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Prevalence of systemic arterial hypertension in the state of Rio Grande do Sul has been remained at constant levels for the past decades, and the population's level of awareness of it has improved slightly. However, the control level of systemic arterial hypertension has not increased. This study allowed the definition of a target group -- elderly, obese individuals with low educational level -- for both diagnostic campaigns and better control of blood pressure levels.

Health strategies based on primary health care have been expanding in Brazil. An instrument applied to users, the Primary Care Assessment Tool (the PCATool), which measures the extent of primary care, has been validated in the United States. We sought to adapt the PCATool to Brazil and analyze its validation and reliability through a cross-sectional validation study of the Child PCATool. Validation included: translation, back-translation, adaptation, debriefing, content and construct validate, internal consistency, and reliability analysis. The questionnaire was applied to 468 parents or guardians of children registered with 18 primary health services in Porto Alegre, representing the services' normal pediatric population. Using factor analysis, 8 domains were identified, with Cronbach's aranging from 0.74 to 0.88. Validation resulted in a 45-item scale, divided into 8 attributes (Access to First Contact, Continuity, Coordination, 3 attributes of Comprehensiveness, Community Orientation, and Family Orientation). These results showed that the PCATool-Brasil has adequate validity and reliability and could be used as a national instrument to evaluate primary health care after its application to other population settings in the country.

In Porto Alegre, Rio Grande do Sul State, Brazil, public primary healthcare (PHC) is provided by traditional Basic Health Units (BHU), the Family Health Strategy (FHS), the Murialdo Health Center (MHC), and the Community Health Service (CHS) of Grupo Hospitalar Conceição. This study compares the quality of adult healthcare among these different types of services. Quality of care was measured by interviews focusing on the experience of physicians and nurses in the services (n = 340), using the Primary Care Assessment Tool. Overall scores for the FHS, MHC, and CHS were significantly higher than for the BHU. The CHS also showed a significantly higher overall score compared to the FHS and MHC. In the multivariate analysis, the variables "specialized training in PHC" and "continuing education" were associated with high overall score. Thus, expansion of FHS coverage and investment in professional training are important potential strategies for improving PHC in Porto Alegre.

ResumoObjetivo: traduzir e adaptar o PCATool versão usuários adultos ao contexto brasileiro e avaliar sua validade e fidedignidade. Métodos: Foi realizado um estudo transversal no qual foram entrevistados 2.404 usuários adultos residentes nas áreas adscritas da rede pública dos serviços de Atenção Primária à Saúde (APS) em Porto Alegre e usuários vinculados a um plano de autogestão. O processo de validação constituiu-se de tradução e tradução reversa, adaptação, validade de conteúdo, validade fatorial e fidedignidade. Resultados: Na análise fatorial, foram considerados 12 fatores que explicaram 50,83% da variação total. Assim, foram reconhecidos os seguintes atributos da APS: acesso -acessibilidade e utilização, longitudinalidade, coordenação -coordenação do cuidado e sistemas de informação, integralidade -serviços disponíveis e serviços prestados, enfoque familiar e orientação comunitária. Para a consistência interna, foi obtido alfa de Cronbach variando de 0,15 a 0,90. A estabilidade temporal não foi verificada para coordenação do cuidado (p<0,05), coordenação de sistema de informação (p<0,05) e integralidade de serviços prestados (p<0,05). Na razão êxito da escala, todos os componentes/atributos apresentaram valores próximos de 100%, à exceção do componente sistema de informação. Conclusões: os resultados indicaram que o PCATool-Brasil possui adequada validade e fidedignidade, podendo constituir-se em instrumento nacional de avaliação da APS para usuários adultos. AbstractObjective: to translate and adapt the PCATool version for adult users to the Brazilian context and assess its validity and reliability. Methods: We conducted a cross-sectional study of 2404 adult users living in areas covered from public services Primary Care in Porto Alegre, and users of a selfmanagement plan. We performed translation, reverse translation and adaptation of the instrument as well as its assessment in respect of content validity, factorial validity and reliability. Results: In the factor analysis were considered 12 factors that explained 50.83% of the total variation. In this way were recognized the attributes of Primary Care: access -accessibility and utilization; longitudinality; coordination -coordination of care and systems of information; comprehensiveness -services available and services provided; family orientation; and community orientation. In terms of internal consistency the values of Cronbach's alpha ranged from 0.15 to 0.90. The stability over time was not observed for coordination of care (p<0.05), coordination information of system (p<0.05) and comprehensiveness of services provided (p<0.05). The scaling success rate was close to 100% for all attributes, except to coordination of information system. Conclusions: the results indicated that the PCATool-Brazil has adequate validity and reliability, and it can act as a national instrument for the assessment of Primary Care from the perspective of adult users.

Though the ecologic nature of our study limits the confidence with which conclusions can be affirmed, the Family Health Strategy appears to have contributed to a major reduction in hospitalizations due to primary care sensitive conditions in this large Brazilian metropolis, while at the same time promoting greater health equity.

Telediagnosis for oral lesions is feasible and has potential to improve the quality of primary health care by bridging the gap between primary and specialized health care.

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