence health promotion and prevention with monitoring of specific groups and morbidities. It was also observed that managers are not able to differentiate the National Policy of Health Promo-tion from the National Policy of Primary Care. Towns where municipal managers better understood and differentiated these policies had community health workers more committed to take health promotion actions, including well-structured inter-sector prac -tices. We conclude that municipal health managers play a crucial role for effecting the competence of health promotion by the community health worker and the Family Health team.Keywords: Health Promotion; Health Manager; Community Health Workers.

Atenção domiciliar do enfermeiro na estratégia saúde da família

The Family Health Strategy (FHS) aims at the reorganizing of primary health care in the country and requires a home visit as an interaction technology in health care. It is an important tool for nurses, since it is the intervention that enables us to approach to the determinants of the health illness in the family. In this context the role of a nurse should be ethical and legal, empowering families who are in vulnerable condition to fight for their health rights. However, the objective of this research is to evaluate the satisfaction of users of the Health Strategy Family in the municipality of Assis – SP in the perspective of home care performed by nurses. This is a quantitative study in which they were used statistical analysis criteria for results evaluation and description. Data collection was carried out through home visits, and it is available a questionnaire with closed questions designed to evaluate the home care performed by nursing professionals. One-hundred participants took place in the survey. They were users who utilize the FHT services. In this study the majority of respondents said that the nurse is only seen when prompted. However, the nurse faces bureaucratic activities of overwork which prevents him from making and program home care, which is as great loss to the people and society as a whole, not have the evaluation of a professional peculiar look peculiar like a nurse.

Avaliação da estratégia saúde da família sob a ótica dos profissionais

Objective: To check if the essential and derivate attributes of Primary Health Care (PHC) are present in the Family Health Strategy (FHS). Methods: This is a quantitative descriptive evaluation research carried out in 21 municipalities in the region of Presidente Prudente (Sao Paulo, Brazil) from June to September 2015. The Primary Care Assessment Tool (PCATool) was used to collect data as it allows to evaluate the following variables: First Contact Access (access, utilization), Coordination (integrated care, information system) and Comprehensiveness (services available, services provided, family orientation and community orientation). Scores and means of the variables were constructed based on the Manual of the PHC Assessment Tool designed by the Ministry of Health. The statistical analysis calculated the mean, the standard deviation, and the minimum and maximum values of the variables (PHC attributes). Results: Participants were 102 professionals (19 health managers, 39 physicians, and 44 nurses). The majority had higher education (98%; n=100), less than half specialized in Family Health (37.3%; n=38) and attended a training course to work in the FHS (48%; n=49). The essential and derivate attributes obtained the following scores: First Contact Access – Accessibility, 5.57; Utilization, 7.71; Coordination – Integrated Care, 7.70; Coordination – Information Systems, 8.74; Comprehensiveness – Services available, 8.29; Comprehensiveness – Services provided, 8.40; Family orientation, 8.53; Community orientation, 8.12. Conclusion: From the physicians’, nurses’ and managers’ perspective, the essential and derivate attributes of PHC evaluated in the FHS of the region are present.

Family health strategy - the point of view of children’s caregivers

RESUMO Objetivo : avaliar sob a otica dos cuidadores de criancas menores de dois anos e usuarios adultos se os atributos essenciais e derivados da atencao primaria a saude estavam presentes e como estavam sendo operacionalizados na Estrategia Saude da Familia. Metodo : estudo quantitativo, descritivo e transversal realizado em tres municipios da regiao de Presidente Prudente, Estado de Sao Paulo, Brasil. Utilizou-se o instrumento de avaliacao da atencao primaria a saude (PCATool) na versao crianca e adulto, em que 176 cuidadores de criancas menores de dois anos e 181 adultos usuarios participaram da pesquisa. Resultados : os atributos da atencao primaria a saude estavam presentes na Estrategia Saude da Familia da regiao; porem, alguns atributos como Coordenacao – Integracao de Cuidados, Acesso de Primeiro Contato – Acessibilidade e Orientacao Familiar precisavam melhorar sua operacionalizacao. Conclusao : os atributos da atencao primaria a saude devem estar adequadamente incorporados a pratica dos profissionais da saude por meio da capacitacao e valorizacao das acoes que caracterizam a Estrategia Saude da Familia como modelo com foco na familia. Descritores : Avaliacao em Saude; Estrategia Saude da Familia; Atencao Primaria a Saude; Saude Publica; Saude da Crianca; Saude do Adulto. ABSTRACT Objective: to assess whether the essential attributes and derivatives of primary health care were present and how they were being implemented in the Family Health Strategy from the point of view of caregivers of children under two years of age and adult users. Method: quantitative, descriptive and cross-sectional study conducted in three municipalities of the region of Presidente Prudente, State of Sao Paulo, Brazil. We used the child and adult versions of the Primary Care Assessment Tool (PCATool), and 176 caregivers of children under two years of age and 181 adult users participated in the research. Results: the attributes of primary health care were present in the Family Health Strategy in the region; however, some attributes, such as healthcare coordination-integration, access to initial contact–accessibility, and family guidance needed to have their implementation improved. Conclusion: the attributes of primary health care should be properly incorporated into the practice of health professionals through training and actions that characterize the Family Health Strategy as a model with a focus on the family. Descritoprs : Health Assessment; Family Health Strategy; Primary Health Care; Public Health; Child Health; Adult Health . RESUMEN Objetivo: evaluar bajo la optica de los cuidadores de ninos menores de dos anos y adultos usuarios si los atributos esenciales y derivados de la atencion primaria de salud estaban presentes y como estaban siendo puestos en marcha en la Estrategia Salud de la Familia. Metodo: estudio cuantitativo, descriptivo y transversal realizado en tres municipios de la region de Presidente Prudente, Estado de Sao Paulo, Brasil. Se usaron las versiones nino y adulto del Instrumento de Evaluacion de la Atencion Primaria (PCATool) y 176 cuidadores de ninos menores de dos anos y 181 adultos participaron en la investigacion. Resultados: los atributos de la atencion primaria de salud estaban presentes en la Estrategia Salud de la Familia en la region; sin embargo, algunos atributos tales como coordinacion-integracion de los cuidados, acceso a primer contacto–accesibilidad y asesoramiento familiar necesitaban mejorar su puesta en marcha. Conclusion: los atributos de la atencion primaria de salud deben ser debidamente incorporados a la practica de profesionales de la salud a traves de capacitacion y desarrollo de acciones que caracterizan la Estrategia Salud de la Familia como un modelo con enfoque en la familia. Descriptores : Evaluacion De La Salud; Estrategia Salud de la Familia; Atencion Primaria de Salud; Salud Publica; Salud Del Nino; Salud del Adulto.

Perspectivas das ações intersetoriais, de inclusão e participação sociais desenvolvidas por agentes comunitários de saúde

Objective: To identify the frequency of intersectoral actions, social inclusion and social participation, developed by community health workers (CHWs). Methods: Cross-sectional, descriptive and qualitative study, with data collection performed at the Regional Management Collegiate (RMG) of Alto Capivari, in the state of Sao Paulo, Brazil. Questionnaires were self-filled by 81 community health workers (CHWs), comprising questions about the five skills proposed by the Ministry of Health for the CHWs: Team integration with the population; planning and evaluation; health promotion; prevention and monitoring of environmental and health hazard; and prevention and monitoring of specific groups and morbidities. Results: Intersectoral actions, social inclusion and participation are still under construction in Alto Capivari RMC, pointing out that there are difficulties in implementing these actions. It is observed that social inclusion initiatives are developed by the CHWs, whereas intersectoral actions are identified and proposed but are poorly implemented; and the social participation of CHWs does not occur. Conclusion: This research allowed identifying that the CHWs acting in High Capivari RMC carry out social inclusion initiatives and propose intersectoral actions; these actions, however, are poorly executed. As for the social participation, CHWs do not participate in the Local Health Councils.

Avaliação das ações de promoção da saúde desenvolvidas pelos agentes comunitários de saúde

Based on the analyzes that were systematically performed on the work of Community Health Agents (ACS), the Ministry of Health constructed a training program for these professionals in which the skills that should compose their profile were defined, health promotion was one of them. The objective of this research was to describe and quantitatively represent health promotion actions proposed by the Ministry of Health. This is a quantitative research concerning the Collegiate Regional Manager (CGR) Alto Capivari in the Presidente Prudente-SP region. The subjects of this study were 97 ACS working in the 17 teams of Family Health of the CGR. Data were collected through a Likert form that allows verifying the occurrence of health promotion actions. The more frequently performed health promotion actions were the ones aimed at the development of self-care, injury prevention, and problems identification, and the less frequently performed actions were the ones of social participation and intersectoral approach. However, among the operationalization challenges of health promotion actions which were more emancipatory by ACS, the attribution of actions different from those proposed by the Ministry of Health, a number of families beyond the recommended and little offer of training for ACS were verified. ACS have potential and perform important actions to promote health, yet this strategy should be prioritized by social and health public policies since its development can positively impact health indicators.