Primary health care assessment from the users' perspectives: a systematic review.

Weslla Karla Albuquerque Silva De Paula,Suzana Lins Da Silva,Malaquias Batista Filho,Maria De Fátima Costa Caminha,Isabella Chagas Samico

doi:10.1590/s0080-623420160000200021

Weslla Karla Albuquerque Silva De Paula, Suzana Lins Da Silva + Show 3 more

Open Access

https://doi.org/10.1590/s0080-623420160000200021

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Abstract

Analyze the evaluation of the attributes of primary care made by users of basic units of Brazilian health by using PCATool instrument adapted to Brazil. A systematic literature review conducted in the PubMed database, IBECS, LILACS, SciELO and BDTD. 4,405 documents were found, selected 23 full texts. After Full reading and application of eligibility criteria, 14 articles were evaluated. The studies showed that primary care performs well in longitudinality attributes, completeness and coordination and worse performance on attributes access first contact, family counseling and community orientation, even in the basic units with the Family Health. The users of basic health units assessed as unsatisfactory attributes considered essential for a health care more equitable and competing for user autonomy and social control. It is inferred that there are still obstacles hindering user access to basic health services and care actions are still being developed without favoring user participation and the community context in which they live. Analisar a avaliação dos atributos da Atenção Básica feita por usuários de unidades básicas de saúde brasileiras, mediante utilização de adaptações do instrumento PCATool para o Brasil. Revisão sistemática da literatura realizada nas bases de dados Medline/PubMed, LILACS, IBECS, SciELO e BDTD. Foram encontrados 4.405 documentos, sendo selecionados 23 textos completos. Após leitura integral e aplicação dos critérios de elegibilidade, 14 artigos foram avaliados. Os estudos apontaram que a Atenção Básica tem bom desempenho nos atributos longitudinalidade, integralidade e coordenação e pior desempenho nos atributos acesso de primeiro contato, orientação familiar e a orientação comunitária, mesmo nas unidades básicas com Saúde da Família. Os usuários das unidades básicas de saúde avaliaram como insatisfatórios atributos considerados fundamentais para uma atenção à saúde mais equânime e concorrente para autonomia do usuário e controle social. Infere-se que ainda existem obstáculos que dificultam o acesso dos usuários aos serviços básicos de saúde e que ações do cuidado ainda estejam sendo desenvolvidas sem privilegiar a participação do usuário e o contexto comunitário onde vivem.

Highlights

The Alma-Ata Declaration advocated that, in order to reach the goal for delivering “Health for all by the year 2000”(1), economic and social development of the countries was necessary, as well as government policies and actions involving other sectors, and the health system, and that it could rely on popular participation
Searching the bibliographical database from MEDLINE data, via PubMed and SciELO, no systematic literature review was found for comprehensively accessing the assessment of these services, from the perspective of users, who serve as guiding parameters for the quality of the care provided. In this context and, taking into consideration the assumption that units with Family Health Care are more Primary Health Care (PHC)-oriented than traditional Basic Health Units (BHU), (16,19) this study focused on analyzing the assessment of PHC attributes carried out by users of Brazilian primary health units, by using the adaptations of the Primary Care Assessment Tool (PCATool) for use in Brazil
Data collecting took place in January 2014 after the following research question: What is the assessment of primary care made by users of Brazilian primary health units, by using the adaptations of the Primary Care Assessment Tool (PCATool) for Brazil? The formulation of the question considered the acronym PICOS (Participants, Interventions, Comparisons, Outcomes, Studies)(20), a strategy followed for defining the eligibility criteria

Summary

Introduction

The Alma-Ata Declaration advocated that, in order to reach the goal for delivering “Health for all by the year 2000”(1), economic and social development of the countries was necessary, as well as government policies and actions involving other sectors, and the health system, and that it could rely on popular participation. Primary Health Care (PHC) was essential for achieving this objective. In developing countries, PHC originally has a selective nature, based on the recommendations of international organizations, such as the World Bank, following a neoliberal policy, reductionist in terms of health spending, and restriction towards the State role, privileging lowincome populations and specific programs, such as the socalled basic service staples, especially in the area of maternal and child health care. Successful in some of its interventions, a great deal of criticism was raised regarding the selective approach of PHC, for not taking into consideration all health determinants, ignoring social and economic contexts in the process(2)

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