Modelo de Atenção na Estratégia Saúde da Família: o cuidado antes e após pandemia por COVID-19

Primary Health Care (PHC) is an important gateway to the Unified Health System for providing comprehensive individual and collective care. Changes in policies and funding and the COVID-19 pandemic have led to alterations in PHC work. This research aimed to analyze the organization of care in the Family Health Strategy (FHS) before and after the COVID-19 pandemic and its challenges from the perspective of health professionals working in PHC. Data was collected through focus groups with four FHS teams and thematic analysis was used to analyze the data. The work organization in the FHS has been undergoing changes since 2016, with an increase in bureaucratic processes and challenges arising from the reduction in workers. During the pandemic, professionals were displaced, continuity of care was disrupted and care was not consistent with the needs of the population, despite new practices and the exchange of knowledge. The challenges originated from the caring of the population in other areas. The changes in the organization of care, due to the increase in demand for care and Previne Brasil, have led to the deconstruction of the FHS care model.

O estudo teve como objetivo caracterizar o cuidado realizado por duas equipes de Estratégia Saúde da Família (ESF) a pacientes com risco de suicídio em município localizado no interior do Rio Grande do Sul (RS). Estudo qualitativo e descritivo, realizado com 15 profissionais da saúde de duas ESF, mediante entrevistas semiestruturadas com perguntas abertas. Os dados foram coletados no período de setembro e outubro de 2018 e analisados conforme análise temática de Minayo. Os resultados apontam para as seguintes categorias relacionadas a cuidado a pacientes com comportamento suicida: identificação das ações realizadas pela equipe; dificuldades da equipe no cuidado de pacientes; avaliação da equipe acerca de como cuidam. Entende-se que o cuidado a pacientes com comportamento suicida por equipes de ESF parte de uma boa avaliação do risco para, a partir disso, realizar o cuidado de modo personalizado, envolvendo também práticas voltadas às famílias e a comunidade, com medidas de prevenção.

This study aimed to determine the level of and identify factors associated with the health-related quality of life (HRQoL) of oral health professionals working in primary health care in Brazil. A cross-sectional survey was carried out among 96 dentists and 65 dental assistants working in the Family Health Strategy in six municipalities in the metropolitan area of Salvador, Brazil. HRQoL was evaluated using the 36-item Short Form Health Survey Questionnaire (SF-36). Higher mean scores in the SF-36 Physical Component Summary were associated with younger age, post-graduate education in public health, and frequent leisure time. The Mental Component Summary was associated with frequent leisure time, >40 weekly working hours, suitable dental offices, satisfaction with colleagues, and satisfaction with working in primary health care. In conclusion, the HRQoL level of oral health professionals working in primary health care in Brazil was comparable to those found in the available literature and associated with several modifiable factors. Incidentally, a literature search found very few studies about the HRQoL of oral health workers that use the SF-36 and those found were produced outside the main scientific centers.

O acesso oportuno e a continuidade do cuidado são duas medidas operacionais importantes para a prática dos cuidados na Atenção Primária à Saúde (APS). Objetivo: Realizar um estudo da demanda de uma equipe da Estratégia Saúde da Família (ESF) que utiliza o acesso avançado (AA) como modelo de organização da agenda. Métodos: Trata-se de uma análise documental, quantitativa, descritiva e retrospectiva realizada em uma equipe da ESF no Rio de Janeiro. Os 1410 dados foram coletados em uma planilha do Microsoft® Excel® no Google Drive, utilizada no processo de trabalho da equipe e foram tabulados e analisados em planilhas do Microsoft Excel®. Foram incluídos os registros do período de agosto e setembro de 2017 e excluídos os registros no qual o motivo da consulta (MC) não foi preenchido. Os MC foram codificados a partir de demandas, queixas e necessidades expressas nas narrativas dos usuários, e adaptadas à conformidade da codificação da CIAP (Classificação Internacional de Atenção Primária). Resultados: Dos 1392 registros de MC dos usuários restantes, 149 não foram atendidos por motivo de falta, reagendamento ou evasão, totalizando 1243 registros analisados. Predominou o sexo feminino, faixa etária entre 55 e 59 anos, atendimentos realizados em demanda espontânea, pela manhã, principalmente nas primeiras horas do acolhimento e com queixas gerais e não-específicas. Conclusão: Com o AA parece haver uma acessibilidade maior aos usuários que poderão ter o acesso de primeiro contato mais facilmente para a resolução dos seus problemas. Realizar o estudo da demanda possibilita o levantamento de dados para a elaboração de um planejamento para uma melhor organização da agenda refletindo em um melhor atendimento à população de forma resolutiva, oportuna e integral.

to analyze perceptions of the Family Health Strategy (FHS) professional team about mental health-disorder and to identify health actions developed by the team for people with mental disorders. a qualitative study of a Marxist theoretical framework and a dialectical method. 99 FHS middle and higher level professionals from São Paulo participated. Semi-structured interviews were conducted. Data were submitted to ALCESTE software and Thematic Content Analysis. there were three empirical categories: Training in Mental Health; Perception of the FHS professional about mental health-disorder; and Health actions developed by the FHS team with people with mental disorders. Actions that converge and diverge from the psychosocial care model were identified. there is an effort from professionals to work according to the psychosocial care model, but it is necessary to invest in the Permanent Education in Health of these professionals to overcome barriers and foster successful territorial actions.

Background Violence against women (VAW) is a public health challenge in Brazil. The country ranks 6th globally for femicide, with a high prevalence of domestic violence, amplified by the pandemic. Primary healthcare (PHC) workers can play a significant role caring for survivors, but their training on how to identify and respond to survivors is a major gap. This study aimed to investigate frontline PHC workers' needs and concerns in the care of VAW survivors, aiming to co-design a participatory model of capacity building to be implemented in the Brazilian PHC. Methods This study is based on participatory action-research (PAR) through participant observation and in-depth interviews with an interdisciplinary team of 13 PHC workers from Paranaguá, South of Brazil. Data were collected between Aug/2020-Jan/2021, transcribed, coded and synthetized through thematic analysis. Results Major needs and concerns were: 1) unanimous need of capacity building for all PHC workers and managers; 2) training ideally should be face-to-face, and more than one day, based in practical cases (not just in theory); 3) clarifying the role of the cross-sectoral network and referral options; 4) contents needs to address confidentiality, qualified listening, empathy and respect, with practical guidance on how to approach survivors. Other issues included: integrating VAW approaches with violence against children and adolescents; ensuring PHC units have a private room to care for survivors; and electing a key professional in each unit, with more specialized knowledge, to support survivors and staff. Conclusions This PAR revealed key issues to collaboratively design a capacity building model for PHC in Brazil, tailored to local needs. The next step will be applying for funding to implement a pilot training. Key messages Frontline PHC workers routinely attend cases of VAW, therefore their insights are essential to design capacity building to care for survivors in PHC settings. Training healthcare workers to care for survivors of violence needs to address local concerns, targeting knowledge, skills and competences.

Objective: to analyze the operationalization of the Primary Health Care by Family Health Strategy teams, focusing on priority groups. Methods: qualitative research h eld in Fortaleza-CE 2011-2012. It has involved the participation of 31 health workers of the Family Health Strategy and 42 users. Semi-structured interviews, focus groups and systematic observation themed discourse analysis were used. The ethics committee in research under the number 10724452-7 approved the study. Results: the prioritization of strategic actions taken in priority groups organizes the demand and solves the major health problems of the community, yet there is a generalization of the living standards and health. It was observed that the care/healing activities tend to be more valued than those preventive/educational are by users. Final Considerations : health professionals and users should be aware of the importance of health promotion; health managements should reduce the service bureaucracy, providing an effective support for families.

Este estudo objetivou caracterizar como a equipe da Estratégia Saúde da Família percebe sua dinâmica de acompanhamento de famílias que convivem com a doença crônica da criança. Trata-se de uma pesquisa qualitativa que teve como referencial teórico o Interacionismo Simbólico e como método a Análise de Conteúdo, técnica de análise categorial temática. Para a coleta de dados utilizou-se o grupo focal, que foi desenvolvido com três equipes de Saúde da Família, totalizando 32 sujeitos. Os resultados foram organizados em três categorias temáticas: Peculiaridades das famílias que convivem com a doença crônica da criança; Equipe, família e Estratégia Saúde da Família e Limitações para cuidar. A percepção da equipe é que o desenho da Estratégia Saúde da Família favorece o acesso à experiência familiar, permitindo o reconhecimento de suas especificidades. Os dados revelam ainda as limitações da equipe em sua capacidade de resolução e a necessidade de investimentos na articulação entre os distintos serviços, setores e equipamentos sociais.

Abstract: Introduction: The trajectory of medical schools towards the transformation of the traditional training model to an innovative and advanced perspective of training, including in the field of mental health, has been observed since the implementation of the Family Health Strategy. Objective: The present study sought to understand the initial medical training in mental health, from the perspective of the physician working in Primary Health Care (PHC). Method: For this purpose, a qualitative, exploratory, descriptive approach was adopted, in which data were obtained through interviews with physicians working in the PHC of a municipality in the Northeast of Brazil, whose corpus was treated based on the application of the thematic content analysis. Data collection for the study took place between June 2020 and June 2021, when medical professionals working in the municipal Family Health Strategy (FHS) were invited to participate. It is, therefore, an intentional, non-probabilistic sample. Of the seven physicians working in the municipal health network at the FHS level, five were included in the study. Results: The study results indicate that medical training in mental health is still related to a biomedical vision, in which the hospital scenario is valued as a space for practices and PHC is underutilized in the development of professional skills and abilities, producing gaps that affect performance in the context of mental health care in PHC. The speeches also show deficiencies in the training related to the appreciation of issues related to medicalization and the difficulty in granting autonomy in mental health care. Conclusion: Medical training in mental health should approach the reality of the general practitioner’s work, in order to prepare them for the demands they will face in their daily routine in PHC.

SummaryThe posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in‐depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high‐performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd

BackgroundTimely detection and management of comorbid mental disorders in people with epilepsy is essential to improve outcomes. The objective of this study was to measure the performance of primary health care (PHC) workers in identifying comorbid mental disorders in people with epilepsy against a standardised reference diagnosis and a screening instrument in rural Ethiopia.MethodsPeople with active convulsive epilepsy were identified from the community, with confirmatory diagnosis by trained PHC workers. Documented diagnosis of comorbid mental disorders by PHC workers was extracted from clinical records. The standardized reference measure for diagnosing mental disorders was the Operational Criteria for Research (OPCRIT plus) administered by psychiatric nurses. The mental disorder screening scale (Self-Reporting Questionnaire; SRQ-20), was administered by lay data collectors. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PHC worker diagnosis against the reference standard diagnosis was calculated. Logistic regression was used to examine the factors associated with misdiagnosis of comorbid mental disorder by PHC workers.ResultsA total of 237 people with epilepsy were evaluated. The prevalence of mental disorders with standardised reference diagnosis was 13.9% (95% confidence interval (CI) 9.6, 18.2%) and by PHC workers was 6.3% (95%CI 3.2, 9.4%). The prevalence of common mental disorder using SRQ-20 at optimum cut-off point (9 or above) was 41.5% (95% CI 35.2, 47.8%). The sensitivity and specificity of PHC workers diagnosis was 21.1 and 96.1%, respectively, compared to the standardised reference diagnosis. In those diagnosed with comorbid mental disorders by PHC workers, only 6 (40%) had SRQ-20 score of 9 or above. When a combination of both diagnostic methods (SRQ-20 score ≥ 9 and PHC diagnosis of depression) was compared with the standardised reference diagnosis of depression, sensitivity increased to 78.9% (95% (CI) 73.4, 84.4%) with specificity of 59.7% (95% CI 53.2, 66.2%). Only older age was significantly associated with misdiagnosis of comorbid mental disorders by PHC (adjusted odds ratio, 95% CI = 1.06, 1.02 to 1.11).ConclusionRoutine detection of co-morbid mental disorder in people with epilepsy was very low. Combining clinical judgement with use of a screening scale holds promise but needs further evaluation.

The study explored the knowledge and service delivery skills of primary health care (PHC) workers to conduct cervical cancer screening programmes in Sango primary health centre in Sango town, Ado-Odo Ota, Ogun State in Nigeria. Cervical cancer is the second most common cancer affecting women. The prevention and control services in Nigeria are provided mainly at post-primary health facilities. Authorities have advocated the integration of cervical cancer prevention into reproductive health services provided at PHC centres. The service delivery capabilities of PHC workers are critical for successful implementation of screening programmes. Exploratory qualitative research design was used. Data were collected among 10 PHC workers who were purposively sampled at Sango PHC. Semi-structured interview guide with broad items and a checklist were used to assess participants' cervical cancer screening knowledge and service delivery skills using visual inspection screening methods. Data were analysed thematically and triangulated. A range of roles were represented in the interviews of the health care workers at the PHC studied. They had poor knowledge and skills about cervical cancer screening using visual inspection with acetic acid and visual inspection with Lugol's iodine. Study participants perceived nurses as most equipped PHC workers to conduct screening at PHC level, followed by the community health officers. Participants reported no cervical cancer services at the centre and community. The findings provided useful insight that guided the training of primary health workers and the development of a community-based cervical cancer screening model for women in rural communities. Nurses and other PHC workers should be trained on visual inspection screening method. This low-cost but effective methodology could be incorporated into their training curricula as a strategy for scaling up cervical cancer prevention programmes across Nigeria.

Primary health care (PHC) in Brazil is based on Family Health Strategy (FHS) teams. These teams are supported by Expanded Family Health and Primary Care Centers (Nuclei) (NASF-AB) whose services are backbone elements for comprehensive health care within PHC. NASF-AB encompass several professional groups that aim to increase the responsiveness and scope of actions of the FHS teams. The objective of this study was to identify the dimensions of collaboration in the work dynamics of NASF-AB in the capital of Northeast Brazil. The study was a descriptive and exploratory research using a qualitative approach through semi-structured interviews with nine NASF-AB workers and three district health managers. Three analytical categories were identified following content analysis: “Interprofessional and inter-organizational collaboration,” “Mainstays of collaboration in the relationship between NASF-AB and FHS,” and “Challenges for a culture of collaboration in health care work.” The results revealed important characteristics for interprofessional collaboration, including recognition of the attributions of the different teams and the key role of communication and planning. Participants highlighted roadblocks for interprofessional collaboration that hampered comprehensive care, such as the shortage of manpower and material resources, work overload, and lack of availability of professionals for effective teamwork.

BackgroundQuantitative methods for estimating the workload of primary healthcare (PHC) workers are essential for improving the performance of PHC institutions. However, measuring the workload of PHC workers is challenging due to the diverse and complex range of services covered by PHC. This study aims to use an equivalent value (EV)-based approach to assess the workload of PHC workers and inform policymakers about the current workload burden in Beijing, China.MethodsThe EV-based workload assessment system was designed by three main steps: identifying the list of essential PHC service items provided by PHC workers, quantifying the EV of each service item, and calculating the corresponding workload for PHC workers and community health centers (CHCs). The study included 18 CHCs, which were divided into three groups based on population density and topography: Group I (eight urban CHCs), Group II (six CHCs in semi-mountainous areas), and Group III (four CHCs in mountainous areas). Data were collected from local health information system, which automatically collected real-time service volume data for 500 PHC service items at 18 CHCs in the sample district in Beijing from 2017 to 2021.ResultsThis study identified 503 essential PHC service items and defined their EVs. The theoretical full-capacity workload per PHC worker was 6024 EVs, serving as the base workload. The actual annual workload per PHC worker was 7240.0 EVs during 2017–2021. The base workload per budgeted position for the three types of CHCs was 6468.6 EVs for Group I, 5268.5 EVs for Group II, and 5038.7 EVs for Group III. Compared with the actual workload of 7702.3 EVs, 6568.3 EVs, and 5979.0 EVs in each group, respectively, all PHC workers in the sample district were overburdened during the study period.ConclusionsThe EV-based method provides a feasible solution for comprehensively assessing the workload of publicly funded PHC institutions in other regions. This study offers valuable insights to help local policymakers understand the workload burden of PHC workers, objectively evaluate their performance, and guide future health workforce planning.

Objetivo: Avaliar as dificuldades de médicos da Estratégia Saúde da Família (ESF) para proverem assistência à saúde das mulheres em todos os estágios de suas vidas. Métodos: Foi aplicado questionário semiestruturado a 203 médicos que atuam na ESF, em três regiões do Estado de Minas Gerais, com questões específicas relativas à atenção à saúde da mulher: prevenção do câncer do colo e das mamas, cuidado pré-natal e no puerpério, cuidados à saúde reprodutiva e atenção à saúde no climatério. Resultados: O motivo mais comum para serem médicos da ESF foi o interesse em trabalhar na Atenção Primária à Saúde (38,4%). As dificuldades mais frequentes foram atender mulheres no climatério (61,9%) e prover atenção à saúde reprodutiva (41,9%). Comparando os médicos segundo o tempo de formação, verificou-se que os mais jovens (com até três anos de formação) apresentaram mais dificuldades em prover todos os tipos de cuidados à saúde das mulheres. A análise multivariada confirmou as limitações dos médicos mais jovens no atendimento ao climatério (p<0,009) e a sua baixa participação em atividades educativas voltadas para as mulheres (p<0,021). Conclusões: Os médicos mais jovens apresentaram mais dificuldades específicas em todos os tipos de cuidados à saúde das mulheres e menor participação em atividades educativas. Presume-se que as dificuldades desses médicos estejam ligadas a deficiências na sua formação durante a graduação e à escassa participação nas ações programáticas de atenção à saúde das mulheres.