Family Health Care Program Research Articles

THIRD-YEAR HEALTH PROFESSIONS STUDENTS’ INTERPROFESSIONAL EDUCATION IN THE COMMUNITY SETTING: WHAT DID THEY EXPERIENCE?

Background: Learning by experiencing a real situation is believed to be more powerful than using simulation. This hypothesis is also applied to interprofessional learning for students in health professions education. Learning to collaborate and practice students' knowledge of health care in a community became the purpose of the community and family health care (CFHC) program in the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada.Aim: To describe the third-year students’ experiences of learning interprofessional collaboration in a community setting based on their activity report.Case Discussion: The CFHC team created a particular design for third-year students, focused on community health problems rather than family health problems. The groups conducted focus group discussions to explore health issues and to decide together with the community the main problem that would be given intervention. The groups documented the entire process through a written report, video, and an article about their intervention outcome.Conclusion: The reports showed that students were able to demonstrate interprofessional practice in solving health problems in the community. They learned to work as an interprofessional team while experiencing it. Thus, conducting community-based IPE for undergraduate students is necessary to develop interprofessional collaboration competencies.

EVALUATING INTERPROFESSIONAL EDUCATION PRINCIPLE IN A LONGITUDINAL COMMUNITY-BASED PROGRAM FOR 3 SCHOOLS OF HEALTH PROFESSIONS: MEDICINE, NURSING, AND NUTRITION

Background: Interprofessional education (IPE) is a method offered to support the collaboration of two health professions or more in order to create an ideal teamwork. This study aims to evaluate students’ interprofessional attitudes during the implementation of IPE in a community-based program among 3 health professions students.Method: Second and third year undergraduate students from three health profession schools in Faculty of Medicine, Universitas Gadjah Mada, medicine (n = 50), nursery (n = 50), and nutrition (n = 50), were recruited in 2015. Students were sent to a community setting in a small group of 10 consisting of those three schools’ students. They were assigned to a certain family and followed them longitudinally in a curriculum called the Community and Family Health Care program. Quantitative data were collected with a survey using Interprofessional Attitude Scale instrument containing 5 subscales (27 items): teamwork, roles and responsibilities; patient-centeredness; interprofessional biases; diversity and ethics; and community-centeredness. The items used 5-level Likert scale. Descriptive analysis was performed for the quantitative data and comparison among those three groups used Kruskal-Wallis test.Results: Most of the students strongly agreed they learned a lot about interprofessional attitudes during this program (mean scores of each subscale: 3.85, 4.19, 3.18, 3.83, and 3.99, respectively). There were significant differences among mean scores of each subscale (p< 0.05). Medical and nursery students had higher mean scores compared to nutrition students, except in the subscale of community-centeredness (p = 0.197).Conclusion: IPE can be implemented successfully in a longitudinal community-based education curriculum and benefits undergraduate students in studying interprofessional attitudes. The program should be evaluated and improved to assure all students to get equal benefits.

Humanization policy in primary health care: a systematic review

OBJECTIVETo analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy.METHODSA systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis.RESULTSAmong the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users.CONCLUSIONSAlthough many practices were cited as humanizing they do not produce changes in the health services because of the lack of more profound analysis of the work processes and ongoing education in the health care services.

Avaliação da qualidade do programa Saúde da Família em municípios do Ceará: uma abordagem multidimensional

We evaluated the quality of the Family Healthcare Program of Ceará (Brazil) by adopting a multidimensional model based on the theoretical assumptions of two important scholars, both well-known at an international level, namely Avedis Donadedian and John Øvretveit. We adopted the well-known approaches to the quality of healthcare of the first author: structure, process and outcome. Of the latter, we adopted the three dimensions of quality: quality perceived by patients, by professionals and by managers. The research was conductedten municipalities of the State of Ceará. Even though different nuances and emphases were used, the informants (physicians, nurses, coordinators of family healthcare teams, municipal secretaries of health and users) some aspects responsible for the improvement of the quality of Family Healthcare were identified. As a final result the study highlight a range of dimensions and quality indicators according to the perspective of the different actors involved in the study.

Assistência Farmacêutica no Programa Saúde da Família: encontros e desencontros do processo de organização

The scope of this study was to discuss the organization of the pharmaceutical assistance service in the family healthcare program. Qualitative research from a critical/analytical perspective was conducted in family healthcare units in a municipality of the state of Bahia, Brazil. Data was collected on the basis of systematic observation, semi-structured interviews and documents analysis from a dialectic standpoint. The organization of Pharmaceutical Assistance consisted of selection, planning, acquisition, storage and dispensing activities. The process was studied in the implementation phase, which was occurring in a centralized and uncoordinated fashion, without the proposed team work. An excess of activity was observed among the healthcare workers and there was an absence of a continued education policy for the workers. For the transformation of this situation and to ensure the organization of pharmaceutical assistance with quality and in an integrated manner, a reworking of the manner of thinking and action of the players concerned (managers, health workers and users), who participate directly in the organization, is necessary. Furthermore, mechanical, bureaucratic and impersonal work practices need to be abandoned.

As representações sociais dos trabalhadores sobre o Programa Saúde da Família

The scope of this study is to analyze the social representations of workers regarding the Family Healthcare Program (FHP) to check its potential and limitations in order to change the healthcare model. Data were obtained through semi-structured interviews with eighteen health workers and by observing the working process of the teams of the Healthy Family Program (HFP) of five Regional Administrations in the Federal District. The data obtained from the interviews were analyzed using ALCESTE software, which generated two main trends. The first is related to social representations of the FHP, composed of several classes: the first class deals with FHP as a strategy to change the healthcare model; the second class refers to the difficulties of infrastructure, and the fifth class deals with family interaction based on medical practice. The second trend deals with daily practices of the HFP, composed of a third class, namely the actions developed by the HFP, and a fourth class that demonstrates the forms of organization and division of labor.

Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil)

The scope of this study was to analyze child healthcare in the Family Healthcare Program (FHP) in Teixeiras, MG, Brazil. A descriptive transversal study was conducted by applying a questionnaire to 161 mothers of children under 2 years of age. A specific score system was used to analyze the dimensions of structure, process and result and the respective attributes, classifying the town in the incipient, intermediary and advanced categories. The FHP was classified in the intermediary (49.6%) category, characterized by fragmented child healthcare, though with some advances in the organization of care for this group. The physical installations, the quality of care given to control of diarrhea and respiratory infection, community participation and interdisciplinarity were considered incipient. Progress was seen in receptivity to the program, though the scant preventive and promotional activities of the FHP means that it is viewed as an annex to the hospital and merely another place for medical care. The activities of the FHP in child healthcare are not in line with the proposal for reorientation of the hegemonic healthcare model for which it was created, thereby hampering disease prevention strategies and the promotion of healthcare.

Validação inicial do índice de necessidade de atenção à saúde bucal para as equipes de saúde bucal na estratégia de saúde da família

This survey set out to validate the Index of Oral Healthcare Needs (IOHN), based on a pre-defined algorithm of the social status of families. The validation process was divided into two phases, namely a face validation and a construct validation. In the latter, data on caries experience, toothache and access to oral health services was collected. To validate the index a random, stratified sample of 412 children aged 3-5 and 7-12 was obtained, based on the IOHCN algorithm, all the children being from the areas of Recife covered by the family healthcare program. The analysis consisted of a descriptive and an analytical phase, adopting a 5% level of significance. The index was considered by an expert committee to have good face validity. The convergent construct validation was associated with a decay component of dmft (p = 0.03) and DMFT (p = 0.01); the divergent construct validation was associated with access to oral care (p = 0.001) and filled component of dmft (p = 0.05), showing no association with the filled component of DMFT. The Index of Oral Healthcare Needs was shown to have good initial validation and canbe used as a useful tool in the planning of dental care at a local level.

Reorganização do sistema familiar na condição do câncer

This study aimed to expand our understanding of the interaction that occurs in family systems of patients with cancer, who are suffering social vulnerability, and with their suprasystems. This article is part of a qualitative study, carried out with families assisted by a Family Health Care Program, which used Symbolic Interactionism and Grounded Theory as theoretical and methodological references. It was conducted between 2008 and 2009, in a countryside city in São Paulo. After identifying the characteristics of each family, through a questionnaire containing closed questions, semi-structured interviews were conducted with six families who are socially vulnerable. The ongoing comparative analysis of the data revealed that families began to consider support providers as their family rather than next of relatives or the people they live with. Thus, we can conclude that the meaning of family was being constructed while the care was being received, during much suffering, in the social context of poverty, vulnerability and social exclusion. The interaction that occurs in the family subsystems and suprasystems directly affects what they consider the meaning of family to be and this affects their relationships. This study can be used as an information resource in caring for families of patients with cancer, who are socially vulnerable.

Programa Saúde da Família como estratégia de atenção primária: uma realidade em Juazeiro do Norte

This study analyzes the practices and organization of Family Health Program, in the municipality of Juazeiro do Norte according to the discussion of elements that feature the primary attention, as proposed by Starfield. The theoretical context chosen understands the primary attention as a level of attention organized by the features: First contact, longitude, integrality, coordination. This is a qualitative research, using focus group techniques, semi-structured interview and non-participant observation in eight family health units in the municipality. There are difficulties in accessing the primary care in the units, caused by structural barriers imposed to the organization of attention, represented by an excess of clients for each team and reduced availability of medical professional. Considering that there are a compulsory enrollment of the population to the Family Health Care program health units, this level of attention in the city presents itself as a traditional doctor-hegemonic model of healing practices associated with the prioritization of vertical programs of the Ministry of Health.

Molecular analysis and risk factors for nasal colonization with methicillin-resistant Staphylococcus aureus among community individuals attending a Family Health Care Program in Rio de Janeiro, Brazil

tests for detection of Mycobacteria and Fungi in urine specimens. Methods: Study was done in Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, from October 2005 to September 2007. Urine samples of 50 patients with clinical suspicion of Tubercular and Fungal etiology of Urinary tract infection of immunocompromised patients [Diabetes mellitus (14), AIDS (13), Renal transplant recipient (09), Malignancies (07), End stage renal disease/ Chronic renal failure (06), Systemic lupus erythematosus (01)] & 50 apparently immunocompetant patients were taken as diseased control. For Mycobacteria microscopy (Ziehl-Neelsen staining), Culture (Lowenstein Jensen Medium and BACTEC medium), PCR and NAP test were done. For Fungus microscopy (Direct wet mount, Gram’s stain), Culture (Sabouraud’s Dextrose Agar), Germ tube test, Corn meal agar, Sugar Fermentation & assimilation test were done. Culture was considered as gold standard. Results: Out of 50 immunocompromised patients, 7(14%) were positive for mycobacteria [MTBC 5(10%), MOTT 2(4%)] and 10(20%) were positive for fungi [C. albicans 4(8%), C. glabrata 4(8%) and C. tropicalis 2(4%)]. Out of 50 apparently immunocompetant patients (diseased control), 4(8%) were positive for mycobacteria [MTBC 3(6%), MOTT 1(2%)] and 3(6%) were positive for fungi [C. albicans 2(4%) and C. tropicalis 1(2%)]. Sensitivity and specificity were 71.42%, 90.69% of Ziehl-Neelsen stain, 88%, 100% of Lowenstein Jensen culture, 57%, 100% of PCR for Mycobacteria, 80%, 100% respectively for wet mount for fungi. Conclusion: Incidence of mycobacterial/fungal infection in immunocompromised patients is more then to immunocompetent individuals and with immunocompromised conditions, urinary tract infection should be screened for mycobacterial and fungal pathogens.

Information literacy for community health agent training in Brazil: a proposal for mediation based on the extensive and collaborative models

This article presents methodology based on the extensive communication model (SIMEAO, 2006) and Alfin, an acronym published by Unesco to offer a concept for the process of information literacy acquisition (information literacy), in research applied to the communication context of information on health in Brazil. This paper assesses the mediation of Community Health Agents (ACS) in their work in the Brazilian Unified Health System (SUS) through the development of Alfin training workshops. In testing whether the proposal is applicable in a professional workspace which is more open, with more informal communication relationships, the research group observes the Community Health Agent (ACS), a supporting professional and the main mediator in the Family Health Care Program, and his/ her performance as a communicator. The hypothesis is based on the following proposition: once trained by specialists in the fields of technology, information and communication, the ACS will be able to act as mediators with a broader view in terms of communication. The study also aims to identify the sources of information used by the ACS and the perspectives of expanding such sources after training in the Alfin workshops. The content produced in the workshops will also be a subject of study and of theory and methodology discussions; this contributes to broadening the proposition of the extensive communication model.

Alfabetização em informação para a capacitação do agente comunitário de saúde no Brasil: proposta de mediação baseada no modelo extensivo e colaborativo

This article presents methodology based on the extensive communication model (SIMEAO, 2006) and Alfin, an acronym published by Unesco to offer a concept for the process of information literacy acquisition (information literacy), in research applied to the communication context of information on health in Brazil. This paper assesses the mediation of Community Health Agents (ACS) in their work in the Brazilian Unified Health System (SUS) through the development of Alfin training workshops. In testing whether the proposal is applicable in a professional workspace which is more open, with more informal communication relationships, the research group observes the Community Health Agent (ACS), a supporting professional and the main mediator in the Family Health Care Program, and his/her performance as a communicator. The hypothesis is based on the following proposition: once trained by specialists in the fields of technology, information and communication, the ACS will be able to act as mediators with a broader view in terms of communication. The study also aims to identify the sources of information used by the ACS and the perspectives of expanding such sources after training in the Alfin workshops. The content produced in the workshops will also be a subject of study and of theory and methodology discussions; this contributes to broadening the proposition of the extensive communication model.

A PARTICIPAÇÃO DO HOMEM/PAI NO ACOMPANHAMENTO DA ASSISTÊNCIA PRÉ-NATAL

Com objetivo de identificar os fatores que influenciam a participação do homem/pai no acompanhamento prénatalem uma Unidade de Saúde da Família de Recife – PE, foi realizado um estudo transversal do tipo descritivo, exploratório,de abordagem quantitativa. A amostra intencional foi constituída por 13 homens/pais companheiros de gestantes, querealizavam o pré-natal em uma unidade de saúde da família. Este estudo mostra que 53,8% (n =7) dos homens entrevistadosnão consideraram a gravidez oportuna e referem o trabalho como motivo para não participar da consulta pré-natal, 61,5%(n =8) consideraram como maior contribuição no processo gestacional o apoio emocional e financeiro e 84,6% (n =11) dospais não participam dos grupos de gestantes na unidade de saúde em estudo. Este estudo evidencia que há baixoenvolvimento paterno no período pré-natal com necessidade dos profissionais de saúde atuarem no processo educacionalcom vistas à aproximação da participação do homem/pai na gestação.

Implantação de programas e redefinição de práticas profissionais

Com o objetivo de avaliar as perspectivas de incorporação de novas características ao perfil profissional médico na implantação de novas práticas de atenção (Programa de Saúde da Família) no Programa de Articulação Docente-Assistencial de Florianópolis, entrevistaram-se preceptores e alunos da décima fase do internato médico do curso de Medicina da Universidade Federal de Santa Catarina. A análise indicou que o tipo de desempenho no presente e a socialização representada pela oferta da experiência pela universidade foram fatores explicativos potentes para compreender a incorporação de novas características identitárias pelos alunos e novas variações na identidade dos profissionais. Os estudantes reconheceram a necessidade de adquirir novos perfis de práticas e de saberes para recuperar as bases éticas e relacionais da medicina, consideradas perdidas com a tecnificação e especialização da profissão. Avaliaram o PSF como mercado de trabalho promissor e uma possibilidade intermediária até o alcance da situação ideal na posição especializada.

A representação social do cuidado no programa saúde da família na cidade de Natal

This study examines the core and outlying representational elements of healthcare constructed by Family Healthcare Program teams in Natal, Brazil, using the theory of social representations and the central core theory. The sample consisted of ninety healthcare practitioners working with this Program, with data collected through free word association, a questionnaire and focus groups. The core representation consists of attention/love and comfort, disclosing different understandings and showing that accumulated knowledge is supported by a view that is close to care-giving. However, traditional values and trivial connotations are maintained, hindering the implementation of more effective interventions in by this Program. The core composition indicated that any capacity-building efforts that try to modify attitudes - and thus the daily practice of these practitioners - must assign high priority to discussions on redefining these elements of attention/love and comfort. They must consider the set of mental, emotional, and practical elaborations as well as explanations arising from daily life that are introduced into the constitution of the social representations under examination, influencing choices and shaping the strategies used by practitioners to provide care.

Dialética do modo de vida de portadores de hipertensão arterial: o objetivo e subjetivo

The aim of this study is to understand the way life of hypertensive patients under the care of a Family Healthcare Program, regarding the theoretical-methodological historical and dialectical materialism. Eleven interviews were held with these patients, based on analysis of the speech procedures, which showed themes related to daily life social reality. The six empirical categories identified - beliefs, feelings, beyond-individual, under-control pressure, out-of-control pressure and hypertension causes - were analyzed according to two dialectical categories - the subjective and the objective - and the health-illness-care process. Daily life has revealed contradictions related to the needed treatment and the illness not assumed as it is; need for changes of habits and human values which oppose to these changes; the impossibility of pressure levels control due to way of life conditions, such as nervousness and familiar problems. Nursing needs to change its way of caring about patients falling chronically ill.

Controle da hipertensão arterial em uma unidade de saúde da família

To assess the impact of the implementation of the Family Health Care Program for arterial hypertension management in a primary care unit. There were studied 135 patients with confirmed diagnosis of arterial hypertension (45 patients from each primary care team) who received treatment between December 2003 and December 2004 and were followed up until July 2005 in the city Salvador, Northeastern Brazil. Blood pressure measures were compared at baseline and at the end of the follow-up period, and their association with cardiovascular risk factors and variables such as gender, age, body mass index, number of medical visits, number of antihypertensive drugs taken by patients, education level and family income were evaluated. Data were described as means and standard deviations, absolute and percentual values and the Wilcoxon, Kruskal-Walis and Chi-square tests were performed. Mean blood pressures at baseline and at the end of the follow-up were 155.9+/-24.1/95.3+/-13.9 mmHg and 137.2+/-16.1/86.7+/-8.7 mmHg (p<0.01), respectively. At starting treatment, 28.9% hypertense patients had well-controlled blood pressure levels (<140/90 mmHg) compared to 57% at the end of the follow-up period (p<0.01). The mean number of medical visits was 10.1+/-3.9, with 91.8% compliance. Two antihypertensive drugs were used by 50.4% and one drug by 35.6% of the patients. The prevalences of associated risk factors assessed at entering the program were overweight/obesity (71.9%), dyslipidemia (58.5%) and diabetes/impaired fasting glucose (43.7%). The results of the different care teams were comparable. The implementation of the Family Health Care Program has provided a better management of arterial hypertension but the associated risk factors have remained at higher levels than those recommended and thus needing better management.

Strengthening Primary Health Care with Family and Community Medicine in Brazil

This paper reviews the development of the specialty of family medicine with attention to strategies that may be used to strengthen Brazilian health care with appropriately trained family doctors. These strategies include establishing academic departments of family and community medicine in all Brazilian medical schools, ensuring a common core curriculum in training programs, and defining standards for the evaluation and certification of family doctors. These strategies could enhance the quality, scope and effectiveness of the Brazilian Family Healthcare Program.

Competência profissional e assistência em anticoncepção

To evaluate the technical competence of professionals carrying out activities related to contraceptive care. Evaluative research in the field of health was conducted in eight districts of the State of Ceara from July to September 2003. Data was collected by means of interviews with 29 nurses working in the Family Health Care Program within these districts and 50 people being attended by this program. Observations of the Family Health Care Units were a complementary source of data within this study. The majority of nurses had received some form of training regarding contraception and the technical norms regulating their use. However, professional barriers were reported by the nurses and others were identified by lay persons being attended by the program, that indicate the need to provide better training for professionals engaged in this area of care. The nurses recognized they had deficits in information and communication skills as well as technical deficits in dealing with contraception. There are gaps in professional competence with regard to contraceptive care that, when associated to the lack of systematization of team work, generates distortions in the quality of care. Team work was characterized by the lack of definition of team members' specific attributions and tasks.