Abstract
The purpose of this study was to characterize the scope of practice of physicians working in primary healthcare participating in the Mais Médicos (More Doctors) Program ('PMM') and investigate the factors associated with execution of a larger number of clinical activities. It is an exploratory study carried over January to March 2016, through a self-applied questionnaire containing a list of 49 procedures, activities and actions carried out in primary healthcare. A total of 1,241 physicians took part in the study, most of them female, between age 40 and 49, and of Cuban nationality. The physicians carried out an average of 22.8 ± 8.2 procedures; they reported knowing how to carry out a larger number of procedures. Factors associated with executing a larger number of procedures were: being male, having graduated more recently, two years or less practicing in their primary healthcare unit, practicing in the North or South geographical regions, in small towns and more distant from the regional health headquarters. The main reason for not carrying out the procedures and activities that they reported knowing how to do was the lack of materials and inadequate infrastructure. The results show that the scope of practice of the physicians of the PMM is lower than their capacities, and that interventions with the intention of widening their scope are necessary.
Highlights
The process of institutionalization of Brazil’s Unified Health System (SUS) has been going on for more than twenty years, and one of the measures of its organization and implementation is the strengthening of Primary Healthcare, seeking to serve the population in accordance with the local realities
Considering only the Brazilians, this profile was different, with younger participants, shorter time since graduation (≤ 5 years; 47.3%), less time working in primary healthcare (≤ 8 years; 79.6%) and lower proportion of people graduating outside Brazil (35.4%)
The majority worked in the primary health unit at the time of filling out the questionnaire for two years or less (58.4%), these being allocated in the Northeast (43.5%) and in state capitals and metropolitan regions (23.5%), with distance from the headquarters of the health region of up to 15 minutes (36.1%) (Table 1)
Summary
The process of institutionalization of Brazil’s Unified Health System (SUS) has been going on for more than twenty years, and one of the measures of its organization and implementation is the strengthening of Primary Healthcare, seeking to serve the population in accordance with the local realities. In this context, the scope of practice of doctors who work in primary healthcare is crucial for ensuring capacity to provide solutions in meeting the various health demands for the population, because these are the professionals who operate at the frontline of the SUS1,2. The way in which the scope of practice is established directly impacts the composition and productivity of the workforce and, the quality and the cost of health services
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