Coordinación y longitudinalidad del cuidado en la atención primaria de salud en la Amazonia brasileña

Rabelo, Amanda Lia Rebelo; Lacerda, Rúbia Aparecida; Rocha, Esron Soares Carvalho; Gagno, Juliana; Fausto, Marcia Cristina Rodrigues; Gonçalves, Maria Jacirema Ferreira

doi:10.1590/0034-7167-2018-0841

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0841 linkcopiar

Coordinación y longitudinalidad del cuidado en la atención primaria de salud en la Amazonia brasileña

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos: evaluar los atributos de atención primaria de salud, longitudinalidad y coordinación del cuidado, a partir de la percepción del profesional y los pacientes en el estado de Amazonas, Brasil.

Métodos: investigación evaluativa cuantitativa en la que se utilizó un instrumento de evaluación externa con 469 profesionales y 1.888 pacientes de 367 centros de atención primaria de salud, que se adhirieron al Programa de Mejora del Acceso y Calidad de la atención primaria de salud estandarizado por el Ministerio de Salud de Brasil. Los datos se agruparon por análisis de grupos multivariados de cluster para encontrar una clasificación de la atención primaria de salud desde el punto de vista de profesionales y pacientes.

Resultados: los atributos de coordinación y longitudinalidad todavía se expresan de manera débil y poco desarrollado en el escenario de la Amazonia brasileña.

Conclusiones: es necesario reconocer las barreras organizativas y lo que puede promover las condiciones para que los equipos de atención primaria de salud actúen desde la perspectiva de una atención continua, integral y coordenada.

Descriptores: Atención Primaria de Salud; Integralidad en Salud; Continuidad de Atención al Paciente; Evaluación en Salud; Política de Salud

Care coordination	Health teams n = 469	%	Cluster
Women’s health
Performs cytopathological examination	401	85.5	Good
Performs active search for delayed cytopathological examination	270	57.6	Good
Ensures puerperal consultation up to 10 days after childbirth with visit of the community health agent or any team member	337	71.9	Good
Ensures puerperal consultation up to 10 days after childbirth with consultation at special time in any day of the week	181	38.6	Regular
Organizes service offers and referrals of pregnant women classified by risk and vulnerability	154	32.8	Regular
Records altered cytopathological examinations	140	29.8	Weak
Children’s Health
Keeps updated records of children up to two years old	309	65.9	Good
Performs active search of children under two years old	296	63.1	Good
Records the growth and development of children	348	74.2	Good
Records the nutritional status of children	328	69.9	Good
Performs active search of children with delayed vaccine calendar	293	62.5	Good
Records timely vaccination of children	389	82.9	Good
Performs active search of premature children	196	41.8	Regular
Performs active search of underweight children	244	52.0	Regular
Performs active search of children with delayed childcare consultation	238	50.7	Regular
Records the heel-stick test in children	235	50.1	Regular
Proves the records of activities performed at schools	237	50.5	Regular
Records family violence in children	77	16.4	Weak
Records the accidents of children	69	14.7	Weak
Performs care routine of schoolchildren	151	32.2	Weak
Has records of the number of schoolchildren with needs	122	26.0	Weak
Chronic diseases
Monitors people with systolic hypertension and diabetics	434	92.5	Good
Schedules consultation and examination of hypertensive and diabetic people by risk and vulnerability	223	47.5	Regular
Ensures cardiologist consultation in less than 30 days	159	33.9	Regular
Ensures fundoscopy in less than 30 days	204	43.5	Regular
Tuberculosis/Leprosy
Records the number of patients with tuberculosis	316	67.4	Good
Proves to provide the patients’ directly observed treatment for tuberculosis	176	37.5	Regular
Proves to provide the active search of missing patients of directly observed treatment for tuberculosis	149	31.8	Regular
Proves the record of the number of patients with leprosy	110	23.4	Weak
Proves the treatment follow-up of leprosy patients	94	20.0	Weak
Proves the record of active search for missing patients of directly observed treatment for leprosy	56	11.9	Weak
Referral
Specialized consultations
Proves keeping the record of higher risk patients referred to other health care facilities	149	31.8	Regular
Refers children with problems to ophthalmologic evaluation	185	39.4	Regular
Coordinates the referrals for specialized clinics	140	29.8	Weak
Refers patients at higher risk to other health care facilities	137	29.2	Weak
Performs follow-up of patients until receiving the specialists evaluation feedback	93	19.8	Weak
Refers children with problems to evaluation with an otorhinolaryngologist	73	15.6	Weak

Longitudinality	Health teams n = 469	%	Cluster
Schedule
Guarantees the scheduling of consultation for patients who could not be seen in the same day	415	88.5	Good
Has free space on the schedule to clarify patients’ post-consultation doubts	199	42.4	Regular
Has consultation schedule for people in psychic suffering in any time of the week	215	45.8	Regular
Proves having reserved space on the schedule for patients showing the exam results for the professionals	131	27.9	Weak
Visitation and homecare
Keeps the schedule organized for homecare	365	77.8	Good
Schedules the visitation of community health personnel according to priorities of the whole team	385	82.1	Good
Proves the records of the number of bedridden patients	277	59.1	Regular
Proves the survey of patients who need homecare	145	30.9	Weak
Proves the protocols with definition of priorities for homecare	162	34.5	Weak
Patient satisfaction
Considers the opinion of users for the reorganization and qualification of the work process	396	84.4	Good
Performs user satisfaction survey	217	46.3	Regular
Has communication channels for recording the opinion and suggestion of users	269	57.4	Regular
Refers the demands to municipal secretariat	227	48.4	Regular
Proves the existence of local councils or other spaces of popular participation	73	15.6	Weak

Care coordination	Health teams n = 1888	%	Cluster
Had to be referred to another professional in another health facility	793	42.0	Regular
Had to be referred to another professional in another health facility, can schedule consultation through the health care itself and be informed at the time or later	332	17.6	Weak
Can schedule consultations in the health clinic with other professionals when necessary	332	17.6	Weak
Finds easy access to talk about their exams results	921	48.8	Regular
Has the next appointment scheduled after the consultation (women’s health)	110	5.8	Weak
Has the next appointment scheduled after the consultation (hypertensive patients)	117	6.2	Weak
In prenatal care, always or most of the times leaves with the next consultation scheduled.	202	10.7	Weak
Was oriented about the maternal facility where they would deliver	220	11.6	Weak
Longitudinality
Considers the consultation time with the doctor is sufficient	1476	78.2	Good
Considers the consultation time with the nurse is sufficient	1708	90.5	Very Good
In this unit, has the same doctor available after service	886	46.9	Regular
In the unit, has the same nurse available after service	1018	53.9	Regular
Professionals of the family team call you by your name	1806	95.7	Very Good
Professionals of the family team ask you about your relatives	578	30.6	Regular
Consider it is easy to clarify doubts with the professionals who cared for you	666	35.3	Regular
You are contacted when treatment is interrupted for whatever reason or to know what happened and return to treatment	326	17.3	Weak
Feels comfortable, always or most of times, to talk to the health team about your worries.	1404	74.4	Good
Receives home visits from the community health agent	1514	80.2	Good
Always receives home visits from other health team professionals	249	13.2	Weak
You are asked about food, leisure, physical exercise, problems with drugs and violence, besides the main complaint	666	35.3	Regular

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