Avaliação dos serviços de Atenção Primária a partir de seus atributos: a perspectiva de médicos e enfermeiros da Estratégia de Saúde da Família

Abstract

The Family Health Strategy is the Primary Health Care (PHC) model adopted in Brazil and is associated with better health indicators. Due to its relevance, the quality of its services needs continuous monitoring and evaluation. Objective: To evaluate the orientation of Primary Health Care services in relation to their attributes from the perspective of physicians and nurses. Methods: This is an evaluative, cross-sectional study with quantitative approach conducted in the municipality of Contagem, Minas Gerais, in 33 Family Health staff, from July to October 2023. Data collection was used Primary Care Assessment Tool (PCATool) Professional Health Version, with the participation of 46 professionals. Information on sociodemographic profile, training, qualification, times of action in PHC and aspects of satisfaction with practice in the service was collected. Data tab was performed at Excel® 2019 software and statistical analyses were performed on the R Program version 4.2.2. Essential, general and derived scores were calculated, and the scores for each attribute (access, longitudinality, coordination, integrality, family and community orientation), as well as the absolute and relative frequencies for each item of the attributes categorized in high and low score. Average scores equal to or greater than 6.6 indicate high orientation of services for PHC attributes. Results: Nurses presented higher average age, higher qualification and time in the staff and PHC, comparatively to doctors. The results for the essential, general and derivative scores of the PHC were respectively, 6.2, 6.4 and 6.8. Professional category analysis showed no statistically significant difference. The attributes Access, Longitudinality and Coordination (information system) were evaluated as low orientation to the PHC. Higher average age, training time in undergraduate, length of professional experience in the current staff and APS, were negatively associated with the scores of integrality attributes (Available Services), Family Orientation and derived score. The largest age of the professionals has been negatively associated with the average of derived and general scores. The qualification of professionals in the Primary Care did not have a statistically significant association with the essential, derived and general scores. Conclusion: Services were evaluated as low orientation to PHC, with a general score of 6.4, and the “Access” attribute obtained the worse evaluation. The study brought contributions to the management of services, based on the recognition of how attributes are being operationalized in the daily practice of professionals, identifying the strengths and weaknesses of aspects related to the structure and process of work in teams. The analysis of the qualification profiles and times of action of professionals, the level of satisfaction with aspects of work and the perception of the degree of violence by doctors and nurses provided perspectives for facing their determinants.