Family Health Strategy Teams Research Articles

Analysis of Users’ Perception of Home Care Provided by the Family Health Strategy Team: A Quali–Quantitative Approach

Background/Objective: Home care involves actions and services aimed at promoting health. Despite being an important strategy for humanized care, strengthening bonds, and improving access, there is a lack of scientific evidence regarding users’ perceptions of home care. The objective of this study was to analyze the perception of users regarding the home care provided by the Family Health Strategy team. Methodology: A descriptive, quali–quantitative approach was used, with a sample of 60 patients who required home care. Interviews were conducted using a semi-structured guide, and the analysis applied the Collective Subject Discourse. Results: Most participants were female (60%) and aged between 71 and 85 years (45%). The duration of home care varied, with 41.6% receiving care for 13 to 24 months. The majority of participants (61.6%) received home care weekly, while 33.4% were visited every 15 days, and 5% monthly. The most present professionals were community health agents (45%), followed by nursing assistants (18.3%), nurses (15%), and doctors (15%). Dentists and physiotherapists made fewer visits (3.3%). Regarding the care received, 36.6% valued the continuity of treatment, 31.6% were satisfied with the quality, and 25% highlighted the humanization of care. Only 6.6% desired more frequent visits. Conclusions: The analysis of perceptions revealed that participants valued the continuity of treatment and the quality of care received. Home visits were predominantly carried out by community health agents.

Territorial-based mental health in Brazil: a systematic review of the literature

The research aims to investigate the actions of territorial and community-based services focused on mental health, with the participation of the Psychosocial Care Network, focusing on the family health strategy team. The Systematic Review methodology is used. The analysis of the key characteristics listed in the RAPS and the synthesis of the data were carried out according to the availability of data from the 10 eligible studies, covering topics such as Psychosocial Care Center, referral and matrix support, medicalization, care strategies in the territory, public policies, stigma/prejudice, training and social reintegration. Through the analyzed studies, it could be concluded that this service network is still under development, pointing out the importance of territorial-based care, and the need for expansion and implementation of extra-hospital infrastructure closer to the daily lives of mental health users, to that does not overload the insufficient substitutive services of assistance that are characteristically community, inadequate assistance approaches to the point of lack of assistance in some cases.

Intersectional equity in Brazil's remote rural municipalities: the road to efficiency and effectiveness in local health systems.

The Brazilian remote rurality has been classified more reliably only recently, according to demographic density, proportion of urban population, and accessibility to urban centers. It comprises 5.8% of the municipalities, in nearly half of the states, with a population of 3,524,597 (1.85%). Remote rural localities (RRL) have reduced political/economic power, facing greater distances and barriers. Most health strategies are developed with the urban space in mind. We aim to understand how RRL are positioned concerning efficiency/effectiveness in health, compared to other urban-rural typologies of Brazilian localities, focusing on Primary Health Care (PHC), and its organizational models. We evaluated the efficiency and effectiveness of the organizational models using the health production model, from 2010-2019, gradually deepening the immersion into the RRL reality. We analyzed the human and financial resources dimensions, emphasizing teams, the results of PHC actions, and health levels. We used the fixed effects model and data envelopment analysis, cross-sectioned by intersectional inequities. We compared the Brazilian states with and without RRL, Brazilian municipalities according to rural-urban typologies, and RRL clusters. Brazilian RRL states show superior resource/health efficiency through services utilization according to health needs. The remote rural typology demonstrated greater efficiency and effectiveness in health than the other typologies in the RRL states. The organizational models with the Family Health Strategy (FHS) teams and the Community Health Worker (CHW) visits played a key role, together with local per capita health expenditures and intergovernmental transfers. Thus, financial resources and health professionals are essential to achieve efficient/effective results in health services. Among the RRL, the Amazon region clusters stand out, denoting the importance of riverine and fluvial health teams, the proportion of diagnostic/treatment units in addition to the proportion of illiteracy and adolescent mothers along with the inequity of reaching high levels of schooling between gender/ethnicity. Hopefully, these elements might contribute to gains in efficiency and effectiveness, prioritizing the allocation of financial/human resources, mobile FHS teams, availability of local diagnosis/treatment, and basic sanitation. Finally, one should aim for equity of gender/ethnicity in income and education and, above all, of place, perceived in its entirety.

O PAPEL DO AGENTE COMUNITÁRIO DE SAÚDE NA MELHORIA DOS DADOS EPIDEMIOLÓGICOS COMO REDUÇÃO DE ÓBITOS SENSÍVEIS À ATENÇÃO BÁSICA

Introduction: The Community Health Agent (CHA) is responsible for working in the prevention and promotion of health by informing the Family Health Strategy (FHS) team of the population’s needs. Objective: To analyze the responsibilities of CHAs in the care of patients with certain conditions sensitive to primary healthcare, such as Diabetes Mellitus (DM), hypertension (HTN), and acute myocardial infarction (AMI) in the municipality of São João Del Rei/MG (SJDR) in the year 2020. Methodology: A quantitative study was conducted using data from the Department of Informatics of the Unified Health System (DATASUS), gathering the number of deaths from certain preventable causes due to the performance of Primary Health Care (PHC), alongside a literature review. Results: The municipality of SJDR reported deaths from causes sensitive to PHC interventions, such as DM, HTN, and AMI in 2020. When compared to the state of Minas Gerais, the municipality had nearly twice the number of deaths from HTN and AMI, highlighting the need for patient engagement with PHC, as the high mortality rates from these causes negatively impacted the state’s data. Conclusion: It is concluded that the municipality of SJDR had higher mortality rates from DM, HTN, and AMI compared to the state of Minas Gerais in 2020. These data suggest the need for more effective and targeted interventions to prevent the worsening of these conditions, with the role of CHAs becoming crucial in this contexto.

Clinical-functional vulnerability index in older people of a family health strategy team in the central zone of Rio de Janeiro

AimTo evaluate the applicability of the Clinical-Functional Vulnerability Index (IVCF-20) in monitoring the health of older people in primary health care (PHC), estimate the prevalence of functional decline and identify associated factors. MethodsCross-sectional descriptive study, with individuals aged 60 or over, from a PHC unit in Rio de Janeiro. The instrument included sociodemographic, health and lifestyle variables and the IVCF-20. A descriptive analysis was carried out, prevalence ratios (PR) were calculated, and Poisson multiple analysis was performed. ResultsThe sample consisted of 120 individuals, mean age of 72.9 years (SD= 0.75), the majority were female. According to IVCF-20, 61 (50.8 %) of the individuals were robust, 41 (34.2 %) were in potential functional decline and 18 (15.0 %) were in established functional decline. In the bivariate analysis, not performing regular physical activity (RP 2.60 CI95 % 1.21–5.57), not believing that you live a healthy life (RP 4.39 CI95 % 1.92–10.06), not being satisfied with the way you live (RP 6.74 IC95 % 2.51–18.11) and reference to chronic illness (RP 4.57 IC95 % 1.22–17.14) showed an association with functional decline. In the Poisson model, the variables age (RP 1.37 95 % CI 1.07–1.75), not believing that you live a healthy life (RP 1.54 95 % CI 1.01–2.33) and lack of satisfaction with the way you live (RP 1.75 CI95 % 1.18–2.60) remained associated. ConclusionThe study made possible to draw a profile of the older adults accompanied by a team at PHC, contributing to discussions on care proposals for the older people with a focus on preventing functional decline.

Team climate and patients’ perception of primary healthcare attributes in Brazil: a cross-sectional study

ABSTRACT Team climate and attributes of primary healthcare (PHC) are key elements for collaborative practice. Few researchers have explored the relationship between team climate and patients’ perceptions of PHC. This study aimed to assess the association between team climate and patients’ perceptions of primary healthcare attributes. A quantitative approach was adopted. In Stage 1, Team climate was assessed using Team Climate Inventory in 118 Family Health Strategy (FHS) teams at a PHC setting. In Stage 2, Patients’ perceptions of PHC attributes were assessed using the Primary Care Assessment Tool (PCATool) in a sample of 844 patients enrolled in teams studied in Stage 1. Cluster analysis was used to identify team climate groups. The analysis used multilevel linear regression models. Patients assigned to teams with the highest team climate scores had the highest PHC attributes scores. Patients who reported affiliation at the team level had the highest PCATool scores overall. They also scored higher on the attributes of comprehensiveness and coordinated care compared to patients with affiliation to the health unit. In conclusion, patients under the care of FHS teams exhibiting a more favorable team climate had more positive patient perceptions of PHC attributes.

Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.

MEANINGS OF PRIMARY CARE AND FAMILY HEALTH STRATEGY AND THE SINGULARITIES IN ITS DOING

Introduction: health, being a sphere of life, in all its diversity, did not remain outside the unfolding of the changes that occurred in society. The Family Health Strategy consists of a strategy for changing the so far existing Brazilian health model experienced until the 1990s. The Family Health Strategy is inserted in a context of political and institutional decision-making to strengthen primary care within the Unified Health System. The multiprofessional health work carried out by the Family Health Strategy (ESF) teams has been characterized by a division of labor among health professionals in order to promote positive and effective impacts on the different factors that interfere in the health-disease process. Objective: to understand the historical trajectory of transformation of the Brazilian health care model with a focus on primary care and its interface with the uniqueness of the performance of professionals working at this level of care. Methods: an integrative literature review study was conducted. Results: the results showed the relevance of the work developed for health effectiveness, in which it is understood that the performance of these professionals should follow a model that integrates competence, knowledge and problem solving. Professionals working in the family health strategy are important in the promotion, information and health education of the communities in which they are included. The work involves a respectful and humanized action with emphasis on autonomy, the development of healthy habits, prevention and health care of the population that meet the new vision of health system in the country. Conclusion: the historical construction of the Brazilian health system has gone through the paradigmatic change of understanding of the health-disease process, requiring dynamic, proactive and community, managerial and interpersonal skills to this reform.

STUDY ON ATUAÇÃO DO CIRURGIÃO-DENTISTA NA ATENÇÃO PRIMÁRIA FROM AN INTEGRATIVE REVIEW

This is a study developed through bibliographical research, with a qualitative basis, of a descriptive and exploratory nature, of an integrative literature review type. The objective was to verify how dental surgeons who work in primary care in family health strategy teams have carried out oral health services with a view to promoting care. Initially 1,090 articles were collected, of which after reading the titles, 450 articles were excluded, resulting in 640 articles, of which the abstracts were read, 575 articles were excluded, resulting in 65 articles of which, after reading in full, 50 articles were excluded, thus resulting in a sample of 15 selected articles. According to the work presented, we concluded, through research, interviews and reports given to dental surgeons themselves, that many professionals, due to lack of preparation and lack of information, have doubts regarding their performance in primary care. Facing difficulties in their daily lives, compromising their performance and ability to perform their role as a dental surgeon.

Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit.

To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Efficiency of public spending on primary health care: analysis of São Paulo’s cities

Objective: To analyze the efficiency of São Paulo’s cities with spending on the Primary Health Care sub-function in the year of 2018 and its association with geographic location, population size, wealth generated in the city (GDP – Gross Domestic Product) and budget expenditures with this public policy.
 Methodology: Exploratory descriptive and explanatory study with São Paulo’s cities in six similar cluster whit combine population and GDP. It uses the settled expense as input, the Number of FHS (Family Health Strategy) Teams, FHS’s Coverage Percentage, Number of Basic Health Units (BHU) and Percentage of Live Births of mothers who performed more than 7 doctor's appointments in the prenatal period as an output. The efficiency level of each city is shown on georeferenced maps. Pearson's correlation is used to estimate the levels of associations between quantitative variables.
 Results: 102 cities have a maximum level of efficiency, distributed between the six groups. Cities with a lower number of inhabitants and GDP tend to be more inefficient. Efficiency has a low correlation with population size, GDP or health public spending. The cities with the lowest levels of efficiency are neighbors of São Paulo (Metropolitan Region) or small cities scattered throughout the state’s territory.
 Theoretical Contributions: The research identifies that the management (formulation, implementation and evaluation) of the primary health care policy must consider different programs that focus on its location in the cities’ territory, population and wealth. There are references to the benchmarks for good practices in managing Primary Health Care policies.

Comunicação interprofissional e participação do usuário na Estratégia Saúde da Família

Abstract This study deals with collaborative competencies to strengthen teamwork and interprofessional collaboration in Primary Health Care services, supported by the framework of the health work process, interprofessional work and competencies. Its objective is to understand the conceptions and experiences of professionals from the Family Health Strategy teams regarding the core collaborative competencies: interprofessional communication and patient-centered care. This is an exploratory and interpretative qualitative study. A secondary database was used, with 34 interviews conducted with professionals from the teams of three health units located in two municipalities. Thematic content analysis was adopted, with support by the WebQDA software. The findings show the professionals’ understanding of collaborative competencies as complementary and as impossible to being treated independently. Interprofessional communication is recognized as a focus on meeting the user’s health needs, limited by unsatisfactory working conditions. Patient-centered care appears weak, since the sense of user participation prevails as a transfer of responsibility for their care to professionals and in a minority way, as sharing the construction of the care plan.

Quality of health care in Primary Care: perspective of people with Diabetes Mellitus.

to identify how people with diabetes assess the care offered by Primary Care teams. a cross-sectional study based on structured interviews with the application of the Patient Assessment of Chronic Illness instrument to people with Type 2 Diabetes Mellitus. Data were submitted to statistical analysis. 451 individuals participated in the study, more than half aged 60 years or older (64.0%); 63.9% had been diagnosed for more than five years; and 23.9% used insulin. The average score obtained was 2.5, which indicated little involvement in self-care and low support for the care of the chronic condition by the Family Health Strategy team, and was higher among women and people with a partner. people with diabetes consider that they do not receive individualized treatment, with dialogue and discussion for setting goals, and that they are not prepared for self-managing their health condition.

Strengths and weaknesses in the high-risk baby care network.

To characterize the Stork Network in health care for high-risk babies, pointing out its main challenges. questionnaires were applied with those responsible for the babies and with network health professionals. Data were analyzed quantitatively. statistically relevant variables were: link with the Basic Health Unit; individuals' awareness of Family Health Support Center team; awareness of Family Health teams regarding the diagnosis of high-risk pregnancy and compliance with prenatal care; means of communication of individuals' birth; awareness of the need for hospitalization as well as its duration; awareness of follow-up in Secondary Health Care; and its outcome, pointing to a difficulty in the axis of coordination and longitudinality of the services provided in the network. the greatest challenges lie in covering the territory by Family Health strategy teams, expanding teams and solidifying partnerships with Higher Education Institutions, guaranteeing a differentiated professional training.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Prevalence of occupational stress in health care personnel during the COVID-19 pandemic: a cross-sectional study.

Occupational stress has been exacerbated in health care personnel during the COVID-19 pandemic, which can harm the health of professionals, managers and the population. To estimate the prevalence of occupational stress in professionals of the Family Health Strategy of a Health District in the city of Salvador, Bahia, Brazil. This is a cross-sectional study carried out with 105 professionals from the Family Health Strategy teams of three Family Health Units in a Health District in the city of Salvador, Bahia, Brazil. A questionnaire with sociodemographic and work information and the Work Stress Scale were applied. Numerical stress values were categorized, from the average, into low and high stress levels. Measures of central tendency and bivariate analysis between stress and other variables were calculated. The high level of stress presented a prevalence of 46.7%, with the following most punctuated TSE stressors: lack of qualifications, few prospects for career growth, deficiency in the disclosure of decisions, discrimination at work and lack of autonomy. The prevalence of a high level of occupational stress among health professionals at Family Health Units reached 46.7% of the sample studied; a fact that deserves awareness on the part of managers regarding the promotion and protection of the health of health care personnel.

Escuta e valorização dos usuários: concepções e práticas na gestão do cuidado na Estratégia Saúde da Família

Abstract We aimed to analyze the practices of receiving, bonding, and shared responsibility in producing care in the Family Health Strategy. This qualitative, exploratory study in the dimension of hermeneutics-dialectics was conducted from August and November 2021 in Iguatu, Ceará, with 25 professional coordinators of the Family Health Strategy teams. A semi-structured interview was adopted to collect data. We identified different conceptions among the coordinators about reception and bonding. We shared responsibility: conceptual aspects linked to the experimental care practice mode the team experienced, the aspects that intervened in these processes, and the relationships built through care management and production. We evidenced contributions to evaluating and improving care management and production in the Family Health Strategy and the Unified Health System (SUS). Reception, bonding, and shared responsibility were proven potential tools in qualifying care management in the Family Health Strategy. Improving professional skills and investing in relational technologies are required for humanized health practice.

Listening and valuing clients: conceptions and practices in the care management in the Family Health Strategy.

We aimed to analyze the practices of receiving, bonding, and shared responsibility in producing care in the Family Health Strategy. This qualitative, exploratory study in the dimension of hermeneutics-dialectics was conducted from August and November 2021 in Iguatu, Ceará, with 25 professional coordinators of the Family Health Strategy teams. A semi-structured interview was adopted to collect data. We identified different conceptions among the coordinators about reception and bonding. We shared responsibility: conceptual aspects linked to the experimental care practice mode the team experienced, the aspects that intervened in these processes, and the relationships built through care management and production. We evidenced contributions to evaluating and improving care management and production in the Family Health Strategy and the Unified Health System (SUS). Reception, bonding, and shared responsibility were proven potential tools in qualifying care management in the Family Health Strategy. Improving professional skills and investing in relational technologies are required for humanized health practice.

Processo de trabalho para coordenação do cuidado na Estratégia de Saúde da Família

Abstract Objective To understand the work process of Family Health Strategy teams in the coordination of care, highlighting factors involved in this coordination. Method Qualitative study based on the attributes of care coordination, carried out with 18 care and management professionals between January and March 2020. Results Three final themes emerged: “Care plan”; “Standardization of practices”; and “Dialogical communication at different levels of care”. The pattern of responses points to the fragmentation of care and weakens coordination mechanisms. The exposure of restrictive factors related to the meso- and macro-organizational levels of the municipal health system reverberates in the ability of teams to coordinate care. Conclusion and implications for practice The coordination of care faces obstacles related to the work process of teams and structural issues in the organization of the health network. The contributions go beyond care and management, reaching education, research, and extension in professional training. Permanent education enables reorientations to guarantee the flow of users in the care network and provide comprehensive care to the population.

Undergraduate dental students’ perceptions of an internship at a Brazilian family health strategy center

We conducted a cross-sectional study to evaluate the perceptions of undergraduate dental students (UDSs) of an internship in primary dental care within a Family Health Strategy Team (FHS-T) and associated factors. Data were collected via a self-report questionnaire. Poisson regression models were used in multivariate analysis (p<0.05). Of 175 UDSs included, 150 (85.7%) classified the FHS-T internship as important to their dental education. Being enrolled in the Community Dental Health (CDH) III course (vs CDH I) increased by 9% (prevalence ratio [PR] 1.09; 95% confidence interval [CI], 0.99-1.21) the likelihood of students classifying the internship as important to their dental education. Considering the start of the FHS-T internship in the 7th semester adequate (vs inadequate) increased this likelihood by 15% (PR 1.15; 95% CI, 1.05-1.25). Classifying user embracement and home visits as important (vs unimportant) activities also increased this likelihood by 8% (PR 1.08; 95% CI, 0.99-1.17) and 21% (PR 1.21; 95% CI, 1.09-1.33), respectively. Our results suggest that the early insertion of UDSs in the FHS-T and their involvement in ‘user embracement’ and ‘home visits’ activities can significantly contribute to delivering interprofessional dental education.