Programa Médicos pelo Brasil : mérito y equidad

O Programa Médicos pelo Brasil (PMPB) foi lançado em 2019 pelo Ministério da Saúde com objetivo de ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. As principais mudanças propostas no PMPB são: obrigatoriedade de registro no Conselho Federal de Medicina; alocação de vagas com prioridade para as pequenas e distantes cidades, contratação dos profissionais via CLT e formação qualificada em Medicina de Família e Comunidade (MFC), permitindo a titulação dos médicos após dois anos. Com essas mudanças, espera-se um aprofundamento na interiorização dos profissionais, com possibilidade efetiva de fixação, além da formação em larga escala de MFCs. A formação através da residência também será impulsionada, com incentivo financeiro municipal para esse fim, em consonância com as ações do novo financiamento federal da Atenção Primária à Saúde (APS), o Programa Previne Brasil. O PMPB será executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), um modelo inovador de gestão pública, que trará eficiência ao programa. Com essas características, o PMPB pretende oferecer um solução perene para a oferta de serviços médicos no âmbito da APS do Sistema Único de Saúde.The Médicos pelo Brasil Program (PMPB) was launched in 2019 by the Ministry of Health with the objective to expand the supply of medical services in places of difficult provision or high vulnerability. The main changes proposed in the PMPB are: mandatory registration with the Federal Council of Medicine; allocation of vacancies with priority for small and distant cities, hiring of professionals via national labor legislation and qualified training in Family Medicine (FM), allowing the doctor’s speciality certification after two years. With these changes, it is expected to deepen the internalization of professionals, with effective possibility of fixation, in addition to training in scale in FM. Training through residency will also be promoted, with municipal financial incentives for this purpose, aligned with the actions of the new federal financing of Primary Health Care (PHC), the Previne Brasil Program. The PMPB will be executed by the Agency for the Development of Primary Health Care (Adaps), an innovative management model that will bring efficiency to the program. With these characteristics, the PMPB intends to offer a solution for the provision of medical services within the PHC of the Brazilian Public Health System.El Programa de Médicos pelo Brasil (PMPB) fue lanzado en 2019 por el Ministerio de Salud con el bjetivo expandir la oferta de servicios médicos en lugares de difícil provisión o alta vulnerabilidad. Los rincipales cambios propuestos en el PMPB son: registro obligatorio en el Consejo Federal de Medicina; designación de vacantes con prioridad para ciudades pequeñas y distantes, contratación de profesionales a través de las leyes laborales nacionales y capacitación calificada en medicina familiar y comunitaria (MFC), lo que permite la certificación de especialidad después de dos años. Con estos cambios, se espera profundizar la internalización de profesionales, con posibilidad efectiva de fijación, además de capacitación a gran escala de los MFC. La capacitación a través de la residencia también será promovida, con incentivos financieros municipales para este propósito, en línea con las acciones del nuevo financiamiento federal de Atención Primaria de Salud (APS), el Programa Previne Brasil. El PMPB será ejecutado por la Agencia para el desarrollo de la atención primaria de salud (Adaps), un modelo de gestión innovador. Eso traerá eficiencia al programa. Con estas características, el PMPB pretende ofrecer un solución perenne para la prestación de servicios médicos dentro de la APS del Sistema Único de Salud

Evaluating the performance of primary health care services in Turkey and the use of the Primary Care Assessment Tool (PCAT) : lessons from Brazil in a national random household survey

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Following the legacy of professors Barbara Starfield and Leiyu Shi in Brazil as health policy : the National Health Survey (PNS), led by the Brazilian National Institute of Geography and Statistics (IBGE) and the Primary Care Assessment Tool (PCAT)

We present to the scientific community the pioneering of Brazilian National Institute of Geography and Statistics (IBGE, the Brazilian Census Bureau) in partnership with the Ministry of Health, the largest fieldwork ever conducted in a single country in the world, using the PCAT in a national household sample survey, visiting more than 100,000 households and 40% of the country’s municipalities. In Brazil, PCAT is being consolidated as an instrument to support public policy for the evaluation of primary health care. We believe that it represents a virtuous example of dialogue between scientific community and health management, following the legacy of Professors Barbara Starfield and Leiyu Shi

Measuring the quality of primary care in national health surveys : lessons from Brazil

Background: South Africa started to lead the cross-culturally validation and use of the Primary Care Assessment Tool (PCAT) in Africa, when Professor Bresick filled a gap, as this continent was until then the only one that had never used it in evaluation of primary health care facilities until 2015. Aim: The authors aim to demonstrate that after the consolidation of Bresick’s team to an African version of PCAT, it had been adapted to household survey in Brazil. Methods: In this letter, authors reflect on how Brazil had adapted PCAT to a national random household survey with Brazilian National Institute of Geography and Statistics (IBGE) – the Brazilian Census Bureau. Results: In the the beginning of 2019, Brazilian Ministry of Health brought back the PCAT as the official national primary health care assessment tool. Brazilian National Institute of Geography and Statistics (IBGE) included a new module (set of questions) in its National Health Survey (PNS-2019) and collected more than 100 000 households interviews in about 40% of the country’s municipalities. This module had 25 questions of the Brazilian validated version of the adult reduced PCAT. Conclusion: We believe that IBGE innovation with the Ministry of Health can encourage South Africa to establish a similar partnership with its National Institute of Statistics (Statistics South Africa) for the country to establish a baseline for future planning of primary health care, for decision-making based on scientific evidence

Access to diabetes diagnosis in Brazil based on recent testing and consultation : the Brazilian national health survey, 2013 and 2019

Background: Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults. Methods: The Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals. Results: Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86). Conclusions: Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race

Associação entre sintomas depressivos e comportamento de procura de cuidados odontológico entre idosos brasileiros

Introdução: Os sintomas depressivos são altamente prevalentes na população idosa (10%). Estes sintomas aparecem frequentemente quando há uma perda de qualidade de vida associada à exclusão social e ao aparecimento de doenças graves. Sentimentos de tristeza, desânimo, desânimo e decepção, e eventos, tais como a perda de amigos próximos e familiares podem também estar relacionados a estes sintomas. As consequências de sintomas depressivos incluem os resultados negativos de saúde oral, tais como uma diminuição na frequência de escovação, maior prevalência de cárie e maior probabilidade do aparecimento de periodontite. Objetivo: Este estudo teve como objetivo avaliar a associação entre a presença de sintomas depressivos e comportamento saúde bucal orientada para o problema, bem como a ausência de comportamento de procura de cuidados de saúde. Foram avaliados 872 idosos vivendo em dois distritos de saúde em Porto Alegre. Material e método: Eles forneceram informações sobre variáveis socioeconômicas em uma entrevista, e responderam à Escala de Depressão Geriátrica-15 e a um questionário avaliando o comportamento de procura de cuidados dentários. Além disso, foi realizado um exame oral. Quando analisados por meio de regressão de Poisson com variância robusta, as variáveis sexo masculino, menor escolaridade, menor renda, número de dentes reduzidos, presença de restos de raiz e presença de sintomas depressivos foram encontrados para ser associados de forma independente com o resultado. Resultado: Houve uma diferença significativa em relação ao comportamento de procura de cuidados dentários em relação aos idosos com sintomas depressivos e aqueles em baixo nível socioeconômico com estatuto oral deficiente. Conclusão: Concluiu-se que esses fatores precisam ser levados em consideração ao avaliar o comportamento de procura de cuidados dentários.Background: Depressive symptoms are highly prevalent among the elderly population (10%). These symptoms frequently appear when there is a loss of quality of life associated with social exclusion and the appearance of severe diseases. Feelings of sadness, discouragement, despondency and deception, and events such as the loss of close friends and family can also be related to these symptoms. The consequences of depressive symptoms include negative oral health outcomes, such as a decrease in the frequency of toothbrushing, greater prevalence of caries and higher probability of the appearance of periodontitis. Aim: This study aimed to evaluate the association between the presence of depressive symptoms and problem-oriented oral healthcare behavior, as well as the absence of healthcare-seeking behavior. Material and method: 872 elderly people living in two health districts in Porto Alegre were evaluated. They provided information on socioeconomic variables at an interview, and responded to the Geriatric Depression Scale-15 and to a questionnaire assessing dental care-seeking behavior. In addition, an oral examination was performed. When analyzed using Poisson regression with robust variance, the variables of male sex, less schooling, lower income, reduced number of teeth, presence of root remnants and presence of depressive symptoms were found to be independently associated with the outcome. Result: There was a significant difference regarding dental care-seeking behavior in relation to elderly people presenting depressive symptoms and those in low socioeconomic strata having poor oral status. Conclusion: It was concluded that these factors need to be taken into consideration when evaluating dental care-seeking behavior

Bases para la Reforma de la Atención Primaria de Salud en Brasil en 2019 : cambios estructurales después de 25 años del Programa de Salud Familiar

O ano de 2019 marcou a estruturação das bases para uma profunda reforma na Atenção Primária à Saúde (APS) do Brasil. Os desafios enfrentados através dessa reforma foram a falta de priorização política real da APS, o financiamento insuficiente da APS e focado na estrutura de serviços, os obstáculos ao acesso de primeiro contato, a escassez de profissionais qualificados, a necessidade de maior informatização da APS e a ausência de integração de dados clínicos, a fragilidade clínica e necessidade de ampliação do escopo profissional e a falta de informação de qualidade para tomada de decisão clínica e gerencial. Com ações direcionadas a cada um desses desafios, a Secretaria de Atenção Primária à Saúde do Ministério da Saúde criou estratégias sistêmicas e integradas entre si que representam mudanças estruturantes e investimentos em governança clínica para transformar a APS brasileira, garantindo mais e melhor saúde para a população, com mecanismos transparentes e técnicos para seu financiamento, organização, oferta, monitoramento e avaliação.The year was 2019. It marked the foundations for a profound Primary Health Care (PHC) Reform in Brazil. The challenges faced through this were the lack of real PHC political prioritization, insufficient PHC funding and focused on the service structure, obstacles to first contact access, the shortage of qualified professionals, the need for greater PHC computerization and the lack of integration of clinical data. Also, the clinical fragility and the need to expand the professional scope and the lack of quality information for clinical and managerial decision making. Actions were directed to each of these challenges, and the Ministry of Health’s Secretariat of Primary Health Care created systemic and integrated strategies which represented structural changes and investments in clinical governance to transform Brazilian PHC, ensuring more and better health for the population, with transparent and technical mechanisms for its financing, organization, provision, monitoring and evaluation.El año era 2019. Marcó la estructuración de las bases para una reforma profunda en la Atención Primaria de Salud (APS) en Brasil. Los desafíos enfrentados a través de esta reforma fueron la falta de una priorización política real de APS, fondos insuficientes de APS y centrados en la estructura del servicio, obstáculos para el acceso de primer contacto, la escasez de profesionales calificados, la necesidad de una mayor informatización de APS y la falta de integración de datos clínicos, la fragilidad clínica y la necesidad de ampliar el alcance profesional y la falta de información de calidad para la toma de decisiones clínicas y gerenciales. Con acciones dirigidas a cada uno de estos desafíos, la Secretaría de Atención Primaria de Salud del Ministerio de Salud creó estrategias sistémicas e integradas que representan cambios estructurales e inversiones en la gobernanza clínica para transformar la APS brasileña, garantizando más y mejor salud para la población, con mecanismos transparentes y técnicos para su financiación, organización, provisión, seguimiento y evaluación

Quality assessment of primary health care accessible to the elderly in two districts of Porto Alegre, RS, Brazil

Objetivo: avaliar a orientação dos serviços de Atenção Primária à Saúde (APS) e comparar a qualidade da APS entre Unidades Básicas de Saúde (UBSs) e Unidades de Saúde da Família (USFs) em dois distritos de Por-to Alegre, Rio Grande do Sul. Sujeitos e método: neste estudo de delineamento transversal, foram entrevista-dos 402 idosos, selecionados por meio de uma amostra por conglomerados. Foi aplicado um questionário com questões sociodemográficas, além do instrumento Pri-mary Care Assessment Tool (PCATool-Brasil). Atributos com escores maiores ou iguais a 6,6, em uma escala de 0 a 10, foram considerados orientados para a APS. Foi realizada análise descritiva das variáveis, e a diferença entre as variáveis entre UBSs e USFs foi verificada pelo teste Qui-Quadrado. Resultados: dos 402 entrevista-dos, 69,7% eram do sexo feminino, as médias encon-tradas foram: de idade, 69,18 anos; de anos de estu-do, 4,91; de renda, 1.433,84 reais. A maioria (77,9%) utilizava os serviços de UBS e 22,1% utilizavam USF. Quanto à qualidade dos serviços, 22,9% estavam dentro do preconizado pelo escore essencial da APS. Quando comparadas as UBSs e as USFs, houve dife-rença estatisticamente significativa em relação à idade (≤ 70 anos acessavam 71,9% USFs X 58,3% UBSs) e aos atributos: primeiro contato (39,7% UBSs X 51,7% USFs com orientação para APS, p = 0,044) e longitudinali-dade (68,5% USFs X 50% UBSs com orientação para APS, p = 0,02). Conclusão: os resultados evidenciam a necessidade de investimentos para a qualificação da APS, pois, embora a Estratégia de Saúde da Família seja prioridade na reorganização da APS, essa demonstrou superioridade em apenas dois atributos: primeiro con-tato e longitudinalidade.Objective: To assess Primary Health Care (PHC) instruc-tion and to compare the quality of PHC among Basic Health Units (BHUs) and Family Health Units (FHUs) in two districts of Porto Alegre, RS, Brazil. Subjects and method: In this cross-sectional study, we interviewed 402 elderly selected through cluster sampling. Inter-views were conducted using a sociodemographic ques-tionnaire in addition to the Primary Care Assessment Tool (PCATool-Brazil). Attributes with scores higher than or equal to 6.6, on a scale from 0 to 10, were found instructed for PHC. The descriptive analysis of variables was performed and the difference of variables betwe-en BHUs and FHUs was verified by the chi-square test. Results: From the 402 respondents, 69.7% were wo-men, average age was 69.18 years, years of education was 4.91, and income was R$ 1,433.84. The majority (77.9%) used BHU services and 22.1% used FHUs. As for the quality of services, 22.9% were within the re-commended by the essential PHC score. When compa-ring BHUs and FHUs, there was a statistically significant difference regarding age (≤ 70 year-olds attended FHUs 71.9% vs. 58.3% for BHUs) and the following attribu-tes: first contact (39.7% BHUs vs. 51.7% FHUs with PHC instruction, p = 0.044) and longitudinality (68.5% FHUs x 50% BHUs with PHC instruction, p=0.02). Con-clusion: The results show the need for investments on PHC qualification, because even though the Family He-alth Strategy is prioritized in the reorganization of PHC, it was superior in only two attributes: first contact and longitudinality

Satisfaction of Primary Healthcare Dentists after the Completion of a Distance Learning Course in Pediatric Dentistry

Background: The aim of the present study was to assess the level of satisfaction of dentists working in primary healthcare (PHC) with a Distance learning (DL) course in pediatric dentistry offered by the TeleHealthRS cen-ter, and to the investigate possible associations between the variables indicative of their satisfaction and their performance on the questionnaires applied before and after the course. Methods: The course was offered in 2015 by the Federal University of Rio Grande do Sul (UFRGS) together with the TeleHealthRS center in Brazil. Data were collected on the participants’ personal and professional pro-file, their pre- and post-course knowledge about pediatric dentistry, and their satisfaction with the course. Stu-dent's t-test and the ANOVA test were used to assess the possible associations between the variables indicative of their satisfaction and their performance on the questionnaires applied before and after the course. Results: Overall, the participants were satisfied with the course, however, no statistically significant association was found between the variables indicative of their satisfaction and the grades they earned on the pre- and post-course questionnaires. Conclusion: The available pediatric dentistry course received positive evaluations from the participants, consti-tuting a possible strategy for the qualification of primary care dentists. Future studies are warranted to further investigate the expectations of DL course participants, aiming to enhance the quality of future editions of this learning modality for pediatric dentistry contents