Primary Health Care In Brazil Research Articles

Perceptions of physicians on the use of screening tools for mental disorders in primary health care in Brazil.

This study aimed to analyse perceptions, knowledge and ways of incorporating screening tools for mental disorders (MDs) into the daily practice of physicians working in primary health care (PHC) in the Brazilian public health system. This is a descriptive qualitative study with a sample of 24 physicians. The data collected in the semi-structured interviews were subjected to reflective thematic analysis. The use of screening tools was low, not only due to lack of knowledge, but also due to reasoned criticism of this strategy developed by physicians trained in PHC. Physicians also presented a scenario of chaos, work overload and the fragility of the psychosocial care network as barriers to effective care of patients with MDs and to the incorporation of innovations in this care. Interventions aimed at improving the quality of mental health care should include training on the topic, (re)organizing work processes, strengthening the health care network and producing robust scientific evidence on interventions aimed at qualifying professionals in mental health in PHC.

Mental Health Collaborative Care in Brazil and the Economy of Attention: Disclosing Barriers and Therapeutic Negotiations.

The introduction of mental health collaborative care (MHCC) is one of the strategies to scale up access to mental health care in primary health care in Brazil. This article investigates an experience of mental health collaborative care in the city of Rio de Janeiro, Brazil. It is a qualitative study involving interviews with physicians and mental health professionals working in primary health care units located in the northern part of the city of Rio de Janeiro, Brazil. The aim is to examine the various strategies and negotiations that primary health care professionals deploy to identify mental distress and plan health care interventions. We discuss the results within the economy of attention framework. We argue that divergences in diagnostic design and therapeutic planning carried out by professionals and users or observed in MHCC meetings illustrate the health-disease-care seeking phenomenon as a negotiated process, entangled in complex interactions. Our results evince that those interactions are not always evident and configure 'what is at stake' in mental suffering. The incorporation of cultural and structural determinants in collaborative care may enable the expansion of mental health initiatives sensitive to local needs and realities.

Health-related quality of life of oral health workers in primary health care in Salvador, Brazil

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.

Effects of parliamentary amendments on municipal financing of primary health care in the Brazilian Unified National Health System

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

The use of Information and Communication Technologies in Primary Health Care in Brazil - the period of 2014 to 2018.

Information and Communication Technologies in Health allow the storage and processing of digital data, access to information and remote communications. The objective of this article was to describe the use of these Technologies to support clinical practice and continuing education by primary health care teams in Brazil the period of 2014 to 2018, within the scope of the Access and Quality Improvement Program Basic, according to characteristics of the geopolitical context. It's a cross-sectional study that analyzed the data collected from the teams of the Basic Health Units. A growing use by the teams of Telehealth resources, the Telemedicine University Network and the Open University of the Unified Health System was observed to aid clinical practice and permanent health education. In the North and Northeast regions, the use of these Technologies doubled, from cycle II to cycle III. The need for investments in infrastructure, human resources in Primary Health Care, qualification and professional training is a way to strengthen the Unified Health System and its Health Care Network, contributing to a continuous flow of care, with quality and access universal.

Evolution of the availability of Information and Communication Technologies in primary health care in Brazil, 2012 to 2018.

To verify the evolution of the availability of information and communication technology equipment and inputs in primary health care services that participated in the external evaluation of the Access and Quality Improvement Program in Primary Care and its distribution according to context characteristics social and geographic. Cross-sectional study, analyzed the distribution of information and communication technology equipment in basic health units in Brazil, during the three cycles (2012 to 2018) of the Program for Improving Access and Quality in Primary Care. The variables were examined at the municipal level and stratified by geopolitical region. Univariate analysis was performed, using the chi-square test and testing the distributions of exposures among themselves and between the outcome and exposures. The availability of information and communication technology equipment increased from 9.4% (2012) to 17.5% (2018), with emphasis on the Southeast and South regions, in municipalities with a population size of up to 10,000 inhabitants², with greater family health coverage and high/very high HDI-M. Over the period from 2012 to 2018, basic units joined the program and increased availability of information and communication technologies, such as Internet access, which ranged from 45.2% (n=6,249) to 74.0% (n=21,423), with emphasis on the Northeast region, which increased from 19.1% (n=970) to 58.8% (n=7,087). Investment in technologies and constant evaluation of primary care in the country is necessary, contributing to its strengthening.

Evaluation of the impact of the implementation of the new primary health care information system on records of patient care and home visits in Brazil

The replacement of the Primary Care Information System (SIAB, 1998-2015), as of January 2016, by the new Health Information System for Primary Care (SISAB) determined new forms of collecting, processing, and using information, with a possible impact on the records of activities carried out in primary health care in Brazil. This study aimed to evaluate the implementation impact of the new information system on records of physicians' and nurses' patient care and home visits of community health workers (CHW) in Brazil from 2007 to 2019. To this end, a Bayesian structural time-series model approach was used, based on a diffuse state-space regression. From 2016 to 2019, 463.47 million physician care, 210.61 million nursing care, and 1.28 billion CHW visits were recorded. Following the trend recorded before the implementation, 598.86 million, 430.46 million, and 1.5 billion physician and nursing appointments and CHW visits would be expected, respectively. In relative terms, there was a decrease of 25% in physician care, 51% in nursing care, and 15% in CHW visits when compared to the value expected by the Bayesian method. The negative impact on the records of patient care and home visits identified in this study, whether due to difficulties in adapting to the new system or a reduction in improper records, must be investigated so that the challenge of improving the primary care information system can be understood and overcome in a planned way.

Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction.

To understand Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction. Cross-sectional multi-methodological research, composed of quantitative and qualitative steps, independently and sequentially. Data collected remotely, through a questionnaire and focus group, analyzed using descriptive statistics and thematic analysis by Braun and Clarke, respectively. The project was approved under Opinion 22691119.0.0000.0030. A total of 145 nurses participated in the study in the quantitative step and 20 in the qualitative step, working in Primary Health Care in Brazil. Of the 93.1% nurses who reported having already cared for people with Urinary Tract Dysfunction, only 54.4% provided guidance, mainly for training the pelvic floor muscles. Even though they have legal support and access to demand, nurses do not have the knowledge to offer conservative treatment for Lower Urinary Tract Dysfunction. Despite this, they were motivated to do so as long as they received specific training.

Temporal trend in the evaluation of adequate management for diagnosis and treatment of tuberculosis in primary health care in Brazil (2012-2018)

This study aimed to analyze the presence of infrastructure and adequate work processes in primary health care (PHC) for the diagnosis, monitoring, and treatment of tuberculosis (TB) in Brazil from 2012 to 2018. This is a temporal trend study carried out with data from basic health units (BHU) evaluated in the cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). Variance-weighted least-squares regression was used to estimate annual changes, in percentage points, of the infrastructure and adequate work process of TB in relation to the macroregion, municipality size, Municipal Human Development Index, and Family Health Strategy coverage. The sample consisted of 13,842 BHU and 17,202 health teams in cycle I; 24,055 BHU and 29,778 teams in cycle II; and 28,939 BHU and 37,350 teams in cycle III. There was a gradual improvement in the proportion of infrastructure and work process for TB care over the three cycles of the PMAQ-AB, but none of the sites is fully adequate. The greatest trend of adequate infrastructure was observed in the South Region, and in 2018, 76.5% of the UBS had all the instruments for TB care. The greatest trend of adequate work process was in the North Region, and in 2018, 50.8% of the teams had all the items for TB care. The Brazilian National Program for Tuberculosis Control and the PMAQ-AB have contributed to these advances, but there is still a need to promote public policies that ensure the continuous improvement of TB care in PHC, the effectiveness of TB control and prevention measures.

Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review

Purpose The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa). Methods A scoping review guided by Arksey and O’Malley’s framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data. Results The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services. Conclusion This review discusses BRICS countries’ rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.

Quality of antenatal care in primary health care in Brazil: a latent class analysis

Abstract Background Adequate antenatal care (ANC) is fundamental in preventing maternal and neonatal mortality. Developing indicators for assessing the ANC quality in Primary Health Care (PHC) is essential. Objective To characterize subgroups of quality of care with respect to ANC at the PHC level in Brazil. Methods We conducted a cross-sectional study with data from the first Brazil’s National Program for Improving Primary Care Access and Quality (PMAQ-AB) Cycle (2011–2012). A total of 16 566 PHC teams participated in the first cycle of the PMAQ-AB, corresponding to 49.6% of the teams active across Brazil, distributed across 69.3% of Brazilian municipalities. To assess the quality of ANC, six indicators were defined: ‘Group of medicines,’ ‘Protocols and patient flows,’ ‘Record-keeping practices,’ ‘ANC routine tests,’ ‘Protocols for early detection of pregnant women and ANC provision,’ and ‘Identification and ANC of low/high-risk pregnancies.’ Latent Class Analysis (LCA) was carried out to characterize the quality of care provided by PHC teams according to these six indicators. Results ‘Identification and ANC of low/high-risk pregnancies’ indicator had the highest percentage of teams providing adequate care (39.5%), while ‘ANC routine tests’ had the lowest percentage (16.8%). The LCA identified three classes, and 20.5% of PHC teams had the probability of belonging to the class denominated ‘High adequacy.’ Conclusion Using a national PHC-level dataset, we evaluated PHC teams’ ANC adequacy through six indicators. Brazilian PHC teams consistently show weaknesses across these indicators, particularly in essential care. This approach can guide global initiatives to evaluate the quality of ANC.

PROFILE OF THE DENTAL SURGEON IN PRIMARY CARE: a literature review

The profile of the dental surgeon has been changing since colonial Brazil, with preventive and restorative techniques promoting oral health. The evolution of the dental surgeon's profile has changed a lot from the past to today, along with the basic ethnic codes that the dental surgeon must have. Regulations have been created to help shape this professional profile, in which surgeons are more humanized in their dental practices. The aim of this study is to review the literature on dental surgeons working in primary health care in Brazil and thus stimulate reflection on their importance in contemporary professional training. The profile of the dental surgeon has a major impact on society, as it does on various health professions. The dentist must have a humanist character, be endowed with empathy, nurture respect for others and enjoy the uniqueness of caring for the well-being of others. To excel in this area, it is highly recommended to have an enviable ability to concentrate, admirable patience and to be meticulous down to the last detail. These qualities are real assets in the career of a successful dental surgeon.

Care provided to adults with obesity, systemic arterial hypertension, and diabetes mellitus in primary health care in Brazil

Non-communicable chronic diseases have high prevalence rates, increasing demands for healthcare services within the Unified Health System. Primary Health Care stands as a strategic level for organizing the care and management of users within these services. The study aimed to assess the care provided to individuals with obesity, systemic arterial hypertension, and diabetes mellitus in Brazilian Primary Health Care during 2019. It is a cross-sectional study based on data extracted from the Health Information System to evaluate the proportion of visits, interventions offered, and professional categories involved in the care for adults with obesity, hypertension, and diabetes. Visits for hypertension and diabetes were close to their prevalences. Those for obesity matched its prevalence. The most frequently recorded intervention was scheduled follow-up care, and physicians were the most prevalent healthcare professionals across all three conditions. The care provided for the three evaluated conditions was similar in some aspects. However, regarding obesity, there were fewer visits compared to the other conditions, and there were differences in the most involved professional categories in these visits.

Violence in the Nursing Workplace in the Context of Primary Health Care: A Qualitative Study.

Violence demands considerable attention due to its complexity and social consequences. The objective of this study was to analyze violence in the nursing professional workplace in the context of primary health care in Brazil. It is a qualitative study with theoretical and methodological reference to institutional analysis. It was carried out in basic health units in Brazil. Nursing professionals (N = 11) participated in semi-structured interviews and discussion groups, in addition to a research diary and participant observation. Data collection took place from October to December 2021. The results are presented in five categories: types of violence and aggressors from the perspective of nursing professionals; the causes of violence reported by professionals; strategies for the management of violence; professionals' proposals for preventing violence in health contexts; the consequences of violence in the workplace. Nursing professionals make up a large part of the workforce and have reported verbal, physical, moral, and psychological violence. The main causes are associated with user access to services. For the prevention of violence, professionals do not see themselves as protagonists of change. The consequences are the loss of quality of work and the health of professionals who requested sick leave and transfers. The study's findings can help in the development of public policies and educational and management actions.

Incidence and risk factors for polypharmacy among elderly people assisted by primary health care in Brazil

BackgroundPolypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years.MethodsThis was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals.ResultsThe incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093–1.267).ConclusionsThe incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.

Determinants of socioeconomic factors for quality of life and depressive symptoms in community-dwelling older people: A cross-sectional study in Brazil and Portugal.

Our aim was to analyze the association between socioeconomic status and quality of life (QoL) among older people with depressive symptoms treated through the Primary Health Care (PHC) system in Brazil and Portugal. This was a comparative cross-sectional study with a nonprobability sample of older people in the PHC in Brazil and Portugal conducted between 2017 and 2018. To evaluate the variables of interest, the socioeconomic data questionnaire, the Geriatric Depression Scale and the Medical Outcomes Short-Form Health Survey were used. Descriptive and multivariate analyses were performed to test the study hypothesis. The sample consisted of n = 150 participants (Brazil n = 100 and Portugal n = 50). There was a predominance of woman (76.0%, p = 0.224) and individuals between 65 and 80 years (88.0%, p = 0.594). The multivariate association analysis showed that in the presence of depressive symptoms, the QoL mental health domain was most associated with the socioeconomic variables. Among the prominent variables, woman group (p = 0.027), age group 65-80 years (p = 0.042), marital status "without a partner" (p = 0.029), education up to 5 years (p = 0.011) and earning up to 1 minimum wage (p = 0.037) exhibited higher scores among brazilian participants. The portuguese participants showed an association between the general health status domain and woman group (p = 0.042) and education up to 5 years (p = 0.045). The physical functioning domain was associated with income of up to 1 minimum wage (p = 0.037). In these domains, the portuguese participants exhibited higher scores than the brazilian participants. We verified the association between socioeconomic profile and QoL in the presence of depressive symptoms, which occurred mainly among woman, participants with low levels of education and low income, with QoL aspects related to mental, physical and social health and self-perceived health. The group from Brazil had higher QoL scores than the group from Portugal.

The Work of Nurses in Primary Health Care: Crossings of the New Public Management.

The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.

Common mental disorders and associated factors in healthcare workers during the COVID-19 pandemic: A cross-sectional study.

The coronavirus 2019 (COVID-19) pandemic changed the way people live. As a result, workload and mental health problems increased, especially in healthcare workers. To verify the prevalence of common mental disorders (CMD) and its association with sociodemographic and work variables in healthcare workers of a Family Health Support Center in the Primary Health Care context (NASF-AB) in Brazil during the COVID-19 pandemic. This cross-sectional study was conducted with 68 healthcare workers, both sex (55 female/13 male), from the Primary Health Care context in Brazil, particularly NASF-AB of Salvador Bahia. NASF-AB is part of a policy to consolidate Primary Health Care in Brazil. NASF-AB of Salvador has twelve multidisciplinary teams distributed in twelve health districts. The data collection was performed from May to August 2021. The self-reporting questionnaire - 20 (SRQ-20), that assessed the prevalence of CMD, and a sociodemographic questionnaire assessed sociodemographic and work variables via Google forms. The prevalence of CMD was 39.71%. On SRQ-20, 70, 59% of participants felt nervous; 54, 41% felt tired all the time and 51, 47% felt tired easily. CMD was also significantly associated with females (p < 0.001). The prevalence of CMD was high (39, 71%), with females (n = 27/55) being more susceptible to CMD than males (n = 0/13). Feel nervous, tired all the time and easily tired were the most frequent symptoms reported by the participants, indicating depressive/anxious mood, and reduced vital energy. Our findings highlight the need for specific measures to improve health and quality of life of healthcare workers.

Clinical impact of comprehensive medication management services offered to geriatric and hypertensive patients

Abstract Objectives To assess the clinical impact of comprehensive medication management (CMM) services offered to geriatric and hypertensive patients in primary health care in Brazil. Methods A quasi-experimental study was carried out with patients followed up in primary care in three Brazilian cities (n = 346). McNemar’s test was used to assess the clinical impact of the service. Key findings A total of 1308 drug therapy problem (DTPs) were identified and 581 (44.4%) were resolved. Among the DTPs, the majority were related to non-adherence to therapy (23.9%; n = 313) or the need for additional medications (18.2%; n = 238). It was observed an increase in the proportion of people who had their blood pressure controlled at the last visit when compared with the first visit. Conclusions This study indicates that the CMM service can contribute to achieving blood pressure control in geriatric and hypertensive patients. The frequency of DTPs was high in the studied population, but many DTPs were resolved by pharmacists.

Implementation of advanced practice nursing in primary health care in Brazil

Implementation of advanced practice nursing in primary health care in Brazil