ESF Teams Research Articles

Smoking: Profile of an Elderly Sample in the City of Porto Alegre-RS/Brazil

Objective: The objective of this study is to determine the profile of smokers in a sample of elderly people served by the Family Health Strategy (ESF) in the city of Porto Alegre/RS. Theoretical Framework: Smoking is one of the main risk factors for several chronic diseases, including cardiovascular disease, cancer, chronic obstructive pulmonary disease (COPD) and several other conditions. Although the number of smokers is declining in many countries, the impact of smoking remains a significant public health concern. Method: Cross-sectional study with prospective data collection involving a sample of 567 elderly people. 30 ESF teams from different Health Districts were chosen through a stratified random draw and 36 elderly people were selected from each team. Results and Discussion: The prevalence of smoking was 21.5%, with a higher prevalence in men (26%). Widowed elderly people had less history of smoking (47.8%), as did retired elderly people (54.7%), religious practitioners (50.7%) and those with higher incomes. An increase in prevalence was observed in elderly people who stopped smoking, with an increase in age groups. Research Implications: The research can provide specific data on the profile of elderly smokers in Porto Alegre, allowing public policies to be created or adjusted to more effectively serve this population. Originality/Value: While many studies on smoking focus on younger populations or middle-aged adults, the choice to specifically study smoking among older adults is less common and therefore fills a significant gap in the literature.

Is primary health care worth it in the long run? Evidence from Brazil.

This paper assesses whether Brazilian primary health care is worth it in the long-run by estimating the accumulated costs and benefits of its flagship, the Family Health Strategy program (ESF). We employ an alternative strategy centered on years of exposure to the program to incorporate its dynamics. We also account for the program's heterogeneity with respect to the remuneration of ESF health teams and the intensity of coverage across Brazilian municipalities, measure by the number of people assisted by each ESF team, on average. To address heterogeneity in professional earnings, this paper employs, for the first time, a dataset containing the remuneration of professionals allocated to all ESF teams nationwide. The benefits are measured by the avoided deaths and hospitalizations due to causes sensitive to primary care. Results suggest that the net monetary benefit of the program is positive on average, with an optimum time of exposure of approximately 16years. Significant heterogeneities in cost-benefit results were found since costs outweigh benefits in localities where the coverage is low intensive. On the other hand, the benefits outweigh the costs by 22.5% on average in municipalities with high intensive coverage.

“Do mesmo jeito que existe cachorro branco e preto”: uma análise acerca das intersecções entre raça e saúde

Abstract This paper reflects on the Family Health Strategy (ESF) workers’ understanding of racial relationships and health intersections. We conducted semi-structured interviews with ESF teams’ professionals in the State of Pernambuco, Brazil, whose data were analyzed in light of the discussions that focused on the racial theme. The results point to discrepancies between different health models in the daily routine, race/skin color invisibility in training and professional work, and whiteness as a structuring element of race relationships. The study reaffirms the need for Public Health to focus on the intersection between the issue of race/skin color and healthcare relationships and invest in the training of professionals regarding race discussions.

"The same way as there are black and white dogs": an analysis of the intersections between race and health.

This paper reflects on the Family Health Strategy (ESF) workers' understanding of racial relationships and health intersections. We conducted semi-structured interviews with ESF teams' professionals in the State of Pernambuco, Brazil, whose data were analyzed in light of the discussions that focused on the racial theme. The results point to discrepancies between different health models in the daily routine, race/skin color invisibility in training and professional work, and whiteness as a structuring element of race relationships. The study reaffirms the need for Public Health to focus on the intersection between the issue of race/skin color and healthcare relationships and invest in the training of professionals regarding race discussions.

Relationship between team climate and satisfaction at work in the Family Health Strategy.

ABSTRACTOBJECTIVE To analyze the association between team climate, team characteristics and satisfaction at work in teams of the Estratégia Saúde da Família com Saúde Bucal (Family Health Strategy with Oral Health) (ESF with SB).METHODS Cross-sectional correlational study with ESF teams with SB in the municipality of São Paulo. Universe of 1,328 teams and random sample of 124 teams with 1,231 professionals. Applied questionnaire with data teams’ characterization, team climate scale, and satisfaction at work. Analysis of validity, of climate and satisfaction scores through mean among professionals in each team, cluster analysis, association between variables by Pearson’s correlation and Chi-square, and tested linear regression model for the two factors of satisfaction at work.RESULTS There was a directly proportional association between team climate and satisfaction at work. The better the climate with regard to team goals, the greater the intrinsic satisfaction at work and with the physical environment. The better the climate with regard to team goals and task orientation, the greater the satisfaction with hierarchical relations. The group with best team climate reported higher percentage of teams ranked with better satisfaction at work, and in the group with the worst team climate there was higher percentage of teams with the lowest satisfaction at work.CONCLUSIONS The study provides consistent although moderate evidence of association between favorable teamwork climate and job satisfaction in ESF with SB. It emphasizes the dimensions of climate, common goals and task orientation, and may serve as subsidy for management and permanent education of teams, aiming at the quality of care to the health needs of users, family and community in APS.

Primary care coverage and individual health: evidence from a likelihood\xa0model using biomarkers in Brazil

BackgroundAlthough the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects.MethodsThe empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey.ResultsHousehold ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage.ConclusionsThe presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.

Family Health Strategy Care Accessibility in West Bahia.

This study assessed the Family Health Strategy (ESF) health care accessibility in the municipal system, which is the health macro-region headquarters in Bahia. It consisted of two levels of analysis: the municipal management and the local organization of ESF teams. Data production combined documentary analysis, non-participant observation, and interviews with managers, professionals, and users. Goal-image was used with evaluative criteria and dimensions of the accessibility in Primary Care. Family Health Teams (EqSF) still do not entirely fulfill the role of preferential contact in municipal health services, and the health care accessibility reflects the interdependence of municipal and local factors. Rural and peripheral teams performed better in organizational accessibility, and central urban teams performed better in geographic accessibility. The assessment focused on geographic and organizational criteria, combining different sources of evidence and health system players using analysis levels considering the municipal and local PHC management are relevant contributions of this study, which can be extended to other municipal systems with similar characteristics.

Perfil de gestantes atendidas no pré-natal em equipes de estratégia saúde da famí­lia

Objetivo: O presente estudo teve por objetivo analisar o perfil assistencial das gestantes atendidas no pré-natal em equipes de Estratégia Saúde da Famí­lia de um municí­pio do Norte de Minas Gerais. Método: Trata-se de um estudo descritivo, transversal, quantitativo e documental, realizado com dados de 6.545 gestantes cadastradas no SISPRENATAL e atendidas em 110 equipes da Estratégias Saúde da Famí­lia do municí­pio de Montes Claros, MG, no ano de 2016. Resultados: Os dados mostraram que a maioria das gestantes se declarou parda (55,19%). A idade predominante estava entre 20 a 34 anos (70,69 %). Em relação a quantidade de consultas de pré natal realizadas, apenas 34,59% realizaram o número preconizado para a gestação, captadas no primeiro trimestre de gestação (56,52%) e acompanhadas até a 40ª semana de gestação (29,46%). Conclusão: O estudo possibilitou a análise do perfil assistencial das gestantes atendidas pelas equipes da ESF em um municí­pio do Norte de Minas. Observa-se que parte dos indicadores de acompanhamento de pré-natal estão sendo atingidos, o que revela um resultado favorável das equipes de Atenção Primária í Saúde (APS) na assistência pré-natal. Porém percebe-se pontos de fragilidade da assistência prestada que merecem maior reflexão tanto pelas equipes, quanto pelos gestores de forma a aprimorar a qualidade do cuidado í s gestantes.

Trabalho do enfermeiro com adolescentes nas estratégias saúde da família: desenvolvimento de ações educativas

Resumo: Objetivo: conhecer como são desenvolvidas as ações educativas voltadas aos adolescentes no contexto de trabalho do enfermeiro nas Estratégias de Saúde da Família. Método: pesquisa qualitativa, descritiva-exploratória desenvolvida com 10 enfermeiros de Estratégias Saúde da Família. A coleta dos dados ocorreu no mês de maio de 2015, por meio de entrevista semiestruturada. Os dados foram analisados a luz da análise de conteúdo. Resultados: emergiram duas categorias de análise, sendo, o desenvolvimento das ações educativas pela equipe da ESF; dificuldades no desenvolvimento das ações educativas. Conclusão: percebe-se que as ações educativas são desenvolvidas em coletividade, desde o planejamento e execução, na maioria das ESF, e nos locais onde isso não ocorre, os enfermeiros compreendem a necessidade de iniciar um trabalho em equipe. O enfermeiro é percebido como responsável por coordenar a equipe, e orientar o processo de preparação das ações educativas.

“I won’t sleep tonight”: professional emotions related with family violence against child in Brazil

Abstract Background Interpersonal violence is a diverse cultural phenomenon. Worldwide, 300 million children aged 2 to 4 years has experienced violent discipline by their caregivers. In Brazil, Family Health Strategy (ESF) and Extended Family Health Core (NASF) are essential public policies of primary health care in Unified Health System (SUS). Emotions are extended psychological dimensions; however, society gets influence the way to express it. As a matter of fact, they cannot be an isolated case of contextual social interactions. This research aims to identify and discuss emotions that arises at health professional area which supports children victims of family violence. Methods Qualitative, descriptive research collecting data from observation, diary notes and interviews. Authorized by Human Research Ethics Committee of Federal University of Bahia. Held with 7 ESF teams and 1 NASF team, between November 2017 and June 2018, in Salvador-Bahia-Brazil. Empirical data were analysed through thematic analysis with ATLAS.ti 8.0. Results The code group 'subjectivity' grouped 2 codes: 'fear' and 'emotions'. The code 'fear' appeared in co-occurrence with 17 other codes, mostly: reception, reporting, avoiding case; and received 21 quotations. This topic stood out about nurses check notes, home visitors, psychologist and social worker, supporting their care needs. Fear appeared strongly related to those people who are “involved” with drug trafficking and avoiding of “getting into cases”. The code 'emotions' had 35 quotations and in co-occurrence with 11 other codes: suspicion, monitoring, referral, among others. Participants cited different emotions produced in these cases: revolt, sadness, anger, pain, despair, indignation, compassion. Conclusions Health professionals, both ESF and NASF teams were affected by family violence against children. The results suggest the necessity of a professional multidisciplinary supervision to improve child care. Key messages For managers: suggestion implementing systematic supervision with multidisciplinary team practicing primary health care services. For professionals: suggestion including the family violence topic to discuss in group, meetings and educational activities.

Desafios da enfermagem em saúde mental nas estratégias saúde da família

O objetivo do presente estudo foi investigar os desafios da assistência de enfermagem no âmbito da Saúde Mental nas Estratégias Saúde da Família. Trata-se de um estudo transversal, de caráter misto, quantitativa e qualitativa, em que 24 participantes foram entrevistados, 4 enfermeiros e 16 técnicos de enfermagem, em 8 equipes de ESF no município de Maceió - AL, sorteadas aleatoriamente através do programa Excel®. Dentre os resultados encontrados, destacam-se a inexistência de práticas em Saúde Mental, falta de capacitação e infraestrutura inadequada, recursos humanos e monetários insuficientes, predomínio cultural pela assistência ineficaz, ideologia de que o tratamento em Saúde Mental é para loucos e não como uma doença a ser tratada, receio e insegurança da equipe de enfermagem. Conclui-se que os desafios, apesar de reincidentes, são particulares entre os indivíduos em decorrência dos seus conhecimentos, preceitos e experiências. Os participantes identificaram seus desafios, angústias, necessidades, e consequentemente, alcançaram reflexões quanto às ações e práticas que possam ser realizadas no âmbito da SM, o que possibilita estratégias de mudança na assistência.

Estudantes de enfermagem e medicina inseridos na prática profissional: percepção de equipes

A Estratégia Saúde da Família constitui-se como uma reorganização do modelo de atenção em saúde e as mudanças na formação profissional são essenciais para a transformação da prática. O objetivo desse estudo foi analisar a percepção de profissionais de saúde de equipes de Estratégia Saúde da Família sobre as atividades e a inserção dos estudantes de 1° e 2° anos dos cursos de Enfermagem e Medicina de uma faculdade pública. Os dados foram coletados por entrevista semiestruturada e analisados com base na análise de conteúdo, modalidade temática. Os temas emergentes foram: O processo de inserção dos estudantes na equipe da ESF; O vínculo entre estudantes, famílias e equipe da ESF favorecendo a aprendizagem significativa e Desafios inerentes à formação profissional por métodos ativos de ensino-aprendizagem. Os profissionais acolhem as necessidades de aprendizagem dos estudantes e reconhecem que há troca de saberes. A inserção ocorre por meio da comunicação efetiva com a equipe. A presença do estudante na ESF é considerada como fator importante na construção do vínculo e facilitação do acesso ao serviço de saúde, entendidas como ferramentas prioritárias para o bom desenvolvimento do modelo de vigilância em saúde. As dificuldades de inserção no cenário foram atribuídas ao desenvolvimento inerente à aprendizagem ativa. Inserir, portanto, o estudante na ESF fortalece o que é preconizado para a formação atual das profissões da saúde, oportunizando a valorização da qualidade da assistência, a relevância do trabalho e, principalmente, o cuidado em saúde.

Advances and challenges of health care of the elderly population with chronic diseases in Primary Health Care.

This paper analyzes the developments and challenges of healthcare for older adults, especially those with chronic diseases in primary care, in a study setting of a family clinic in the city of Rio de Janeiro. Data were produced through the development of techniques such as participant observation, a focal group with a Family Health Strategy (ESF) team, an interview with the family clinic manager, and interviews with seniors accompanied or not by relatives or caregivers. Worth highlighting is the shift of the biomedical healthcare model to the biopsychosocial model and its implications in elderly care, prevention and health promotion. Despite care advances, some difficulties were observed, especially regarding the access of the population to the service, pointing to the perpetuation of health care inequities. Concerning the elderly with chronic diseases, it is noted that the ESF team employs a set of both individual and group strategies, whose effects were identified in the statements of the older adults, family members and caregivers, who positively qualify the care received. We can conclude that the care process is influenced by a myriad of factors that appear as objects of questioning and intervention in primary care.

Operacionalização do Sistema de Vigilância Alimentar e Nutricional (SISVAN) no município de Balneário Piçarras: relato de experiência

Objective: To report the experience of training Family Health Strategy (Estrategia Saude da Familia – ESF) professionals in the city of Balneario Picarras, Santa Catarina, as a strategy to operationalize SISVAN. Data synthesis: Participants were 67 professionals from the 7 ESF teams working in the municipality from April to September 2016. Two meetings were held: one for the identification of the difficulties in implementing the system (such as: multiple activities, lack of printed forms, and the poor conditions of anthropometric scales) and initiation of the training (addressing the importance of SISVAN); and the other to teach how to complete the forms and insert the data into the software. Conclusion: After all, the professionals became interested in activating SISVAN. The participants also reported the importance of including nutrition professionals in the ESF teams to collaborate in the activities related to food and nutrition education and in the provision of guidelines and interventions based on the food and nutritional situation of the population. After the training was completed, there was a more efficient data logging into SISVAN by some teams.

Comprehension of Representations and Health Education Practices from Users and Professionals of the Family Health Strategy

Objective: To understand the representations and health practices between users and ESF team. Material and Methods: Cross-sectional study in which a target population composed of 416 competition student athletes aged between 10 and 20 years of both genders, basketball (n=100), handball (n=60), soccer (n=96), Semi-structured quantitative and qualitative research focused on interview techniques with the theory of Social Representations as a benchmark for analysis and participant observation. Seventy-five subjects participated in four groups: a) Higher-education professionals, five nurses, three doctors and one dentist; b) eight professionals with technical training in nursing and dental health; c) ten community health workers; d) forty-eight users of ESF units. Data were analyzed using content analysis, whose categories were retrospectively established. Results: Education as well social value, cultural to be preserved in the family; as individual self-care; Health education as transmission, prescription of body care. Conclusion: The principles of popular health can support redefinition processes of the practices analyzed.

Implementation of Brazil's “family health strategy”: Factors associated with community health workers’, nurses’, and physicians’ delivery of drug use services

BackgroundBrazil's “family health strategy” (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers’ provision of drug use services. MethodsCross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State. Outcome variable: provision of drug-use services. Predictors: capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome. ResultsThirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services. ConclusionESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers’ delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers’ capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives.

Saúde mental na atenção básica: possibilidades para uma prática voltada para a ampliação e integralidade da saúde mental

O presente estudo buscou conhecer como vem se configurando as práticas em saúde mental na atenção básica, através de uma equipe de Estratégia Saúde da Família (ESF), a fim de que novas reflexões sejam despertadas acerca da temática. A pesquisa foi realizada por meio de entrevistas semiestruturadas e individuais, com dez profissionais da equipe de ESF, esses tinham entre 20 e 50 anos de idade, sendo todas mulheres. A partir da análise dos dados foram identificadas as seguintes práticas: atendimento diferencial, os grupos e visitas domiciliares, a responsabilização da família e a medicalização. Estas práticas foram articuladas com as concepções de saúde mental referidas pela equipe. Os resultados indicam que as práticas assistenciais refletem a concepção de saúde mental como doença/transtorno mental; poucas vezes houve referência a práticas de caráter promocional e preventivo à saúde mental. Com isso pode-se constatar que os princípios da integralidade e de um fazer para a clínica ampliada ainda não estão presentes na referida equipe de ESF. Para a concretização de uma clínica ampliada e integral se faz necessário equipes de ESF dispostas a assumir seu papel estruturante na rede de cuidados, construindo novas concepções e práticas, pautadas nas necessidades e subjetividades que envolvem os usuários que buscam o serviço, primando por articular a rede de serviços e as práticas promocionais e preventivas da saúde mental.

Fixação de enfermeiras e médicos na Estratégia de Saúde da Família, município de Praia Grande, São Paulo, Brasil

A captação, formação e fixação de profissionais são condições necessárias para a consolidação da Estratégia Saúde da Família (ESF) como modalidade estruturante da Atenção Primária à Saúde no País. O presente artigo teve como objetivo traçar o perfil de médicos e enfermeiras da ESF, identificando os profissionais que se fixaram à ESF no município de Praia Grande, São Paulo. Foram realizadas entrevistas semiestruturadas com todos os profissionais de nível superior em 2004-2005, e em 2007 foi verificada a permanência na ESF desses profissionais. Todas as enfermeiras e 66% dos médicos anteriormente entrevistados permaneceram atuando após 2-3 anos. Não foi observada associação estatística entre tempo de formado, possuir residência médica/especialização, morar no município com a não permanência na ESF. No entanto, é clara a associação entre o motivo de entrada na Estratégia e a saída: aqueles profissionais que entraram na ESF motivados pelo salário e oportunidade de emprego foram os que mais deixaram o serviço.

Planejamento local no cotidiano das equipes de saúde da família em Joinville - SC

This article presents the analysis of the perception of professionals of the Strategy for Family Health (ESF) in relation to motivation, facilities and difficulties found in the preparation and application of Local Health Planning (PLS) and the community participation in the process. This research was made in October 2008 to January 2009 and was developed to understand the problem selected by triangulation methods, starting by an evaluative study with exploratory characteristics and quantitative approach to all reports of PLS developed in 2007 in the city of Joinville, Santa Catarina. Focus groups were conducted with a qualitative approach (thematic analysis) of the material obtained. The main results were: the perception that the development and distribution of a PLS protocol enhances the culture of PLS, contributing to the development of the actions of the ESF teams. As obstacles to the practice of planning in the local level, was identified a weakness in the strategies of involvement and mobilization of the community and lack of practices and actions between all departments. Further studies of the areas listed can help to implement the ESF teams to build more remedial health authorities in areas that they develop their activities.

The family health strategy and the programmatic vulnerability in assistance to HIV/AIDS: a literature survey

The study aimed to analyze in published literature the potentialities and difficulties of Family Health Strategy (ESF) regardingthe Programmatic Vulnerability in assistance to HIV/AIDS. This is a narrative survey of publications in the period January-July 2009 in thedatabases LILACS, MEDLINE, ScIELO, PeriEnf and Teses USP. We selected 16 texts that were grouped, analyzed and prioritized in Structureand Dynamics of Services Organization (access to services and resources, qualification of professionals, ESF team internal organizationand with other services) and Actions Implementation (early diagnosis, counseling, educative groups and home visits). Although thereare challenges, ESF has contributed in important ways to the reduction of Programmatic Vulnerability to HIV/AIDS.