Avaliação da qualidade da Atenção Primária à Saúde na perspectiva de médicos e enfermeiros

Abstract

Primary Health Care is the first level of health care, forming the initial contact of the population with health services. This level of care is considered a priority strategy for the expansion and consolidation of the principles and guidelines of the Brazil's Unified Public Health System (SUS) and its concept was systematized by Starfield, through the definition of essential and derivatives attributes. Evaluating the offered services by this Care level is important so that investments in health quality, reformulations in services management and health actions can be made more incisive and humanized. This study aimed to evaluate the quality of primary care, based on the presence and extension of the essential and derived attributes from the primary care units, and had the following specific objectives: to characterize the health professionals, physicians and nurses of the health units, according to sociodemographic and professional variables; to describe the answers obtained in each of the items that make up each attribute of the instrument; to describe the scores obtained in each attribute, the essential score and general score of each health unit; to analyze the sociodemographic and professional variables influence on the essential and derived attributes from primary care from the perspective of physicians and nurses from the health units. A quantitative and cross-sectional study was carried out in which 108 physicians and nurses. Data collection took place between March and June 2018 and the instruments used were the Primary Care Assessment Tool and a sociodemographic and professional questionnaire. Data were submitted to descriptive analysis, as well as a T test for dichotomous predictors and Pearson correlations for quantitative predictors. For the analysis of the simultaneous and independent influence of sociodemographic and professional predictors on each of the attributes, the multiple linear regression analysis was included through the Statistical Package for Social Sciences version 13. This research was approved by the Research Ethics Committee of the Universidade Federal do Triângulo Mineiro, through the Brazil Platform, under the protocol CAAE: 80264917.4.0000.5154. In evaluating the quality of primary care from the perspective of physicians and nurses, low evaluations (<6,6) were evidenced regarding the presence and extent of attributes, with the exception of Longitudinality and Family Orientation attributes. Access to first contact-accessibility was the one that presented the lowest average. In the multivariable model, the variables that presented statisticalsignificance and that were associated with the low general score were: professional stocking and profession. It was possible to conclude that there is a poor orientation of the health units for the primary health care and, consequently, the low quality of this level of Care. The results of this study may help health units and management bodies to create alternatives to improve the primary care quality, as well as reflecting on the importance of expanding the family health strategy as a hegemonic model for integral care and health quality.