Quality of child health care in the family health strategy

OBJECTIVE: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. METHODS: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. RESULTS: 84.1% of the FHS-teams rated themselves as providing "Elementary" actions and services, and 47.7% of them considered that they provided "Advanced" ones. The health teams with less than four years of implementation rated themselves better. CONCLUSION: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation

Evaluation of the quality of Primary Health Care services for children : reflections on the feasibility of using the Brazilian version of the Primary Care Assessment Tool as a routine assessment tool

ABSTRACT Objective To assess the quality of the Primary Health Care services provided to children and the feasibility of using the Brazilian version of Primary Care Assessment Tool (PCAT-Brazil) as a routine quality assessment tool. Methods A cross-sectional study was carried out in Joanópolis, a small rural town in the State of São Paulo (SP), Brazil. Seven health professionals and 502 caretakers of children using the public health center were interviewed using the PCAT-Brazil, collecting data on the core and related attributes of Primary Health Care provided to children. The score of each attribute was calculated. Results Caretakers rated as good the following attributes; “degree of affiliation”, “first contact care − use of services”, “coordinated care”, and “comprehensive care − available services”. The attributes of “first contact accessibility”, “long term person care”, “comprehensive care − offered services” and “family- and community-oriented care” were scored as poor. The health professionals only rated the attribute of “first contact accessibility” as satisfactory, and considered that all other Primary Health Care attributes needed improvement. To conduct this study, at least 1,241 working hours were invested, and the estimated budget was R$12.900,00 (or U$3,953.00). Conclusion The use of the PCAT-Brazil as a routine assessment and planning tool seemed to be not feasible in the given setting due to high costs, lack of trained personnel and the huge workload. To overcome the encountered obstacles, advices are given based on field experience.</div

Qualidade da Atenção à Saúde da Criança na Estratégia Saúde da Família

AbstractObjective: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. Methods: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. Results: 84.1% of the FHS-teams rated themselves as providing “Elementary” actions and services, and 47.7% of them considered that they provided “Advanced” ones. The health teams with less than four years of implementation rated themselves better. Conclusion: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation.ResumoObjetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família (AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção à “saúde da criança”, dentro da dimensão “atenção à saúde”. Resultados: os padrões elementares de qualidade foram encontrados em 84,1% das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7%). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade

Evaluation of Primary Health Care for children in the municipality of Joanopolis, State of São Paulo, Brazil

This study evaluated Primary Health Care services that children aged 0 to 12 used in a small city, the Municipality of Joanopolis, in the State of São Paulo, from the point of view of the legal responsibles and of the health professionals. The interviewed legal responsibles (the parents) evaluate the health services for their children as 5,62/10 (General Primary Health Care Score), which is lower than the established cut-off point of 6,60. The parents refer they are unsatisfied with the attributes of accessibility, long-term person care, integrated care- provided services, family and community oriented care. If we consider the Essential Primary Health Care Score the mean is 6,92. The interviewed health professionals consider the services as inadequate: the General Score for PHC is 5,52 and the Essential Score is 5,67. The only attribute they consider adequate is accessibility. There is a discrepancy between the scores the parents and the health professionals attribute to the accessibility of health services for children in Joanopolis. The actual study results, in a small city, are comparable with the results from published studies in big urban centers: in both scenarios the family and community oriented care is considered inadequate, which leads us to the question about what kind of PHC we are talking in Brazil. This research studied the dimension of access to health services in details. It was observed that almost a third of the studied children live in rural zone areas: even with an existing geographic barrier the rural children were able to access the PHC-services in this study. Children of all age ranges were able to access PHC-services in this study: the normal distribution of the age of the studied children is an indicator of access to health services, even if the realized access was studied. The parents living in rural areas consider the quality of provided services less times as “very good” compared with parents living in urban areas (P value <0,001). The study also showed that carrying out an evaluation of used Primary Health Care services using the PCATool-Brasil in this small rural city needed an investment of 1.241 working hours (and corresponding budget), as well as motivated health professionals and managers to perform the studyO atual estudo avaliou os serviços de Atenção Primária à Saúde que as crianças de 0 a 12 anos utilizaram num município de pequeno porte, o Município de Joanópolis, SP, do ponto de vista dos responsáveis legais e dos profissionais de saúde. Os responsáveis legais (os pais) entrevistados avaliam os serviços de saúde para os seus filhos como 5,62/10 (Escore Geral de Atenção Primária à Saúde), o que é inferior ao determinado de 6,60. Os pais apontam uma insatisfação com os atributos de acessibilidade, longitudinalidade, integralidade-serviços prestados, e orientação familiar e comunitária. Se considerarmos o Escore Essencial de APS a média é 6,92. Os profissionais de saúde entrevistados consideram os serviços como inadequados: o escore geral de Atenção Primária à Saúde é 5,52 e o escore essencial é 5,67. O único atributo considerado adequado é a acessibilidade. Há uma discrepância de escores entre os pais e os profissionais de saúde sobre a acessibilidade dos serviços de saúde para as crianças em Joanópolis. Os atuais resultados, num município de pequeno porte, são comparáveis com os resultados dos estudos publicados nos grandes centros urbanos: em ambos os cenários a orientação familiar e comunitária é insatisfatória, o que nos leva a perguntar sobre que tipo de APS falamos no Brasil. O estudo aprofundou-se na dimensão de acesso aos serviços de saúde. Observou-se que quase um terço das crianças estudadas são moradoras da zona rural: mesmo tendo uma barreira geográfica as crianças rurais conseguiram acessar os serviços de APS neste estudo. As crianças de todas as faixas etárias conseguiram acessar os serviços de APS nesta pesquisa: a distribuição normal da idade das crianças estudadas é um indicador de acesso aos serviços de saúde, mesmo estudando o acesso realizado. Os pais que moram na zona rural consideram a qualidade dos cuidados prestados menos vezes como “muito bom” comparado com os pais que moram na zona urbana (valor p <0,001). O estudo mostrou também que a realização de um estudo de avaliação dos serviços usados de Atenção Primária à Saúde utilizando a ferramenta PCATool-Brasil nesta pequena cidade rural requereu um investimento de 1.241 horas trabalhadas (e orçamento correspondente), e precisou também de profissionais de saúde e gestores motivados para executa-la.BV UNIFESP: Teses e dissertaçõe