Vera Maria Vieira Paniz

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.

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.

Knowledge about contraceptives in a population 15 years or older in a southern Brazilian city

A prevalencia de uso de anticoncepcional no Brasil e alta; porem, e frequente seu uso incorreto e inadequado, sugerindo escasso conhecimento sobre os metodos. Assim, avaliou-se o conhecimento sobre metodos anticoncepcionais mais utilizados por meio de um escore (0-10) e fatores associados a este conhecimento. Foi realizado um estudo transversal de base populacional, com 3.542 individuos de 15 anos ou mais, residentes na zona urbana de Pelotas, Rio Grande do Sul. A media de escore de conhecimento foi de 4,65 (dp = 2,07), sendo 5,02 (dp = 2,10) para as mulheres e 4,18 (dp = 1,92) para os homens. Menor idade, maior escolaridade, relato de gravidez indesejada e uso de metodo anticoncepcional exclusivo ou combinado ao longo da vida mostraram-se associados a um maior escore de conhecimento entre os homens, enquanto, para as mulheres, os determinantes de maior conhecimento foram maior idade, viver com companheiro, maior escolaridade, melhor nivel economico, nao ter religiao e uso de metodo anticoncepcional exclusivo ou combinado ao longo da vida. Apesar da alta prevalencia de uso de anticoncepcional (75,3%), e limitado o conhecimento sobre os metodos mais utilizados, ciclo menstrual e periodo fertil.In Brazil, prevalence of contraceptive use is high, but incorrect and inappropriate use is frequent, suggesting limited knowledge about methods. This study thus evaluated the knowledge about the most widely used contraceptive methods, measured through a score (0-10) and related factors. A population-based cross-sectional study was performed, with 3,542 subjects ages 15 or older, residing in the urban area of Pelotas, Rio Grande do Sul State. The mean overall knowledge score was 4.65 (sd = 2.07): 5.02 (sd = 2.10) for women and 4.18 (sd = 1.92) for men. Lower age, higher schooling, a report of unwanted pregnancy, and any lifetime use of contraceptive methods (exclusive or combined) were associated with higher knowledge scores among men, while for women, the determinants of higher knowledge were higher age, living with a partner, higher schooling, higher socioeconomic status, not reporting a religion, and any lifetime use of contraceptive methods (exclusive or combined). Despite high prevalence of any lifetime contraceptive use (75.3%), knowledge is still limited about the most widely used methods, as well as about the menstrual cycle and fertile period.

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.

Características da demanda do serviço de saúde de emergência no Sul do Brasil

This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.

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.

Uso de serviços básicos de saúde por idosos portadores de condições crônicas, Brasil

OBJETIVO: Avaliar a utilizacao de servicos de saude entre idosos portadores de doencas cronicas. METODOS:Estudo transversal realizado com 2.889 individuos com idade a partir de 65 anos, portadores de condicoes cronicas - hipertensao arterial, diabetes mellitus e doenca mental -, residentes em areas de abrangencia de unidades basicas de saude em 41 municipios das regioes Sul e Nordeste do Brasil em 2005. Os dados analisados foram obtidos do estudo de linha de base do Programa de Expansao e Consolidacao da Saude da Familia. As variaveis estudadas foram sexo, idade, cor da pele, situacao conjugal, escolaridade, renda familiar, tabagismo, incapacidade funcional e modelo de atencao da unidade basica de saude. A analise ajustada dos desfechos foi realizada com regressao de Poisson. RESULTADOS: A prevalencia de consulta medica nos ultimos seis meses foi de 45% no Sul e de 46% no Nordeste. A prevalencia de participacao em grupos de atividades educativas no ultimo ano foi de 16% na regiao Sul e de 22% na regiao Nordeste. Nas duas regioes, o uso dos servicos foi maior por idosos com idade inferior a 80 anos, baixa escolaridade e residentes em areas de abrangencia de unidades basicas de saude com Programa Saude da Familia. Apenas na regiao Sul os idosos com incapacidade funcional apresentaram maior prevalencia de consultas medicas. CONCLUSOES: As prevalencias de consulta medica e de participacao em grupos de atividades educativas foram baixas, quando comparadas com estudos anteriores realizados com idosos no Brasil. Os resultados indicam que, apesar de o Programa Saude da Familia promover maior uso de servicos das unidades basicas de saude pelos idosos portadores de condicoes cronicas, ha necessidade de ampliar o acesso daqueles com mais de 80 anos e dos portadores de incapacidade funcional.OBJECTIVE To assess the use of healthcare services by elderly individuals suffering from chronic diseases. METHODS Cross-sectional study carried out with 2,889 individuals aged 65 years or more with chronic conditions - arterial hypertension, diabetes mellitus and mental illness -, living in catchment areas of primary care units in 41 cities of the South and Northeast regions of Brazil in 2005. The analyzed data were obtained in the baseline study of Programa de Expansão e Consolidação da Saúde da Família (Program for the Expansion and Consolidation of Family Health). The studied variables were sex, age, skin color, marital status, level of schooling, family income, smoking, functional disability, and care model of the primary care unit. The adjusted analysis of outcomes was performed by means of Poisson regression. RESULTS The prevalence of medical visit in the last six months was 45% in the South region and 46% in the Northeast region. The prevalence of participation in groups of educational activities in the last year was 16% in the South and 22% in the Northeast. In both regions, use of services was higher for elderly people under the age of 80 years, with low level of schooling and living in catchment areas of primary care units with Programa Saúde da Família (Family Health Program). Only in the South region did the elderly with functional disability have higher prevalence of medical visits. CONCLUSIONS The prevalence of medical visit and participation in groups of educational activities was low when compared to previous studies conducted with elderly individuals in Brazil. The results indicate that, although the Family Health Program promotes greater use of services at primary care units by elderly people with chronic conditions, it is necessary to expand the access of those aged over 80 and of individuals with functional disability.

Fatores associados à continuidade interpessoal na atenção à saúde: estudo de base populacional

This study focused on the prevalence of interpersonal continuity of care and its determinants. A cross-sectional population-based study was conducted with 3,133 individuals 20 years or older in Pelotas, Rio Grande do Sul State, Brazil. Multivariate analysis used Poisson regression, with the first level representing socioeconomic and demographic variables and the proximal level including health care and health needs variables. Prevalence of interpersonal continuity of care was 43.7% (95%CI: 42.0-45.5). Female gender, higher age, higher income, consultation during the previous year, report of chronic disease, and consultation outside the public health system showed higher interpersonal continuity of care. Among individuals that consulted in public primary health care services, female gender, age, and the Family Health Program were associated with interpersonal continuity of care. Some vulnerable groups (low-income and users of the public health system) showed low prevalence of the outcome.

Use of primary care services by elderly people with chronic conditions, Brazil

OBJETIVO: Avaliar a utilizacao de servicos de saude entre idosos portadores de doencas cronicas. METODOS:Estudo transversal realizado com 2.889 individuos com idade a partir de 65 anos, portadores de condicoes cronicas - hipertensao arterial, diabetes mellitus e doenca mental -, residentes em areas de abrangencia de unidades basicas de saude em 41 municipios das regioes Sul e Nordeste do Brasil em 2005. Os dados analisados foram obtidos do estudo de linha de base do Programa de Expansao e Consolidacao da Saude da Familia. As variaveis estudadas foram sexo, idade, cor da pele, situacao conjugal, escolaridade, renda familiar, tabagismo, incapacidade funcional e modelo de atencao da unidade basica de saude. A analise ajustada dos desfechos foi realizada com regressao de Poisson. RESULTADOS: A prevalencia de consulta medica nos ultimos seis meses foi de 45% no Sul e de 46% no Nordeste. A prevalencia de participacao em grupos de atividades educativas no ultimo ano foi de 16% na regiao Sul e de 22% na regiao Nordeste. Nas duas regioes, o uso dos servicos foi maior por idosos com idade inferior a 80 anos, baixa escolaridade e residentes em areas de abrangencia de unidades basicas de saude com Programa Saude da Familia. Apenas na regiao Sul os idosos com incapacidade funcional apresentaram maior prevalencia de consultas medicas. CONCLUSOES: As prevalencias de consulta medica e de participacao em grupos de atividades educativas foram baixas, quando comparadas com estudos anteriores realizados com idosos no Brasil. Os resultados indicam que, apesar de o Programa Saude da Familia promover maior uso de servicos das unidades basicas de saude pelos idosos portadores de condicoes cronicas, ha necessidade de ampliar o acesso daqueles com mais de 80 anos e dos portadores de incapacidade funcional.OBJECTIVE To assess the use of healthcare services by elderly individuals suffering from chronic diseases. METHODS Cross-sectional study carried out with 2,889 individuals aged 65 years or more with chronic conditions - arterial hypertension, diabetes mellitus and mental illness -, living in catchment areas of primary care units in 41 cities of the South and Northeast regions of Brazil in 2005. The analyzed data were obtained in the baseline study of Programa de Expansão e Consolidação da Saúde da Família (Program for the Expansion and Consolidation of Family Health). The studied variables were sex, age, skin color, marital status, level of schooling, family income, smoking, functional disability, and care model of the primary care unit. The adjusted analysis of outcomes was performed by means of Poisson regression. RESULTS The prevalence of medical visit in the last six months was 45% in the South region and 46% in the Northeast region. The prevalence of participation in groups of educational activities in the last year was 16% in the South and 22% in the Northeast. In both regions, use of services was higher for elderly people under the age of 80 years, with low level of schooling and living in catchment areas of primary care units with Programa Saúde da Família (Family Health Program). Only in the South region did the elderly with functional disability have higher prevalence of medical visits. CONCLUSIONS The prevalence of medical visit and participation in groups of educational activities was low when compared to previous studies conducted with elderly individuals in Brazil. The results indicate that, although the Family Health Program promotes greater use of services at primary care units by elderly people with chronic conditions, it is necessary to expand the access of those aged over 80 and of individuals with functional disability.