Avaliação da atenção primária à saúde sob a ótica das internações por condições sensíveis e da qualidade dos serviços em população infantil

Abstract

The health systems oriented by the Primary Health Care (PHC) logic comprise option on the organization of the health assistance that has proved able to bring gains for the health of the population. With that in mind the Family Health (FH) strategy has the purpose to organize the practice of attention to health at the first level of attention, taking a central role at the Unified Health System and representing the purpose of reorientation of the caring model in Brazil. However, the restructuring of the model comprises a major challenge, becoming relevant to evaluate the results reached and the quality of the offered services. Ahead of such context the study had as objective to evaluate the effectiveness and the PHC quality on the infantile population ranging from 0 to 9 years old in the municipality of Juiz de Fora/MG. This is about a cross-sectional study that assessed the PHC taking the Hospitalizations for Primary Care-Sensitive Conditions (HPCSC) in the period between 2010 to 2012 and through the application of the Primary Care Assesment Tool (PCATool) in a sample. 12.412 hospitalizations occurred amongst the infantile population ranging from 0 to 9 years old living in Juiz de Fora, being 4.117 HPCSC. The Bacterial Pneumonia (40,0%) were the main causes of such hospitalizations followed by Acute Bronchitis (18,4%), Infectious Gastroenteritis (11,6%), and by the Epilepsies (7,6%). The PCATool was applicated to 104 care takers, 54,8% indicated a link with the PHC (PHCU-FH and Traditional-PHCU) and 45,2% with Other Services, defining three layers of analysis. The atributes Longitudinality, Coordination – Information System and Family Guidance showed strong presence and extension amongst the interviewees linked to the PHC. The component Use of the attribute Primary Health Care showed strong presence and extention independently on the referenced service by the care taker. Community Guidance was the attribute having the worst results. The PHC Essential Score (PHCES) was unsatisfactory for the PHCU-FH and Other Services while the PHC General Score (PHCGS) for the three layers. Despite of the studies showed a national tendency of reduction of the HPCSC rates, the results of the present study show na increase of those hospitalizations in Juiz de Fora. The strong of orientation of attributes as Longitudinality and Family Guidance only on the primary level comprise positive aspects on the assessment of the PHC of the municipality since those attributes are charactecristic of this level of attention. However, Community Guidance stands out, fundamental point of the PHC, by presenting unsatisfactory result. On the bivariate analysis, the only variable that has proved itself importantly linked to the PHCES was the care taker’s age group. For the PHCGS, it has shown important association to the variables marital status and model of attention – sample layer. Both to the PHCES as to the PHCGS, the variable prevalence of HPCSC has not shown itself importantly linked. We can conclude the need of the health mangers for attracting the attention to the PHC, with emphasis in their attributes, to better operate and potencialize the response capacity of this level of attention, being possible to reflect on the HPCSC, once these events that should not happen at the presence of a resolutive and appropriate PHC.