Family Health Strategy Program Research Articles

Quality of life of older adults in Family Health Strategy: a cross-sectional study.

With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

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.

Associações entre ansiedade e incapacidade funcional em pessoas idosas: estudo transversal

Abstract Objective to estimate the prevalence of anxiety in older adults and its association with different levels of functional disability in a small town in the state of Paraiba, Brazil. Method a cross-sectional analytical study was carried out of 233 randomly-selected older users of the Family Health Strategy program. Data were collected using the World Health Organization Disability Assessment Schedule 2.0 and the Geriatric Anxiety Inventory. Results were analyzed using descriptive and bivariate statistics adopting a significance level of p &lt; 0.05. Results Overall, 48.1% of the participants had some degree of selfreported anxiety, with significantly higher levels among women (mean rank = 128.11; p = 0.002). An association was also found between severe anxiety level and severe disability level (p &lt; 0.001). Conclusion the high prevalence of different degrees of geriatric anxiety and its association with severe functional disability indicates the coexistence of psychoemotional and motor alterations. These findings suggest the need to break the chain of underdiagnosis and strengthen the implementation of specialized interventions in the field of gerontology and geriatrics.

Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts.

The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.

Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status.

The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.

Continuity of Primary Care in the Brazilian Amazon: A Cross-Sectional Population-Based Study.

Background:Few studies have evaluated the continuity of primary care in universal health care systems, especially in underserved areas.Methods:This was a cross-sectional study with 4,001 adults (≥18 years old) living in the Manaus Metropolitan Region in 2015. Interviews were conducted in households selected with probabilistic sampling. City and neighborhood variables were collected from databanks. Prevalence ratios (PR) of the continuity of care (defined as using a primary care service and having been previously registered in the Family Health Strategy program) and 95% confidence intervals (CIs) were calculated with multilevel Poisson regression analysis.Results:A total of 20.6% (95%CI 19.4-21.9%) of the participants reported continuity of primary care. Women (PR = 1.38; 95%CI 1.18-1.61), nonwhite individuals (PR = 1.13; 95%CI 1.05-1.21), and poorer people (PR = 1.55; 95%CI 1.19-2.02) had higher levels of continuity, whereas health insurance holders had lower levels of continuity (PR = 0.46; 95%CI 0.34-0.62). Individuals with continuity of care had more physician consultations (PR = 1.06; 95%CI 1.02-1.10), dentist consultations (PR = 1.16; 95%CI 1.05-1.28), fewer depressive (PR = 0.59; 95%CI 0.44-0.79) and anxiety symptoms (PR = 0.64; 95%CI 0.48-0.85), and a higher quality of life (β = 0.033; 95%CI 0.011-0.054) than those without continuity.Conclusions:Continuity of care was attained by two-tenths of the population and the level of continuity was high among socioeconomically disadvantaged people. Good outcomes and health services usage increased with continuity of care.

Centrality of family bonds in the experience of middle-aged women.

To analyze meanings attributed to middle-aged women from their experience in their family relationships. Qualitative study of the Convergent Care Research method. Gender was used as an analytical category, developed with a total of thirteen middle-aged women from the coverage area of the Family Health Strategy program in a city in the southwest of Bahia state, through reflection workshops and interviews. Data were analyzed using discourse analysis. They express the affective relationship with children and grandchildren as the greatest highlight of middle age in overlap with the relationship with partners and other bonds, which makes their uniqueness and identification of demands for health care unfeasible. Female middle-aged are marked by conceptions of femininity that emerge from their condition as a woman-mother, from her complete donation. The research points to an urgent need to add gender as a reference for the care of middle-aged women, in order to consider the biopsychic and social interlaces in their life experience and that outline demands for care.

Associations between sociodemographic factors and physical activity and sedentary behaviors in adults with chronic diseases during COVID-19 pandemic

The pandemic of the new coronavirus (COVID-19) may be affecting the physical activity (PA) level in much of the population. This study aimed to investigate the prevalence of physical inactivity and sedentary behavior (SB) among adults with chronic diseases and their associations with sociodemographic factors during the COVID-19 pandemic. This cross-sectional study included 249 participants (age: 18–91 years; 61.4% female) with chronic conditions and attended the Family Health Strategy program in a small town in Brazil. Data were collected between 2020-07–13 and 2020-07-24 by face-to-face interviews. Self-reported PA, sitting time, chronic diseases, medication use, sociodemographic data, and self-isolation adherence were obtained by questionnaire. During this specific time point of the COVID-19 pandemic, 71.5% of participants did not meet the PA recommendations (≥500 METs-min/week), and the prevalence of SB risk (≥4 h sitting) was 62.7%. Adjusted logistic regression indicated that male participants (odds ratio [OR]: 1.89 [95% CI 1.02–3.53]), living alone (OR: 2.92 [95% CI 1.03–8.30]) or in a two-person household (OR: 2.32 [95% CI 1.16–4.63]), and those who reported sometimes performing self-isolation (OR: 3.07 [95% CI 1.47–6.40]) were more likely to meet the minimum PA recommendations. Current smokers had a lower odds (OR: 0.36 [95% CI 0.14–0.95]) of meeting the PA recommendations. Older participants (OR: 2.18 [95% CI 1.06–4.50]) and those who had multimorbidity (OR: 1.92 [95% CI 1.07–3.44]) were more likely to have a higher degree of SB. There is an urgent need to mitigate physical inactivity and SB, and public health interventions must take into account sociodemographic status.

Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis.

To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59years of age to 22% among participants aged 70-79years. Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Programa de ensino pelo trabalho: levantamento de demandas acerca da atuação de agentes comunitário de saúde em uma unidade de saúde na Cidade de Belém, Brasil

Os Agentes Comunitários de Saúde (ACS), são profissionais que integram a equipe de saúde do Programa Estratégia Saúde da Família (ESF). A atuação do ACS acontece nas comunidades em contato com a população, em seus núcleos familiares. Contudo, o objetivo deste estudo é relatar a experiência de discentes participantes do Programa de Ensino pelo Trabalho, a partir de uma atividade realizada com ACS e descrever acerca das principais dificuldades na sua atuação nas microáreas de uma ESF da cidade de Belém. Para melhor sistematização, o levantamento de demandas acerca da atuação dos ACS foi dividida em 5 etapas: na primeira etapa foi apresentado os espaços e os serviços oferecidos da unidade pela enfermeira responsável aos universitários. Na segunda etapa, houve a apresentação das ACS da equipe e a organização da atividade para o levantamento de demandas da unidade. Na terceira e quarta etapa, realizou-se a atividade sistematizada pelos alunos. A quinta etapa, contou com a organização de estratégias a serem inseridas na unidade para o aprimoramento do serviço. A partir da realização da atividade, verificou-se que as principais dificuldades identificadas pelos ACS deste território eram: ausência de materiais de proteção, ausência de acolhimento e desinteresse da população, problemas pessoais, sobrecarga de trabalho, ausência de infraestrutura e capacitação. O objetivo deste estudo foi alcançado. Entretanto, nota-se a fragilidade nos investimentos do poder público na saúde. Todavia, é importante haver constante capacitação a estes profissionais, visando a melhoria do atendimento à população.

Capacidade funcional e disfunção familiar de idosos na saúde da família no Ceará, Brasil: um estudo transversal

Capacidade funcional e disfunção familiar de idosos na saúde da família no Ceará, Brasil: um estudo transversal

Prevalence and correlates of generalized anxiety disorder among elderly people in primary health care

ABSTRACT Objective To examine the prevalence of generalized anxiety disorder (GAD) and its associations with sociodemographic and health factors. Methods A cross-sectional study with a population-based sample of 578 individuals aged 60 years or older from the Family Health Strategy (FHS) program of Porto Alegre, RS, Brazil. Home visit screening and general data collection were made by trained Community Health Workers (CHWs). Diagnoses of psychiatric disorders were made by board-certified psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus) in the Hospital São Lucas of the Pontifical University of Rio Grande do Sul (PUCRS). Results GAD was found in 9% of the sample (n = 52; CI 95% = 6.9-11.6). The main results of the multivariate analysis show associations between GAD and retirement (PR: 0.43, CI: 0.25-0.76), history of falls (PR: 2.52, CI: 1.42-4.49), cohabitation with four or more people (PR: 1.80, CI: 1.04-3.13), having more than one hospitalization in the last year (PR: 2.53, CI: 1.17-5.48) and self-perception of health as regular (PR: 2.75, CI: 1.02-7.47). Retirement in the elderly shows 2.32x less risk of GAD, although confounding factors may have overestimated this finding and underestimated the association with female gender (PR: 1.61, CI: 0.83-3.10). Conclusions We estimate a high prevalence of GAD in this population. Associations were found between GAD and health self-perceived as regular, cohabitation with four or more people, history of falls and more than one hospitalization in the last year. These epidemiological data from the Family Health Strategy are important to develop further strategies for this age group that could improve the health care practice.

Associação entre dados sociodemográficos e os domínios do WHOQOL-Bref entre profissionais de enfermagem

Objetivo: analisar a associação dos dados sociodemográficos e os domínios do Instrumento Abreviado de Avaliação de Qualidade de Vida (WHOQOL-Bref) em profissionais de enfermagem. Métodos: pesquisa do tipo transversal, realizada com 85 profissionais de enfermagem, nas Estratégias Saúde da Família. Coleta de dados realizada por meio do formulário de informações sociodemográfico e do WHOQOL-Bref. Os dados sociodemográficos foram analisados a partir da estatística descritiva e os do WHOQOL-Bref, através da análise de variância, teste t de ‘Student, e teste de comparações múltiplas de Tukey. Adotou-se nível de significância de 5%. Resultados: na associação referente às características sociodemográficas presente entre os profissionais de enfermagem e ao WHOQOL-Bref, evidenciou-se associação estatística significativa para o domínio ambiente, quando vinculado à renda familiar. Conclusão: profissionais com rendas mais baixas tendem a ter melhor qualidade de vida.

Occurrence of respiratory symptoms in elderly persons heard by the family health strategy in Águas Lindas, Ananindeua, Pará State

Respiratory diseases are among the five leading causes of death in Brazil, particularly among the elderly. This study identified the occurrence of respiratory symptoms in older persons. Specifically, a descriptive, observational, and quantitative study was conducted using a sample of elderly people enrolled in the Hypertension and Diabetes sessions of the Family Health Strategy program in a Brazilian city. MRC-ATS-DLD78 questionnaires were used to analyze respiratory symptoms with a sample comprised of 50 volunteers (mean age = 69.96 years). The median time living in a dwelling within a polluted sample area was 30 years, with 82% reporting spending more time per day at home or in the neighborhood. The presence of coughing was reported by 18% persons, expectoration (17%), productive cough (14%), wheezing (34%), dyspnea (12%), and respiratory diseases (26%). Physiological changes in aging associated with the effects of pollution exposure leave elderly people more vulnerable to respiratory diseases because they are predisposed to diseases, such as decreased pulmonary elasticity, elevated lung compliance, reduced oxygen diffusion capacity, reduced expiratory flow, and premature closure of airways. The occurrence of respiratory symptoms in the elderly was 30% with one symptom, two (22%), three (10%), four (6%), and five (2%).

General and Central Adiposity in Older Adults in Palmas (TO): Prevalence and Associated Factors

Objectives: To evaluate the prevalence and associated factors with general and central adiposity in older adults in Palmas (TO).Methods: Cross-sectional study with older adults (≥60 years) of both sexes enrolled in the Family Health Strategy program in Palmas (TO). Sociodemographic aspects, health conditions, and functionality were evaluated as independent variables and Body Mass Index (BMI) for general adiposity and Waist Circumference (WC) for central adiposity as dependent variables. Descriptive analysis and hierarchical multiple Poisson regression with robust variance were performed.Results: A total of 449 seniors (50.6% women) from 60 to 92 years of age, average of 68.3 years, were evaluated. The prevalence of general adiposity was 46.8% (95% CI: 42.2%–51.4%) and central adiposity was 78.8% (95% CI: 74.7%–82.3%). The prevalence of both outcomes was significantly higher among women and the participants with a history of hypertension, diabetes, dyslipidemia, and rheumatic diseases and those dependent in activities of daily living (ADL) than among men. Lower frequency of adiposity (general and central) was found with increasing age. After adjustment, the prevalence of both outcomes was significantly higher in women aged 70–79 years and hypertensive.Conclusions: The results of this study confirm the need to establish nutritional status monitoring and direct obesity prevention and control interventions in programs to promote health and quality of life of older adults and those in the stages prior to old age.

ELEMENTOS DA FORMAÇÃO DO ENFERMEIRO NA PREVENÇÃO DA VIOLÊNCIA CONTRA A PESSOA IDOSA

Objective: To analyze elements of nurses’ training that influence their professional activity for the prevention of violence against the elderly. Materials and methods: Qualitative research with nurses working in the Family Health Strategy (ESF) program. The data were processed by the IRAMUTEQ software and analyzed through Descending Hierarchical Classification based on the Discourse of the Collective Subject. Results: The results led to establish six categories: Category 1 - Training process: need for constant updating, Category 2 - Difficulty in identifying cases of violence against the elderly in the ESF program, Category 3 - Prevention of violence against the elderly in the ESF, Category 4 - Recognition of cases of violence against the elderly in the ESF, Category 5 - Early identification of cases of violence and potential risk factors, Category 6 - Home care visits to the elderly as a strategy for health promotion and violence prevention. Conclusion: Ongoing training of health professionals is necessary in order for them to be prepared and oriented towards interventions in cases of violence. Being nurses key professionals of this process, they are able to detect situations of violence against the elderly person and to carry out the necessary interventions.

Community health agents, nurses and physicians conducting research in Brazil's family health program.

While the integration of community-based providers within interprofessional health teams has been recommended by policymakers worldwide, there is limited research on how medical and community-based providers inform and participate in health research. Our study uses cross-sectional data from 169 Community Health Workers (CHWs), 62 nurses, and 31 physicians within Brazil's Family Health Strategy Program. Using an integrated framework of social cognitive theories and Theory for Planned Behavior, a reliable and valid instrument was developed to examine differences in past research involvement, and opinions about health and public health research (research efficacy and perceptions of research process). Descriptive frequencies and ANOVA F-tests were performed. Results indicated that CHWs has greater mistrust in the research process, and were not involved in substantive aspects of research (specification of aims, data collection, analysis, dissemination). Nurses compared to CHWs recruited participants to research studies, and had greater willingness to learn, participate and implement research initiatives. Physicians compared to CHWs and nurses developed survey instruments and disseminated research. For community-based and medical providers to be involved in all aspects of research, researchers ought to set up structured infrastructures of community collaborative boards. Furthermore, researchers can test our scale with other providers working within health teams globally.

Validity and concordance of self-reported diabetes mellitus by the elderly

The scope of this study was to verify the validity and concordance of self-reported diabetes (DM) by the elderly in Campina Grande, State of Paraíba. It involved a cross-sectional home-based study, conducted with 362 elderly people aged 60 years of age and above registered in the Family Health Strategy (FHS) Program in Campina Grande, State of Paraíba. A sensitivity calculation, specificity and positive predictive value (PPV) and negative predictive value (NPV) in relation to demographic and socioeconomic variables was carried out to verify the validity and reliability of self-reported DM. The Kappa test was used to verify the concordance between the diagnosis and the reporting of the disease. Among the study participants, 67.4% were women. The prevalence of diagnosed DM of 14.1% and self-reported DM of 18.1% was observed Moderate sensitivity (58.8%), excellent specificity (87.8%), moderate PPV (44.8%) and excellent NPV (92.7%), and moderate concordance of self-reported DM (Kappa = 0.413 p < 0.001) was observed. In this study, due to moderate validity and concordance of self-reported DM among the elderly, it is considered not to be advisable that self-reported DM should be used as a disease prevalence indicator in the population studied.

Development of a health literacy instrument related to diabetic foot

ABSTRACT Objective: To develop and verify the validity, reliability and interpretability of an assessment instrument of the Health Literacy regarding Diabetic Foot (HLDF). Method: Methodological study among people with diabetes enrolled in Family Health Strategy (FHS) program, composed of eight phases: selection of participants; development of LSPD; verification of content validity by the committee of experts; pre-test (n=20); reliability estimation (n=62): Cronbach's alpha (CA), Kappa (K) and Intraclass Correlation Coefficient (ICC), satisfactory results (≥0.60); estimation of concurrent validity (n=62); interpretability of scores: range from 0-18, if ≤14 HLDF inadequate; hypothesis test (multiple logistic regression): OR/IC95% in a sample estimated for infinite population, using SPSS. Results: The HLDF has adequate and fast application, being relevant as to its content and to the construct that proposes to evaluate. About the reliability CA=0.73, two items presented Kappa&lt;0.60, ICC=0.79. About the concurrent validity, there was correlation between the HLDF and schooling (rs=0.647; p=0.000). Interpretability: 50.2% (n=112) presented inadequate HLDF. The younger ones presented lower levels of inadequate HLDF (0.96/0.93-0.99); as to those with lower scholarship (1.15/1.06-1.25) and lower family income (1.01/1.00-1.01) presented higher levels of inadequate HLDF. Conclusion and implications for practice: The HLDF was considered as valid, reliable and interpretable. The HLDF can identify people with more effective educational strategies needs.

Utilização da Estratégia de Atenção Integrada às Doenças Prevalentes na Infância

Estudo que objetivou descrever a utilização da Estratégia de Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) por médicos e enfermeiros que atuavam na Estratégia Saúde da Família em capital do centro-oeste brasileiro. Estudo descritivo desenvolvido com 50 médicos e 51 enfermeiros que trabalhavam em unidades de saúde da família. Os dados foram coletados utilizando-se um questionário. A maioria dos pesquisados era do sexo feminino (69,3%), com três a cinco anos de formados (32,7%), sendo que 50,5% demonstrou conhecer o conteúdo sobre a estratégia, aprendido durante a graduação. Cerca de 44,6% dos profissionais utiliza parcialmente a estratégia, sendo que o elemento mais usado por eles é a avaliação de crescimento e anemia (25,4%). Os resultados encontrados são preocupantes, pois a não utilização de todos os componentes da AIDPI pode refletir na impossibilidade de detecção de doenças tratáveis na atenção primária, aumentando o número de internações hospitalares evitáveis.