Primary Health Care Attributes Research Articles

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.

Evaluation by Community Health Agents of the attributes of Primary Health Care for fighting leprosy

Objective: To evaluate whether the attributes of Primary Healthcare are present in leprosy control actions in Londrina from Community Health Workers (CHW) perspectives. Methods: Observational and evaluative study. Data collection took place between January and March 2020 in Londrina, Paraná, using the questionnaire "Primary Care Assessment Tool (PCATool) - Hansen's disease - CHW version" and a population-based census of 246 CHWs from 52 Primary Healthcare Units. The analyses used a cutoff point (≥ 6.6), central tendency, and dispersion measures. One-way ANOVA and Tukey's post hoc tests were used to analyze differences. Results: The general performance towards the primary healthcare attributes were evaluated as strong (mean = 6.95 / SD = 1.08) and the essential score (mean = 7.39 / SD = 1.0). On the other hand, the derived score was evaluated as poor (mean = 6.07 / sd = 1.06). Concerning the Access attribute, the rural zone had a lower score than the urban (mean = 4.47 / SD = 1.63). As for the Comprehensiveness attribute of services provided to leprosy patients, the central region had a lower mean (mean = 4.87 / SD = 3.44) than the south region (mean = 6.76 / SD = 2, 24). Concerning the Integrality, the rural region presented a higher score (mean = 8.15 / SD = 1.22) than the western (mean = 6.16 / SD = 2.91) and central regions (mean = 6.13 / SD = 3.27). As for Community Orientation, the western region had a lower mean than the others (mean = 5.04 / SD = 2.44). The vocational guidance attribute had a higher average in the rural region (mean = 4.14 / SD = 2.62). Final Considerations: The study highlights issues that can be improved, such as first contact access, catalog of services offered to leprosy patients, information provided to the community, professional training, and differences in PHC performance between urban and rural regions.

AVALIAÇÃO DOS ATRIBUTOS ESSENCIAIS NA ESTRATÉGIA SAÚDE DA FAMÍLIA: PERSPECTIVA DOS USUÁRIOS E USUÁRIAS

ABSTRACT Objective: to evaluate the presence and extent of the essential attributes of Primary Health Care from the perspective of users of the Family Health Strategy. Method: this was a cross-sectional, quantitative study of 256 users of 26 family health units in Santa Catarina, Brazil, carried out between June and December 2021. A characterization questionnaire and the Primary Care Assessment Instrument were used. Descriptive and inferential statistics analysis was carried out. Results: users evaluated the units as having a sub-optimal score for the presence and extent of the essential attributes. However, users with health problems rated the essential score (p=0.001), the longitudinality attribute (p=0.024), and the comprehensiveness attribute (p=0.001) positively.). Conclusion: periodically evaluating the presence and extent of the attributes makes it possible to guide strengthening strategies and contributes to the continuous improvement of Primary Care, based on indicators for qualified health management, with the difference of considering the views of users.

Comparative analysis of primary health care attributes between children under and over 3 years of age using the primary care assessment tool

IntroductionChild health actions in Brazil have their primary focus on early childhood. A new epidemiological profile is emerging for children after the first one thousand days: an increase in non-communicable chronic diseases. This research aimed to analyze the attributes of Primary Health Care comparatively among different age groups, using three years of age as the cutoff point. MethodsThe study design was cross-sectional and conducted in three Primary Health Care Units and three Ambulatory Medical Assistance facilities in the Western Region of São Paulo. The PCA Tool Brazil was used as the assessment instrument. ResultsA total of 311 interviews were conducted with caregivers of children aged 0 to 12 years; 153 children were under three years old, and 158 were three years or older. The attributes that showed statistically significant differences between age groups (< 3 years and > 3 years) were affiliation (4.9 × 3.8), longitudinality (5.7 × 5.2), information system (7.4 × 6.3), and services provided (5.4 × 4.5). Through linear regression analysis, it was observed that there was a trend for better overall and essential scores in the evaluations of the group of children under three years old who attended Primary Health Care Units. ConclusionThe comparative analysis of Primary Health Care attributes among pediatric age groups revealed a trend towards higher scores, according to caregivers' perceptions, for children under three years old. This study suggests the need for the implementation of programs that can better address the healthcare needs of children beyond early childhood.

Territórios Integrados de Atenção à Saúde: potencialidades de inovações para a Qualificação da Atenção Primária à Saúde

Abstract This article aimed to analyze the results of implementing the Integrated Health Care Territories (TEIAS) project in a Brazilian capital. The quantitative study was based on secondary data from the e-Gestor AB, e-SUS, the Electronic Citizen Record, the Primary Care Health Information System, and the TEIAS project management reports from 2020 to August 2023. The results suggest the power of innovation strategies for strengthening Primary Health Care (PHC) through professional training aligned with the characteristics and demands of the territories, increasing PHC coverage, service provision, resolution, and service user evaluation. We concluded that innovations expanded and improved access to PHC, and the most significant advances were achieved in training professionals at the residency level (strictly oriented towards PHC attributes) and incorporating new practices not previously performed by PHC into the territory in question.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis.

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Primary Health Care assessment in the COVID-19 pandemic from physicians' and nurses' perspective.

to assess the operationalization of Primary Health Care in the COVID-19 pandemic, according to Primary Care Assessment Tool: PCATool-Brasil attributes, from physicians' and nurses' perspective. a cross-sectional study, carried out with 99 physicians and nurses from Basic Health Units in a state in northeastern Brazil, with the aid of the adapted instrument PCATool-Brasil. Essential Score was classified as high performance (6.6) and General Score as low performance (6.5). First Contact Access, Care Integration, and Community Guidance scores were <6.6. The best performances were attributed to the Longitudinality, Comprehensiveness and Family Guidance services (scores>6.6). the attributes of Primary Health Care, in general, showed values above or close to the cut-off point in the assessment. These data can support strategies for local and national managers to strengthen Primary Health Care in the COVID-19 pandemic and future public health emergencies.

Attributes of primary health care in Mato Grosso do Sul state: PCAT-Brazil paired for users and health professionals, 2018

ObjectiveThe objective of the present study was to analyse the quality of adults and older adults health care in Primary Health Care (PHC) services in the State of Mato Grosso do Sul, 2018.MethodsA quantitative survey was carried out in which the municipalities participating in the study included the four macro-regions following the Director Regional Plan (DRP). In this study, the quality of care was verified using the validated version of the PCAT-Br for adult and older adults users over 18 years of age and professionals. The professional’s and users’ views were compared between PHC attributes in the State of Mato Grosso do Sul. We performed the paired student t-test. STATA v.14.2 software (College Station, TX, USA) was used for the analyses. Sensitivity analysis was done to compare socio-demographic characteristics.ResultsEight hundred twenty-five users and 424 professionals participated in the study. According to users, the Accessibility attribute had the worst performance in all macro-regions (mean score PCAT = 3.58). There were significant differences between the perception of users and professionals (PCAT = 5.32 for users and PCAT = 7.11 for professionals) in all attributes evaluated.ConclusionsThere was a difference in users’ and professionals’ perceptions between PHC attributes. Therefore, it is necessary to strengthen PHC care networks in the State, mainly considering the users’ perspectives.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

ABSTRACTObjective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients.Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP).Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. “First contact access – use”, “longitudinality” and “coordination – information system” were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes.Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

Atenção primária no contexto da epidemia zika e da síndrome congênita da zika em Pernambuco, Brasil: contexto, vínculo e cuidado

The Zika epidemic brought to the fore the birth of children with unknown and unexpected needs that demand longitudinal follow-up, strengthening the bond, comprehensiveness and coordination of care in health, which are essential attributes of primary health care (PHC). This article aims to evaluate the orientation of PHC care, using the PCATool-Brasil. The data were collected between 2016 and 2019, by means of interviews with parents of children who were born in a public maternity hospital in Recife (state of Pernambuco) between October 2015 and February 2016, a critical period of the microcephaly outbreak, especially in the Northeast of Brazil. The parents of 109 children participated in the survey, 15.6% of which had a confirmed microcephaly diagnosis. The degree of affiliation and access was sufficient, but the aspects of coordination of care, longitudinality, comprehensiveness, family and community orientation were insufficient. In the context of congenital Zika syndrome, these attributes are essential for the care of children and families. The fostering of health from these domains depends on the orientation of the models of care and their management with state and federal investments. The defense of life depends on the ability to place life above all other rationalities.

Primary Health Care Quality

This study aims to analyze the dimensions of the Service Quality Scale (SERVQUAL) and its relationship with the essential attributes of Primary Care. This is a qualitative research with elderly people living in eight cities in ‘Serra Gaúcha’ region, in Southern Brazil, with Family Health Teams and Primary Care Teams. Semi-structured interviews were conducted and the responses of each dimension were analyzed, relating them to the essential attributes of Primary Health Care. First contact accessible evidenced in the dimensions reliability, responsiveness, assurance, empathy and tangible. Continuity emerged in reliability, responsiveness, assurance and empathy. Comprehensiveness appeared in the dimensions reliability, responsiveness, assurance and empathy. Finally, coordination was reflected in reliability, responsiveness, assurance and empathy. The SERVQUAL scale proved to be a useful instrument for the evaluation of Primary Care.

Minors using Ritalin: obstacles in Primary Health Care surveillance

Objective: to understand how nursing workers from Family Health Strategy teams track children and adolescents using Ritalin. Methods: qualitative study, based on the theoretical references of the essential primary health care attributes. The participants were 27 nurses from the Family Health Strategy. Data collection took place through interviews later submitted to content analysis in the NVivo software. Results: three categories emerged: (Lack of) knowledge about the population who uses Ritalin: co-responsibilities in the process of assistance and difficulties to follow up on the use of Ritalin; Primary care knowledge and know-how in the setting of Ritalin use; The prescription of Ritalin as a demand from schools. Conclusion: the monitoring of children and adolescents who use Ritalin has shortcomings, and primary health care must organize itself to increase and strengthen the care to this population.

Assessment of the attributes of Primary Health Care with women of reproductive age.

to evaluate the quality of Primary Health Care attributes according to the characterization and perspective of women of reproductive age. descriptive, quantitative, cross-sectional study, with 397 women of reproductive age from six municipalities in the 16th Health Region of the state of Paraná, with variables for sociodemographic characterization and the Primary Care Assessment Tool (PCATool). mean age, 30.43 years old, most were married, 70.2% worked outside the home and 55.5% had completed high school. The highest average score of the eight domains evaluated was "Family Guidance" and "Coordination - Integration of Care", with averages of 5.86 and 4.89. Domains "Integrality - Services Provided" and "Community Orientation" had lower averages (3.32 and 3.76). the study allowed tracing the characterization of the participants and identifying that the attributes of Primary Care are unsatisfactory, making it necessary to expand access to the services offered and to qualify the comprehensive care for women's health.

Residência de Medicina de Família e Comunidade: percepções de egressos sobre sua formação e processo de trabalho

The article analyzed how the Residency in Family and Community Medicine (RFCM) in a capital of the Northern region of Brazil contributed to the formation and development of the current work process of its graduates. This is an exploratory, descriptive and cross-sectional study, with a qualitative approach focused on 31 graduates, through electronic questionnaires with open questions. The answers were interpreted based on the Content Analysis Thematic technique, constituting four empirical categories: training in Family and Community Medicine (FCM) in the graduate’s work process; recognition and application of the attributes of Primary Health Care (PHC); potentials of the FCM training and the challenges of the specialty. The analyzed data show that the studied Programs contribute to the education for professional practice and the profile of its graduates through the strengthening and implementation of the Primary Health Care (PHC) attributes, also extending beyond the specialty.

Why does mental health care not follow the structuring of primary care?

ABSTRACTOBJECTIVE:To verify if primary care teams with better structured primary health care (PHC) attributes could offer better mental health (MH) care.METHODS:Cross-sectional study based on data from the external evaluation of the second cycle of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB - Access and Quality Improvement of Primary Care Program), involving 31,587 primary care teams, between 2013 and 2014. Two typologies were built: quality of mental health care (dependent variable) and PHC structuring according to essential attributes (independent variable). We identified some contents for the construction of the mental health typology (module II of the PMAQ) and performed sums of questions for the categorization of indices. The Delphi technique rendered consensus in four rounds endorsed by experts, following the attributes of PHC structure. Multinomial logistic regression analyses verified the association between the typologies and identified which attribute most contributed to the quality of mental health care.RESULTS:We found out that 29.2% of the teams are at low levels of quality in assistance to MH, while 7.5% of the teams have a low level of structuring the PHC according to essential attributes. Regional differences are maintained, both for the structuring of the PHC and for the quality of mental health care. There was a greater chance of providing care in MH with better quality when the PHC is better structured at a high level (OR = 14.74) and at a medium level (OR = 2.193). A high level of completeness is associated with a high level of Quality of Care in MH (OR = 3.21).CONCLUSION:results indicate a predominance of low levels of quality in mental health care, out of step with the process of PHC structuring and its essential attributes.

Avaliação dos atributos essenciais da atenção primária em Montes Claros –MG

Objective:to evaluate the essential attributes of primary care in a Family Health Strategy in the city of Montes Claros -MG from the perspective of the assisted population. Materials and Methods:this is a quantitative and descriptive study, with a sample of 130 patients. The Sociodemographic Questionnaire and the Questionnaire for the Evaluation of the Attributes of Primary Care were applied between the months of September and October 2018. The results were tabulated in an Excel spreadsheet. Results:the four Essential Attributes of Primary Care were mostly answered with a reasonable level of satisfaction or above. Overall average satisfaction was 6.8 points. Conclusion:the reduction of waiting time for appointments with general practitioners and the absence of specialists in the FHS were the main demands. However, in the eyes of users, it was evident that the four Essential Attributes of Primary Health Care, in general, are well exerted.

Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study.

Background:Nurse practitioners (NPs) have been regulated primary care providers in British Columbia since 2005; however, many practices and contributions of NPs, especially those in northern or rural regions, remain unarticulated in primary health care. The objective of this study was to evaluate NP practices in the context of providing primary health care in northern BC.Methods:This was a qualitative-dominant mixed-methods study. We recruited NP participants working in northern BC; recruitment and data collection occurred between April and June 2018. Participants completed the validated 28-item Primary Health Care Engagement (PHCE) Scale to assess their perceptions of their workplace with 8 attributes of primary health care (quality improvement, community participation, patient-centred care, accessibility, intersectoral team, interdisciplinary collaboration, continuity and population orientation). We also interviewed NPs about their everyday practice. Transcribed data from the interviews were analyzed interpretively.Results:In total, 13 of 30 (43%) eligible NPs participated in the survey and interview. The PHCE Scale results showed that all NPs perceived their workplaces to be highly engaged in patient-centred care, but none reported their workplaces as accessible. Interview data were organized into 5 headings which described how NPs see patients who are medically and socially complex, address inequities in access, practice collaboratively, address local service gaps and improve patient abilities to access care.Interpretation:In interprofessional primary health care teams, NPs are key members and attend to both direct patient care and broader social conditions affecting health. Nurse practitioners can help accelerate advancements to deliver responsive community-based primary health care.

Frailty in elderly individuals and perception of problems in indicators of attributes of primary healthcare: results of the ELSI-Brasil

This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.

Primary health care attributes of family health teams with and without family physician

Abstract Background The four essential attributes of primary health care (PHC): access, longitudinality, comprehensiveness and coordination, guide the professional practices of service management and also the professionals of the family health strategy teams. Family medicine residence (FMR) is the speciality that trains medical practitioners capable of acting properly in PHC. It develops a person-centred approach, oriented towards the individual, his family and community, which dialogues with the PHC precepts of comprehensive patient care from a social point of view. Thus, the objective of this study was to verify whether there are differences in the PHC attributes perceived by patients treated by teams with FMR doctors and by the others. Methods This was an observed cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate preliminarily 28 PHC teams working at the city of São Paulo, Brazil. The teams were compared based on 337 patient answers using domains medians and Mann-Whitney tests. The study was approved by the ethics committee. Results Eight teams (28.6%) had doctors trained in FMR. The attributes of longitudinality and access were very similar between the two groups. The teams with FMR doctors showed better evaluations in the components: information systems, median 7.78, versus 6.67 (p = 0.391); services available, median 6.52, versus 6.06 (p = 0.086); and services received, median 4.85, versus 3.85 (p = 0.180) of the coordination and comprehensiveness attributes. Conclusions We didn't find statistically significant results indicating better PHC attributes of teams with FMR doctors, based on user perception. A continuous study is recommended to follow the evolution of this speciality in the PHC context. Key messages FMR is a fundamental key to PHC and must be evaluated continuously. It is necessary to strengthen their insertion in the Brazilian health system and discuss the ways to do so.

Brazilian National Household Health Survey and PCAT: the case of Mato Grosso do Sul, Brazil

Abstract Brazil is divided into five administrative regions, 27 federation units and 5,570 municipalities. Mato Grosso do Sul is one of the states located in the Midwest region and has 1.6 million km2 and a resident population of 2.8 million inhabitants, that is, it has an even lower demographic density than its region - only 7.8 inhabitants/km2. Mato Grosso do Sul has part of the Pantanal, a biome considered the largest continuous floodplain in the world, rich in biodiversity. For this reason, displacements for data collection in household surveys combine roads and rivers. In 2019, the Brazilian National Institute of Geography and Statistics (Istituto Nazionale di Statistica del Brasile) in partnership with the Ministry of Health launched the world's largest household sample survey, the National Health Survey (PNS-2019), in which part of its questions included the use of Primary Care Assessment Tool (PCAT, adult version), created by professors Barbara Starfield and Leiyu Shi in the 2000s. IBGE interviewers visited more than 100,000 households across the country. In Mato Grosso do Sul, more than 3,000 households were surveyed. In this work, we present the data collection instrument used by IBGE and its multiple analysis possibilities in the scope of primary health care, crossing the variables from other questionnaire modules in order to compare the results from Brazil with the state of Mato Grosso do Sul and its capital, Campo Grande. Developing a baseline and measuring the attributes of primary health care in each of the Brazilian states is another step towards giving health policy accountability, towards strong primary care. IBGE's experience in household surveys and innovation in data collection in primary care is an example for the world that yes, it is possible to develop statistically representative national sample surveys and make them perennial in their regular household surveys, by the time World Health Organization (WHO) discusses universal health coverage. Key messages Evaluation of primary care using an internationally validated instrument is possible on national bases with random household sample surveys. A questionnaire elaborated academically can be used as an instrument of public policy to evaluate nationwide health services.